USMLE Step 3 Facts

When should I take Step 3?

In contrast to Steps 1 and 2 of the USMLE, it is required that Step 3 be taken after completion of medical school, generally during residency. The timing of when during residency to take the test varies from student to student. Some students may wish to take the exam earlier in training in order to have the licensing process completed, which may open up opportunities for moonlighting, etc. Other students may wish to delay the examination due to either financial considerations or a desire to focus on their new specialty field.

A 2003 study examined the impact that both postgraduate training and timing had on Step 3 performance. Results were controlled for students' performance on the Step 1 and 2 exams. The study found that graduates whose postgraduate training focused on broad areas performed better than those with more specialized training, with those residents studying either med-peds or family practice performing the best on the exam relative to earlier USMLE performance. Residents from fields like emergency medicine, internal medicine, and pediatrics also performed well. These results are not surprising given the generalist-oriented nature of Step 3. Among residents from these general fields, performance improved with increased amount of postgraduate training. However, performance on the exam was still less than what would be expected based on Step 1 and 2 results. (Only the med-peds and family practice residents with over a year of postgraduate training performed better than expected.) This may be due, at least in part, to the fact that many residents study less for Step 3 than they did for Steps 1 and 2. These findings suggest that residents from more generalized training programs may perform better if they take the exam later in their training.

The study had somewhat different findings for students amidst more specialized postgraduate training. Residents from the fields of anesthesiology, psychiatry, radiology, pathology, surgery, and Ob/Gyn all performed relatively poorly in relation to what their earlier scores might have predicted, compared to residents in more general specialties. Contrary to what might be expected, delay in taking the exam did not negatively impact scores. It is unclear if this reflects a trend for residents taking the exam later to have studied longer.

Reference

Sawhill AJ, Dillon GF, Ripkey DR, Hawkins RE, Swanson DB. The Impact of Postgraduate Training and Timing on USMLE Step 3 Performance. Academic Medicine , 78 (10), October Supplement 2003, S10-S12.

Why should I care about my Step 3 score since I am already in residency?

The USMLE exams are designed to assess one's competency to practice medicine. Step 3 is the last in the series of tests, and passing it is required to obtain a medical license. Though not designed for this purpose, both Step 1 and Step 2 are heavily weighted in the resident selection process. In contrast, Step 3, typically taken during or after the first year of residency, is not used in resident selection. While it is important to pass the exam, most fellowship directors and eventual employers do not place much emphasis on the raw score. If released, scores from the USMLE Step 3 exam are sent back to the resident's original medical school, which helps the medical school make judgments about certain elements of the curriculum.

Step 3 is even more clinically relevant than Step 2, testing more complex concepts with an emphasis on patient management and prognosis. The Step 3 exam has a computerized patient simulation section in addition to the standard multiple choice section during which the student must order the appropriate tests and administer the correct treatments for a given patient, with changes in the patient's status based upon the examinee's actions. This interactive format is meant to mimic actual clinical situations.

Studying for Step 3 gives the resident the opportunity to synthesize information learned across different subspecialties. The Step 3 score report also provides feedback that breaks down the examinee's performance by subspecialty; this may help the resident identify areas of weakness. This is particularly helpful for residents in fields such as family medicine where all the tested areas will likely be part of their future clinical practice.

Reference

Andriole DA, DB Jeffe, Hageman HL, Whelan AJ. What Predicts USMLE Step 3 Performance? Academic Medicine. 80 (10), October 2005 Supplement, S21-S24.