How can you optimize your USMLE Step 3 percentile – and does it really matter?
Step 3 is the final step in becoming licensed to practice medicine independently in the US. It’s a very clinically-focused exam, designed primarily to measure the ability to diagnose and manage patients. By the time you get to this exam, you’ve got plenty of testing experience, having passed three previous USMLE exams (Step 1, Step 2 CK, and Step 2 CS). You have a pretty good idea of what to expect on the exam.
It’s important to remember that Step 3 tests a broad range of clinical knowledge. At the same time, many of those taking it have entered a residency in a particular specialty, and are not being exposed through their clinical experiences to the broad range of material needed to pass Step 3. This is why we recommend that you don’t underestimate Step 3. You will need to consciously focus on finding and addressing your weaknesses, so that you make sure that you do as well on this exam as you’d like.
What does it take to pass Step 3? Does your score on this exam matter? Here’s what you need to know about the final exam in the USMLE series.
USMLE Step 3 percentiles
Although all three steps of the USMLE use a roughly similar three-digit scoring system, the specifics of the scoring differ for each exam. Data from the NBME indicate that, for US medical graduates taking Step 3 for the first time, the median score is around 226. The 25th percentile is around 216, and the 75th percentile is around 236. The minimum passing score for Step 3 was raised to 198 at the beginning of 2020. (Before that, it was 196.)
Does your Step 3 score actually matter?
This is ultimately what most people are wondering as they think about USMLE Step 3 percentiles. Most students stressed a lot over Step 1, and many also put significant effort into preparing for Step 2 CK. Do you need to be as worried about Step 3?
For many students, the answer is that your Step 3 score won’t make too much of a difference, as long as you pass the exam. You generally won’t take Step 3 until you’ve been in residency for a year or so, so it won’t matter for your residency applications. (Consistent with this, residency program directors state that Step 3 is not important in their decisions. The exception might be international medical graduates, who sometimes use Step 3 to try to stand out when applying for a US residency.) If you’re planning to finish your medical education at the end of your residency, then the only important thing is to pass Step 3. This will allow you to become licensed to practice medicine independently. As long as you pass the exam, it’s not likely that your specific score will have a huge impact on your ability to get a job in medicine after graduation.
However, if you’re thinking of applying for a fellowship after your residency, then your Step 3 score may matter more. This is especially true if you’re considering a more competitive subspecialty, such as cardiology; for these subspecialties, NRMP data show that the median score for applicants who successfully match is around 240, which is above the 80th percentile.
For the most part, the program directors want to see that your Step 3 score is in line with the previous steps. They definitely don’t want to see a failed attempt on your record, so we would never recommend that you walk into Step 3 without preparing and hope that you’ll pass. Step 3 isn’t the most important aspect of your fellowship application, but it could end up being the edge that gets you into the fellowship of your choice.
When do you take Step 3?
In order to offer you a slot for taking Step 3, the NBME requires two things. You must have passed all of the previous steps already, and you must have officially graduated from medical school. (Note that it takes a few weeks for your graduation paperwork to filter through; if you apply to take Step 3 too soon after your graduation, then you may not be approved.)
In general, it’s recommended to take Step 3 after your PGY-1 year (your first year of residency, or intern year). However, it can be taken earlier or later than this. Many programs require that you pass Step 3 by the end of your PGY-2 year, so that you become fully licensed to practice medicine independently. Most people take it near or just after the end of their PGY-1 year. Ideally, you’ll want to take the exam when you have lighter clinical responsibilities (such as during a research block).
Note that, in order to become licensed to practice medicine independently, all states require at least one year of postgraduate medical training, and some require more. Even if you pass Step 3 early on in your PGY-1 year, you still won’t be able to get your license early. Some international medical graduates might choose to take Step 3 early in order to use it on their residency applications, but
How can you prepare for Step 3?
1. Commit to a test date.
Having your test date set will get you to commit to a study timeline. This is because you know how much time you have to study for the exam, so you’re able to make a study plan. Setting a test date will also help you to stay efficient and focused as you study, and help to stop you from procrastinating. Also, the sooner you set your test date, the better your chances of being able to take it at the most convenient testing center, so that you don’t have to travel to take the exam.
Carefully consider your schedule when you select a test date. Make sure that the date you pick is during a period when you have a lighter workload. This will give you some time to study for the exam, and the two days necessary to complete it.
Keep in mind that you can either schedule the two days of the exam consecutively, or you can space them apart from each other, as long as you finish them both within 14 days. Which option you choose depends on your personal preference, as well as on your scheduling needs. The earlier you schedule your exam, the more options you’ll have, so that you can choose whatever will work best for you.
2. Use Qbanks (like UWorld) effectively.
It would be a rare medical student who makes it to Step 3 without ever having used UWorld’s Qbank to prepare for a USMLE exam. We recommend that you reach for UWorld again as you prepare for Step 3. You should definitely aim to get through its Step 3 question bank at least once, and preferably twice. If you finish UWorld, then AMBOSS is the next step. Make sure you’re using the Qbank efficiently; try to learn as much as you can from every question, and address any knowledge gaps or other weaknesses that you discover. Doing a lot of questions, but not really understanding why you’re getting certain questions wrong, will tend to lead to a plateau.
If you’re consistently scoring below 70% on UWorld blocks, then it may be time to set up a session with a tutor so that you can get personalized feedback on where you’re going wrong.
3. Become familiar with computer-based case simulations (CCS).
CCS are really what differentiate Step 3 from previous USMLE steps. CCS make up about 1/3 of exam performance, so it’s important to be prepared for this section. The CCS software is not particularly intuitive (for example, you must “advance time” in order to progress within the simulation), and so you should make sure that you practice with it before your exam so that you don’t waste time trying to figure it out. There’s some information on the USMLE site that can help you get acquainted with the software.
UWorld offers CCS questions along with the regular Qbank (which addresses the multiple-choice questions). Try to get through all of these at least once before your exam date.
4. Remember the breadth of material
In general, you’ll take Step 3 after the first year of your residency. You will have spent this year learning a lot about patient care in your specialty. However, your exposure to other specialties is very limited. Remember that Step 3 covers a wide variety of patients. For example, if you’re a peds intern, you’ll need to spend some time brushing up on care of adult patients.
Take Step 3 seriously
We recommend that you avoid making the mistake that we sometimes see residents making – they don’t take Step 3 seriously. They assume that their clinical experience during their intern year will be enough for them to pass this exam. Unfortunately, this leads to some people failing the exam and having to retake it. This is expensive and a huge hassle, and it also can take away some options in terms of fellowships later on. Make sure that you take Step 3 seriously, and spend some time studying for it.
If you want some extra help preparing for Step 3, you may want to consider reaching out to a professional tutor with experience in helping people prepare for this exam. Here at Medlearnity, our tutors have all scored exceptionally well on their USMLE exams, and have experience in helping others on these tests as well. Whether you have failed Step 3 or believe you might be in danger of failing it, experience test anxiety and need help with feeling more confident, or want to get a spectacular score to look great on your fellowship application, we can help you. You can schedule a free one-hour session to find out what tutoring is like.