USMLE STEP 3 Preparation Scheme

 USMLE STEP 3 Preparation Scheme

By Waqas Nawaz M.D 

What is this exam? How it is important? - How it is related to Visas?
In this post, I will try to explain facts related to step 3. Most of people don't know about step 3 at the
start of step journey. It is an exam that is mandatory to pass while doing residency, not to apply for it.
But recently it has gained unprecedented importance among IMGs because of increasing
competition for residency.

1- It is a 2 day exam - One day of clinical exam similar to CK and the second day of exam
comprising of simulated cases, CCS in which you behave as a physician , order labs and treatment
on computer, get Instant results and you are tested, how you proceed with a case straying from
history till management -it's not live interaction with patients as in CS rather it is computer based
2- Step 3 can only be taken in the USA and can only be taken if you are an MD- means after you
have passed step 1, step 2 Ck and CS.
3- One can apply for residency match after MD without step 3. They have to pass step 3 before
completing residency. But people who are done with step 3 before applying match are preferred over
those who have not. This is because most programs want their residents should be done with step 3
before starting training so that they can give full attention to patients not to exam during residency.
4- It takes 2-3 months to prepare for step 3- even less for people who recently took step 2 CK as
most of the knowledge is same except that CK tests diagnosis more, while step 3 tests your ability
manage the cases.
5- Another thing that makes step 3 really important is its relation with H1-b visa. People who are MD
are eligible only for j1 visa that is sponsored by ECFMG. On the other hand, if a resident wants H1b
visa, he must have passed step 3 before match day.

Duration: 3months = 50 days (1st read) +35 days (2nd read) +10 DAYS (3rd read) 1 days (NBME) 1
DAY (Derm Net) + 1 day (drug adds/ biostats website)
Materials Needed:

>Kaplan series
> and drug ads.
> CCS course
> 25 dollar course for biostats available on USMLE. Official NBME website
SCORES: Unlike step 1 and step 2, it is really tough to have 99 (>226) in step 3. Any score >225 is
considered very good in step 3. So don't get disappointed.

 FIRST READ: 50 days (approximate)
In 1st read, one should read system wise. e.g Cardiology, gastroenterology etc. When one system is
finished, don't rush to the next system. Rather read it from MTB step3. This will cover MTB along
with. (Remember, MTB in STEP 3 is equivalent to First Aid in step 1, rather MTB is a little bit more
1st reading is similar to 1st read of step 2 CK. If you recently took step 2; it will be easier and will
need just 1 and half month.

Medicine: 5 weeks
Cardiology 4 days (3+1)-3 days from Kaplan and 1 day of MTB
Gastroenterology and Hepatology 4 days (3+1)
Pulmonology 3 days (2+1)
Infectious Disease 3 days (2+1)
Nephrology & Electrolytes 3 days (2 +1)
Endocrinology 2 days (1+1)
Rheumatology 3 days (2+1)
Hematology /Oncology 2 days (1+1)
Neurology 4 days (3+1)
Emergency Medicine 3days (2 +1)
Preventive Medicine 1 day
Dermatology-1 day
Opthalmology-1 day
Rdaiology-1 day

Surgery: 5 DAYS (3 +2 days)
Pediatrics: 4 days (3 days +1)
Gynecology+ Obstetrics: 5 days (2+2 days of Kaplan +1 day of MTB)
Psychiatry/ Behavioral sciences (statistics part): 4 days (1+1 days of Kaplan + 1 day of the MTB +1
day of drug adds-you can find these drug ads on USMLE forums .At least 4 adds are asked in the

SECOND READ: 35 days
In second read, DO NOT REVISE KAPLANS as was advised in CK. Rather 2nd read should be
focused on U WORLDS AND START PREPARING CCS -2nd part of step 3 exam. U world is very
imp in step 3 almost as imp as text books. Every day, reserve 1-2 hours for 2 cases of CCS-there
are total 45 cases; if you do 2 cases each day; you will finish CCS 1st read in this read. CCS is very
interesting part; playing around computer; will upload CCS instructions in few days; it is CCS that
makes a difference in step 3 scores. MTB step 3 should also be read with the respective unit in this
read. e.g; if reading cardiology u world; also revise cardiology unit of MTB that will take just a few
hours + CCS 1-2 case every day that takes 1-2 hours
Medicine: about 23 days
Cardiology 3days
Gastroenterology and Hepatology 3 days
Pulmonology 2 days
Infectious Disease 2 days
Nephrology & Electrolytes 2 days
Endocrinology 1
Rheumatology 2 days
Hematology /Oncology 1 day
Neurology 2 days
Emergency Medicine 3 days
Preventive Medicine /radiology 1 day
Dermatology-& Opthalmology-1 day

Surgery: 3DAYS
Pediatrics: 3days
Gyn/OBS: 4 days(2+2)
Psychiatry/ Behavioral sciences (statistics part): 3days (2 for psych and 1 for stats)

THIRD READ: 12 DAYS (7 days of U world 4-5 days of CCS)
One is supposed to go through U worlds and CCS in this read . No need of going through MTB3 in
this read.


After completing U worlds; give 3-4 days to CCS cases. One can easily do 10 cases of CCS in this
read in one day; so finish 45 cases in 4-5 days (CCS is a very technical thing. Will post a separate
article on how to solve CCS-this is the only exam in which residents perform better than non

After 3rd read, one should read MTB 3 continuously that will take 3 days. After that Take NBME that
will test your step 3 but not CCS. (NBME of Step 3 does not predict the exam score really )

Keep one day for derma net- this is a website that has pictures of skin manifestations of all systemic
diseases. Highly useful ; will take just 7 hours to go through, but will really help in the exam as lot of
diagrammatic questions Now one can take the exam. CCS part comes on the 2nd day ; so after 1st day of exam , one can revise ccs cases and can appear on 2nd day for ccs.
There is an option ; one can have 1-2 days in between 2 days of the exam as well. Means exam
then, 2 days break then 2nd day of exam. But it is not recommended as it breaks tempo.
This scheme can be variable; but summary:

1st read: Kaplan + MTB3
2nd read: Uworld +MTB +CCS
3rd READ: Uworld + CCS

Registration of Step 3: This is important to mention here that Step 3 is not an ECFMG exam unlike
step 1, step 2. It is FSMB exam- for registration; please go to FSMB website.




  1. hello. can someone tell me when was this last updated? i used your advise for step2CK and did GREAT! so thank you..
    please let me know about this one. and what predictive test we can take, since NBME are not predictive.


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