Step 3

When You Should Take USMLE Step 3

I’m about to finish my first year of residency. Although I might not be ready to be a resident I sure as hell am ready to not be an intern anymore. Intern year of residency is exhausting. There’s no way around it. And studying for yet another seemingly pointless USMLE is the last thing anyone wants to do after a long day in the hospital.  Here are some tips to help you figure out when you should take USMLE step 3:


Does step 3 even matter?

Yes and no. It truly depends on what you plan on doing with your medical degree. If you don’t plan on specializing it is hard for me to see how your step 3 score will impact your ability to get a job. Especially when you have to pass a board certification exam in your respective field in order to practice.

But if you are looking to pursue a fellowship then you might not want to ‘just pass’. The 2016 NRMP program director (PD) survey asked fellowship PD’s the importance of various factors when looking at applicants. They rated importance of each factor from 1-5 with 5 being very important. Let’s take a look at a graph from the 2016 NRMP PD survey that shows which factors PD’s across every specialty found to be the most important when selecting applicants to interview:

interview 1

And now which factors were most  important in ranking applicants:

ranking 1

Ultimately, step 3 isn’t the most important factor. But it is still a factor. Additionally, each specialty is different. A vascular surgery fellowship program is clearly looking for something different than what a sleep medicine fellowship program is looking for (take a look at the data yourself if you know what fellowship you’re interested in: Results of the 2016 NRMP Program Director Survey). But in general, there are more important things than step 3 when it comes to fellowships. I would err on the side of caution however and make sure it isn’t important. Meaning, don’t score so poorly that they end up looking at your score and make it a big deal. Let it be just another check mark on your application. Something to keep you on par with other applicants.



What is your specialty?

Generally speaking, USMLE step 3 is skewed in favor of primary care fields like internal medicine and family medicine. The majority of the test is composed of medicine topics. So medicine residents see a lot of what is on the test in everyday practice. This means that medicine residents can probably wait until the end of intern year and study intensely for 2 months or so and take it and pass. Essentially, waiting till the end of intern year won’t hurt you much. However, for anyone going into specialties like pediatrics, psychiatry, OB/GYN, or surgery I suggest you take it as soon as humanly possible. Some of my colleagues from medical school even took it the first month of residency. Their program even gave them a month of ‘research’ to study for it. So for anyone not going into a primary field like internal or family medicine you should, for the most part, take it as soon as possible.



Should you take step 3 before before residency starts?

Depends on a few factors. First off, can you afford it? Step 3 costs $875. Second, you need to graduate prior to even applying to take USMLE step 3². So unless you graduate early and have a considerable amount of time prior to starting residency I wouldn’t even put the thought in your head. Trust me, during residency the last thing you are going to be thinking is ‘I wish I studied more before residency started’. But what you do prior to starting residency is up to you. So unless you are required to take step 3 prior to starting residency I would hold off on taking it until during residency.



What does your intern year schedule look like?

For the most part you only need 2 months or so to study for this exam. So find a period in your schedule when you are on a lighter service. For me that was in December right before Christmas when I had a week of clinic followed by a week of vacation and three weeks of elective followed by another week of clinic and a notoriously light general medicine service. So I had ample time to study. Find a time in your schedule that will allow you about two months of time to study.



How should you study for USMLE step 3?

That’s an entire blog post in and of itself. Keep on the look out and subscribe so you don’t miss it!



What other questions or concerns do you have about taking USMLE step 3? Comment below!




1-  (2017). Retrieved 23 May 2017, from

2- Federation of State Medical Boards. (2017). Retrieved 24 May 2017, from

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  1. Hey Marc, I graduated in November and will be taking step 3 next week since I had a lot of time. Can you tell if you took the uworld self assessment and how accurate it was? I took it today and got solidly average score, which is absolutely fine with me. However, I’ve read mixed things about its reliability since it’s light on biostats and doesn’t include ccs.

    • Marc N. Katz says:

      Hey Alwin, in my experience (meaning I do not have statistically significant data to back me up) UWSA is pretty accurate. For me, I scored higher on step 3 than UWSA for some of the reasons you mentioned. Specifically, that there are AT LEAST 4 biostats questions per section on step 3 for the first day. I highly recommend purchasing the extra UWorld biostats section. If you can do those questions inside and out you should be fine. Ultimately, I feel that if you did well on the UWSA then you will do even better on the real thing

  2. Hi Marc, do you have a blog post posted yet for how to study for step 3? Curious to hear your thoughts on the study plan end for the exam.

    • Marc N. Katz says:

      Working on it! But the quick answer is UWorld. Both the question bank and the additional biostats review portion. If you get through UWorld and cram the biostats then you should be set up for success

      • I’m applied to IM this year (waiting for interview season to start) but do have the interim year off so I was thinking of taking it before next June. Would I be more prepared if I waited until the end of intern year or is it more worth capitalizing on that time to get the exam out of the way. I am thinking about plans to subspecialize in the future but no finite plan yet, but I want to perform better than CK to put myself in a good position for fellow apps.

        • Marc N. Katz says:

          As I detailed above, step 3 is not nearly one of the most important aspects of a fellowship application. From my understanding the most important aspects of a fellowship application is your clinical acumen, your letters of recommendation, and your research. Of course, this all varies based on what subspecialty you plan to pursue. By far, cardiology and gastroenterology are historically the most competitive specialties in internal medicine and require more research than others. Pulm/critical care and heme/onc also require a good amount of research. So with regard to your fellowship application, just get step 3 out of the way so you can focus on research.

          *Disclaimer: I am an internal medicine resident not a fellowship program director so please take my advise with a grain of salt with regard to fellowship applications

    • Marc N. Katz says:

      Hey Josh, check out my new blog post about how to study for step 3. Hope it helps!

  3. Pingback: How To Study For USMLE Step 3 | Kitty Katz, MD

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