Step 3

This post is more on the exam than on a study plan for sure since I feel that is more confusing than the study preparation itself. Basic format of the NEW exam is as follows

DAY 1

• Total exam duration - 7 hours
• Has 6 blocks – 42-43 questions with 60 minutes for each block.

DAY 2

• Total exam duration 9 hours in total. Has 2 parts
• Part 1 –

o   6 blocks with 33 questions and 45 minutes for each block.

• Part 2 – (CCS)

o   13 case simulations with each being either 10 or 20 minutes in length.

The MAIN change according to me is in the scheduling of the exam. I mean in the new pattern you can schedule day 2 of your exam at a different date but at the SAME test centre and within 14 days.

Materials I used:

1. OLD MTB 3
2. USMLE world - Qbank, CCS, UWSA
3. Archer introductory videos

The general question on everyone’s mind at the moment I think is should I read my basic science book like 1^st aid for Step 1 and go through biochemistry and learn the enzymes and also to buy the new MTB 3 (I have not read it so not sure about MTB 3 new addition) My advice would be a firm NO, as I feel step 3 is basically the same as CK but they are more focused on the management aspect of the patient and how you can apply your BASIC science concepts. At least for me it wasn't like step 1 where I had to mug up a couple of enzyme names and know the deficiency of which causes what and so on and so forth. My advice would be prepare the same as you would for the old step 3 examination. In addition to the Uworld qbank do the Uworld self-assessment test and USMLE.org practice materials.

Coming to the CCS part of the exam I felt this part was my Achilles heel. I would highly recommend doing the Uworld CCS cases as many times as possible and read the explanation. Also Uworld also gives you a PDF handout for 40 to 50 cases which I think is good enough. Furthermore to help in CCS there is a person called Archer who has a course.  I recommend watching his CCS Strategies video which is 2.45 hours long which gives you a quick over view of CCS. Also do the CCS cases that USMLE has on their web site.

The difficulty of the questions were essentially according to me like Step 2 CK, but as I do not have my result I would not like to say anything for sure. Also I felt day 2 was tougher than day 1 but some guys I spoke to felt both days were easy. Any how my study time was around a month and a half technically with studies being in between interviews and Christmas festivities. At the moment as my result is unknown I cannot exactly say whether it was sufficient or not but hoping for the best.

Good luck to all who are giving it soon!

(Update 25th March 2015- Pass)

U.S. Preventive Services Task Force Recommendations

Summarized version of the latest USPS Task force recommendation. This is used in the USMLE Step 2 CK as well as Step 3.

Link to the post as well as PDF copy at the end of the post :)

Population	Recommendation
Abdominal Artery Aneurysm
Men Ages 65 to 75 Years who Have Ever Smoked	The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men ages 65 to 75 years who have ever smoked.
Breast Cancer
Women, Age 50-74 Years	The USPSTF recommends yearly screening mammography for women 50-74 years.
Women, Before the Age of 50 Years	The decision to start regular, yearly screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
Women, 75 Years and Older	The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older.
Women who have Family Members with Breast, Ovarian, Tubal, or Peritoneal Cancer	The USPSTF recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.
Women, Increased Risk for Breast Cancer	The USPSTF recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene.
Cervical Cancer
Women 21 to 65 (Pap Smear) or 30-65 (in combo with HPV testing)	The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.
Chlamydia and Gonorrhea
Sexually Active Women	The USPSTF recommends screening for chlamydia in sexually active women age 24 years and younger and in older women who are at increased risk for infection.
Sexually Active Women	The USPSTF recommends screening for gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection.
Colon Cancer
Adults, beginning at age 50 years and continuing until age 75 years	The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.
Prostate Cancer
Men, Screening with PSA	The U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA)-based screening for prostate cancer.
Lipid disorder screening for Men
Men 35 and Older	The USPSTF strongly recommends screening men aged 35 and older for lipid disorders.
Men 20-35 at Increased Risk for CHD	The USPSTF recommends screening men aged 20-35 for lipid disorders if they are at increased risk for coronary heart disease.
Lipid screening Women at Increased Risk
Women 45 and Older at Increased Risk for CHD	The USPSTF strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease.
Women 20-45 at Increased Risk for CHD	The USPSTF recommends screening women aged 20-45 for lipid disorders if they are at increased risk for coronary heart disease.
Lung Cancer
Adults Aged 55-80, with a History of Smoking	The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Osteoporosis
Women, 65 and Older	The USPSTF recommends screening for osteoporosis in women aged 65 years and older and in younger women whose fracture risk is equal to or greater than that of a 65-year old white women who has no additional risk factors.
RH Testing
Pregnant Women, During First Pregnancy-Related Care Visit	The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.
Antibody Testing Unsensitized Rh (D)-Negative Pregnant Women	The USPSTF recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24-28 weeks gestation, unless the biological father is known to be Rh (D)-negative.

Information collected from http://www.uspreventiveservicestaskforce.org/BrowseRec/Index

PDF format file:

USPS Recommendations

Step 2 CK experience

Preparation time of around 2 months properly.

Books referred to

• Kaplan Notes and Videos
• MTB 2 (Master the Boards)
• MTB 3
• 20 cases videos by Conrad Fischer
• Flashcards by Conrad Fischer

Now my method of studying was like this. Initially tried watching the Kaplan videos the same way I watched it for Step 1 using 3X speed, but this time I did not repeat the mistake of marking in Kaplan textbooks, but marked them in MTB directly since they generally are the same.

There is a lot of confusion on what to read for Step 2. I would say the following. For all internal medicine stuff MTB 2 and all other subjects MTB 3. This is what I did regarding the 2 books and how to read them. Say at the moment I am reading an IM related topic, my base book would be MTB 2. I would quickly go through the book and later quickly scan through MTB 3 and see if there is anything extra or if it the same. If I found anything interesting or better explained in the MTB 3 I would copy it into the base book or make a reference in MTB 2 that the particular topic was well explained in MTB 3. So this way covered both books simultaneously and learned new stuff if any. I know it sounds a bit tedious but you might as well slog now than cry later.

Towards the end of the study period I would recommend using the flash cards. If you can't, then recommend at least Fischer's 20 cases. You will definitely remember them during the exams since they are funny and very graphically explained. I did not give any NBME’s so don't ask me about it. I only gave a UWSA and got a score of 238.

Regarding USMLE world utilization, I would advise this while studying MARK QUESTIONS that you feel is too much to remember or write down in the book, no matter whether you got it right or wrong, so that towards the end prior to your exam, you can do ONLY those MARKED questions and nothing else. Because in the end it comes down to how many times you have done USMLE world and how much you can remember and how quickly.

Finally at times you might feel you are ill prepared for the exam since you just heard someone give some long convoluted explanation for something which you have a simple way to understand, follow your method because it way more easier to remember and reproduce at the exam.  I mean some person I studied with knew all the anti-arrhythmics and which class they belonged to. I naturally started panicking that I have no clue about that. I just knew adenosine or some drug was used for the problem and that was the end of it. He even explained the idea behind it, but now that I look back it though it made me wiser it did not help me in any way for boosting my confidence or score since if you the basic gist of why something is done it should be enough.

Lastly please don't think you don't know anything and that you will mess up, trust me you won't. Taking my own case let me tell you that I even wanted to delay my exam or so to say drop the entire year and prepare for the exam later. But my mom firmly told me if I delay this exam she will not be sponsoring the rescheduling fee and that was just 2 weeks prior, so imagine my plight then. She happily even states that she has full confidence that I will get a good score. I tried convincing her otherwise but to no avail. 

Finally when doomsday arrived I only thought I would be flunking but by the grace of god and of course my parent’s prayers got a decent score of 242. Not too bad I must say at least for the effort that I put just happy it a decent scoreJ

This was in short my study method. I owe my scores to god definitely and so also to my parents and friends for praying for me.

People have asked me which book is good for what. The following is how I did it. You might have your own preference. Stick to what is good for you.

MTB 2

• Infectious Diseases plus MTB 3 ending
• Allergy and Immunology
• Cardio
• Endo
• Pulmonary
• Rheumat
• Hemat
• Gastro
• Nephro

MTB 3

• Preventive
• Dermat
• Surgery
• Peds
• Obs
• Gyn

Read BOTH

• Onco
• Radio
• Psyche
• Emergency/Toxic
• Ethics