ExamGuru Blog

As you begin residency, you will be very busy and likely won’t think much about USMLE Step 3. However, it is important not to wait to start planning for this examination. If you wait too long, it will sneak up on you! Fortunately, there are several simple steps you can take to make this process easier.

Start by figuring out which state you will likely want to be licensed in first and read that state’s requirements for initial licensure. You can find this information at: https://www.fsmb.org/step-3/state-licensure/. Remember, you should look at the state you want to be licensed and work in after residency, not the state you are currently doing residency in. If you are not sure at this point what you will do after residency, then go with the state you are doing residency in.

Then, about three-to-six months prior to the time when you are eligible to get a license in your preferred state, apply for and take the Step 3 Examination. This way, you will time it such that you will get your Level 3 score report (hopefully you passed) right when you are eligible to apply for licensure. In all circumstances, you should take the Level 3 examination by the end of your 2nd year of residency, but I would strongly recommend you take it as soon as you are eligible and your schedule allows it. This is because you want to leave ample time available to study for your ABMS board certification examination and to search for a permanent position after residency. If you are not able to get a permanent position immediately after residency, then by having a license in that same state ahead of time, you can at least get a moonlighting or locum tenens position nearby while you continue looking for a job. If you are doing residency in a broad-based specialty such as internal medicine, pediatrics, and family medicine, you will not need as much time to study and can aim to apply three months before you become eligible for a license. If you are in a highly- specialized field like orthopedics, urology, or pathology, then you should apply six months in advance to give yourself more time to study for the USMLE Step 3 examination.

You should start studying as soon as you apply for the USMLE Step 3 examination. Pick your three-month scheduling window carefully. Ideally, you want to take the examination during a rotation that is less demanding. You also want to set up a realistic study schedule where you have some easier rotations in which you can get some studying done. You will likely be able to realistically study only about one hour a night during residency, and maybe 3-4 hours on a weekend. Therefore, you will have about 10 hours of study time per week at most. This is not much. This is why you need to start a few months in advance. The examination is mostly internal medicine, so these residents will have an advantage. If you are in a broad-based specialty, don’t underestimate the importance of just paying attention during residency and learning as much as you can on the wards. Of all three levels of licensing examination, USMLE Step 3 is the most clinically applicable, and a lot of the questions you see on the examination will be things you have actually seen in patients as a resident physician.

Keep in mind that this examination contains clinical case simulations. These are very important. You must take time to practice these and to learn the computer system that administers these so you don’t waste precious time on examination day learning how to navigate through them. They will measure you on how efficiently you work through the given problem, so going about them in a “shotgun” approach where you check every lab and order every test is not recommended. You want to develop a strong hypothesis-driven approach to solving these cases, and the only way to do this is to practice, practice, and practice.