I recommend taking it as an intern if you're in something other than medicine so you can maximize your time studying for your specialty. I'm not sure "who" exactly Step 3 is targeted for, but I thought of it as an exam more for the general practitioner before they go onto get their license.
A lot of Step 3 is general medicine and you can pass doing great on general medicine. Step 3 does cover OB and peds, but from what I hear, its usually the high points and big concepts.
There is basic sciences on Step 3.
Not a huge amount, but reviewing the mechanisms of common drugs used every day in clinic and wards will help you. I've heard there could be some CRAZY pharmacological/enzymatic metabolism questions.
Difficulty
Step 3 is a different difficulty for everyone. The way to really pass it with a good score is not just to have a superficial med school knowledge of medicine. You need to get down into your differential diagnoses and know everything there is to know about thyroid pathology and iodine uptake, how vitamin D and PTH and calcium all interact in disease, generally a solid foundation in pathophysiology and patient management.
Don't listen to how long other people are preparing. You do you. Prepare for as long as you think you need to pass the exam in one attempt. Some people take 2 weeks, some people take 2 months. Shore up your weaknesses until you feel confident. That's the philosophy I took during college and med school. Forget about those other boastful people
Prep Materials
I prepared for Step 1, Step 2 CK, and Step 3 with UWorld. For Step 2 CS I just rented the First Aid book on Kindle from Amazon. If you want the highest score, I'd suggest combining UWorld with First Aid Step 3 CK and
Biostats
Get good at biostats! I can't emphasize that enough. Classic things like number needed to treat, types of study bias, and specificity and sensitivity are all over that exam in every block.
Clinical Cases
I honestly recommend practicing the clinical case scenarios because the software is terribly not intuitive and you could fail Step 3 if you don't know how to order labs, when to move patients to different treatment settings, and importantly, how to order surgical procedures and consults.
You will have to take into consideration what treatments/exams come first, the proper setting for them, and doing the appropriate follow up. I had to shore up weaknesses on ulcerative colitis and Crohn's disease management as well as pediatric GI problems.
Radiology/Special
Expect to read a lot of films on your exam. Make sure you know classic findings. The patient in the question stem might not have their symptoms described or have any other information other than the chest radiograph you have to read. Don't miss questions because you haven't reviewed deep sulcus sign or what a perforated ulcer looks on CXR.
Expect some basic EKGs as well as how they will tie into patient management. Know what treatments actually impact mortality instead of just symptoms.
Know at least your first and second-line treatments!
If I Could Do it All Over Again
I would take any free time as a med student to study for Step 3 without interruption and take it earlier in intern year so I could open more time to study for my specialty. I had the problem of a lot of heavy rotations early during intern year, but if I had the luxury of more time, I would've taken it earlier.
Bottom Line
All you really need to do is pass. If you want a fellowship, find out how important your score for Step exams are early on before preparation. Passing this exam will boost your confidence and do wonders for your morale intern year. It feels just as good as passing Step 1 because you can feel the transition to another part of your career. You might feel like you're deciding between 2 correct choices, and what might often be the case is just choosing the one that is the best first step rather than second step in work up/treatment.
Happy studying. Good luck!
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