This is the account of one of our students in the Scrubs Community about studying and preparing for the USMLE Step 3: the third test for the revalidation of the medical diploma in the USA. Get inspired!

Hey friends!

I matched last cycle and I am sharing here tips from my preparation for the 3 Steps. For context, I am an older graduate (YOG 2006) with Residency in Pediatrics in Brazil, balancing studies with a full-time job in Brazil. Please let me know if you have any questions. I would be happy to help! Best of luck in your preparation!

Step 3
Preparation Time: 4 Months

Context
After receiving a PASS on Step 2CK in January 2024, I went to the US for an observership in May 2024. I took this time to work, take care of my family, and prepare for the observership. At that point, it still wasn’t clear whether I would apply in the 2024–2025 Match cycle or not.

I then completed my observership in May 2024. Through this experience, I not only had the opportunity to network, secure a strong letter of recommendation, and improve my medical English, but I also gained clarity about my path. I returned to Brazil and decided to apply. Between June and July 2024, I took the OET and obtained my ECFMG certification. I submitted my ERAS application in September.

In August 2024, I began studying for Step 3. I wanted to complete it before intern year and potentially qualify for an H1B visa. Since I had time off during the December holidays, I planned to take the exam by late December. The challenge was balancing my study schedule with a full-time job and the interview
season. It was difficult—but doable.

Study Routine
My Step 3 study routine was similar to my Step 2 CK preparation. I woke up at 5:00 AM and studied until 7:30 AM, focusing on completing one 40-question block per day. After each block, I thoroughly reviewed all the questions and created flashcards for my mistakes, as well as for high-yield UW diagrams, tables, and algorithms. My first pass was organized by system; the second was random.

Throughout the day, I reviewed Anki flashcards (both from the AnKing deck and my own), whenever possible—between patients, during lunch, and in any free moments. I watched YouTube videos (highly recommend Dirty Medicine) and listened to Divine Intervention podcasts while driving and exercising. I also rewatched Sketchy Pharm and Micro videos, focusing on symptoms and treatment. Two months before the exam, I began working through CCS cases.

Study Materials
UWorld (UW)
This was again my most important resource. I activated my subscription on August 4, 2024, and completed two full passes (one 40-question block per day, six days per week). The UWorld Step 3 question bank is smaller than the ones for the previous Steps.

● First pass (by system): 79% correct
● Second pass (random): 91% correct

During both passes, I used Anki (AnKing) and created my own deck for mistakes and UWorld high-yield content.

Anki
I used the AnKing deck and added my own flashcards based on UW explanations. I reviewed about 300 cards per day—on waiting lines, between patients, or anytime someone was late.

First Aid (FA)
I only used the Rapid Review section from FA Step 1 the day before the exam.

Sketchy
I watched all Micro and Pharm videos once but focused more on symptoms and treatment.

YouTube & Podcasts
I watched Dirty Medicine and listened to Divine Intervention while driving.

CDC Vaccination Schedule & USPSTF Guidelines

One week before the exam, I memorized the CDC vaccination schedule and the most relevant USPSTF recommendations. Although most of this is covered in UW and Anki, I verified the latest updates and downloaded a specific Anki deck for these topics.

CCS Cases
My main advice: start early to get familiar with the CCS format—it’s the most different part of Step 3. I aimed for 3–5 cases per day and completed the entire CCS case bank. I marked the cases where I scored below 50%, then repeated those and high-yield cases in the final week. Another tip is to have a checklist of critical orders in mind. I also wrote down the patient’s age, gender, comorbidities, and chief complaint (you’re allowed to do this on the provided sheet during the exam). In the last 2 minutes of each case, I made sure to include:

● Smoking cessation
● Alcohol counseling
● Exercise advice
● Age-appropriate screenings
● Safe sex counseling
● Seat belt use
● Vaccinations
● Diagnosis-specific counseling

Practice Exams
I completed both UWSAs after each UW pass:
● 17/11/2024: 71%, Score 229 (91st percentile)
● 21/12/2024: 84%, Score 251 (99th percentile)

I also did the Free 120 questions from the official USMLE website.

Exam Day
I took the two-day exam back-to-back in Worcester, Boston.
I found Day 1 more challenging, as it felt more like Step 1 and included one long, abstract-style Biostatistics question per block. I completed two blocks at a time.

Day 2 felt more like Step 2, with more “What is the next step in management?”-style
questions.

Overall, I thought Step 3 was harder than Step 2 but came with less pressure since the score carries less weight.

Final score: 258
I emailed all the programs I interviewed at to update them on passing Step 3.

Good luck!

Dr. Alessandra Lemos de Carvalho