When should I take Step 3?
In contrast to Steps 1 and 2 of the USMLE, it is required that Step 3 be taken after completion of medical school, generally during residency. The timing of when during residency to take the test varies from student to student. Some may wish to take the exam earlier in training in order to have the licensing process completed, which may open up opportunities for moonlighting, etc. Other students may wish to delay the examination due to financial considerations or a desire to focus on their new specialty field.
A 2003 study examined the impact that both postgraduate training and timing had on Step 3 performance. Results were controlled for students' performance on the Step 1 and 2 exams. The study found that graduates whose postgraduate training focused on broad areas performed better than those with more specialized training, with those residents studying either med-peds or family practice performing the best on the exam relative to earlier USMLE performance. Residents from fields such as emergency medicine, internal medicine, and pediatrics also performed well. These results are not surprising given the generalist-oriented nature of Step 3. Among residents from these general fields, performance improved with increased postgraduate training. However, performance on the exam was still less than what would be expected based on Step 1 and 2 results. (Only the med-peds and family practice residents with over a year of postgraduate training performed better than expected.) This may be due, at least in part, to the fact that many residents study less for Step 3 than they did for Steps 1 and 2. These findings suggest that residents from more generalized training programs may perform better if they take the exam later in their training.
The study had somewhat different findings for students in more specialized postgraduate training. Residents from the fields of anesthesiology, psychiatry, radiology, pathology, surgery, and Ob/Gyn all performed relatively poorly in relation to what their earlier scores might have predicted, compared to residents in more general specialties. Contrary to what might be expected, a delay in taking the exam did not impact scores negatively. It is unclear if this reflects a trend for residents taking the exam later to have studied longer.
Sawhill AJ, Dillon
GF, Ripkey DR, Hawkins RE, Swanson DB. The Impact of Postgraduate Training and Timing
on USMLE Step 3 Performance. Academic Medicine , 78 (10), October Supplement 2003,