Personally, I thought this exam was hardest of all three steps (I am not currently in residency and I am applying). This exam does not necessarily ask what is “best treatment/diagnostic means/medication of care” but rather wants you to know “which of the following from the choice is the best to use” and some questions presents a scenario testing how well you know the diagnostic criteria for a pathology. For example, you may know the first choice medication to use in lupus glomerulonephritis, but what would be first choice in pregnant women with lupus nephritis and etc. Therefore, the questions were more situational rather the facts.

Books: I used Master the Boards (2013 edition) and I tried using Crush the step 3. But after couple of weeks I only used Master the boards.
Q-bank: I completely exhausted UWorld step 3 bank for preparation and literally wrote all the feedback in the master the board to supplement for reviews. I used Kaplan Step 3 qbook but the questions seem old and relatively easy testing basic pathopys knowledge, so I ended finishing 7 section of Kaplan q-book (total 8/17; 2 IM, 2 peds, 1 ob, 1 surg,1 psych, 1 neuro) and then stopped using. I tried using MKSAP Internal medicine, which were hard and easy but sometimes over the top details for step 3, so I recommend to not worry about doing MKSAP. If you really want to do, I suggest endocrine and GI.

Preparations: I’m working part-time as research associate, so somedays, it was hard and easy for me to prepare. Qbank had approximately 1350 (but now it may be even more), and if you divide 1350/48=28. I took two months to prepare for the exam and in the first twenty days, I just read the Master the boards from cover to cover. And in the next five weeks (35 days), I would do a block of 48 questions in time and random (excluded biostats and derm, I did them more at within last twenty days to keep it fresh in my memory). I tried to do all the questions in time (non-tutor mode) because I am slow in terms of time and wanted to prepare for it. At the end, I had about 2 and half weeks to re-review all the questions in the q-bank as well as go over master the boards to read what I added from uworld.

For CCS cases, I read the uworld online CCS files and used CCS software. I recommend atleast go over twice with the online cases in uworld because only are they helpful for understand/ordering for CCS section of the test but it adds content to the pathologies for multiple choice. I did all the cases in software twice to acclimatize with ordering rituals in different conditions. They were helpful for preparation for all the contents in test.

SO on the first day had seven blocks (first fours 47 q’s and next three 46 q’s). We all will be familiarize with software and etc to save 15 min to add that in break time.
First block, I ran out of time, so I ended randomly picking any choice in two questions. Second block, randomly picked 1 question, third block none, fourth 5 questions, sixth 2 questions and seventh 1 question. I practiced all of the uworld in timed mode and still struggled in time during the exam, beware of time management for the test. Questions at the beginning were usually big stem; at the end, most of the time questions were 3-line stem with few long (16 line with labs) stemmed questions. Again some questions were direct questions from reading master the boards or uworld, some required to know all the diagnostic criteria or medical intervention for a disease, some required knowledge from step 1 (yes basic science) regarding pathology or physiology of disease. I had lot of biostat-passage questions where there is an article and you have to interpret how it would useful for the patient care. But all in all, uworld with master the board is good but not complete. SO PLEASE DON’T THINK IF YOU PLAN TO DO ONCE AND IT BE ENOUGH FOR YOU, BECAUSE IT MAY WORK OR MAY NOT WORK IN YOUR FAVOR.

Next day, I had four blocks of 36 questions, I still continued to struggle missing total of 6 questions (randomly picking or not even had enough time to pick anything) Similar story in terms of the questions and length, but somewhere even 1 line questions. One thing I realized is the step 3 did not completely cover with questions with topics like RA, COPD, colon caner etc the topics you think will have higher set of questions.
CCS: DON’T MEMORIZE UWORLD CCS CASES because step 3 will not be asking the same topics on the test. Be familiar what to order in different situations in terms of office and ER (routine and stat) and when to send a patient to ER from office etc. Cases on the step 3 were little bit difficult to diagnose and anxiety/frenziness in your head in making sure to order test sometimes freezes your brain for the name of the diagnoses, which happened to me. SO BE AWARE.

When I came out of the exam, I thought I might have failed the exam for missing the multiple-choice questions and contemplating the choices and not able to write or figure out the diagnosis on CCS. I even started working on Plan B of figuring details on how to prepare next time and changes that may be included in new exam. But guess what I got my score and I passed 195.

One more thing, I recommend the day or two days before go over ob/gyn, peds and psych from master the boards, because they will help to answer some questions really fast and help save time in other topics.

Glad I done with steps now and thanks Steps for teaching part of me that I never knew: NERVOUSNESS and ANXIETY

Let me know if you have questions or queries that I may be able to answer