Finding time to study for the United States Medical Licensing Examination Step 3 (USMLE) and the Comprehensive Osteopathic Medical Licensing Exam Level 3 (COMLEX-USA) can be difficult for those in the busy first year of residency, often referred to as the intern year. Four physicians who have been through the process offered tips for balancing test preparations with rotations to ensure better understanding of the subject matter and boost scores.
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.
Take the USMLE Step 3 seriously
One mistake residents should avoid is underestimating the difficulty of the exam.
“Make sure you don’t ignore the test,” said Janani Krishnaswami, MD, MPH, an author for UWorld, an online learning platform used to prepare for high-stakes exams. Her expertise includes exam preparation across the entire USMLE series. Conversely, “you don't want to go crazy overpreparing for it because you have enough to deal with in the intern year.
When pondering the amount of study time it takes to pass Step 3, the intensity and extent of your exam preparation will depend on what you cover in your day to day as a first-year resident, said Dr. Krishnaswami, a practicing internist with a focus on preventive and lifestyle medicine. In general, she recommended an exam-preparation window of about 90–120 days. If you are in a highly specialized field or have a history of struggling as a test-taker, you might want to begin preparing as much as six months out.
Exploit small gaps in your schedule
Without knowing when exactly you will get these windows of time, you may be able to count on several popping up each day.
“Rotations definitely make it hard to find free time,” said AMA member Ellia Ciammaichella, DO, a spinal cord injury medicine physiatrist in Nevada who completed residency and fellowship training in Texas and Utah, respectively. “Some people liked to hang out and talk between patients, but I used that time to do practice questions or look things up on the computer. That helped me learn something new every day so I didn’t have to cram it all in right before the test.”
Those short time windows, when added up, can make up a large share of your study time during rotations.
“I would look at the calendar say: If I want to get these 2,000 questions done during the month, I have to do X number of questions per day,” said Laura E. Halpin, MD, PhD, who completed her psychiatry residency and fellowship training at the University of California, Los Angeles, Semel Institute for Neuroscience and Behavior. “By noon, I might try to have 20 questions done, and by 5 o’clock, another 20. That way, I was coming home to maybe 15 questions I didn’t get done because my patients were all on time, instead of needing to do all 40.”
Dive deeper:
- USMLE Step 3 FAQs: When to take the exam, how to prepare
- Licensing and board certification: What residents need to know
- 3 tips to help resident physicians balance service, learning
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Leverage your clinical consults
Real-life cases provide a vital complement to practice questions.
“There are some rotations where what you’re doing and what you have to know are going to be very relevant to the exam,” said Dr. Halpin, an AMA member now in practice as a child and adolescent psychiatrist in California. “So, you need to figure out which rotations will be high yield for test questions. Residents a year ahead of you will know which ones those are.”
In addition, studying those topics simultaneously can improve your understanding and retention.
“When I had a patient that had a specific diagnosis, like diabetes or COPD or heart failure, I would study those cases,” Dr. Ciammaichella said. “That helped me remember things better because I could imagine how the patient was doing and which medications helped.”
It’s important to note, however, that correctly answering test questions can differ from clinical problem solving.
"What we do at the bedside is not always what the test-makers want you to answer on the test," said Scott H. Pasichow, MD, an AMA member who completed his emergency medicine residency training at the Warren Alpert Medical School of Brown University. "Make sure you note these differences, and trust that the question bank is going to lead you to what the test creators want on the test.
Don’t reinvent the wheel
Draw from your experience preparing for other tests.
“Whatever worked for you on Step 1 or Step 2, try to think of ways to build that into your residency schedule,” Dr. Halpin said. “If you were someone who was doing questions every day, do that. If you were someone who enjoyed listening to podcasts, listen to podcasts. If you’re someone who likes to read, bring a book with you and read it during the day.”
Here again, though, it’s important to accept that your schedule will be less predictable than it was in medical school.
“I needed dedicated study time, and a little buffer was important too,” said Dr. Pasichow, who is now assistant medical director of emergency medical services at a Level 1 trauma center in New Jersey. “So, if I was going to be done with my shift at 5 p.m., I would schedule my studying to start at 6 or 6:30. Then if I got stuck late at work, I didn't feel like I was failing at studying.”
