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The NEW Thx Testing History Report System (for more information click here)

Registration & Test Dates (22 times a year): (click here)

Registration Fee: $210. Additional: $50 for late registration and $50 to re-schedule, + $50 to change a test center if done on separate occasions
More Information: www.aamc.org.  2007 MCAT essentials PDF: (click here)
Applicants & Matriculates Summary Data (click here)

Important Notice.  Computer Based ONLY, 22 test dates, less questions, hundreds of test sites with Prometric.  For Test Dates (click here).  For Test sites (click here)  For more info (click here)

The MCAT is considered a very difficult exam.  With exception to only one Allopathic (the traditional theory of treating disease in the U.S. designated by the title M.D.) medical school in the U.S. (Johns Hopkins University), the MCAT is required for admission.  It is roughly the equivalent to your undergraduate GPA when under consideration for medical school admissions, and rightfully so.  The MCAT consists of four, time limited sections; Verbal Reasoning, Physical Sciences, Writing, and Biological Sciences.  The paper test last 9.5 hours long, with two ten minute breaks (one in the morning and one in the afternoon), and a one hour lunch break (8:00am to approximately 5:30PM).  For the CBT (Computer Based Test) start time will be provided in the confirmation e-mail, and candidates are instructed to arrive one half hour early.  The CBT takes 7.5 hours with two optional 10 minute breaks (after the first and third sections) and an optional 1 hour lunch break.   YOU MUST BRING 2 FORMS OF ID to take the exam.  It is required that you register 6 weeks prior and designate a test taking center among many around the U.S.  The Verbal Reasoning section examines your ability to comprehend information, reason, and think critically.  This is the first section of the exam, and consists of 65 questions in 85 minutes, and graded on a scale of 1-15 (15 being the highest).  The Physical sciences section is based on your knowledge of Physics, and Inorganic Chemistry.  The Physical Sciences section consists of 77 questions in 100 minutes, and graded on a scale of 1-15 (15 being the highest).    After a one-hour lunch break, the writing sample section begins.  This section examines your ability to write analytically, and is graded on an “weird” scale of J-T (with T being the highest).  The final section is Biological Sciences, which is based on your knowledge of Biology, and Organic Chemistry.  This section consists of 77 questions in 100 minutes, and graded on a scale of 1-15 (15 being the highest).  You are given ten-minute breaks prior to the Physical Sciences section, and the Biological Sciences section (a great time to review note cards of key formulas or common mistakes from previous practice test).  It is important that you become familiar with this exam, its’ questions, and time constraints, prior to planning a test preparation strategy.  The average score for all 2000 applicants to medical school were: 8.7 Verbal (9.5 for Matriculates), 8.9 Physical (10.0 for Matriculates), 9.3 Biological (10.2 for Matriculates), and an “P” in Writing (“P” for Matriculates) (Statistical information available through AAMC™ at http://www.aamc.org/data/facts/start.htm).  Keep in mind the different average scores between applicants who were accepted and not accepted.  The message here, STUDY HARD!

Sample Questions

Going over some sample questions like those found in the Verbal Reasoning, Physical Sciences, Writing, and Biological Sciences sections of the MCAT are a good idea even before planning your study tactics.  This way, you can get an idea of how much preparation you may need.  Note:  Most students get scared out of their mind on the first time they encounter sample MCAT questions.  This feeling is common to most.  Don’t feel too intimidated, the exam is very possible once you have properly prepared.

April or August

The MCAT is offered twice a year, in April and August.  There are advantages and disadvantages in taking the exams on either date.  As mentioned previously, the disadvantage of the April MCAT is studying for the exam would coincide with your normal semester course work.  For those who feel very well prepared with the topics examined, you may feel more comfortable with this test date.  The advantage often mentioned with the April MCAT is a better national curve in comparison to the August MCAT, as most test-takers in April are taking the exam for the first time.  Therefore, competition could be a little stiffer in August, and your scores a little lower (in theory at least), since the “curve” is derived from an analysis of the scores of all test takers at that time.  Another advantage is that if you do not do as well as you had hoped in April, you have the opportunity to retake the exam in August, and still apply for medical school that year (furthermore, medical schools often consider your composite best scores in each section.)  You can plan ahead for your April MCAT by undergoing a lighter course load for that spring semester.  The August MCAT has the advantage of allowing you to prepare full time for the exam without the extra burden of your undergraduate courses.  Some feel an intense preparation for the exam will work best for them.  The second disadvantage to waiting to take the August MCAT first, is that you have only one shot at the exam, and you find out your score 6-8 weeks later in the middle of the application process, which makes it too late for you to retake the exam again for that application year.  Their seems to be a lot of disadvantages for the August MCAT, but for many, the intense preparation and pressure of having only one shot works out to be the best strategy (it worked well for me).

Study Courses or Self-Preparation

Basically there are two ways that you can prepare for this exam, and those are self-preparation, or participating in a study course.  In self-preparation, you must carefully ascertain the exact material that will be covered on the exam, and acquire many practice questions and solutions.  The advantage of preparation courses is that they have already acquired such information, at a price of course.   

Self-Preparation

It is very important that when self-preparing for the MCAT, you study only the material relevant to this exam (their will be plenty so please, do not feel disappointed).  Knowing exactly what material to study can be done by following a review book.  Princeton Review™, and Kaplan™, both of which offer MCAT preparation courses, also sell books which pretty much sum up their courses, and many test taking strategies necessary to do very well on this exam.  They do a great job of summing up ONLY the relevant information, and in a manner, which familiarizes you with the format of the actual exam.  In addition, these companies usually offer accompanying books containing actual MCAT tests and their explained answers.  The combination of information review (physical sciences, biological sciences, and verbal reasoning) and the practice test are great.  Keep in mind that this test probably involves as much test-taking skill as actual knowledge of science material and writing.  The MCAT tests your ability to work well under pressure, and to take apart questions to reach an answer behind the scenes.  Beyond a natural ability, often the best method to improve your score is by taking as many practice exams as possible under EXACT TEST TAKING CONDITIONS (there are only so many ways a question can be asked).  Therefore it would be to your advantage to attain additional practice exams, from any source (friends taking test preps, or sample tests from another test preparation company).  Self-preparation will also only cost you about $50 bucks ($30 for review book, $20 for practice test book) and some extra change for photocopying.  The AAMC™, which is the organization that organizes the MCAT, offers several resources.  The Web MCAT® Practice Test V, is the latest release of official MCAT questions available online at the price of $40 for unlimited access within a specific time frame.  Users have many customizable options, and can take full-length test, take specific test sections and perform diagnostics.  AAMC™ also offers several physical official MCAT test booklets to practice on.  More and information about these resources, and additional resources provided by AAMC™ can be found on their website at www.aamc.org/students/mcat/start.htm

Study Courses

Many companies offer test preparation courses for the MCAT.  We mentioned the Princeton Review™, and Kaplan™ as two companies who have become very popular, and who have spent millions of dollars in research for better test preparation.  Of course the service comes with a pretty heavy price tag.  You can expect to spend upwards of $600 for a course.  Keep in mind that both companies offer reduced or complete fee waivers for the financially disadvantaged, therefore contact each company near you if you feel you may qualify.  The same fee waivers may assist in reducing the cost of your AMCAS applications as well.  Most often, you will encounter additional test preparation courses offered through your local University, local medical schools, or individual science professors.  These generally come with a lower price tag (from $200 up), but without the research funds for your benefit.  Ask around, and try to evaluate what might be the best course for you (be it price, methods, or availability as the key factors). 

MCAT Score Release Options

During your exam, your answer sheet will allow you to designate the option to have your scores sent only to you or to all AMCAS schools you have applied to.  If you designate only yourself, you will receive those scores approximately 50 days later, after which you can have your scores sent to the medical schools.  Not releasing scores is often held against you, under the impression of a poor performance on the exam (your taking of the test IS recorded in your AMCAS application test history).  However, some schools do not really look at not releasing scores negatively.  The Princeton Review book, ‘The Best Medical Schools, 2000 Edition’, lists all of the US Allopathic Medical Schools, and how they consider this factor and many others on a school-by-school basis.  The registration fee for the MCAT covers the expense of having your scores sent to six non-AMCAS medical schools.  It cost $6 dollars per additional non-AMCAS medical school to which you want to receive your scores. 

Tips and Pointers

It is very important as with most standardized tests, that you become familiar with the structure of the test.  You must be familiar with the time constraints, the way questions are asked, and common tricks.  The best manner to become most familiar is to take as many practice exams as possible, AND UNDER AS EXACT TEST TAKING CONDITIONS AS POSSIBLE.  This means waking up that morning, eating breakfast, sitting uninterrupted for the exact allotted time, and completing the entire test in one sitting.  Just as importantly, you must go over the exam and the questions afterwards, reviewing those in which you answered incorrectly, and just as importantly including those, which you may have guessed.  Here is a good tip, while taking your practice exam, write a “?”  on the answer sheet next to the number of any question in which you guessed.  Don’t lie to yourself about guessing, because under these circumstances you can look up the answer afterwards, and avoid having to guess again during the actual exam.  Going over your incorrect answers will also help to avoid making the same mistakes on the actual test.  A good method to keep track of these mistakes is to prepare note cards for your mistakes, and review them on a regular basis (you will also have the opportunity to review these note cards during the breaks between sections on the REAL exam).  This is a great method of preparation, and you will often find that your biggest improvement in score will come through these test simulation tactics. 

 Remember, this test examines not only your knowledge of the sciences and reading, but your capability to work well under pressure, and even more so, to carefully read information in the form of a passage, then quickly, and accurately determine the relevant information to answer a question.  BE RELAXED, when taking your exam.  Rest well the night before, as cramming for this exam will only minimize your potential. 

Registering for the MCAT

For the 2003 MCAT cycle, the fee for the exam is $185, and can be reduced to $80 if one qualifies for the fee assistance program (FAP).  For the 2003 MCAT cycle, registration will be via online only at http://www.aamc.org/students/mcat/registration.htm.  Don’t forget to register early to avoid a $50 late registration fee.

For questions about registration and test administration:

MCAT Program Office
P.O. Box 4056
Iowa City, IA 52243
(319) 337-1357
mcat_reg@act.org or online at http://www.aamc.org/students/mcat/start.htm  (back to top)

A new way of reporting MCAT scores has arrived: the Testing History (THx) Report. This new online system was designed to simplify the process for examinees and schools and to implement the MCAT's new "Full Disclosure" policy. "Full disclosure" means that all 2003 (and later) MCAT scores will be automatically made available to institutions when scores are reported. All of your 2003 and later scores are automatically released to AMCAS. The new THx Reports automatically include your entire history of MCAT performance from 2003 onward. AMCAS will also receive any older (1991 - 2002) scores that you have ever released to AMCAS. The THx Reports will show only the older scores that you have chosen to send.

Some schools and application services have designated themselves as "full disclosure schools," meaning that they require your entire MCAT history as part of your application. Those schools are in a different list on the THx report system. When you select one of them, your entire THx report will go to them; you will not be able to withhold any of your older scores. Most of these schools have always had this requirement, only now the MCAT program is able to assist them by automating the process.

Using the new MCAT THx score reporting system:

• All 2003 and later MCAT scores will be automatically released to AMCAS and included in your THx Report.

• Scores from 1992-2002 you have released to AMCAS also will be included in your AMCAS applications. To send unreleased scores to an AMCAS school, you may either release them to AMCAS or have a THx Report sent to that individual school.

• Scores from 1991-2002 will be included in the THx Report unless you "un-select" them.

• You can see your entire testing history, including new scores.

• You will be able to print a copy of your testing history for sending to schools that are not on our list. The THx site includes a secure method for schools to verify the accuracy of the scores on the report.

• You can access the THx system online at www.aamc.org/mcat beginning June 9, 2003.

• Paper requests for MCAT scores earned after 1990 will not be honored. The online THx system will be the ONLY way to send those MCAT scores. The only paper requests that will be honored are for pre-1991 MCAT scores.

• It is FREE to send MCAT scores.

• April 2003 MCAT scores will be available in the THx system on June 24, 2003.

If you have any questions, please let us know at mcat@aamc.org.

Above text extracted from the AMCAS website: http://www.aamc.org/students/mcat/sendscores/testhistory.htm  (back to top)

Step 1 of the Boards

The below text is from the upcoming SOM book, "Getting Into Today's Highly Competitive U.S. Residency Programs", sequel to "Getting Into Today's Highly Competitive U.S. Medical Schools"  To get more information on this upcoming book for medical students, due out spring of 2004 click here.

Introduction 

I was once told, “Step 1 of the boards is the most important test of your life.”  This statement may be a bit far fetched, but perhaps not that far from the truth for some.  The step 1 of your boards test you on all information learned in Years 1 & 2 of Medical School, considered the Medical Basic Sciences.  What you learn during years 3 & 4 are considered the clinical sciences.  Medical school is grueling, and there is so much to learn on a day by day, month by month basis.  So imagine reviewing all of that into preparing for a one day test.  It’s tough.  The importance of your score in the exam depends on what type of residency you wish to pursue after medical school, and where.  It may be difficult to know for sure at this point what specialty you wish to pursue, but doing well on step one will keep all doors open, and doing poorly, will close many.  Despite the intended principle of this exam to only measure basic science knowledge for the purpose of medical licensure, many residency programs use your score on this exam, like some medical schools use the MCAT.  That is, to set a cut-off score and only review applications from applicants whose scores measure above.  That being said, you can expect that doing poorly or even average, can limit ANY residency position at the BEST programs.  Furthermore, certain specialties are so competitive, that regardless of where you apply, your scores are crucial (i.e. Neurosurgery, Orthopedics, Plastics, Radiology, Dermatology, ENT, etc).  Last but not least, programs in cities like NY, or LA tend to be highly desired, and are often more competitive than other “less desirable” locations.

Don’t be afraid 

Like I said, I was told that this was the most important test of my life sometime during the first two years of medical school by my older brothers, and as expected I was freaking out in the weeks prior to the exam.  Although this test is extremely important primarily for licensure, but secondarily for getting into residency, you must always remember to keep your cool, and know that there exist strategies to help you do as well as you would like (or close too it).  Keep in mind, that every one in medical school including you is exceptional.  If you have already forgotten, talk to some current pre-med undergrads about how hard it is to get into medical school.  Therefore, remember that you are still exceptional, and regardless of your first two year grades, you can still do well on the boards (it just might take a little more work, that’s all).

Contents 

Topics from 1^st and 2^nd years covered include: anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology.  This exam, focusing on individual organ systems is further subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations.

Test Breakdown 

Once upon a time, the test was administered in two days, in written format, and administered on specific dates.  With the advent of computers, things are quite different.  The exam now is scheduled at testing centers across the nation (and world), taken completely on computer.  Once completed, the exams are graded electronically, and you receive your results nearly 6 weeks after.  The exam is subdivided into seven, 50 question blocks for a total of 350 questions, timed at 60 minutes per block.  The exam begins with a 15 minute tutorial that if you complete before hand, the additional time will be forwarded to your allotted break time.  At the end of the exam, there is a short questionnaire block, that does not count towards your final score.  Once you begin a block, the 60 minute timer will not stop.  Within in each block you can review questions and change answers.  However, once your 60 minutes is up, or once you have decided to finish a block and move to the next one, you can not return to previous blocks to make changes.  The advantage to finishing a block early is that the extra time is forwarded to your allotted break time.  IMPORTANT:  finishing early does not provide extra time towards future blocks, all blocks are at most 60 minutes long, time is only added to your breaks, and rushing through the exam for this slight benefit is not advised. 

Registering for the exam 

To register, you must designate a 3 month period in which you wish to take your exam.  Once you are approved for that 3 month period, you can call the Prometric testing center, or schedule online a specific date within those three months, depending upon availability at specific locations.  (Some locations offer weekend test dates)  You can choose from any national Prometric testing location.  The fee for the 2003 test is $420.  The fee for extending your 3 month testing period by another 3 months is $50, and it can only be extended once.  Additional extension will require re-application, and re-submission of total fees.  You can complete the application partially online with a portion to mail in, or download all forms to complete and send in with a check.  Go to www.nbme.org to find out more about the online, and downloadable applications.

Preparing

So how do you prepare.  Most students take the exam the summer immediately following their 2^nd year, in the few weeks available prior to starting their 3^rd year.  It is very important that on the onset, you evaluate your goals, and formulate a plan/time-line that is realistic and that you can stick to.  4 weeks is the average length of time.  Probably the best way to prepare for this exam is by doing well during your 1^st and 2^nd years.  For those who did very well, perhaps 3 weeks will suffice depending on your goals.  For those who did not do as well during the 1^st two years, you may need a little extra time, but not too much as it is very easy to get burned out.  You will be better off with a more thought out, and dedicated study plan.  I would say that a rational limit for all students would be six weeks, although if you plan well, get good books, and do lots of questions, 4 weeks will still be good enough.  Make sure then when making this plan, you research what resources your school may offer to help guide you.  Some schools have test specialist, who can help you develop this plan based on your goals, and recommend (or even lend you) books and materials to study from.

Self Pre-paring or Course

This is the same dilemma we faced when preparing for the MCAT.  Some medical schools offer their own reviews, which can be good or bad.  KAPLAN offers an expensive review, as they did for the MCAT.  My impression is that most people study on their own, from texts, review books (first aid, step up), and do tons of questions (NMS, Qbank).  Some students use their own notes from medical school.  With the test in recent years presented more and more as clinical vignettes, it is important that your review materials emphasizes this approach.  The key is that you use the books, in the format you liked best during your first two years, cover everything, but don’t dive too deep into specific topics.  Make sure that if you where marginal in certain topics (i.e. micro, pharm) you compensate in your plan to eliminate proficiencies.  Don’t be initially overwhelmed with the amount of information you must review.  Set a steady consistent pace, and with time great progress can be made, day by day, week, by week (look at the Grand Canyon, although you have a little less time...)  Use your reading as a base, but as important is taking practice exams, and reviewing your answers (those that were right as well as those that were wrong). Take notes on your practice test reviews, and review these.  I feel as it did for me with the MCAT, this portion of my standardized test preparation is always the most important.

Sample questions 

Now the next question is, where do I find questions that accurately represent the questions & format I will encounter on the real exam?  You might have already heard of Kaplan’s online Qbank.  In case you have not already heard, Kaplan provides access to their online bank of questions (for a price of course).  With access, you get a member’s area, which tracks your progress in terms of how many questions taken, and your score.  Then it further breaks down your score by discipline, for instance anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and more, and tells you in which discipline are you proficient or deficient.  Besides breaking it down into disciplines, it also breaks it down by organ system, reporting proficiency and deficiency.  You can later create test with emphasis on these specific disciplines or organ systems.  There are approximately 2400 questions.  What I think is the greatest asset of this resource, is that it is presented in the identical format as the actual test, and you can then become better familiar with timing, and navigation (good aspects to be proficient in, prior to the real test).  The big question, and you will find much debate on this, is how much the questions on Qbank resemble the actual test questions (a sample scale can be found below)?  You will here lots of opinions, but in mine, the average Qbank question focuses on more detail, than the average question on the actual exam.  This is an important point, because the majority of the questions in Step 1 focus on less detail, and cover the major more fundamental concepts of medicine.  Qbank questions focus on more detail, of more extraneous/non-fundamental topics in addition to fundamentals.  Making sure you have the fundamental concepts to medicine down is essential, as the majority of the questions you will encounter on the real exam will be aimed towards there.  However, mastery of these fundamental questions in great detail, AND the more superfluous ones, is what will help you answer these rarer types of questions, and set you above the average score into exceptional.   The reason I stress this, is because I feel that when I was studying for my test, using mostly Qbank questions, based on its popularity, I was steered under the impression that most questions where going to be at that level of detail, and I focused on these details, loosing sight of the central more fundamental concepts of medicine which also required mastery.  During the actual exam, I found myself cruising through these superfluous questions, and under-pressure through the more fundamental ones, and there are a lot more fundamental questions.  A good contrast between fundamental and non-fundamental can be made when looking at the kidney, and details on how all its segments work for example, versus all of the possible manifestations of Von Hippel Lindau Disease.  Ultimately, the exam went really well as apparent by my score, but I probably missed a couple of more basic, fundamental questions because I overemphasized on the rarer more detailed ones.  Had I known this before, I could have probably done even better.

Sample questions are also available by NMS in “Review for USMLE Step 1; 6^th Edition”, and these are also known to be pretty good.  Ask around, and see if you can get sample test from some third years, in addition to more advice.

Delaying you exam

This is a difficult topic to assess.  You must be very careful and honest to yourself when trying to decide this option.  Try to speak to a faculty advisor to assist you.  The only reason to delay taking your exam is because you feel that you are not prepared to take the exam, because you were not able to give your preparation 100%.  This should not be as a result of a lack of planning, but more as a result of circumstance that may have occurred to throw you off track.

 The Cons:

³     You are farther away from the Year 1 and Year 2 where you meticulously learned all the relevant material, and may continue to forget with extended time

³     If you start Year 3, you have even less time to study for step 1 during clerkships.  It will become necessary for you to designate several weeks in between clerkships to properly prepare.  Taking extra time to study for step 1 in between clerkships will limit opportunity for electives which may become very important late in your 3^rd and early 4^th year

³     What you learn in preparing for step 1 is very important to a good performance on clerkships in year 3. 

 The Pros: 

³     Giving yourself your best shot

³     Developing a clinical thought process useful in deciphering the clinical vignettes found on step 1 by completing clerkships like medicine and surgery

³     If you are unprepared, and fail the exam, it looks bad, but you can retake it.  However, if you are unprepared and marginally pass, it looks bad, but you can’t retake it, and you will greatly limit your residency options.

 Most often, delaying your exam will not lead to a better score.  However, in rare cases it can.  You must be true to your self to make the decision.  I must say, I don’t know anyone who felt totally prepared for the exam, and everyone freaks out in the days leading up to it.

Exam day

Go to the test center on your confirmed date 30 minutes before your scheduled testing time.  Present your Scheduling Permit and unexpired, government-issued form of identification that includes both your photo and signature, e.g., a driver's license or passport. Your name on the ID and permit must match exactly, with the exception that there may be no middle name, initial or suffix on one or the other.

Results/Interpreting Scores

Upon completion of your exam you will receive a certificate of completion from the test coordinator at your site before you leave.  The answers will be mailed to you approximately 6 weeks later.  The letter will give you three grades.  The first is the easiest to interpret, Pass or Fail.  The next two grades are not as easy to interpret, and includes a 3 digit number (with mean, standard deviation, and standard error of measurement), and a 2 digit number (with the number needed on this scale to pass, the 3 digit equivalence of the 2 digit score mark to pass, and the standard error of measurement).  The 2 digit number is derived from your 3 digit number, is NOT a percentage, and it is set at a scale that a score of 75 corresponds to the lowest passing score.  The 2 digit number is used in score reporting because some medical licensing authorities require a scale describing a "passing score of 75." In Early 2003, the 3 digit pass number was 182, and the average for first-time examinees from US and Canadian Medical schools was approximately 216 with a standard deviation of 24, and standard error of measurement of 6 points.

The best information I could obtain on the significance of the results are:

“The primary focus of USMLE is on the licensure decision, and Steps 1, 2, and 3 scores are used in this process. The scores for each administration of a USMLE Step are equated so that a given two-digit or three-digit score always represents the same level of examinee performance for that Step. In other words, a score of 200 on one administration of a Step indicates the equivalent level of examinee performance as a score of 200 on any other administration of the same Step. This equivalence holds even if the pass-fail standard is changed, which permits comparing performance across time” (Extracted from http://www.usmle.org/news/newspercent.htm) 

“The 3-digit score is calculated using statistical procedures that ensure that scores from different years are on a common scale and have the same meaning” (extracted from http://www.usmle.org/news/faqusmlescores.htm) 

More information can be found at (http://www.usmle.org)

One Sample Scale of 3-digit Step 1 Scores I came across:

245+ = “A+ or Exceptional” (Approximately 80’s in Qbank)
230-245 = ”A or Great” (Approximately 70’s in Qbank; also, some secretly talk about a cut-off of 230 on Step 1 for many competitive specialties at competitive programs, below which applications are overlooked)
215-230 = ”B or Good” (Approximately 60-70’s in Qbank)
200-215 = ”C or Average” (Average in 2003 was 216, with SD of 24)

182-200 = “D or Pass” (Pass in 2003 was 182; Kaplan talks about a 50-60% on Q-bank to pass Step 1)

Be very careful when looking at the above scores, and the scale.  I know that many statisticians may feel this scale is very simplified, and it is.   Also, the Step 1 is weighted differently by different programs, and some are considering not using it at all, relying more accurately to determine your potential for the field by grades, evaluations and letters.  Lastly, you will find by asking around, that there were students getting 75’s on Qbank who failed the actual exam, so take these figures with a grain a salt.

First Aid & Step-Up

It is necessary to comment on these very popular study aids.  First aid goes by disciplines, Step-up by Organ systems.  They can be quite useful during the second year when many medical schools, take an organ based approach to teaching.  For Step 1, they are useful to review topics as high-yield quick reads and as a supplement to your primary reading, but probably not sufficient as a single source to do very well on the exam.

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Truly an examination marathon. Two days, 8 hours of time allotted (though most finish early on day two).  Let’s start from the beginning.

To be eligible to take step 3 you must meet the following:

• M.D. or D.O. degree
• Have completed Steps 1 and 2 (CK & CS)
• If foreign medical school graduate, must obtain certification by the ECFMG or successfully completed a “Fifth Pathway” program
• Meet the state board requirement to which you are applying (i.e. number of post-graduate months of residency needed to be licensed.)

You must also be eligible to sit for step 3 at the time you process your application. This entails: 

• If you have taken step 3 before, you may not reapply prior to 60 days from the previous test date.
• Also, you can not take Step 3 more than 3 times in a 12 month period.

Now on to exam content.

Purpose and content including the Problem/Disease list are best completely summarized at the USMLE website here http://www.usmle.org/step3/purpose.htm. 

While Step 1 assesses whether you can understand and apply important concepts of the basic sciences, and Step 2 whether you can apply medical knowledge to supervised patient care, Step 3 is designed to assess your ability to practice UNSUPERVISED medicine.  And I quote,

“Step 3 assess whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. It provides a final assessment of physicians assuming independent responsibilities for delivering general medical care. (FSMB 2006)”

Step 3 uses two different testing formats. Traditional multiple choice questions (MCQ’s; Entirely on Day 1, and first part of day 2), and the Primum^TM computer-based care simulations (Day 2 only).  Step 3 will have approximately 480 multiple choice questions, divided in to blocks of 50 questions in 60 minutes on day 1, and blocks of 35 questions in 45 minutes on day 2.  Upon completing the MCQ blocks on Day 2, you will then have to complete 9 Primum^TM case simulations, 25 minutes allotted for each case.

As with the Step 1 and 2 (CK), the tests are administered by Prometric.  By this time you should know what studying method works for you, and do it again.

Some additional tips:

• Get a book and review some questions.  Everyone will tell you to review the Primum^TM care simulations, which is possible via a download of the tutorial and sample cases available online.  (click here).  However, some will tell you not to bother studying hard that if you did well on the other steps, you will do fine on the last.  I borrowed a review book from someone who told me that, and the book was highlighted, underlined and annotated from beginning to end.  Hmmm???  Although most of the test items are common sense at this point for most with some post graduate care experience, I would certainly review questions specialties outside your own (Peds, Psych, OBGYN, Medicine, Neuro, Surgery).  I personally did not review questions from my own specialty; however, in retrospect after taking the exam, perhaps I would have reviewed a few practice questions since things are done slightly differently from the primary care provider role.
• DEFINITELY REVIEW THE PRIMUM^TM CASE SIMULATIONS.  Nothing else really needs to be said, and it will take you only about 1-2 hours.  The most high yield review you can do for this test.
• Call your testing center, and find out about parking ahead of time.  Parking was not a problem at the test locations where I took Step 1 & 2, so I expected the same the morning I was almost late for Step 3.  Big mistake.
• As you can imagine from the previous step, if you are late, or going to be late even by 5 minutes, CALL AHEAD.  When I mean late, I mean later than 30 minutes PRIOR to your start time.  If the testing center does not hear from you 30 minutes before your test time, they can potentially give up your seat.  This can be especially the case if one of their computers goes down.  If you call ahead they will be glad to hold your spot if within reason since you will likely be taking the longest test.
• Don’t forget you can review some high yield notes between day 1 and 2.  The Day 2 Primum^TM cases will ask you to enter specific treatment medicines (not dosages).  Not a bad time to review these.
• Don’t over do it on studying, you know most of what you will need for the exam already.  It’s a marathon, not a race, so make sure you get rest both nights before, and eat a good breakfast, and lunch the days of.
• A little prayer never hurt anyone either…

Links:

State board requirements (click here)

All about Step 3 Bulletin (click here)

Download Primum Case software (click here)    (back to top)

www.studentsofmedicine.com