Purpose of Sharing my Failure Story:
I want to share tips from my personal journey of preparing for the USMLE Step 3 exam and passing the retake after failing. To all the residents and graduates out there, I hope my story provides some insight and encouragement as you prepare for your own exam.
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Understanding the USMLE Step 3
The USMLE Step 3 is a critical milestone as it's the final exam in the USMLE series that assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. After passing Step 3, you can apply for your medical license and step into the autonomous practice phase through moonlighting (if your program allows).
The Initial Shock of Failing
I want to share a painful personal experience that I'm still processing and learning from. Earlier this year, I received the unsettling news that I failed USMLE Step 3. As someone who is nearing the completion of their first year in psychiatry residency and on the brink of entering my second year, this was a tough pill to swallow.
Receiving the results was undeniably disheartening. After dedicating months of study while balancing the demanding responsibilities of a psychiatry resident, the news felt like a setback. It's easy to understand how one's self-doubt can spike after encountering such unexpected outcomes. In our field, doctors are often seen as infallible, but the reality is that we are human too, prone to mistakes and failures.
Facing the Reality of a Retake
Retaking such an important exam can feel daunting. Initially, I was disappointed and frustrated with myself when I realized that I would need to retake the Step 3. It's normal to feel a range of emotions, but it's important to view this as an opportunity for growth rather than a setback.
Reflecting on the Path Forward
Despite the initial shock, which I learned in the bathroom on the in-pt psych unit in between rounding on my patients, it is crucial that I take this moment as an opportunity for growth and reflection. Failing Step 3 is not the end; instead, it is a chance to reassess my approach and tackle the exam with renewed focus and strategies. It's important to remember that many physicians before me have faced similar hurdles and have gone on to achieve success.
Mental Reset Before Studying again
I learned from failing USMLE Step1 and from mentoring countless medical students who have failed, it is crucial to take time off to mentally reset. This meant NO STUDYING for a few weeks to a full month. Here I focused on mental health, sleep, and regaining confidence.
Exam Breakdown & Accommodations
Step 3 is divided into two days: the first day is multiple-choice, and the second includes more complex questions and cases. For me, getting accommodations to split these over a span of four days was crucial. It allowed me to maintain my mental state, given I work better in shorter, concentrated blocks.
I recommend any medical student or resident who's focusing on Step 3, and who has previously encountered challenges on STEP exams, to see if they qualify for accommodations. (Check out my previous post for more info)
Identifying My Weaknesses
One of the first steps I took was an honest assessment of my previous exam performance. I carefully reviewed my score report to identify the areas where I struggled the most. Understanding these weaknesses was crucial in tailoring my study plan effectively. Whether it's internal medicine, surgery, or another domain, pinpoint your areas of improvement. For me it was Biostats and CCS cases.
Redefining My Study Strategy
I realized that my study habits needed a refresh. For my retake, I diversified my study materials. I used a combination of online question banks, Sketchy Biochem & Pharmacy, and audio Devine Intervention lectures. The questions banks, in particular, were invaluable as they provided me with practice questions that simulated the exam experience. Scheduling regular study sessions and blocking distractions were essential parts of this strategy.
UWorld and Practice Tests
Practice tests are vital, and it's crucial to have a strong buffer (at least 10% above passing or one quartile above) in your scores to mitigate against variables like anxiety on test day. In hindsight, scoring about 60% on practice questions, rather than the 52% I achieved, would have reassured me of being ready. The UWorld bank remains the gold standard for practice questions, and it’s vital to complete it thoroughly (especially the biostats questions).
Taking practice tests played a significant role in building my confidence. These tests not only assessed my knowledge but also helped improve my time management skills and reduce my anxiety about the real exam situation. After each practice test, I spent time reviewing my answers, focusing particularly on the questions I got wrong.
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The CCS component of Step 3 brings its own challenges. While I completed all UWorld cases, insights from the CCS website proved especially beneficial. It's crucial to focus on developing a high-yield document of typical cases and treatments. Time management and familiarity with specific procedural names and diagnostic steps are key here.
Make sure to always do IN ORDER: physical exam, order pulse ox/labs/ & imaging, then order oxygen & saline, and lastly order meds. Then wait to the last 2 min to order all vaccines, education, and standard exams for that age (colonoscopy, Pap smears, mammogram, etc).
I did 4 CCS cases per day. Created a spreadsheet for every case (what went right/wrong, key steps, diagnoses missed). Then, reviewed the list of cases nightly.
Since Biostats is my weakest subject I did all of the UWorld Biostats question bank and did some AMBOSS Biostats practice questions. I also made a biostats sheet with equations and rewrote it daily.
Studying During Residency
Balancing residency duties and studying is tricky. I've found it's essential to remain connected to practical applications during studies, which for me meant working alongside co-residents and fellows who encouraged my focus on Step 3 while engaging me in clinical cases relevant to my studies.
For those navigating the complexity of Step 3, know that you're not alone. My residency in psychiatry meant limited time with internal medicine, sparking a need to focus on areas of lesser familiarity through rotations and self-study. I engaged deeply in fields relevant to the content being tested, like antibiotics and common (not rare) diagnoses in each specialty
Don’t underestimate the power of community. I reached out to colleagues and mentors who had successfully passed their Step 3. They provided me with practical tips and moral support. Joining study groups also provided a sense of camaraderie and accountability. I am fortunate to have the support of my colleagues, mentors, and family during this challenging time. I utilized their guidance and wisdom as I prepared to take on this exam again. This journey has reinforced my passion for psychiatry and my determination to become a compassionate and competent psychiatrist.
The Importance of your OWN Health
Balancing study with life responsibilities can be challenging. During my preparation, I ensured I took care of my physical and mental health. Consistent exercise, a balanced diet, and meditation were key components in managing stress and maintaining my focus. Prioritizing your health is non-negotiable. Ensuring adequate rest, exercise, and pacing yourself with breaks can significantly boost your capacity to perform well. Don't rush back into studying if you don't feel ready, as burnout looms as a real threat.
On exam days, I made sure to get adequate rest the night before and ate a healthy breakfast. During the exam, I stayed calm and reminded myself of the preparation and hard work I invested. It's essential to pace yourself and take short breaks to maintain focus and stamina throughout the long testing sessions.
Moving Forward With Purpose
Resilience is key in the medical profession, as is the willingness to learn from our failures. This experience has taught me about humility and perseverance. It is a reminder that growth often comes from discomfort and that each challenge is a stepping stone to excellence.
To fellow test-takers: trust in your training and your abilities. Surround yourself with a support net of mentors and peers who uplift and remind you that one test does not define you. I’m grateful for the understanding and support I found within my residency program, and I hope you find the same in yours. We are good enough to succeed, and we’re in this together!
Failure can feel isolating, but it is a universal experience in a doctor's journey. I hope that by opening up about my setback, I can encourage others who are facing similar challenges to keep pushing forward. Remember, success is not defined by how few times we fall, but by how we rise after each fall.
Passing the USMLE Step 3 on my second attempt was a humbling and rewarding experience. Retaking the exam taught me resilience, perseverance, and the importance of continuous learning. To anyone preparing for the retake, remember that determination and an effective study plan can turn this challenge into a successful achievement.
Thank you for joining me on this journey. Whether you're facing a retake or preparing for your first attempt, take the time to prepare thoroughly and believe in your capabilities. Good luck!
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UWorld Step 2 Bonus Questions: Use Code STEPH10 for 10% savings AMBOSS BiostatsDivine Intervention PodcastSketchy Pharm & Micro