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Taking Step-3

July 22, 2011

A question from an IMG who is a US citizen: Taking Step-3 is not mandatory for me before residency. I understand that Step-1 scores are most important and Step-2 scores are a little less important. If Step-3 is not required, does taking it have a benefit on my application? I suppose if I fail the test it would hurt, but if I score a 99 vs an 85 does it make any difference?

When I look at applications I don’t look at Step 3. The AMG or US citizen candidates I see don’t have step 3 as they usually take the exam during residency. I don’t know how step 3 scores correlate to residency and ABIM board success. In a 2005 study (Academic Medicine 2005;80(10 Suppl):S21-4), investigators found associations between Step 3 scores and Step 1 / Step 2 scores (good test takers are good test takers) and PGY-l performance evaluation score (whatever that is). In my experience, it is not helpful for me to know what your Step 3 score is. On the other hand, if you fail Step 3 before you apply then something is wrong. My advice in your case is to take step 3 before residency but after you have matched. It is hard to study for step 3 during the intern year, you just don’t have the time.

Facts about Step 3 that most of you know:
Step 3 is not required for ECFMG Certification.
ECFMG Certification is required to take Step 3.
Passing Step 3 is required for an H1B visa.
The majority of states require some residency training before taking Step 3. From what I can find, Arkansas, California, Connecticut, Florida, Louisiana, Maryland, Nebraska, New York, South Dakota, Texas, Utah, Washington and West Virginia all allow IMGs to take Step 3 before residency.

I took my Step 3 in Rhode Island during residency but before fellowship. I was just happy to have a day off and not be post call. I got a nice big headache after the exam.

Step 3 scores do not matter for fellowships, as long as you have passed. If you are going to take it, make sure you study hard. The 2009–2010 Step 3 data shows that for IMGs the pass rate is only 79-83% whereas the pass rate for AMG MDs is 94-96%. Everyone tends to think that Step 3 doesn’t matter, is easy or just doesn’t have time to study for it during internship. Yes all of these thoughts are true but if you use them as excuses not to study you may not like your score…

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