 All right guys, welcome to today's video. Today I have one of our listeners asking one of their related questions regarding step three. Hopefully I can answer them. Hopefully you guys can find some benefit through it as well. Jen, welcome to the TMJ show. How are you doing? Good, thank you so much for having me. Of course. So let us know how we can help you. What's going on? Yeah, I'm a fourth year med student and looking at starting internships soon in pediatrics. And I wondered what you would recommend for preparing for step three and even any tips for intern year. I loved all of your step two study guides and clerkship study guides. So I'm curious about step three. Sure. Yeah, I appreciate checking out all the content. Intern year is definitely something I'll be looking forward to talking about cause I'm like relatively recent and fresh from it. So hopefully we can give you some advice there. Regarding step three, do you have any thoughts about when you're planning on taking it or kind of what you're, I know you probably haven't had a match yet with the making of this video. So probably don't even know a schedule, but do you have kind of a timeframe in mind when you plan on taking it? I don't know. People always advise, like we have a few months of outpatient. That's all I know right now. Cool. I will tell you from my own experience of doing this incorrectly COVID played a part of this is ideally try to take it as early as possible into your first year. And I know they give you kind of all the way up until your second year or most institutions do. And so the thing I would say is kind of look at your schedule when it does come out. Try to find kind of a two to three month kind of lesser intense time in your pediatrics internship. So when you're not on ICU or you're not on a busy like inpatient rotation, now would be kind of the timeframe to look to when to schedule it and having that two to three months gives you the flexibility because honestly you probably just need like four to five weeks to study for it, but things will come up. The rotation will be busier than you expected it to be. You may not be as motivated because finally you have some time off. And so having that two to three month window will be nice. Another thing that I learned is that scheduling step three can be hard, especially depending on what part of the country you're on. So you may not be able to get your first choice in coordinates with your busy schedule. So that would be the first things. Whenever your schedule comes out for your, you know, your upcoming residency is to definitely keep in mind like where is the lightest rotation? Ask your upper levels and like what rotations they tended to take step three on and then find that beautiful kind of spot that's open. Does that make sense? Yes, thanks. And then in regards to like actually how to study for materials, you know, simple is better especially with the busy residences. I would definitely say to minimize as many resources as you can do. Your world is honestly probably more than enough. And then you can use other supplementary resources once you realize like there's like a big weakness from experience. My pediatric knowledge was terrible coming into step three because I was like almost a year and a half removed. So for you will probably be better but maybe things like internal medicine or surgery will probably be like, oh, I haven't done that in quite some time. So if you run into those questions on your world then that would be like looking to see whatever resources you enjoy it for your rotations and maybe referring back to those. But you will probably be like the honestly the best resource that you could use and try to give yourself a nice friendly schedule where it could be like 10 questions a day, 20 questions a day. And then when you're on that really light rotation or you have like sometimes, I don't know, it depends on what your residency will have but maybe you'll have like a, you know an elective month where you can kind of work at home or do research and then you have more time on your schedule. And those times you can obviously do like 30 questions a day, 40 questions or more but keeping it simple at the start will be really key to like avoiding freaking yourself out. Sounds good. Have you heard about the cases or kind of how it's like formatted? Not a ton, just from residents here and there. Sure. So I don't mind sharing with you as well as all the other listeners. So step three is weird obviously because it's two days but they both kind of include practice questions and question banks, which I didn't know until pretty recently when I was actually about to take it. So I knew the first day it was like filled with practice questions or you know, multiple choice questions and the second day also kind of starts with 50% of your day being the same. The question blocks are just like shorter and then the other half of the day on the second day is where you do those cases and that's where you're like in their simulation software and they basically tell you so and so at such and such age comes with this main complaint and they give you kind of an initial history and then it's your job to figure out should they go to the emergency room? Should they go and get admitted and what labs and tests and like management things do you need to do immediately? So that one's a little odd. You know, we naturally do this when we take care of patients you naturally do it when you're about to take care of kids. I do it when I take care of adults but we don't do it in the form of like I need to press this button and this button and then I can need to make sure these orders and usually just kind of done subconsciously. So I would recommend, you know, initially maybe familiarizing yourself with the multiple choice things and realizing what areas from like your third year in med school are really weak and spending the first few weeks doing that. And then, you know, let's just say you give yourself six weeks to study then I would spend those last three weeks to like do more of the cases and less of the practice questions to kind of changing your distribution of where your focus is and maybe a hundred percent of questions on the first two, three weeks and then adding a little bit more cases and then as you're getting closer you wanna do more of those cases than you're comfortable like managing their odd simulation. It's actually quite fun once you like get the hang of it. Does your world have both the multiple choice questions and then the cases? Yeah, they do. So they have like their own it's kind of like when you log in you get to choose like what you wanna do. So it's actually three things. So one, you'll have the actual questions just like your normal step two, step one question banks. And then two, they'll have like the cases and then there's cases that you can do in like a simulated form. And then there's cases where it's not really a case it's kind of like they give you a paragraph of the situation and then they walk you through what they would have done. So those are helpful to read through but honestly the ones where you actually do it are the most useful because you can go through the case and then compare yourself to what they would have done. So that's really like where you make the money. But there's like 50 cases so it can be pretty time intensive because if you're actually doing them with like pure focus each of them probably takes from like five, 10 some even 15 minutes spacing that out to where like the latter part of your studying is you're getting closer to like day two of your exam to where you get to do all those questions or all those cases is gonna be super helpful. Action. Yeah. And they also have like online if you go through the NBME website they actually where you can install the simulator onto your computer like a test drive and so you can get familiarized. Like you rolled it really nice. They actually did a good job of mimicking what the actual test looks like. But there are some things where the actual test is a little bit more friendly. So for example, when you're ordering a test you can choose, you do you want a stat? Do you want it like a certain amount of hours or do you want a routine? Like you don't really care. Most of the time when you're ordering stuff for the test you want it stacked because you want to know what the results are but on your world you actually have to like waste your time to like make those decisions on the actual test it's automatic selected as stats. That just kind of helps. So getting familiarized with those small little nuances of where you get to stress on and where you don't have to are super helpful. Is it like other tests where you end up doing like a full practice test at some point or do you just do it in pieces? Yeah, so I can speak for my own personal experience even you will it doesn't have like a full practice exam so they don't have like a self-assessment plus the cases and like one built in exam. And I think it's just because the grading of the actual day one and day two is just so vague. We don't really know exactly how it's graded. It seems to be pretty friendly curve to just cause there's gonna be knowledge that they're gonna ask you from step one and step two things that you're just gonna forget and you're gonna feel like you're doing terribly that everyone has those experiences. So I think just because we don't know exactly how they grade it unfortunately Uworld hasn't been able to create something that combines those two. So you can definitely test yourself on the multiple choice section. And I did one self-assessment to just see kind of where I was and I was happy enough that it was good enough. So I didn't take the second one and then I focused on the cases. So I would do a case and as long as I felt like I did most of those orders then I considered it a pass and I would just kind of keep notes of like, oh, you know, if you run into an OP guy and related case here are things you want to order on every patient. If you run into a pediatric case, you know these are the things you want to consider. So that's kind of how I would grade myself but not a full blown on exam unfortunately. Gotcha, makes it a little different. Yeah. And the last tip I would give and I given this in other videos is that focusing on the bio stats portion especially for day one. For some reason like they both, they have multiple choice sections on day one and day two but day one is very focused on bio stats. So you'll have like those ads you have to answer, you know relative to questions like how to interpret that advertisement and you'll have actual things like on specificity and sensitivity that all of us kind of hate but they're, you know with practice those questions are things that ideally you look forward to because it's that kind of give me question once you know the formula or like the actual full approach to that stat question. So that was the third thing that you world comes with as they come with like their own bio stats question. And so you get a little bit of that as you're doing the practice questions. So honestly, that's all you need but as you're getting closer to test day to build your confidence I mean, I know I got a few questions just from doing that bio stats section. You know, I replace my questions with just reviewing those and they don't take very long. It'll be like one section will be on sensitivity and specificity and it'll give you kind of the brief rundown but then more importantly I'll ask you like five or six questions to see if you can tell the small nuances that the test will question you on and then there'll be another one on like positive predictive value and another one on like, you know assessing relevancy of like an ad. So again, they're not very long but you can quickly just say, okay, I know this, if it showed up on the test I'd feel comfortable. Okay. With step one, step two shelves, things like that I relied pretty heavily on generic books. So it sounds like you're saying more like it's an easier test to just rely on multiple choice question preparation. Yeah, I mean, it will depend a little bit on how you study. I think in this situation when you combine it with being busy in residency and also having some experience under your belt where the first two tests you have a little bit less of that the multiple choice ideally will be able to cover most of it. One approach that I take and I took for past tests as well as this one is I would just have a list of the questions that I would miss and I just created on Excel sheets. So like if I missed a question on contraceptions then I would write, you know that basic topic in one field and then I would write like, you know OPGine in the second field and just to make it a little bit more user friendly on the last field I would just say on a scale of one to five how difficult was this or how much, how important is it that review this? And so eventually I kind of had a huge Excel sheet with everything that I missed on your world and, you know when I would have some time on like downtime during a residency rotation or like a day off or before I started some practice questions I would just do a few of those and then I could sort them based off the things that I thought were the most difficult and review those first and then ideally change the numbers so if something became much easier after reviewing and saying, okay like that makes sense and I would change it from a five to a two and then I could focus on the next hardest things and if it still didn't make sense after reading the Excel block I could then like Google it or YouTube it or whatever resource, you know if you like books and you could use those I was really just time efficient and for me unfortunately I was actually on like an ICU rotation when I was studying for most of this so for me it was all about how can I do the most questions and make the most mistakes now so I don't make them on the test That's a great idea I love that idea Yeah, so super effective and then you can actually like build upon it even for residency for all your Peds knowledge you can, you know if you're on like the Peds cardio block you can add all the topics that you keep missing like diagnoses that you struggle with and then ideally it becomes easier and easier and then you have like a constant list of things that you're better at than things that you're not That's great and that goes into kind of my secondary question even beyond step three when you're thinking about boards and things I have no idea how residents kind of handle that Sure Yeah I would focus less on the boards especially when you first start on I think it depends on what residency you go to and kind of their focus on boards but tend to have like one exam per year and the first two don't matter as in like at least internal medicine you take one after your first year and it's kind of an assessment to see where you are and then you know as a second year I took one actually at the early parts of my second year so it's kind of like I was basically finishing my first year but it was also another form of an assessment and then I'll take my boards you know next year but the most important thing as an intern is just getting as much practice in the field as you can so what that means is and I give this tip to all like the fourth year med students that I work with on awards is you know create a list right now of all the things that would freak you out if on day one if you had a child with that issue you know and you won't know everything on day one but slowly you'll be able to cross that list off for the things that will freak you out the most and then as you look them over or you watch a video or you ask somebody to like help explain it to you then again that becomes something you worry about less then move on to the next thing and the next thing and there's no like rhyme or reason of how many topics you do a day like this is not med school anymore you'll be a grown up with a long list of things that you just don't know and it never ends so that's the sad part but the exciting part is that you get to go at your own pace and so if you're finding a lot of free time during a lesser you know more or like a more relaxed rotation you can say cool like I can use this time to catch up on my freak out topics you know when I'm starting my first rotation like within the first few weeks was ICU I had no idea how to manage somebody on pressers or what to do with a ventilator like it never made sense to me in med school and so those are the topics that I spent the most amount of my time on less for boards but they show up on boards then when you're faced with those patients you feel a little more confident and ideally you know every time you experience the patient then you'll be like okay like this is something I read about and I was able to use and actually worked out and this is something I read about and I was trying to use but actually didn't work out like that's feedback that I need to like go back and learn it and that ability to keep yourself within these experiences of like these are things I'm weak at let me give it a shot and let me see how it goes those will all result in your knowledge base for boards improving so that's kind of my answer to like don't worry about the boards at the moment maybe your residency will give you access to like a question bank you know I have access to mix up which residents use a lot though during my down times you know I may do a few questions here and there per week but there's no rhyme or reason of how many I need to do it's just that when I get a chance you know I'll do it because I know that there'll be stuff I'm weak on and then obviously as boards comes around as any test comes around you kind of get into gear and you start to do more questions more intensely but residency's already gonna be more intense enough that your focus should just be on natural learning instead of like preparing for an exam sure, sure that's perfect does that make sense? yes, that's super helpful do you have any other questions about residency or if not hopefully you get to enjoy these remaining months of fourth year yes, that's the plan cool, well Jen pleasure talking to you best of luck on the match coming up in a few weeks for making of this video let us know if there's any questions we can answer when you're in residency thank you so much that's really helpful of course alright, talk to you soon