u/WILLPASS4

I wanted to write this because a month ago I was desperately searching Reddit for stories like mine.

I passed Step 2 CK in 2022. My first Step 3 attempt was in 2024, and my second and third attempts were in 2025. I recently passed my fourth attempt with a 225.

I’m not writing this because I have everything figured out. I’m still working on getting back into residency. I’m writing this because when I was going through this, I felt very alone, and I hope this helps someone else.

Biggest Mistake #1: Waiting Too Long
If I could go back and change one thing, I would take Step 3 immediately after Step 2 CK or at least early during intern year.
By the time I took Step 3, it had been almost two years since Step 2 CK. A lot of knowledge was rusty, and I spent a huge amount of time relearning things I already knew before.
If you’re thinking about taking Step 3 early, just do it.

Biggest Mistake #2: Following Other People’s Study Plans
For my first attempt, I listened to people around me who told me they only studied for a few weeks, completed 20-50% of UWorld, did around 40 CCS cases, and passed comfortably.
I assumed I could do the same.
I only completed around 40% of UWorld over 2-3 scattered months. I was heavily focused on GI research, conferences, and fellowship-building activities because that was my priority at the time.
My studying was random and disorganized. Subjects weren’t organized in my head, and honestly I felt unprepared.
I took the exam anyway.
I failed.

Looking back, I regret taking the exam when I already knew I wasn’t ready.

The Mental Health Spiral
After failing, things became very difficult mentally.
I became anxious, depressed, angry, and frustrated. I couldn’t concentrate. I kept thinking about all the work I had put into GI and everything I felt I was losing.

I eventually started seeing a psychiatrist because the stress became overwhelming.
While in second year residency, I completed all of UWorld and around 80 CCS cases.
But I made another mistake:
I never did any NBMEs.
I also went into the exam in a very poor mental state.
I failed again.

The Third Failure
My program recommended FMLA leave so I could focus entirely on studying.
I took four months off.
Despite that, I failed a third time.
At that point my program could not continue extending my leave. In the state I’m doing residency at have a rule that, residents cannot advance to PGY-3 without passing Step 3, so my contract ended and I had to return to my home country.
That was one of the lowest points of my life.

What Changed for My Fourth Attempt
Honestly, the biggest difference was my mindset.
Being back home with my family changed everything.
For the first time in a long time, I felt supported every day. My family constantly reminded me that regardless of what happened, there would be solutions and life would continue.

I stopped thinking:
“What if I fail again?”
Instead, I started thinking:
“I will do absolutely everything I can. The result is in God’s hands.”
I kept reminding myself that everything happens for a reason. My responsibility was to do everything possible to prepare. The outcome would come afterward. I needed to do my best so that whatever happens i’d always say i did my best but it just didn’t work out. So i studied like crazy.
That mindset removed a huge amount of anxiety. And stopped taking meds that i was prescribed due to this situational depression.

My Study Timeline
I started studying again around mid-December 2025 and took the exam on May 2, 2026. I had to wait till May cause you have to wait 6 months after the 3rd attempt to be able to proceed to your fourth attempt, but I wanted to do it early May so I can return to residency with the start of the class new year in July.

December was inconsistent because I was still mentally recovering.
Starting in January, I treated studying like a full-time job.
Most days I woke up around 8 AM and studied until 11 PM or midnight.
Some days were around 9 hours and some studied up to 17 hrs a day.

I still had bad days. Maybe 5-6 days every month I would become depressed, sleep all day, and get almost nothing done.
But I stopped letting those days define my preparation and simply got back to work the next day.

How I Studied
I completely changed my approach.
I studied every subject systematically.
For each specialty I completed:
Amboss Step 3
UWorld Step 3
UWorld Step 2 CK
I bought the Imb package, that included multiple question banks. And so had access to lots of q banks and all nbmes.

I already had detailed Step 2 CK notes from 2022.
Every time I learned something from Amboss or UWorld, I added it into those notes.
By the end, I had one giant master document that contained:
My Step 2 CK notes
UWorld Step 3 notes
Amboss Step 3 notes

I also had a separate file with High-yield review points and algorithms that i wanted to review a day before the exam.

I completed most of Amboss and most of UWorld Step 3.
I also completed around 1500 UWorld Step 2 CK questions, though not the entire bank.

Identifying My Weaknesses
Before starting, I asked myself what had caused me to fail.
My biggest weaknesses were:
-Subjects: where all the same in my score reports so i couldn’t recognize my weakest subjects per score report but did through NBME’s and tackled them one by one
-Biostatistics
-Ethics
-CCS
-Stress
-Timing
Timing was a major issue.
During previous attempts I constantly felt rushed.
Twice I had to skip many of the drug advertisement and abstract questions because I simply ran out of time.

Timing: One of My Biggest Weaknesses
Timing was probably one of the most underestimated problems in my preparation.
Even while doing UWorld blocks, NBMEs, and practice exams, I was almost always finishing late. Most of the time I needed an extra 4-5 minutes to comfortably complete a block, and occasionally even more.
For my final attempt, I treated timing as a separate skill that needed training.
I constantly practiced with the clock running. I became very aware of where I should be during each block and worked on keeping my pace around one minute per question.
One strategy that helped me was reading the last sentence of the question first so I knew exactly what the question was asking, then going back and reading the stem from the beginning. This prevented me from getting lost in long stems and helped me focus on relevant information.
I was also advised to read the answer choices immediately after reading the final sentence so I could get an idea of the topic before reading the stem. Many people find this very helpful.
Personally, it didn’t work for me. I found it slowed me down and made me overthink questions.
That’s something important I learned during this process: don’t force yourself to use someone else’s strategy just because it worked for them.
Find what works for you.
By the time I took my fourth attempt, my timing was dramatically better than during my previous attempts, and I no longer felt like I was racing the clock every minute of the exam.

Biostatistics
This was one of the best decisions I made.
I hired a biostatistics tutor early in my preparation in January.
We did about 7 sessions, each around 1.5 hours.
The first session focused on First Aid biostats concepts from the book.
The remaining sessions focused on solving questions and developing a thought process for approaching biostatistics.
Then in April I dedicated about 2.5 weeks primarily to biostatistics and ethics.
For biostatistics I completed:
-UWorld Step 3 biostatistics twice
-Amboss biostatistics
-Around 100 Step 2 CK biostatistics questions
-First Aid biostatistics every time i studied id go through it quick not more than 20 min so i went through it so many times.
-Mehlman HY biostatistics (only first 30 pages, but felt was so easy and step 1 oriented so i stopped)

Ethics and Quality Improvement
Ethics was heavily represented on my exam.
Resources I used:
First Aid ethics
UWorld Step 3 ethics
Amboss ethics
Amboss quality improvement
Amboss patient safety
I felt these resources were extremely useful.

ChatGPT
One thing that helped me tremendously was using ChatGPT to review questions.
Whenever I got a question wrong, I would upload it and ask:
Explain question , and why not x answer that i thought was correct?
What clues point toward the correct answer?
What keywords should I recognize?
How should I think through this question?
It helped organize my thinking process and identify patterns that I had been missing.

CCS Cases
I started CCS preparation early in January.
I completed at least 3 cases every day.
I kept a notebook specifically for CCS where I wrote orders I frequently forgot and important orders for each case.
Over time this became extremely valuable.
I completed all the cases and then repeated them and did HY ones a third time.
One tip that helped me was creating a list of common orders that I copy pasted in the first case and that was very helpful time wise. Just be aware you cant copy paste them from the tutorial , you can now only do it once you start ccs cases , so i had to write them all down the first case and copy the for the rest, which was not bad cause usually the first case is always a 29 min one.
My orders included:
CBC, CMP, EKG, Chest X-ray, ABG, Cardiac Monitor, Pulse Oximetry, IV Access, Urinalysis, Pregnancy Test, TSH, ESR, CRP, Magnesium, Phosphorus, Lipid Panel, HbA1c, Urine Toxicology, Symptomatic Treatment, Definitive Treatment, Consultations, patient location.
For preventive counseling I frequently remembered:
Vaccinations
Safe sex counseling
Smoking cessation
Alcohol counseling
Illicit drug counseling
Medication compliance
Medication side effects
Diet
Exercise
Pap smears
Mammography
Colonoscopy
Reassure
advice

Completing all cases and repeating them significantly improved my speed and confidence.

Risk Factors, Prognosis, and Screening
These topics were very important.
Resources I used for risk factors:
-Divine Intervention risk factor PDFs
-Amboss risk factor questions (very imp)
- uworld risk factor questions

Resources I used for prognosis:
-Divine Intervention prognosis PDFs
-UWorld and amboss notes

Screening Resources I used :
-guideline PDF USCSF
- Amboss screening questions

I did a separate document for each of these and reviewed them repeatedly.

Also For every subject I studied, I specifically focused on:
Prognosis
Risk factors
Diagnosis
Best next step
Management
Screening
I genuinely think this helped a lot, especially for Day 2.

First Aid
I think First Aid is underrated for Step 3.
I reviewed:
-Biostatistics multiple times
-Ethics
-Pharmacology ( the main chapter and all the pharmacology sections in every subject mainly mechanism of action and somedrug side effects or complications) esp antimicrobials, antifungal s , neuro drugs
-Microbiology ( extremely HY) : I did sketchy twice and went through the descriptions of all organisms.
-Biochemistry diseases and quick pass through the chapter
-genetics: i memorized all the AR, XLR, AD , XLD, mitochondrial diseases , as i got multiple questions about the diseases and you have to know what it was and its genetic type, and got questions with genetic charts and you should know what disease it is, but my last attempt i got none of these.
-pathology (very high yield) : esp : Tumor suppressors, Interleukins
- other subjects: Whenever I felt weak in a topic, I would revisit First Aid to rebuild my foundation.

NBMEs
For my successful attempt I finally started using NBMEs.
I completed:
NBME 4
NBME 5
NBME 6
All predicted roughly 210-215.
I was scoring around 68-69%.
Three days before the exam I started NBME 7 and completely panicked because I did poorly on the first two blocks.
I almost postponed.
Instead, I reviewed all the questions, trusted the previous assessments, and continued with my scheduled exam.
I did the same for free 137 , just reviewed the questions as I have done it previously in my 3rd attempt.
Looking back, I’m glad I did not postpone.

CMS forms:
I also did 4 CMS forms for step 2 , one in IM, one in OBGY, one Peds and one Family medicine.
If i had more time i would have done them all instead of doing the 1500 questions of step 2ck , as they were so close to step 3 exam especially day 2.

Accommodations and the New Exam Format
One thing I considered before my fourth attempt was applying for testing accommodations.
I saw someone on Reddit who had gone through the process and found it helpful.
I actually started the application around December.
However, I was told it could take a long time and that if accommodations were approved, my existing exam reservation might be canceled and rescheduled.
Since I was already trying to take the exam as early as possible to avoid delaying my career further, I decided not to continue pursuing accommodations.
Fortunately, shortly afterward the exam format changed.
The shorter 20-question blocks were amazing for me.
Instead of pushing through 40 questions at a time, I could stop after every 20 questions, take a breath, reset mentally, and continue.
For someone who struggled with timing and mental fatigue, this made a huge difference.
One piece of advice:
Plan your break strategy beforehand.
On Day 1 I miscalculated my breaks and lost about 2 minutes from my final block.
It wasn’t disastrous, but it added unnecessary stress.

Testing Center
This may sound silly, but I also chose a different testing center.
My previous attempts were in Toledo.
For my successful attempt, I tested in Chicago.
Walking into a completely new environment helped me mentally separate this attempt from my previous failures.

Final Thoughts
I passed my fourth attempt with a 225.
The biggest lessons I learned were:
Take Step 3 early.
Don’t underestimate the exam.
Don’t copy someone else’s study plan.
Mental health matters.
Timing is a skill and must be practiced.
Use NBMEs.
Master biostatistics, ethics, CCS, risk factors, prognosis, and screening.
Build a systematic study plan.
Do everything you possibly can, then let go of the outcome.

A year ago I genuinely thought my career was over.
Today I have opportunities again.
If you’re reading this after multiple failures, please don’t give up.
Your situation may feel hopeless right now, but it can change.
Do everything you can, trust the process, trust God, and keep moving forward.

Quick summary of the exam:
Day 1:
240 questions , 12 blocks, 20 question each.
Filled with Biostats/ ethics. Around 6-7 drug ads, first aid step 1 questions.
Ethics was 70% easy ones if you practice questions like i did , the rest you’ll never know the correct answer. Same with biostats but after doing what i did this time got most of the questions correct.

Day 2:
Step 2ck like questions much shorter to the point, mostly best next step and diagnosis and management. Lots of prognosis , risk factors , screening questions.

CCS cases:
Out of all of them maybe got 2-3 cases not included in the CCS.org website and they were doable not very hard. Just practice as much as you can. The rest were the exact same concepts in the website literally the same.

Last 3 days revisions:
-Biostats calculations, biases
-algorithms and HY notes i made for last day revisions
-micro graphs about descriptions
-quick moa of drugs i wrote down
-murmurs description
- tumor suppressors
-genetic diseases types

Things i wish I had time for:
- CMS forms
- completing the first aid review at the end of the book
- revising pathology chapter
-not thinking to hard about the questions alot of questions i still got wrong just cause i was like no way its this easy.

Accreditation

ABIM

Chances

Failed Step 3 Three Times, Lost My PGY-3 Position, Passed on My 4th Attempt (225) – Everything That Helped Me