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 How to prepare for the CCS  

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I had many basic questions about step 3 when I started out, especially the CCS part. I have put together some of those questions and answered them from my experience.

1. When is the CCS tested?

Step 3 is a two day exam and CCS is tested on the second day. The first day, there are 7 blocks of MCQs with 48 questions each and second day 4 blocks of 36 questions each. After the MCQs, there are 9 CCS cases.

2. What are the questions like in Step 3? What materials are required for preparation? What duration is ideal?

The questions on step 3 are similar to CK with the focus being more on management than on diagnosis. I think the materials used for CK alone are sufficient for Step 3 and if CK has been taken within 6 months to a year and the score aimed for is similar, then about 2 months of preparation with 6 hours per day must be enough. I used Kaplan materials and UW. I thought of buying Washington manual, Strong Medicine etc, but then decided against it as those are totally new text books for me and it would take considerable time to just go through them.

3. What is the CCS like? How to prepare for it? What are some tips and suggestions? How much time must be spent in preparing for this? How much does this count towards the Step 3 score?

The CCS (Computer- based Case simulations) expects us to manage a typical case that we would encounter in the ER, office or wards. I used only UW cases and the USMLE CD. There are some practice softwares available that others have used and found useful.

I had some breaks in my step 3 preparation. By the time I was ready to practice CCS, my UW subscrition had ran out and I only had the print out of the 60 cases to work with. If I had to do it over again, with the same material, this is what I would do: I would allot the last 15 days of Step 3 prep for CCS.

First, it is good to be familiar with the CCS format and this is best done by solving the CCS cases from the USMLE CD. The first time, I did pretty badly and was extremely nervous as well. Then I read through the CCS cases from UW, taking 10 cases per day. It took me about two to 3 hours per day to to this. In 6 days, I had an idea of what kind of cases were on the exam and what kind of management was expected. Now I was ready to practice the same cases.

I decided to open one of the non-emergent cases in the USMLE CD, and type out instructions like I would for the practice case scenario in UW. I was a little overwhelmed and found myself unable to think while trying to navigate through the software. Then a friend suggested that I try working out the cases on paper. This really helped me. I wrote the instructions on paper and found that I missed about 25% of the stuff suggested by UW. Again, I took 10 cases per day. After the first 30 cases, I was comfortable with my thinking process in approaching the cases, and I only had to master familiarity with the software. I worked the other 30 cases with the software. This time, I was quite comfortable and explored the different options in the software and was able to navigate quite easily. For each case, I wrote down whatever I missed on paper and revised this list before exams. I did feel that UW went a little overboard with investigations, but decided to learn it as such because I guess the fear of litigation and freely available resources compel us to do the same in the real world scenario here.

The USMLE CD is very friendly for practice. It made me smile when I requested a pregnancy test on a man, and it noted that it can only be done on a female. At the end of my preparatin, I had practised all 60 cases in UW with the USMLE CD. I learnt what short cuts I was going to use and what were not so useful. For example, while "cbc" and "cxr" were great, when I typed "oxy" tons of options popped up. I found it easier to type "oxygen". I realized that some options are not available like "sliding scale insulin". After a while, I did not see the need to type out everything, but just what was new like "haptoglobin" "d-dimer" etc. I found the "virus" option useful too, as it helped me remember what I needed to request!

Though the software has few thousand options, we only need to develop a limited vocabulary to work with. For example, we could counsel the patient to stop smoking by typing "stop smoking" or just type "counsel" and then find "Stop smoking". At first, I found it a little annoying that I was not able to counsel for more than one thing at a time, and what I had counselled for did not appear on the final screen. I guess small things like this can cause major anxiety if they have not been tried on the software first and a comfortable alternative way to work around it is found. Eventually, I decided to just type "counsel" and when the counsel options came up, selected one at a time and waited.

I realized that it was useful to develop different strategies while working towards CCS.




I have read that the CCS contributes to only about 20% of the final score on Step 3.

That's all I can think of now. All the best!


Hi Lisa

Thats an extremely helpful post;I wish that you score great with all good preparation in your hands

Good Luck



Dear Lisa,

Thank you for going through the trouble of posting this. It is extremely useful for someone like me who is just starting out.

It is very thoughtful of you to do tthis inspite of so much going on.

yes, you are right about the cousel- it is frustrating to learn that it does only one at a time. I guess that is because each time it takes a few minutes to do it.

Good luck for your score and congrats on finishing another and the last step in this process.

Are you applying for this year's match?


Thank you Parul and Amygdalaa. I am applying for this year's match.

Looks like three paragraphs that I had typed under different fonts in my previous post have vanished for some reason. If anyone has any specific questions, I would be happy to do my best to answer them.


Lisa,thanks a lot for this extremely uselful post,it means a lot to those who r doing their step 3 preparations at present.Good luck for ur scores and for the match.


LisaM good your done with your step 3. Good wishes for your score.


Hi Lisa in your opinion, did you find that the uw cases when read/ practised 2-3 times should prepare us well to deal with the ccs cases on the exam? How about mcqs, did you think s2 notes and uw were sufficient to comfortably answer the exam?

Also was there any difference in the content and pattern of mcqs on the second day?

thanks and hope you are doing well.


excellent thread LisaM..i am going to pin it..

how did ur exam go?


thanks a ton for ur detailed post .
great job Lisa nod


Hi LisaM, congratulations and wishing u the best! Your post has giving the encouragement to continue my studies, I at the final phase of my studies but having difficulty mastering the ccs. I ll try your suggestions and hope it works for me. I hope you get a great score as always.


one more qs; what do you think about crush for step 3?


Thank you for your kind words, everyone.

Amygdalaa, from my experience, I do think that practising CCS cases 2 to 3 times is quite sufficient to prepare for CCS part of Step 3 exam. The first time that I read through CCS cases, I think it helped me to develop a thinking pattern. I visualized a patient in the scenario described (office, ER etc) and tried to think through how I would proceed in real life. The second time, I tried to apply what I had learnt systematically. I wrote down what I missed and learnt that. I did not do a typical third revision, but had an index of the cases presented in the CCS, and tried to just look at the case title, (for example- Lower GI bleed, Pulmonary embolism etc) and mentally went through everything the list of things to do. Though all my exam CCS cases were not exact same scenarios that I had practiced, I was fairly comfortable with them. Reagarding MCQs, I felt that UW and Kaplan CK notes are good enough. The questions on the exam were long and complex but concepts tested were familiar. The form and content of questions on second day were not much different than the first, but questions seemed a little shorter and easier. Probably because each block has only 38 questions!

An, I think my exam went ok though I was exhausted at the end. The score will indeed say the final word! Thank you for all your support, advice and encouragement.

Infliximab, Sorry, I did not use Crush step 3. I mostly used UW and Kaplan CK material. I also read the Kaplan Step 3 material mostly just once, but found the management algorithms and ethics part quite useful. I also went through the case scenarios from the Washington University ethics website. I would recommend this. I thought that the discussion of the option of alternative medicine for an old man with arthrits is not much different from that of a young child with leukemia. But it helps to learn the principles governing such decisions- we can only offer palliation of arthritis pain and the old man is not doing much harm by seeking alternative medicine, but this is not the case of the young leukemic. I got a bunch of questions based on ethics, so wanted to share this too.


Thank you again Lisa.


Thanks LisaM. Your input is greatly appreciated.

Did u do tne nbme?


Yes, infliximab. I did NBME (frustrating that there is only one form!) one week before exam and scored 560.


Excellent performance!

i have about 4 weeks to my exam but i feel far from ready! i hope i dont have to postpone indefinitely. just have to keep on studying. your post really inspired me.


Thats pretty cool lisa .
You ve been very thorough not only in ur CCS but also on the post!!!
Thanks a ton and GL


Thanks a lot for such a thorough and to the point post


hi Lisa, thanks for sharing ur experience, verry useful!!! I graduated from medical school a few years ago but never did internship. How important is clinical experience to passing step 3 with decent score??


guest08, clinical experience could be useful if it follows the protocol of management expected in the USMLE and I guess that is the reason most AMGs take Step 3 during their residency. However, it could actually be an impediment if you are an IMG and what is done in your Med school contradicts with what is common practice in the US. Personally, I dont think clinical experience is terribly important to answering questions on the Step 3 exam. All the best to you!

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