Explanations for the 2017 Official Step 3 Practice Questions

Here are my explanations for the 2017 version of the official USMLE Step 3 free question pdf. This is a constant reader request, so enjoy my take on these 137 questions.

You can find my thoughts on preparing for Step 3 here. In short, I think the free materials and UWorld should be enough for most folks. If you want books recs, they’re in that post. If you need another question source, I haven’t tried any of them, but you can get 10% off BoardVitals if you’re interested by using code BW10.

As for this free practice exam, Blocks 1 and 2 are “Foundations of Independent Practice” (FIP). These should take up to 1 hour each. Blocks 3 and 4 are “Advanced Clinical Medicine” (ACM). These should take up to 45 minutes each. Total practice time should be no more than 3:30 if taking under test-day conditions.

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An ad or two

For the past nearly 10 years of writing on this site, I have completely eschewed any form of display advertising. I’ve never wanted to jam the margins full of ugly banners that detract from the reading experience, and I definitely have no interest in being part of any of the usual industry practices of sneaky cookie-based endeavors, user tracking, gigantic data plan-choking scripts, or other things that make the internet worse.

My purposefully limited monetization has primarily been through Amazon affiliate links to things I write about anyway (see what I did there?). Over the years I’ve added relationships with student loan refinancing companies and a handful test-prep companies that I’m otherwise also interested in writing about, which is fine, but a big part of that has also always been to pass on discounts or bonuses to readers. This has always been a labor of love, which is why the vast majority of my writing doesn’t earn a cent and I keep giving away books for free.

This preamble is all to set up the news that the first ad I’ve ever run on the site is currently live. The reason you can’t see it is that it’s actually a time-limited sponsorship on a single popular (radiology) post. It’s from a company I respect with a relevant product and also includes a discount code. I’ve contemplated making the jump for a while now, and that’s the kind of ad I can get behind. If you’re a radiologist and happen to see it, cool. For the rest of you, it’s business as usual.

You may see eventually see an ad or two on a handful of posts or even maybe a single ad on the sidebar. Or you may not. I’d like to help justify (financially) the time it takes to maintain and grow this site, but it’s important to me to do so in a way that doesn’t jeopardize my editorial or the reader experience. That has and always comes first. There will never ever be any tracking of any kind, and I never collect any information from anyone ever.

If you’re a company–like the dozens that email every week asking me to publish your lame guest posts–and would like to reach a large unique audience of awesome medical students, residents, and other physicians, then get in touch.

NYU and the slow coming wave of “free” school

A couple of weeks ago, NYU announced that they were making medical school tuition free for every student. Dean Robert Grossman stated, “This decision recognizes a moral imperative that must be addressed, as institutions place an increasing debt burden on young people who aspire to become physicians.”

My first thought on this news was, Man, Harvard is going to be so pissed that they weren’t first.

The idea of free tuition has been discussed and debated in multiple contexts across Ivy-type schools for years. These institutions are not immune to the burgeoning reality that their educations are financially untenable for most people and crippling for others. With many such schools fostering endowments numbering in the tens of billions of dollars, actual tuition dollars are no longer the bedrock of a healthy world-class institution. Over the past ten or so years, Harvard has often led the way on increasingly generous undergraduate financial aid, and many similar schools have made corresponding efforts to make undergraduate education more affordable, but until now, no one has taken meaningful steps to fix graduate schools, many of which are now considered mandatory for advancement across many industries. Even this move is largely a token effort, as every other extremely expensive NYU school will still keep its top-dollar cost in the shadow of this brilliant PR stunt.

As an illustration of the numbers involved in making one small school free:

The annual NYU med tuition was an exorbitant $55k per year, and there are 442 total active medical students, which gives a total cost of $24 million per year. “Paying” this requires (according to NYU) an endowment of $600 million because the school is utilizing the famous 4% rule that would make this massive endowment essentially guaranteed to last forever based on historical stock market returns.

Numbers aside, I do agree with the words of the dean (though I would expand them). There is a moral imperative to fix the cost as well as the delivery of medical education. The length, cost, and inefficiency are all otherwise mutable strong arms that are breaking healthcare and squeezing the joy out of young doctors in training from coast to coast.

NYU will not be the only school to offer free tuition. Other rich schools in and outside of medicine likely have been and certainly will be shoring up their endowments to join the club as is feasible. I anticipate this is the first in a salvo of private schools slowly making various programs free, and this will speed up if/when PSLF is eventually canceled, as the program is basically the only justification for charging otherwise unmanageable amounts of money to students who are destined to never be able to actually service their debt. Beleaguered state schools with their chronically strapped budgets will struggle.

 

My second thought is that free tuition will now make NYU about as affordable as the best-priced state schools (because the cost of living in New York is otherwise so high). Four years of living expenses will never be cheap, and it’s much harder to scrounge time to be gainfully employed during medical school compared with college. Clinical rotations are inflexible more-than-full-time jobs.

This will also result in, I imagine, a huge increase in applications to NYU. When my wife and I applied to medical school, we only applied to state institutions back in Texas where we were still residents while away for college. We were not keen to spend as much in a single year as we could on the whole package. People like me may now decide to add NYU to the list, especially since NYC is glamorous.

 

So, good on NYU for being the first to pull the trigger. I hope more schools join their ranks, and I hope most of all that this well-publicized confrontation of medical training costs will lead to a paradigm shift that allows schools and hospitals to rethink the whole process. We can do so much better, for our doctors and for our patients

The Med Ed Trifecta

Akhilesh Pathipati, writing “Our doctors are too educated” in the Washington Post (emphasis mine):

U.S. physicians average 14 years of higher education (four years of college, four years of medical school and three to eight years to specialize in a residency or fellowship). That’s much longer than in other developed countries, where students typically study for 10 years. It also translates to millions of dollars and hours spent by U.S. medical students listening to lectures on topics they already know, doing clinical electives in fields they will not pursue and publishing papers no one will read.

We’ve done an amazing job in medicine findings way to fill years with reasonable-sounding and potentially useful activities and then pretending they are not only worthwhile but necessary.