Step 3 Content Description

Step 3 Clinical Encounter Frames



The content description that follows is not intended as a study guide, but rather is a model of the range of challenges that will be met in the actual practice of medicine. Successful completion of at least one year of postgraduate training in a program accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association should be helpful preparation for Step 3.

INITIAL WORKUP CONTINUING CARE URGENT INTERVENTION
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Patient encounters characterized by initial assessment and management of clinical problems among patients seen principally in ambulatory settings for the first time. These encounters may also include new problems arising in patients for whom a history is available. Patient encounters characterized by continuing management of previously diagnosed clinical problems among patients known to the physician and seen principally in ambulatory settings. Encounters focused on health maintenance are located in this frame.

Also included are patient encounters characterized by acute exacerbations or complications, principally of chronic, progressive conditions among patients known to the physician. These encounters may occur in inpatient settings. 		Patient encounters characterized by prompt assessment and management of life-threatening and organ- threatening emergencies, usually occurring in emergency department settings.

Occasionally, these encounters may occur in the context of a hospitalized patient.
Clinical problems include ill-defined signs and symptoms; behavioral-emotional; acute limited; initial manifestation and presentation of chronic illness. Clinical problems include frequently occurring chronic diseases, and behavioral-emotional problems. Periodic health evaluations of established patients are included here. Clinical problems include severe life-threatening and organ-threatening conditions and exacerbations of chronic illness.
Physician tasks emphasized include data gathering and initial clinical intervention. Assessment of patients may lead to urgent intervention. Physician tasks emphasized include recognition of new problems in an existing condition, assessment of severity, establishing prognosis, monitoring therapy, and long-term management. Physician tasks emphasized include rapid assessment of complex presentations, assessment of patients' deteriorating condition, and prompt decision making.