Step 3 Content Description

Step 3 Evaluative Objectives

The Step 3 Evaluative Objectives are categorized according to the physician tasks and they serve to guide writing and classification of test items. They can be read as more detailed descriptions of the kinds of issues that will be posed to physicians taking Step 3.

Applying Scientific Concepts

Identifies the cause/causal agent or predisposing factor(s); or, given an effect, what is the cause.
Recognizes associated disease conditions, including complications, or indicators for potential disease complications, of a given disease.
Identifies the underlying processes/pathways that account for, or contribute to, the expression or resolution of a given condition.
Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease.
Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location.
Recognizes appropriate methods and techniques related to procedures, artifacts of instrumentation, technical errors/problems contributing to misinformation. Knows the technique, procedure, or site of study.
Interprets results of experimental data or biometric studies.
Knows design features of clinical studies.
Knows issues regarding validity of research protocols.
Recognizes potential bias in clinical studies including the extent to which bias accounts for study results.
Interprets results of clinical studies.
Distinguishes clinical importance from statistical significance.
Knows sensitivity and specificity of selected test.

Obtaining History and Performing Physical Examination

Knows signs/symptoms of selected disorders.
Knows individual’s risk factors for development of condition leading to encounter. Given current symptoms in presented history, identifies pertinent factor(s) in history.
Predicts the most likely additional physical finding; selects either the finding itself, or the appropriate examination technique that would result in the finding.

Using Laboratory and Diagnostic Studies

Selects appropriate routine or initial laboratory or diagnostic studies, or study needed to ensure
effectiveness of intended therapy, or study most likely to establish/confirm the diagnosis.
Interprets the clinical impact of laboratory or diagnostic test findings.
Predicts the most likely laboratory or diagnostic test result.

Formulating the Most Likely Diagnosis

Selects the most likely diagnosis or knows the most likely presumptive or preliminary diagnosis.

Evaluating the Severity of Patient’s Problems (Prognosis)

Evaluates severity of patient condition and identifies indications for consultation or diagnostic assessment.
Assesses severity of patient condition and makes judgment as to current status, prognosis, or need for further action.
Recognizes factors in the history, or physical or laboratory study findings (given symptoms), that affect patient prognosis or outcome, or determine therapy.
Knows clinically relevant implications of specifically referenced treatment.
Interprets laboratory or diagnostic study results and identifies current status of patient.

Management of Health Maintenance and Disease Prevention

Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition itself.
Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of
symptomless/dangerous disorders among various groups.
Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population.
Selects appropriate preventive, therapeutic agent/technique. Knows timing of vaccinations.

Clinical Interventions

Evaluates severity of patient condition in terms of need for referral for surgical treatments/procedures versus other nonsurgical options.
Knows immediate management or priority in management, specifically in emergency or acute cases.
Knows most appropriate management of selected conditions.
Knows appropriate long-term treatment or management goals.
Knows appropriate surgical management among surgical options.
Knows pre/post surgical or procedural management.
Knows indications for admission to the hospital or to another appropriate setting.
Knows most appropriate follow-up monitoring approach regarding the management plan.
Knows most appropriate discharge planning.
Knows components of rehabilitation program.
Knows appropriate counseling of patient or family regarding current and future problems, including risk factors related to present encounter.
Educates patient or family regarding self-care.
Knows relevant roles of allied health personnel.
Knows appropriate use and procedures regarding hospice care.
Knows management of terminally ill patients related to treating chronic pain, and recognizing patient's expression of fear of pain, injury, or death; knows how to comfort the patient or family during crisis such as trauma or death.

Clinical Therapeutics

Selects most appropriate pharmacotherapy.
Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy.
Recognizes factors that alter drug requirements for a patient.
Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimen and knows steps to prevent polypharmacy.
Knows contraindications of various medications.
Modifies therapeutic regimen within the context of continuing care.

Communication

Recognizes physician’s best choice of words in eliciting history or further description of the patient's problem; knows statements that facilitate communication with the patient.