Step 3 Content Description

Examination Design

A principal organizing dimension for Step 3 design is normal conditions and disease categories. The normal conditions section deals with normal growth and development, basic concepts, and general principles. The remaining sections deal with individual diseases/disorders. The Content Outline is derived from a model of practice for USMLE. The categories and content coverage in these materials describing Step 3 are subject to change.

A second organizing dimension is the clinical encounter frame. The concept of frames encompasses several elements that are critical to the definition of a patient-physician encounter. These elements include whether the problem or concern is new or ongoing, the urgency of the need for intervention relative to the underlying problem, the chronology of events, and the degree of familiarity with the patient or the patient’s history. In addition, each encounter between patient and physician occurs in a specifically defined location. The clinical encounter frames are listed; a more detailed description is contained in the Step 3 Clinical Encounter Frames.

• Initial workup. Patient encounters characterized by new problems among patients seen for the first time. Tasks emphasized include extensive data gathering and initial therapeutic intervention.

• Continuing care. Patient encounters characterized by management of previously diagnosed clinical problems among patients. Evaluating the severity of the patient’s problem(s) and prognosis, monitoring therapy, and long-term management are emphasized.

• Urgent intervention. Patient encounters characterized by life- and/or organ-threatening emergencies usually occurring in emergency department or inpatient settings. Tasks emphasized include rapid assessment of complex presentations and prompt therapeutic decision making.

A third organizing dimension for Step 3 design is the physician task: (1) applying scientific concepts (mechanisms); (2) formulating a diagnosis (including history and physical examination, laboratory and diagnostic studies, diagnosis, prognosis); (3) managing the patient (including health maintenance, clinical interventions, clinical therapeutics, communication). See Physician Tasks for a more detailed description.

Much of the test material relates to continuing care encounters as shown in the Step 3 Blueprint. Hence, the bulk of Step 3 is intended to challenge you to consider the severity of illness and to manage ambulatory patients who have previously diagnosed, frequently occurring chronic illnesses and behavioral/emotional problems.

The Problem/Disease List is derived from a model of practice for USMLE. The categories and content coverage in these materials describing Step 3 are subject to change.