Changes to Step 3 examination in 2013
Posted: November 28, 2012
As previously announced, changes to the USMLE Step 3 examination are scheduled to take place no earlier than 2014. The redesigned examination will include assessment of "a comprehensive knowledge of both foundational science and clinical medicine," as well as "a demonstration of evidence-based medicine and quantitative reasoning skills important to patient care and to life-long learning."
Over the next few years, Step 3 examinees will see a gradual increase in test items that assess knowledge of foundational science. To give examinees a sense for what such an item might look like, an example of a 2-item set is provided below. The second item in the set is an example of how foundational science might be assessed in Step 3.
Example Step 3 item set:
A 74-year-old man comes to the ED with a 2-week history of nosebleeds with associated nausea. He says the blood drips down his throat. He denies recent trauma. Medical history includes hypertension and a stroke 2 years ago. Medications: enteric-coated 81-mg aspirin, simvastatin, and losartan. BMI is 21 kg/m2. The patient is pale. Vital signs: T=36.9°C (98.4°F), P=110/min, R=18/min, and BP=115/85 mm Hg. Pulse ox =93% O2 sat. PE: dried blood around the right nostril; left nostril is clear. Muscle strength is 4/5 in the left upper extremity. Stool occult blood is positive.
| Urea nitrogen 49 mg/dL
|| Hematocrit 18%
| Creatinine 1.49 mg/dL
|| Hemoglobin 6.1 g/dL
|| WBC 13,100/mm3
|| Platelet count 212,000/mm3
|| INR 1.3
Which of the following is the priority in management?
(A) Infusion of 0.9% saline
(B) Nasal packing
(C) Referral for colonoscopy
(D) Transfusion of packed red blood cells*
The patient is admitted to the hospital and undergoes transfusion of packed red blood cells. Four hours later, the patient's bleeding recurs. Following cautery and nasal packing, the bleeding ceases. Twelve hours later, the patient develops headache, vomiting, and muscle weakness. He is disoriented and delirious. He appears flushed and uncomfortable. Vital signs: T=38.3°C (100.9°F), P=110/min, R=26/min, and BP=92/60 mm Hg. Physical examination discloses nonpurulent conjunctivitis and a diffuse, erythematous maculopapular rash over the trunk and both lower extremities.
Which of the following is the most likely pathophysiologic mechanism of this patient's current condition?
(A) Exotoxin-mediated T-cell activation*
(B) Interleukin-mediated inhibition of CD 4+ T-lymphocytes
(C) Lipopolysaccharide-induced cytokine production
(D) Sphingosine kinase activation in inflammatory cells
*Correct answers shown in bold.
In 2012, new item formats that assess an examinee's ability to appropriately interpret information presented both in the form of a research abstract and a pharmaceutical advertisement were introduced into the Step 3 examination. More information about these item formats is provided in the Comprehensive Review of USMLE updates.
In 2013, Step 3 examinees will see an increase in the number of research abstract and pharmaceutical advertisement questions.
Review of USMLE Step 2 Clinical Knowledge (CK) minimum passing score
Posted: May 17, 2013
As noted in the USMLE Bulletin of Information, the level of proficiency required to meet the recommended minimum passing level for each USMLE Step examination is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments are posted on the USMLE website.
Every three to four years the Step Committees are asked to complete an in-depth review of standards, and they may schedule more frequent reviews.
At its June 2012 meeting, the Step 2 Committee conducted a review for USMLE Step 2 Clinical Knowledge (CK). As a result of its review, the Step 2 Committee decided to raise the current minimum passing score recommended to pass Step 2 CK from 189 to 196. As previously reported, at that time the Committee decided to closely monitor the effects of this decision on examinees and schools, and to examine trends in performance on an annual basis.
The Committee will review the three-digit score recommended to pass Step 2 CK at its June 2013 meeting. If the Committee determines that a change is appropriate, the new recommended minimum passing score will become effective for all examinees who take a Step 2 CK examination on or after July 1, 2013.
USMLE Step 1 Score Reporting
Posted: March 25, 2013
Most score reporting of Step 1 results occurs within four weeks of testing. However, because of necessary modifications to the test item pool, there will be a delay in reporting for some examinees testing beginning the week of May 13th. The target date for reporting Step 1 scores for most examinees testing the week of May 13th through late June will be Wednesday, July 10, 2013. For examinees whose circumstances require that they receive Step 1 scores before July 10, it is recommended that they take Step 1 no later than May 10, 2013.