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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.

Labs:
Serum      Blood
  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.


 



USMLE Physician Tasks/Competencies

Posted: July 10, 2014

USMLE Physician Tasks/Competencies, a publication that provides a common organization of competencies and tasks assessed in USMLE examinations, is now available.

The outline comprises seven major sections:

  • Medical Knowledge/Scientific Concepts
  • Patient Care: Diagnosis
  • Patient Care: Management
  • Communication and Interpersonal Skills
  • Professionalism, including Legal and Ethical Issues
  • Systems-based Practice, including Patient Safety
  • Practice-based Learning

While this outline is common to all USMLE examinations, each Step will continue to have test specifications specific to that Step and will emphasize certain parts of the outline.

The USMLE Step 3 Content Description and General Information booklet contains a description of physician tasks/competencies covered in the restructured Step 3 examination for examinees taking the Step 3 examination on or after November 3, 2014. An updated USMLE Step 2 CK Content Description and General Information booklet containing a description of physician tasks/competencies covered in that examination will be available in July 2014.

USMLE Physician Tasks/Competencies is useful for understanding competencies assessed by multiple-choice question (MCQ) formats such as Step 1, Step 2 Clinical Knowledge, and the MCQ portion of Step 3. The outline will be updated as work to identify competencies covered by non-MCQ exam formats progresses.


Practice materials and other information for examinees taking the restructured Step 3 examination on or after November 3, 2014

Posted: July 10, 2014

Practice and informational materials for the restructured Step 3 examination have been posted to the USMLE website. Examinees who plan to take a Step 3 examination on or after November 3, 2014 should read the materials and practice with the sample items and cases. The materials include:

A summary of changes resulting from the restructuring of the Step 3 examination is also available.
Practice and informational materials for examinees taking the current Step 3 examination, which will be administered through September 30, 2014, will remain available on the USMLE website until early October, 2014.


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