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.
USMLE Score Interpretation Guidelines
Posted: October 30, 2014
USMLE Score Interpretation Guidelines (SIG) have been posted to the USMLE website. Topics include:
- Description of Examinations
- Understanding Your Score
- Recent Means and Standard Deviations (SDs)
- Norm Table
- Passing Scores
- Precision of Scores
- Guidelines for Use of USMLE Step Scores for Selection Decisions
The means and SDs and the norm table will be updated annually. Because percentile ranks depend on the cohort of examinees, you should always use the most recent norm table available on the USMLE website to obtain percentile ranks.
New display features to be piloted in Practice Sessions
Posted: October 27, 2014
Practice Sessions are primarily intended to provide examinees with the opportunity to become familiar with the Prometric Test Center environment. From time to time, the USMLE program uses Practice Sessions to pilot new features and get feedback from examinees.
Three new user-adjustable display features will be piloted in USMLE Step 1 and Step 2 Clinical Knowledge (CK) Practice Sessions delivered at a limited number of Prometric Test Centers on or after November 3, 2014:
- Reverse color (color inversion)
- Text magnification
- Image magnification
The new display features are NOT currently available on live USMLE administrations or in practice materials available on the USMLE website.
Examinees are encouraged but not required to use the new features; they will not interfere with an examinee’s practice experience. Examinees who take a Step 1 or Step 2 CK Practice Session during this period will be asked to complete a brief post-session survey about their experience, which will help USMLE determine whether examinees like the new features.
If the features become available in the future for use in USMLE Step examinations or the online practice materials, examinees will be notified well in advance.
NOTE: the first 500 examinees to schedule an appointment for a Practice Session with the new display features on or after November 3, 2014 will have a $40 discount applied to their fee. Scheduling is restricted to a limited number of Prometric Test Centers during this pilot.
Inverts the color of the text and background from black-on-white to white-on-black. The ability to reverse color (also known as color inversion) improves readability for some users.
Two levels of text magnification will be available.
Magnifies images, such as photographs and graphs.
Click anywhere within the image to enlarge or to return to original size.