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Update on planned changes to USMLE Step 3 examination

Posted: April 11, 2012

The USMLE Composite Committee and USMLE parent organizations (the National Board of Medical Examiners and the Federation of State Medical Boards) recently approved plans to change the structure of USMLE. Step 3 will be the first examination impacted, with changes to this examination to occur no earlier than 2014.

The plans call for the division of Step 3 into two separate exams, each one day in length, focusing on different sets of competencies. The proposed examinations will continue to be administered by computer using multiple choice questions and computer simulations. The two examinations will be scored separately and examinees will be expected to pass each.

The first exam is expected to focus on whether an examinee possesses the knowledge essential to the independent practice of medicine, including a comprehensive knowledge of both foundational science and clinical medicine. The second exam will assess an examinee’s ability to apply knowledge in the context of patient management, including demonstration of comprehensive knowledge of health and disease, and their impact on patients. The second exam will also require a demonstration of evidence-based medicine and quantitative reasoning skills important to patient care and to life-long learning. Specific information about these changes will be provided well in advance of implementation.

New testing formats that focus on competencies not currently addressed by the Step 3 examination may also be introduced. If new testing formats are to be introduced, announcements will be made and sample material provided in advance of their introduction in the live examinations.

The change to Step 3 will occur no sooner than 2014. After experience is gained with implementation of the Step 3 changes, the Composite Committee and USMLE parent organizations will consider possible modifications to Steps 1 and 2 CK.

As new information becomes available it will be posted to the USMLE website.


Updated information materials for the Step 2 CK examination are now available

Posted: July 25, 2014
Updated: July 29, 2014

Updated information materials for the Step 2 Clinical Knowledge (CK) examination have been posted to the USMLE website. They include:


• USMLE Step 2 CK Sample Test Questions booklet (PDF)
 USMLE Step 2 CK Content Description and General Information booklet (PDF)
• Tutorial and practice test questions for multiple-choice items

Updates to the information materials include information regarding test specifications for the Step 2 CK examination that correspond to the organization of content areas in the USMLE Content Outline for all USMLE examinations, as well as test specifications that correspond to the organization of content areas in the USMLE Physician Task/Competencies outline. All USMLE examinations published in 2014 are being constructed using the classification systems in these two documents. Each Step exam will continue to have test specifications specific to that Step. Each Step exam will emphasize certain parts of both the content and task/competencies outline, and no single examination will include questions on all topics in the content outline.

Please note that changes to the Step 2 CK exam in 2014 resulting from use of the new outlines are minor, and the examination content will be similar to content on previous examinations. One change to note, however, is that the downloadable Step 2 CK practice test questions now include a multi-media item assessing recognition of breath sounds, similar in format to items assessing heart sounds.

The previous Step 2 CK content outline will remain available on the USMLE website for reference.


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.


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