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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.


 



State board sponsorship for Step 3 discontinued

Posted: October 14, 2013
Updated: October 22, 2014

With the introduction of the restructured Step 3 examination in 2014, the USMLE program no longer requires examinees to apply for Step 3 under the eligibility requirements of a specific medical licensing authority.

All other Step 3 eligibility requirements (i.e., medical degree, passing Steps 1-2, ECFMG certification for IMGs) remain applicable, as do all other USMLE program requirements (e.g., no more than 6 attempts at a Step or a Step component).

Note: Removing state board sponsorship as part of the Step 3 examination application does not impact medical licensing requirements in the United States. Most medical licensing authorities have, and will continue to maintain, specific criteria for completion of the USMLE, such as time and attempt limits. A summary of these requirements can be found on the Federation of State Medical Boards website.

At this time, there are no plans for the USMLE program to impose a minimum residency training requirement as part of the Step 3 eligibility criteria. However, the USMLE program will likely continue to recommend that individuals take Step 3 at or near the completion of the first year of residency training.


A message about the Ebola outbreak for individuals scheduled to take USMLE Step 2 Clinical Skills (CS)

Posted: October 21, 2014

The United States Centers for Disease Control (CDC) has issued travel notices for several countries in connection with the Ebola Virus outbreak.   For the most current information concerning affected countries, please see http://wwwnc.cdc.gov/travel/diseases/ebola.

If you reside in or have recently traveled to any country subject to a travel notice, or if you might have come in contact with anyone with Ebola, and have concerns about your health and/or the health and safety of those with whom you might come in contact, you are strongly encouraged to contact your registering entity to reschedule your Step 2 CS examination, at no additional fee. Contact information is available at http://www.usmle.org/bulletin/communicating/.


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