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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.


 



UPDATE - USMLE Step 1 and Step 2 CK Practice Sessions

Posted: March 23, 2015

Three new user-adjustable display features were piloted in USMLE Step 1 and Step 2 Clinical Knowledge (CK) Practice Sessions delivered at Prometric Test Centers beginning November 3, 2014:

  • Reverse color (color inversion)
  • Text magnification
  • Image magnification

The first 500 examinees who scheduled an appointment for a Practice Session with the new display features were offered a $40 discount applied to their fee.

The pilot has ended, and the discount is no longer in effect.

Examinees who take a Step 1 or Step 2 CK Practice Session may see the new display features, but should be aware that the display features are NOT currently available on live USMLE administrations or in practice materials available on the USMLE website.

When the new user-adjustable display features become available for use in USMLE Step examinations and the online practice materials, examinees will be notified.


Step 1 – Delay in score reporting and change in number of test items

Posted: March 18, 2015

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 who test beginning the week of May 11th.

The target date for reporting Step 1 scores for most examinees testing the week of May 11th through late June will be Wednesday, July 8, 2015.  For examinees whose circumstances require that they receive Step 1 scores before July 8, it is recommended that they take Step 1 no later than Friday, May 8, 2015.

During this time period (starting the week of May 11th), a transition will occur in the number of items in current forms of the Step 1 examination.  The change will be from a total of 322 items to 308 items. Although the transition will occur quickly at many test centers, there may be some locations where the changes take slightly longer to complete. The overall transition period will likely last approximately 6 weeks. Please note the following:

• Scores on new and old forms will be comparable; the decrease in the number of items per form will be accounted for in scoring the examination results.
• The length of the examination day will remain unchanged. The test day will continue to be divided into seven 60-minute blocks, administered in one seven-hour testing session.
• The number of items per block will decrease from 46 to 44. There will be a total of 308 items on each examination.


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