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.
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.