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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.


 



Step 2 CK - Schedule for score reporting and change in number of items

Posted: May 19, 2015

The USMLE program usually reports Step 2 Clinical Knowledge (CK) scores 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 between the week of July 13th through late August.  The target date for reporting Step 2 CK scores for most examinees who test during this time period will be Wednesday, September 16, 2015.

 If you need to receive a Step 2 CK score before September 16, we recommend that you take Step 2 CK no later than Friday, July 10, 2015.

During the period July 13 through late August, the number of items per block on a given examination form will vary but will not exceed 44 items. The number of items in a block is displayed on the screen at the beginning of the block.  Please note this information and pace yourself accordingly. 

The total number of items on the overall examination form will not exceed the current 350 items. The length of the testing day will not change. The test day will continue to be divided into eight 60-minute blocks, administered in one nine-hour testing session.  The variation in number of items per block will not impact scoring.


2016 schedule for reporting Step 2 Clinical Skills (CS) results is available

Posted: April 07, 2015

The 2016 schedule provides examinees, and others who rely on Step 2 CS results, with guidelines regarding when a result will be reported for a given exam date. Click here to view the schedule.


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