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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.

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.


Score Reporting of Administrations with Accommodations

Posted: September 05, 2014

The United States Medical Licensing Examination Program provides reasonable and appropriate accommodations in accordance with the Americans with Disabilities Act for individuals with documented disabilities who demonstrate a need for accommodation. The USMLE Composite Committee has directed that USMLE score reports and transcripts issued on or after September 10, 2014 will not include an annotation that a test accommodation was granted.

Step 2 CS Rescheduling Fees

Posted: August 04, 2014

Beginning September 1, 2014, the rescheduling fees for the Step 2 Clinical Skills (CS) examination will change. If you have a scheduled testing appointment and are unable to take the exam on your scheduled test date or at your scheduled center, you may cancel your scheduled testing appointment and reschedule for a different date and/or center, subject to availability. You may cancel and/or reschedule at any time through the end of the day before your scheduled test date. However, no canceling is allowed beginning at 12:00 AM, Eastern Time in the United States, on your scheduled test date. The date that you cancel your testing appointment will determine the amount of your rescheduling fee, as described in the list and table below. All dates and notice periods are calculated using Eastern Time in the United States.

  • If you cancel more than 14 calendar days before your scheduled test date, you will not be charged a fee when you reschedule.
  • If you cancel between 3 and 14 calendar days before your scheduled test date, you will be charged a $400 fee when you reschedule.
  • If you cancel 2 calendar days before your scheduled test date, you will be charged a $615 fee when you reschedule.
  • If you cancel 1 day before your scheduled test date you will be charged a $1,230 fee when you reschedule.
  • If you miss your scheduled testing appointment without canceling, you will be charged a $1,230 fee when you reschedule.

Example: Step 2 CS Rescheduling Fees
Test Date
Cancel Date(s)
July 15
On or before June 30
No fee
July 1 – July 12
July 13
July 14

If you cancel without rescheduling or miss your scheduled testing appointment, there is no guarantee that testing appointments during your eligibility period will be available when you attempt to reschedule. If you do not reschedule within your eligibility period, you must submit a new application and exam registration fee in order to take the exam.

If you are unable to keep your scheduled testing appointment, we encourage you to cancel your appointment as soon as possible, regardless of whether you are ready to reschedule. When examinees cancel more than 14 calendar days before their appointment, it is more likely that another examinee will be able to fill that testing slot. Avoiding large numbers of unfilled testing slots helps the USMLE Program manage capacity and minimize increases in the cost of the exam.

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