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 abbreviation list for Step 2 CS patient notes
Posted: November 03, 2014
Examinees complete a patient note after each patient encounter in the Step 2 Clinical Skills (CS) examination. A list of common abbreviations that may be used in the notes is included in the Step 2 Clinical Skills Content Description and General Information booklet, and is posted at each computer station at all Clinical Skills Evaluation Collaboration (CSEC) test centers.
The Step 2 Clinical Skills Content Description and General Information booklet now includes an updated version of the abbreviation list; this version will be posted at test centers beginning November 3, 2014.
Changes to the list are minor. Examinees should be aware that this is not a complete list of all acceptable abbreviations, but rather represents the types of common abbreviations that may be used on the patient note. Patient notes are rated by licensed, board-certified physicians with experience in medical education, who will understand common medical abbreviations. However, an examinee who is in doubt about the correct abbreviation to use should write out the word or phrase.
USMLE Score Interpretation Guidelines
Posted: October 30, 2014
USMLE Score Interpretation Guidelines (SIG) have been posted to the USMLE website. Topics include:
- Description of Examinations
- Understanding Your Score
- Recent Means and Standard Deviations (SDs)
- Norm Table
- Passing Scores
- Precision of Scores
- Guidelines for Use of USMLE Step Scores for Selection Decisions
The means and SDs and the norm table will be updated annually. Because percentile ranks depend on the cohort of examinees, you should always use the most recent norm table available on the USMLE website to obtain percentile ranks.