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.
USMLE takes action against individuals found to have engaged in irregular behavior
Posted: February 27, 2014
The USMLE Committee for Individualized Review (CIR) meets periodically throughout each year to review cases involving allegations of irregular behavior by applicants and/or examinees.
At its recent meetings, the CIR heard multiple cases involving the following:
- falsified information, including the creation of falsified score reports
- soliciting and/or seeking to obtain unauthorized access to examination materials
- communicating about specific test items, cases, and/or answers with another examinee
- applying and/or attempting to take an examination when ineligible
- making notes of any kind on anything other than materials provided
- failure to follow test center instructions, including writing past the ‘end patient note’ announcement
Actions taken by the CIR at its recent meetings included annotating the individual’s USMLE record with a finding of irregular behavior, barring access to USMLE for periods ranging from 0-3 years, and reporting the finding of irregular behavior to the disciplinary data bank of the Federation of State Medical Boards. State medical boards routinely query this data bank as part of their licensing processes.
As evidenced by the sanctions listed above, a finding of irregular behavior carries significant potential impact. USMLE applicants and examinees are reminded to read the USMLE Bulletin of Information carefully, follow the rules of conduct during testing, and refrain from any pre- or post-examination conduct that might constitute irregular behavior. Specific examples of conduct deemed to be irregular behavior can be found in the Bulletin.
The USMLE is committed to maintaining the integrity of its examination so that state medical boards may continue to rely upon it as an integral part of their decision-making process for licensure. Applicants and examinees are advised to observe all USMLE policies and procedures to avoid the potentially significant implications arising from a finding of irregular behavior.
USMLE encourages you to provide information about cheating and other activity of which you are aware that may compromise the security and integrity of USMLE. Please use our contact form to report such information.
Updated Step 2 Clinical Skills information available
Posted: January 24, 2014
An updated Step 2 Clinical Skills (CS) Content Description and General Information booklet is available.
The Description of the Examination and Scoring the Step 2 CS Examination sections include expanded language on expectations for interacting with standardized patients, as well as additional information on scoring. Appendix B includes new sample patient notes, which have additional information to help examinees understand how the notes are scored.
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