CRU Updates - June 2010

Posted June 14th, 2010

Content Changes

Consistent with changes described previously, Step 1 content is being modified to maximize the clinical context of the concepts being assessed and to align the foundational science contained in Step 1 with changes in science assessment anticipated for Steps 2 and 3. In support of the recommendation to enhance assessment of science across the spectrum of USMLE examinations, small increases in the number of biostatistics and epidemiology items will appear in Step 2 beginning in 2010 and in Step 3 in 2011.

Item Formats

Several new item formats are also under development for computer-based testing (Step 1, Step 2 Clinical Knowledge, and Step 3). USMLE committee members have developed new literature interpretation items that will assess the examinee’s ability to interpret scientific literature and pharmaceutical advertisements. If supported by pilot testing, these items should appear in the USMLE examination sequence in 2012. Work is also underway on a novel format that incorporates both video and new assessment activities such as admissions orders, laboratory testing, etc. to simulate progression of an individual patient case over time, enhancing the clinical authenticity of computer-based assessments.

Step 2 CS

Enhancements to the Clinical Skills examination will extend both the nature and degree of challenges faced by examinees. A recent successful pilot has resulted in changes that will enhance the authenticity of interactions between standardized patients and examinees. Building on this, we anticipate that examinees will face more challenging communications cases in the near future. Additionally, pilot work is underway to shape changes in the patient note that will allow more effective assessment of the examinee’s clinical reasoning. Additionally, examinees will need to use the keyboard for patient notes beginning in mid-year 2011; handwritten notes will no longer be acceptable.

Ongoing Changes

Senior staff associated with the USMLE program have begun to consider potential changes to the structure of the USMLE exam sequence. If structural change is indicated, staff hopes to have developed a draft plan by the end of 2010. Staff members of the ECFMG, FSMB, and NBME continue to meet quarterly and more often as indicated to review developments in the ongoing evolution of the USMLE program. Attentive to the needs of stakeholders, this staff group reviews developments in the USMLE program and targets announcements to the channels and groups needed to share important information. The most current updates and the status of any changes will continue to be available at