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USMLE Step 3 Updates — 2012

November, 2012

Delay in score reporting for Step 3 in 2013
Starting the week of February 11, 2013, a transition period will begin in which routine modifications to the items in the exam, including a minor decrease in the number of multiple-choice questions (MCQs) in current forms of the Step 3 examination, will occur.
Although the transition will occur quickly at many test centers, there may be some locations where the changes take slightly longer. The transition period will likely take approximately 4 weeks. Please note that:

  • The length of the examination day will remain unchanged.
  • Scores on new and old forms will be comparable.
Score reports for Step 3 are usually available within four weeks of testing. However, because of the changes described above, score reporting for most Step 3 examinations administered from the week of February 11, 2013 through early May 2013 will take longer.

The target date for reporting Step 3 scores for most examinees testing the week of February 11 through early May 2013 will be on Wednesday, June 5, 2013.

Changes to Step 3 examination in 2013
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=36.9C (98.4F), 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=38.3C (100.9F), 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.

June, 2012

Change in Minimum Passing Requirements for Step 2 CK
As stated in the USMLE Bulletin of Information and as explained in a previous posting to the USMLE website, the level of proficiency required to meet the recommended minimum passing level for each USMLE Step examination is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments are posted at the USMLE website.

Every three to four years the Step Committees are asked to complete an in-depth review of standards, and they may schedule more frequent reviews. At its June 2012 meeting, the Step 2 Committee conducted such a review for USMLE Step 2 Clinical Knowledge (CK). As a result of its review, the Step 2 Committee decided to raise the three-digit score recommended to pass Step 2 from 189 to 196. The Committee will closely monitor the effects of this decision on examinees and schools, and will examine trends in performance on an annual basis.

The new minimum passing score will be applied to Step 2 CK examinations for which the first day of testing is on or after July 1, 2012.

April, 2012

Update on planned changes to USMLE Step 3 examination
The USMLE Composite Committee and USMLE parent organizations (the National Board of Medical Examiners and the Federation of State Medical Boards) recently approved plans to change the structure of USMLE. Step 3 will be the first examination impacted, with changes to this examination to occur no earlier than 2014.

The plans call for the division of Step 3 into two separate exams, each one day in length, focusing on different sets of competencies. The proposed examinations will continue to be administered by computer using multiple choice questions and computer simulations. The two examinations will be scored separately and examinees will be expected to pass each.

The first exam is expected to focus on whether an examinee possesses the knowledge essential to the independent practice of medicine, including a comprehensive knowledge of both foundational science and clinical medicine. The second exam will assess an examinee’s ability to apply knowledge in the context of patient management, including demonstration of comprehensive knowledge of health and disease, and their impact on patients. The second exam will also require a demonstration of evidence-based medicine and quantitative reasoning skills important to patient care and to life-long learning. Specific information about these changes will be provided well in advance of implementation.

New testing formats that focus on competencies not currently addressed by the Step 3 examination may also be introduced. If new testing formats are to be introduced, announcements will be made and sample material provided in advance of their introduction in the live examinations.

The change to Step 3 will occur no sooner than 2014. After experience is gained with implementation of the Step 3 changes, the Composite Committee and USMLE parent organizations will consider possible modifications to Steps 1 and 2 CK.

As new information becomes available it will be posted to the USMLE website. 

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