Before you apply for any of the three steps of the USMLE, you must become familiar with the bulletin. Overview Content Outline and Specifications Content Description Test Question Formats Overview Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. The examination material is prepared by examination committees broadly representing the medical profession.
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Before you apply for any of the three steps of the USMLE, you must become familiar with the bulletin. Overview Content Outline and Specifications Content Description Test Question Formats Overview Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.
It is the final examination in the USMLE sequence leading to a license to practice medicine without supervision. The examination material is prepared by examination committees broadly representing the medical profession. The committees comprise recognized experts in their fields, including both academic and non-academic practitioners, as well as members of state medical licensing boards.
Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.
The Step 3 examination devotes attention to the importance of assessing the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients. Day 1 Step 3 Foundations of Independent Practice FIP This test day focuses on assessment of knowledge of basic medical and scientific principles essential for effective health care. The test day also includes content assessing knowledge of diagnosis and management, particularly focused on knowledge of history and physical examination, diagnosis, and use of diagnostic studies.
This test day consists solely of multiple-choice questions and includes some of the newer item formats, such as those based on scientific abstracts and pharmaceutical advertisements. Day 2 Step 3 Advanced Clinical Medicine ACM This test day focuses on assessment of the ability to apply comprehensive knowledge of health and disease in the context of patient management and the evolving manifestation of disease over time.
Content areas covered include assessment of knowledge of diagnosis and management, particularly focused on prognosis and outcome, health maintenance and screening, therapeutics, and medical decision making. Knowledge of history and physical examination, diagnosis, and use of diagnostic studies also is assessed. This test day includes multiple-choice questions and computer-based case simulations.
Step 3 is a two-day examination. The first day of testing includes multiple-choice items divided into 6 blocks of items; 60 minutes are allotted for completion of each block of test items.
There are approximately 7 hours in the test session on the first day, including 45 minutes of break time and a 5-minute optional tutorial. Note that the amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires. There are approximately 9 hours in the test session on the second day. This day of testing includes a 5-minute optional tutorial followed by multiple-choice items, divided into 6 blocks of 30 items; 45 minutes are allotted for completion of each block of test items.
The second day also includes a 7-minute CCS tutorial. This is followed by 13 case simulations, each of which is allotted a maximum of 10 or 20 minutes of real time. A minimum of 45 minutes is available for break time.
There is an optional survey at the end of the second day, which can be completed if time allows. If you have a medical need for an item during your USMLE administration, a list of approved personal items is available. The expected outcome of the USMLE process is a general unrestricted license to practice medicine without supervision. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated physician might encounter within the context of a specific setting.
Although you already may have begun specialist training, for this examination you are expected to assume the role of a general, as-yet undifferentiated physician. You are a member of an independent group practice affiliated with a number of managed care organizations.
Your office has regularly scheduled hours. You can admit patients to a bed regional hospital, which provides care for both the urban and the outlying rural communities.
The hospital provides standard diagnostic, radiologic, and therapeutic options, including ICUs and cardiothoracic surgery. There is a labor and delivery suite. A fully equipped emergency department adjoins the hospital, and medical evacuation helicopter service is available for emergency transfer to a regional trauma center. You do not have specialty-oriented hospital privileges, but you may request any specialty consultation.
Step 3 patients reflect the diversity of health care populations with respect to age, gender, cultural group, and occupation. The patient population mix is intended to be representative of data collected from various national health care databases in the United States. The physician-patient encounters described in Step 3 multiple-choice items are usually associated with a setting in which the encounter first occurs.
There are three sites of care, which are described below. You primarily see patients in two locations: an office suite, which is adjacent to a hospital, and at a communitybased health center. Patients are seen for routine and urgent care.
The laboratory and radiology departments have a full range of services available. Your office practice is in a primary care generalist group. Occasionally you will see a patient cared for by one of your associates and reference may be made to the patient's medical records.
Known patients may be managed by telephone. You may have to respond to questions about information appearing in the public media, which will require interpretation of the medical literature. You have general admitting privileges to the hospital including to the children's and women's services.
On occasion you see patients in the critical care unit. Postoperative patients are usually seen in their rooms unless the recovery room is specified. You may also be called to see patients in the psychiatric unit. There is a short-stay unit where you may see patients undergoing same-day operations or being held for observation.
Emergency Department includes emergency department and urgent treatment center. Most patients in the emergency department are new to you and are seeking urgent care, but occasionally you arrange to meet there with a known patient who has telephoned you. Also available to you is a full range of social services, including rape crisis intervention, family support, and security assistance backed up by local police. Step 3 clinical encounter frames encompass several elements that are critical to the definition of a patient-physician encounter.
These elements include whether the problem or concern is new or ongoing, the urgency of the need for intervention relative to the underlying problem, the chronology of events, and the degree of familiarity with the patient or the patient's history. The content description that follows is not intended as a curriculum development or study guide, but rather models the range of challenges that will be met in the actual practice of medicine.
It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change. Successful completion of at least one year of postgraduate training in a program accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association should be helpful preparation for Step 3.
All USMLE examinations are constructed from an integrated content outline , which organizes content according to general principles and individual organ systems. Test questions are classified in one of 18 major areas, depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems.
Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, including principles of therapy. These test items are typically related to normal development. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific. An additional organizing construct for Step 3 design is physician tasks and competencies. More information about the physician task and competencies outline is available.
Items are constructed to focus on assessing one of the following competencies:. Single-Item Questions A single patient-centered vignette is associated with one question followed by four or more response options. A portion of the questions involves interpretation of graphic or pictorial materials. You are required to select the best answer to the question. This is the traditional, most frequently used multiple-choice question format on the examination.
Example Question 1. A year-old man comes to the emergency department because of an acute episode of renal colic. Medical history is remarkable for episodes of painful urination and passing of what he calls "gravel in my urine.
Supine x-ray of the abdomen shows no abnormalities. A 4-mm renal calculus is detected in the distal right ureter on ultrasonography. There is no evidence of dilation of the collecting system. The patient's pain is responsive to narcotic medication. In addition to administering intravenous fluids, which of the following is the most appropriate next step? Acidification of urine by drinking cranberry juice Cystoscopic removal of the calculus Cystoscopic ureteral lavage Shock wave lithotripsy Straining of the urine Answer: E.
A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question within these sets is associated with the patient vignette and is independent of the other question s in the set.
The items within this type of format are designed to be answered in any order. A year-old man returns to the office for reevaluation of an ulcer on his right great toe. The patient has a year history of diabetes mellitus and takes glipizide and rosiglitazone. He first noticed the ulcer 2 months ago.
One month ago, a day course of oral amoxicillin-clavulanate therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. Today, vital signs are temperature Physical examination of the right great toe discloses a 1. Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in both feet. Capillary refill time is 2 seconds in the right great toe.
Which of the following historical factors or physical examination findings is most strongly associated with development of this patient's foot ulcer? Each question is associated with the initial patient vignette but is testing a different point.
Questions are designed to be answered in sequential order.
Most programs require residents to pass Step 3 by the end of their residency training program. Many fellowships require it for acceptance into the program. It is usually a good idea to take Step 3 as early as possible during pathology residency. Don't wait too long, or your clinical skills might have deteriorated significantly!
USMLE Step 3 Exam
Unlike Step 2CK and Step1, where you have focused significantly on preparing theory concepts for multiple choice questions, you will have to now focus on understanding how real life case scenario works on pre-designed software. Most of these failures occurred due to lack of excellent performance on the CCS. It is important that you practice on the original exam software that you can download from www. This is the exact software you will take your exam on. COM, these websites do not replicate the exact exam software.