Test-taking reminders for Step 2 Clinical Skills (CS) examinees
Posted: November 06, 2012
In December 2011 USMLE announced a number of changes to the Step 2 Clinical Skills (CS) examination program; these were implemented in mid-2012.
It is important for examinees to focus on the specific details of each case when interacting with standardized patients. Their actions should be guided by case details and by the information gathered from the standardized patient and from physical findings. Disregard for details of the case, as well as unfocused history questions or physical examination maneuvers, will likely make it difficult to manage testing time properly and may result in a lower score.
The December 2011 announcement also described changes to the Communication and Interpersonal Skills (CIS) subcomponent of the examination, which assesses an examinee’s performance in five functions. Examinees should be attentive to these functions throughout their interactions with the standardized patients.
In addition, the December 2011 announcement described changes to the patient note that is completed after each standardized patient encounter. Please note that examinees are expected to complete all components of the patient note. An incomplete patient note can result in a lower score.
Examinees can find information on what to expect during their Step 2 CS experience, and for all USMLE examinations, in the USMLE Bulletin of Information. Additional information about the Step 2 CS examination is available in the Step 2 Clinical Skills Content Description and General Information booklet.
Please refer to USMLE official announcements http://www.usmle.org/announcements
In December 2011 USMLE announced a number of changes to the Step 2 Clinical Skills (CS) examination program; these were implemented in mid-2012.
It is important for examinees to focus on the specific details of each case when interacting with standardized patients. Their actions should be guided by case details and by the information gathered from the standardized patient and from physical findings. Disregard for details of the case, as well as unfocused history questions or physical examination maneuvers, will likely make it difficult to manage testing time properly and may result in a lower score.
The December 2011 announcement also described changes to the Communication and Interpersonal Skills (CIS) subcomponent of the examination, which assesses an examinee’s performance in five functions. Examinees should be attentive to these functions throughout their interactions with the standardized patients.
In addition, the December 2011 announcement described changes to the patient note that is completed after each standardized patient encounter. Please note that examinees are expected to complete all components of the patient note. An incomplete patient note can result in a lower score.
Examinees can find information on what to expect during their Step 2 CS experience, and for all USMLE examinations, in the USMLE Bulletin of Information. Additional information about the Step 2 CS examination is available in the Step 2 Clinical Skills Content Description and General Information booklet.
Please refer to USMLE official announcements http://www.usmle.org/announcements
Step 2 Clinical Skills (CS) review of minimum passing performance
Posted: September 25, 2012
The USMLE program recommends a minimum passing level for each Step examination. The USMLE Step Committees are responsible for establishing and monitoring these standards, and are asked to complete an in-depth review of each examination every three to four years.
The Step 2 Committee is scheduled to review the minimum passing level for the USMLE Step 2 Clinical Skills (CS) examination at its meeting on December 18, 2012. In addition to meeting the requirement of a periodic in-depth review of standards, this effort is prompted by previously announced changes to the exam, which include a redesigned Communication and Interpersonal Skills subcomponent as well as a redesigned Patient Note.
In the review, the Step 2 Committee will considered data from multiple sources, including:
In the review, the Step 2 Committee will considered data from multiple sources, including:
- Results of content-based standard setting exercises conducted with three independent groups of physicians in 2012;
- Results of surveys of various groups (e.g., state licensing representatives, medical school faculty, samples of examinees) concerning the appropriateness of current pass/fail standards for Step examinations;
- Trends in examinee performance;
- Score precision and its effect on the pass/fail outcome.
The decision of the Step 2 Committee will be posted at the USMLE website. If the Committee determines that a change to the minimum passing level is appropriate, the new recommended minimum passing level will become effective for all examinees who take a Step 2 CS examination on or after January 1, 2013.
The 2013 schedule for reporting Step 2 Clinical Skills results is available
Posted: June 22, 2012
This schedule provides examinees, and others who rely on Step 2 Clinical Skills (CS) results, with guidelines regarding when a result will be reported for a given exam date. Click here to view the schedule.
Change in Minimum Passing Requirements for Step 2 CK
Posted: June 14, 2012
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.
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.
Step 2 CK - Change in number of items and schedule for score reporting
Posted: June 07, 2012
Starting in early August, 2012, the number of items on the Step 2 Clinical Knowledge (CK) examination will change. Although the change will occur quickly at many test centers, there may be some locations where this takes longer to complete.
The overall transition period should last approximately 6 weeks. Please note that:
- The length of the testing day will not change. The test day will continue to be divided into eight 60-minute blocks, administered in one nine-hour testing session. The number of items per block on a given examination form will vary but will not exceed 45 items. Examinees should check the number of items that will be displayed at the beginning of each block. The total number of items on the overall examination form will not exceed 355 items.
- Scores on examination forms taken before and after the change – as well as scores on forms with different numbers of items – will be comparable; the possible variation in the number of items per form will be accounted for in scoring the examination results.
Score reports for Step 2 CK are usually available within four weeks of testing. However, because of the change described above, as well as routine modifications to the test item pool, score reporting for most Step 2 CK examinations administered in August will take longer.
The target date for reporting Step 2 CK scores for most examinees testing in August is Wednesday, September 26, 2012.
The target date for reporting Step 2 CK scores for most examinees testing in August is Wednesday, September 26, 2012.
Review of USMLE Step 2 Clinical Knowledge (CK) minimum passing score
Posted: April 27, 2012
As stated in the USMLE Bulletin of Information, 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 on 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 2010 meeting, the Step 2 Committee conducted 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 CK from 184 to 189. As previously reported, at that time the Committee decided to closely monitor the effects of this decision on examinees and schools, and to examine trends in performance on an annual basis.
The Committee will review the three-digit score recommended to pass Step 2 CK at its June 2012 meeting. If the Committee determines that a change is appropriate, the new recommended minimum passing score will become effective for all examinees who take a Step 2 CK examination on or after July 1, 2012.
Updated practice and orientation materials for Step 2 Clinical Skills (CS) exam have been posted
Posted: March 22, 2012
As previously announced, a new patient note and redesigned Communication and Interpersonal Skills subcomponent will be introduced into the USMLE Step 2 CS examinations beginning June 17, 2012. Updated practice and orientation materials reflecting these changes have been posted to the USMLE website.
Examinees who plan to take the Step 2 CS examination on or after June 17, 2012 should review the updated materials, which include:
• An updated version of the CS Content Description and General Information booklet
• An updated onsite orientation CS video
• A new version of the practice patient note program
• New sample patient notes
• An updated version of the CS Content Description and General Information booklet
• An updated onsite orientation CS video
• A new version of the practice patient note program
• New sample patient notes
Changes to the Step 2 Clinical Skills (CS) Content Description and General Information booklet
The sections of the booklet that have been updated include:
The sections of the booklet that have been updated include:
- The Patient Encounter section (p 6) includes an updated description of the role of the examinee in the Step 2 CS examination.
- The Patient Note section (pp 8, 15-20) includes a description of the new patient note.
- The Scoring the Step 2 CS Examination section (pp 11-12) describes changes to how the Integrated Clinical Encounter (ICE) and Communication and Interpersonal Skills (CIS) subcomponents will be scored. For the ICE subcomponent, standardized patients (SPs) will complete checklists for the physical examination portion of the patient encounter. SPs will no longer complete checklists for the history portion of the patient encounter; an examinee’s ability to gather appropriate history will continue to be assessed in the patient note. SPs assess CIS performance using a checklist based on observable behaviors; this replaces the global rating of communication skills using a series of generic rating scales.
Changes to the patient note
The new patient note provides examinees with an opportunity to document their analysis of a patient's possible diagnoses. Samples of the new patient note and a program for practicing the patient note are available.
Changes to the Onsite Orientation for Step 2 CS video
The new version of the video includes an updated description of the patient note program.
The new patient note provides examinees with an opportunity to document their analysis of a patient's possible diagnoses. Samples of the new patient note and a program for practicing the patient note are available.
Changes to the Onsite Orientation for Step 2 CS video
The new version of the video includes an updated description of the patient note program.
Delay in score reporting for Step 3 in 2013
Posted: November 28, 2012
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.
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
Posted: November 28, 2012
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/m 2. 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.
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/m 2. 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.
Labs:
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=38.3°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.
In 2013, Step 3 examinees will see an increase in the number of research abstract and pharmaceutical advertisement questions.
Update on planned changes to USMLE Step 3 examination
Posted: April 11, 2012
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.
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.
Please refer to USMLE official announcements http://www.usmle.org/announcements