Normal processes

Normal processes:

• embryonic development, fetal maturation, and perinatal changes
• organ structure and function
• cell/tissue structure and function
  • production and function of erythrocytes, hemoglobin, O2 and CO2 transport, transport proteins
  • production and function of platelets
  • production and function of coagulation and fibrinolytic factors
• repair, regeneration, and changes associated with stage of life

Source: http://www.usmleworldwide.com/blog/?p=196

General Principles

• Biochemistry and molecular biology

• Biology of cells

• Human development and genetics

• Biology of tissue response to disease

• Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

• Multisystem processes

• Pharmacodynamic and pharmacokinetic processes
  

• Microbial biology and infection

• Quantitative methods                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Source: http://www.usmleworldwide.com/blog/?p=189                                                                                                                                                           

Quantitative methods

Quantitative methods:

• fundamental concepts of measurement
  • scales of measurement
  • distribution, central tendency, variability, probability
  • disease prevalence and incidence
  • disease outcomes
  • associations
  • health impact
  • sensitivity, specificity, predictive values
• fundamental concepts of study design
  • types of experimental studies
  • types of observational studies
  • sampling and sample size
  • subject selection and exposure allocation
  • outcome assessment
  • internal and external validity
• fundamental concepts of hypothesis testing and statistical inference
  • confidence intervals
  • statistical significance and Type I error
  • statistical power and Type II error.
  
  Source: http://www.usmleworldwide.com/blog/?p=185
  

Microbial biology and infection

Microbial biology and infection:

• microbial identification and classification, including principles, microorganism identification, and nonimmunologic lab diagnosis
• bacteria
  • structure
  • processes, replication, and genetics
  • oncogenesis
  • antibacterial agents
• viruses
  • structure
  • processes, replication, and genetics
  • oncogenesis
  • antiviral agents
• fungi
  • structure
  • processes, replication, and genetics
  • antifungal agents
• parasites
  • structure
  • processes, replication, and genetics
  • antiparasitic agents
• prions
• epidemiology, outbreaks, and infection control 

Source: http://www.usmleworldwide.com/blog/?p=182

Pharmacodynamic and pharmacokinetic processes

Pharmacodynamic and pharmacokinetic processes:

general principles

• pharmacokinetics: absorption, distribution, metabolism, excretion, dosage intervals
• mechanisms of drug action, structure-activity relationships (including anticancer drugs)
• concentration- and dose-effect relationships, types of agonists and antagonists and their actions
• individual factors altering pharmacokinetics and pharmacodynamics
• mechanisms of drug adverse effects, overdosage, toxicology
• mechanisms of drug interactions
• regulatory issues
• signal transduction, including structure/function of all components of signal transduction pathway such as receptors, ligands
• cell cycle/cell cycle regulation.

Source: http://www.usmleworldwide.com/blog/?p=179

Multisystem processes

Multisystem processes:

• nutrition
  • generation, expenditure, and storage of energy at the whole-body level
  • assessment of nutritional status across the life span, including calories, protein, essential nutrients, hypoalimentation
  • functions of nutrients
  • protein-calorie malnutrition
  • vitamin deficiencies and/or toxicities (including megaloblastic anemia with other findings)
  • mineral deficiencies and toxicities
• temperature regulation
• adaptation to environmental extremes, including occupational exposures
  • physical and associated disorders (including temperature, radiation, burns, decreased atmospheric pressure, high-altitude sickness, increased water pressure)
  • chemical (including gases, vapors, smoke inhalation, agricultural hazards, organic solvents, heavy metals, principles of poisoning and therapy)
• fluid, electrolyte, and acid-base balance disorders
• inherited metabolic disorders, including disorders related to amino acids, purines, porphyrins, carnitine, fatty acids, and carbohydrates                                                                                              Source:http://www.usmleworldwide.com/blog/?p=176

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental:

• progression through the life cycle, including birth through senescence
  • cognitive, language, motor skills, and social and interpersonal development
  • sexual development
  • influence of developmental stage on physician-patient interview
• psychological and social factors influencing patient behavior
  • personality traits or coping style, including coping mechanisms
  • psychodynamic and behavioral factors, related past experience
  • family and cultural factors, including socioeconomic status, ethnicity, and gender
  • adaptive behavioral responses to stress and illness
  • maladaptive behavioral responses to stress and illness
  • interactions between the patient and the physician or the health care system
  • patient adherence (general and adolescent)
• patient interviewing, consultation, and interactions with the family
  • establishing and maintaining rapport
  • data gathering
  • approaches to patient education
  • enticing patients to make lifestyle changes
  • communicating bad news
  • “difficult” interviews
  • multicultural ethnic characteristics
• medical ethics, jurisprudence, and professional behavior
  • consent and informed consent to treatment
  • physician-patient relationships
  • death and dying
  • birth-related issues
  • issues related to patient participation in research
  • interactions with other health professionals, including impaired physician and patient safety
  • sexuality and the profession; other “boundary” issues
  • ethics of managed care
  • organization and cost of health care delivery.
  •  Source: http://www.usmleworldwide.com/blog/?p=173

Biology of tissue response to disease

Biology of tissue response to disease:

• acute inflammatory responses (patterns of response)
  • acute inflammation and mediator systems
  • vascular response to injury, including mediators
  • principles of cell adherence and migration
  • microbicidal mechanisms and tissue injury
  • clinical manifestations
• chronic inflammatory responses
• reparative processes
  • wound healing, hemostasis, and repair; thrombosis, granulation tissue, angiogenesis, fibrosis, scar/keloid formation
  • regenerative processes
  
  Source: http://www.usmleworldwide.com/blog/?p=170
  

Human development and genetics

Human development and genetics:

• principles of pedigree analysis
  • inheritance patterns
  • occurrence and recurrence risk determination
• population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium
• principles of gene therapy
• genetic testing and counseling
• genetic mechanisms

Source: http://www.usmleworldwide.com/blog/?p=166

Biology of cells

Biology of cells:

• adaptive cell responses and cellular homeostasis
• intracellular accumulations
• mechanisms of injury and necrosis
• apoptosis
• mechanisms of dysregulation
  • cell biology of cancer, including genetics of cancer
  • general principles of invasion and metastasis, including cancer staging
• cell/tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors

Source : http://www.usmleworldwide.com/blog/?p=160

Biochemistry and molecular biology

Biochemistry and molecular biology:

• gene expression: DNA structure, replication, exchange, and epigenetics
• gene expression: transcription
• gene expression: translation, post-translational processing, modifications, and disposition of proteins (degradation), including protein/glycoprotein synthesis, intra/extracellular sorting, and processes/functions related to Golgi complex and rough endoplasmic reticulum
• structure and function of proteins and enzymes
• energy metabolism. 

Sources: http://www.usmleworldwide.com/blog/?p=157

Comprehensive Review of USMLE (CRU)

1. When will the talked-about changes be implemented?

2. Will Step 1 and 2 CK be combined into one exam? What changes to USMLE exam structure and format will occur within the next 1-5 years?

3. If the current Step structure changes, how can medical schools that make promotion decisions (from MS2 to MS3) continue to make these decisions?

4. Will you continue to report scores, or change to pass/fail?

5. What are the “competencies”? Are they all going to be assessed in USMLE? How?

Source: http://www.usmleworldwide.com/blog/?p=150

What are the “competencies”? Are they all going to be assessed in USMLE? How?

In accordance with direction from the USMLE Composite Committee and the Committee to Evaluate the USMLE Program, USMLE governance will consider changes to the examination sequence in the context of competencies that have become increasingly prevalent in recent years as a means of organizing medical education and assessment. One of the most commonly used competency frameworks was developed collaboratively by the ACGME and the ABMS. This framework identifies six competencies: medical knowledge, patient care, communication and interpersonal skills, professionalism, practice-based learning and improvement, and systems-based practice. Some in the medical education and practice community have also identified a seventh competency related to surgical and other technical procedural skills.

The NBME will explore how best to assess examinees in all competency areas. It is likely that the assessments available via a revised USMLE will not be able to measure all competencies to an equal degree. It is possible that one or more competencies will not be measurable in a valid manner in the context of the USMLE. During implementation of changes to the USMLE, staff will identify how best to assess examinees’ performance in each of the competencies using available methods, develop a research agenda to expand assessment tools for competencies not adequately measured presently, and identify competencies that cannot be reliably measured in USMLE so that assessments in other contexts (e.g., residency training programs) can supplement the information provided by the USMLE.

Source:http://www.usmleworldwide.com/blog/?p=147

Will you continue to report scores, or change to pass/fail?

In conversations with the various stakeholder groups that occurred as part of the USMLE review process, strongly held opinions were expressed on both sides of this question. Some felt that maintaining numeric score reporting is essential while others felt that numeric scores should be abolished. For the present, we do not anticipate changing current practice. As the examination sequence evolves, potential changes in score reporting would be weighed in light of validity research, including intended use of scores.

Source: http://www.usmleworldwide.com/blog/?p=144

If the current Step structure changes, how can medical schools that make promotion decisions (from MS2 to MS3) continue to make these decisions?

Changes in the structure of USMLE exams may have little or no impact on schools using USMLE performance for other purposes. However, the NBME recognizes that medical schools use the results of USMLE examinations for the assessment of both individual students and of the schools’ educational programs. In implementing changes to the USMLE exam sequence, the NBME will be attentive to other assessment needs and the secondary uses of USMLE.

Source: http://usmleworldwide.com/blog/?p=141

Will Step 1 and 2 CK be combined into one exam? What changes to USMLE exam structure and format will occur within the next 1-5 years?

There are no plans to combine Usmle Steps 1 and Usmle Step 2 CK. However, the focus, design, format, and structure of each may change in the future.  Such changes, if made, would occur no earlier than 2016, and any significant changes will be announced well in advance.

The USMLE Composite Committee and USMLE parent organizations (the National Board of Medical Examiners and the Federation of State Medical Boards) have approved changes to the design, format, and structure of the Step 3 exam. These changes will 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.

Additional information about this change is available.

Posted: December 2009
Updated: March 2011
Updated: August 2012

Source: http://www.usmleworldwide.com/blog/?p=137

When will the talked-about changes be implemented?

New multiple-choice question formats: Test material committees have developed multiple choice questions that assess an examinee’s ability to appropriately interpret information presented both in the form of a research abstract and a pharmaceutical advertisement. A small number of these item types have been introduced into the Step 2 CK and Step 3 examinations.

Enhancements to the Clinical Skills (CS) examination: Enhancements to the Usmle Step 2 CS examination, including a new patient note program and redesigned Communication and Interpersonal Skills subcomponent, were introduced into the USMLE Step 2 CS examinations on June 17, 2012.

Posted: December 2009
Updated: March 2011
Updated: August 2012

Source: http://www.usmleworldwide.com/blog/?p=133

Update On Planned Changes To USMLE Step 3 Examination

“Changes on 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. 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 Usmle 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 Usmle 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 UsmleStep 3 changes, the Composite Committee and USMLE parent organizations will consider possible modifications to Steps 1 and 2 CK.

Source :http://www.usmleworldwide.com/blog/?p=130

Biometric Enabled Check-In System

1. What biometric information is collected from a USMLE® candidate?
2. How long will my biometric information be stored?
3. Who will have access to my biometric information?
4. I would like to read the Biometric Enabled Check-In System Privacy Notice.

Source: http://www.usmleworldwide.com/blog/?p=124

Who will have access to my biometric information?

Access to your biometric information will be limited as described in the Privacy Notice for USMLE Candidates. Employees or agents of the USMLE sponsors who have access to the data are bound by confidentiality agreements. The data may be made available to third parties if required by law or as necessary to complete a testing fraud investigation directly related to the relevant candidate(s).

Source: http://usmleworldwide.com/blog/?p=115

How long will my biometric information be stored?

Unless otherwise required by law, the personal information (including your fingerprint image and template) collected using biometrics is retained on behalf of the USMLE program sponsors in a secure, centralized database in the United States on test day and for a period of 5 years from the date of your most recent testing appointment with Prometric.

Source: http://usmleworldwide.com/blog/?p=112