USMLE Step 3 - Day 1
The first day of the USMLE Step 3 exam takes approximately eight hours to complete as the exam-taker will have 60 minutes to complete each section of the test, 15 minutes allotted for a tutorial explaining how to use the computerized exam system, and a 45 minute break. The test is scored based on the number of correct responses and then scaled so that the individual will receive a three-digit and a two-digit score. The three-digit and two-digit scores are based on the scores achieved from the first and second day of the exam. Scores for the three-digit scale usually fall between 140 and 260 with 184 set as the minimum score required to pass the exam. The two-digit scale is not actually an exact percentage score, but still ranges from 0 - 100 with 75 representing the minimum score necessary to pass the exam. The current registration fee for the exam, which includes both days, is $655, which will be raised to $670 in 2008.
USMLE Step III Exam (Both Days) - Diseases and Disorders
The USMLE Step III Exam, in addition to covering information related to the general principles of practicing medicine, covers a wide range of information related to the various diseases and disorders that could potentially be affecting a patient. Many of the diseases and disorders covered on the Step II CK Exam are also covered on the Step III Exam. However, there are also additional diseases and disorders that are covered on the Step III Exam that are not covered on the Step II CK Exam. The types of diseases and disorders covered on the Step III Exam include:- Behavioral Disorders and Emotional Disorders
- Diseases of the Blood
- Cardiovascular Diseases and Disorders
- Endocrine Disorders
- Diseases and Disorders of the Female Reproductive System
- Immune System Disorders
- Diseases and Disorders of the Male Reproductive System
- Disorders of the Musculoskeletal System
- Diseases of the Nervous System and Diseases that Affect the Senses
- Nutritional and Digestive System Disorders
- Disorders associated with Pregnancy, Labor, Delivery, Fetuses, and Newborns
- Renal Disorders and Urinary Disorders
- Diseases of the Respiratory System
- Skin Disorders and Disorders of the Subcutaneous Tissues
USMLE Step III Exam (Day 2) Computer-Based Simulations - Overview
The USMLE Step III Exam, in addition to a series of multiple-choice questions related to the general principles of medicine and the various diseases and disorders that can affect each system of the body and the body as a whole, includes a series of computer-based patient simulations. These simulations are administered using a computer-based case simulation (CCS) program created by Primum. The CCS program will present the exam-taker with a series of approximately 9 different simulations and the individual will be expected to care for a single simulated patient during each simulation. Each simulation will provide the exam-taker with information about why the patient is seeing the doctor, the patient's appearance, the patient's current status, the patient's life signs, and the patient's history. In order to successfully complete each simulation, the individual taking the exam must effectively manage the patient's care as the patient's condition changes during the simulation. Even though a large amount of time may be simulated in a particular simulation, the exam-taker is only allowed a certain amount of real time to complete each case. The exact amount of time necessary to complete each simulation varies depending on the difficulty of the patient's care, but the individual taking the exam will never be allowed more than 25 minutes to complete each simulation. During each patient case simulation, the individual taking the exam will be expected to request or offer advice, consultations, partial or complete physical examinations, nursing orders, procedures, tests, and therapies as would be necessary if the simulated patient were actually a real patient. However, unlike with a real patient, the exam-taker does not actually have to wait a significant amount of real time for the results of any tests that he or she requests as the exam-taker has the ability to speed up the time taking place in the simulation to a point where the test results would be available. The exam-taker must use the information provided by the simulation and a combination of the appropriate examinations, procedures, tests, and other methods to care for the patient and make a final diagnosis in order to successfully complete each simulation.USMLE Step III Exam (Day 2) Computer-Based Simulations - Scoring
USMLE Step III Exam (Day 2) Computer-Based Simulations - Scoring: The computer-based case simulations found on the USMLE Step III Exam are factored into the final two-digit and three-digit scaled scores that an individual will receive for the USMLE Step III Exam. The case simulations themselves are actually scored based on a point system calculated by the CCS program where points are awarded depending on how appropriate each method was to actually caring for the patient in an effective, efficient, and safe manner. The exact number of points awarded for each test, procedure, examination, or other method used to assess or care for the patient varies depending on the exact simulated patient. This variation in the number of points awarded is because each simulation is assigned a series of hidden objectives based on the simulated patient's needs that the individual's methods must complete in order to receive a high score for the simulation. The individual taking the exam will receive points for each action that he or she takes that aids in the patient's care, each action that aids in diagnosing the patient's condition, if the actions carried out by the exam-taker were at the right time, and if the actions carried out by the exam-taker were in the right order based on the condition of the patient. The individual taking the exam will not receive points or may even lose points for actions that are inappropriate, for actions that may actually be dangerous or even deadly for the patient, for actions carried out at inappropriate times or after the patient's condition has begun to deteriorate too far, and for actions that are not carried out in a logical order.The exam-taker will also usually not receive points for actions that could be considered appropriate, but do not relate specifically to the care of the particular patient presented. For example, if the simulated patient appears to have some form of pneumonia and no apparent need for a specific diet, and the exam-taker writes dietary orders, these orders will most likely not be considered in the score for the simulation. This is because, even though writing specific dietary orders may actually be appropriate, it has no direct relation to the patient's condition or the patient's care. However, if the dietary orders had been appropriate and directly related to the patient's care, for example if the patient's potassium levels were too high as a result of the patient's condition and therefore the patient required a special low-potassium diet, the exam-taker would receive points for the action. It is also important to note that the exam-taker may also lose points for ordering tests and procedures that may help in diagnosing or treating the patient, but the cost of the procedures or the procedures themselves may be considered excessive when compared to what would normally be used under the circumstances set by the simulation.
USMLE Step III Exam (Day 2) Computer-Based Simulations - Simulated Patients
The computer-based simulations that an individual will receive on the second day of the USMLE Step III Exam will present the individual with a variety of different patients from different backgrounds. Each simulation will only present the exam-taker with one patient, but the age of the patient, and the ethnic, economic, and social background of each patient will vary from simulation to simulation. The particular problems that a specific patient is experiencing in the simulation will also vary significantly from simulation to simulation and certain simulated patients may be difficult to diagnose while other patients may have relatively obvious conditions. The exact reason that the individual patient has come seeking medical attention may be different for each simulation as well as certain simulated patients may have been experiencing specific problems prior to coming to see a doctor while other simulated patients simply may be coming to receive a routine checkup. In either case, however, it is possible that the exam-taker, by carrying out the appropriate tests associated with the situation, may find other problems that the simulated patient may have been unaware of prior to seeking medical attention. The exam-taker may assume that he or she has the patient's consent, and the parent's consent if the patient is a minor, to carry out any and all necessary tests and procedures on the patient unless the simulation specifically informs the exam-taker otherwise. Regardless of the exact case presented in each simulation, the exam-taker's goal is always to order the tests, examinations, and procedures necessary to effectively care for each specific patient and to issue orders that are in the best interest of the patient.USMLE Step III Exam (Day 2) Computer-Based Simulations - Simulated Locations
All of the computer-based simulations that an individual will receive on the second day of the USMLE Step III Exam will take place in one of two primary medical settings. The first medical setting that a simulation may take place in is an outpatient office where the exam-taker is considered to be a doctor sharing the office with a group of other medical professionals that specialize in a wide range of various medical fields. The second medical setting that a simulation may take place in is a hospital setting where the doctor is working in a 400-bed regional referral center with a fully equipped emergency room, imaging center, intensive care unit, labor and delivery unit, laboratory, and an operating room. Each setting operates in a similar fashion to its real counterpart with similar hours of operation and as such the medical office is only open from 9:00 AM to 5:00 PM while the hospital is open 24 hours a day within the simulation. The exam-taker will be informed whether the simulation is taking place in the medical office or the hospital at the beginning of each simulation and the exam-taker has the ability to move the patient from location to location. However, the exam-taker can only directly move a patient between the emergency room, the intensive care unit, and the outpatient office. In order for a patient to be moved to the imaging center, the labor and delivery unit, or the operating room, or for tests to be performed on the patient and sent to the laboratory, the exam-taker must write orders requesting that specific procedures, tests, or actions should be taken. These actions and any patient transfers that are required to carry out the exam-taker's orders will then be carried out by the hospital's staff.USMLE Step III Exam (Day 2) Computer-Based Simulations - Consultations and Considerations
The in-depth computer-based simulations found on the USMLE Step III Exam are designed to offer a suitable representation of the types of patients and conditions that a doctor might see in any medical practice. However, even though these simulations are extremely detailed and allow the exam-taker an opportunity to prove his or her ability to work in a simulated environment that is very similar to an actual medical environment, there are a couple of things that the exam-taker should keep in mind. First, the individual taking the exam has the ability to request consultations with simulated medical personnel and medical specialists during each simulation. However, the option to request consultations during the simulation is primarily there to assess the exam-taker's ability to determine when a consultation is necessary rather than allowing the exam-taker to receive necessary information. Basically, this means that the consultations may not be very useful to the exam-taker in terms of providing the exam-taker with necessary information, but the exam-taker will receive points for ordering consultations at the appropriate times. Even though in a real-word situation a doctor would be able to request a consultation with another doctor, specialist, or other medical professional in order to discuss a patient's treatment and receive recommendations, the consultations found in the simulations are not very useful because each simulation is designed to assess the exam-taker's ability to act without supervision. As a result, the consultations in each simulation only offer a limited amount of information and, with the exception of certain simulations, will usually not offer recommendations that are very useful to the exam-taker.Second, it is important to realize that other doctors, nurses, specialists, and other similar medical personnel found within the simulation will carry out the exam-taker's orders, but they will not write any orders or take any actions by themselves. In a real-world medical setting, the care of a patient is usually not the sole responsibility of a single doctor, but rather a team effort where the other medical personnel around the doctor would aid in the patient's care by carrying out routine tests and examinations, by informing the doctor of a change in the patient's condition and requesting new orders, writing new orders, or taking other similar actions by themselves. However, the simulation is only assessing the exam-taker and, as a result, the medical professionals within the simulation will only act when the exam-taker orders them to do so.
USMLE Step III Exam (Day 2) Computer-Based Simulations - Understanding the Program
In order for an individual to successfully complete the computer-based simulations that he or she will receive on the second day of the Step III Exam, it is essential for the exam-taker to have a basic understanding of how the simulation software works. The simulations that the exam-taker will receive are administered using a computer-based case simulation (CCS) program created by Primum that presents the individual with a series of simulations one after the other where the exam-taker acts as the primary care physician for each simulated patient within each simulated case. The exam-taker can issue a variety of orders including orders for various consultations, examinations, and procedures simply by typing the desired orders into the program's order sheet. The program is also designed to understand a large number of medical abbreviations associated with writing orders that the exam-taker can use to quickly issue commands to the program. In order to make the program carry out these orders, the exam-taker simply needs to use the clock within the program to advance the time in the simulation. The exam-taker has the ability to cancel or rewrite orders at any time, but the exam-taker can not turn back time in the simulation and any procedures, examinations, or other orders that have already been carried out by the simulation cannot be undone once the time has been advanced.It is important to note that the simulation software is extremely in-depth and relatively easy to use, but it may still be difficult to complete the simulations if the individual is using the program for the first time on the day of the exam. Each simulation is timed and the individual will only have a set amount of real time to complete the simulation so it may be difficult to complete the simulations in the time allowed if the individual is not familiar with the software prior to the exam. In fact, statistics show that individuals who practice with the Primum CCS program prior to taking the exam tend to perform significantly better on the case simulations than individuals who are not familiar with the program. It is also important to note that, although the program understands a variety of orders, there are certain orders and abbreviations that the program may not be able to recognize and the exam-taker may have to rephrase orders so that the program understands what the exam-taker is trying to accomplish.
USMLE Step III - Day 2
The USMLE Step III is the third and final test of the three-part United States Medical Licensing Examination that is required in order to receive a license to practice medicine within the United States. This test, unlike the other two steps of the USMLE, takes two days to complete as the exam is actually administered in two separate sessions. The second session of the Step III test consists of 144 multiple-choice questions split into four sections that are related to evaluating patients, applications of clinical skills and clinical science, biostatistics, common diseases and disorders, human development, interpreting medical literature, medical ethics, patient safety, and the management systems, quality control systems, and other systems required in a medical practice to maintain a high level of care. Each section of the test is not separated by topic, but rather contains 36 randomly distributed questions that pertain to the above topics. The second session of the exam also includes nine computerized patient simulations where the individual will have up to 25 minutes to care for each simulated patient.The second day of the exam takes a total of approximately eight hours to complete, which includes three hours for the multiple-choice portion of the exam, approximately four hours for the patient simulation portion of the exam, a 45 minute break, and a 15 minute tutorial on how to use the computerized patient simulation software. The test is scored based on the number of correct responses from the multiple-choice section of the exam and the individual's performance on the patient simulations. The total score that the individual achieved for Step III of the USMLE is then scaled so that the individual will receive a three-digit and a two-digit score. The three-digit and two-digit scores are based on the number of correct responses and the patient simulation score from the first and second day of the exam. Scores for the three-digit scale usually fall between 140 and 260 with 184 set as the minimum score considered as passing for the exam. The two digit scale is not actually an exact percentage score, but still ranges from 0 - 100 with 75 representing the minimum score necessary to pass the exam. The current registration fee for the exam, which includes both days, is $655, which will be raised to $670 in 2008.
USMLE Step III Exam (Both Days) - General Principles
The USMLE Step III Exam covers a variety of topics related to the general principles that an individual must know in order to practice medicine in an effective, ethical, and safe manner. Many of these principles are similar to the principles covered in the USMLE Step II CK Exam. However, there are also additional principles on the Step III Exam that are not covered on the Step II CK Exam. The general principles covered on the Step III Exam include information related to:- Infancy and Childhood
- Adolescence
- Adulthood
- Senescence
- Medical Ethics and Jurisprudence
- Applied Biostatistics and Clinical Epidemiology
- System-Based Practice and Patient Safety
The infancy and childhood topics covered on the exam are specifically related to the normal processes of human growth and development that occurs from the time of a child's birth to the time that a child reaches puberty. The adolescence topics covered on the exam specifically relate to the changes that a child experiences during puberty and the aspects of sexuality that emerge during adolescence. The questions on the exam that are related to adulthood cover information related to the normal physical findings that a physician may notice when examining an adult patient and the concerns that may arise from a variety of different patient lifestyles. The senescence topics covered on the exam specifically focus on the physical and mental changes that normally occur due to aging. The topics related to medical ethics and jurisprudence covered on the exam include considerations and concerns associated with assisted suicide, confidentiality, death, dying, palliative care, patient consent, informed patient consent, and the patient-physician relationship. The topics related to applied biostatistics and clinical epidemiology covered on the exam include interpreting medical literature, medical statistics, and understanding medical measurements. Finally, the topics covered on the exam for system-based practice and patient safety include methods for quality improvement, methods for reducing medical errors and near misses, methods for maintaining patient safety, and methods of creating an organized and effective system-based medical practice. Most of the questions on the exam will relate specifically to one or more of the topics mentioned here. However, it is important to note that the topics mentioned here do not necessarily reflect every topic related to the general principles of medicine that will be covered on the exam.