Urinalysis Uric acid, serum Examples of suboptimal management of this case would include delay in diagnosis or treatment, or treatment with NSAIDS or corticosteroids alone. Treatment with salicylates would also be considered suboptimal management in this case. Although they would temporarily relieve pain when administered in high doses, there are other agents with fewer adverse effects that would be better treatment options. Examples of poor management would include failure to order any physical examination or failure to treat rheumatoid arthritis. With the availability of effective treatment for rheumatoid arthritis and concerns about opioid addiction, narcotic analgesics should have a limited role in treatment. Examples of invasive tests that would subject the patient to unnecessary discomfort or risk and add no useful information include: Arthroscopy Synovial biopsy While many case scenarios run for a relatively short period of simulated time, a matter of hours or days, this scenario runs for a longer period of time, weeks.

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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.

Exam Format 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.

Site of Care 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. 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.

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 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. Clinical Encounter Frames Step 3 clinical encounter frames encompass several elements that are critical to the definition of a patient-physician encounter. These encounters may also include new problems arising in patients for whom a history is available.

Patient encounters characterized by continuing management of previously diagnosed clinical problems among patients known to the physician and seen principally in ambulatory settings.

Encounters focused on health maintenance are located in this frame. Also included are patient encounters characterized by acute exacerbations or complications, principally of chronic, progressive conditions among patients known to the physician. These encounters may occur in inpatient settings.

Patient encounters characterized by prompt assessment and management of life-threatening and organ-threatening emergencies, usually occurring in emergency department settings. Occasionally, these encounters may occur in the context of a hospitalized patient. Clinical problems include ill-defined signs and symptoms; behavioral-emotional; acute limited; initial manifestation and presentation of chronic illness.

Clinical problems include frequently-occurring chronic diseases and behavioral-emotional problems. Periodic health evaluations of established patients are included here.

Clinical problems include severe life-threatening and organ-threatening conditions and exacerbations of chronic illness. Physician tasks emphasized include data gathering and initial clinical intervention. Assessment of patients may lead to urgent intervention. Physician tasks emphasized include recognition of new problems in an existing condition, assessment of severity, establishing prognosis, monitoring therapy, and long-term management. Content Outline and Specifications Content Description 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.

Content Outline 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.


USMLE Step 3 Uworld



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