What is the USMLE?

USMLE is a standardized examination used to evaluate applicants’ competence for purposes of medical licensure in the United States and its territories. The USMLE is designed to assess a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that constitute the basis of safe and effective patient care. USMLE is accepted by virtually all licensing boards in the US as evidence of competence to practice medicine in the US. State medical boards rely upon successful completion of the three USMLE component exams, or “Steps,” as an important element in the process for licensing physicians. Because of the test’s importance to the public’s safety and to examinees, maintaining its fairness and integrity is a priority for the NBME.

Source: http://usmleworldwide.com/blog/?p=765

Test Accommodations – Introduction

The United States Medical Licensing Examination (USMLE) Program provides reasonable and appropriate accommodations in accordance with the Americans with Disabilities Act for individuals with documented disabilities who demonstrate a need for accommodation. Examinees are informed of the availability of test accommodations in the USMLE Bulletin of Information: Applying and Scheduling and in the Application Instructions.

The following information is provided for examinees, evaluators, medical school student affairs staff, faculty and others involved in the process of documenting a request for test accommodations. Applicants requesting test accommodations should share these guidelines with their evaluator, therapist, treating physician, etc., so that appropriate documentation can be assembled to support the request for test accommodations.

The Americans with Disabilities Act of 1990 (ADA) and accompanying regulations define a person with a disability as someone with a physical or mental impairment that substantially limits one or more major life activities such as walking, seeing, hearing, or learning. The purpose of documentation is to validate that the individual is covered under the Americans with Disabilities Act as a disabled individual.

The purpose of accommodations is to provide equal access to the USMLE testing program. Accommodations “match up” with the identified functional limitation so that the area of impairment is alleviated by an auxiliary aid or adjustment to the testing procedure. Functional limitation refers to the behavioral manifestations of the disability that impede the individual’s ability to function, i.e., what someone cannot do on a regular and continuing basis as a result of the disability. For example, a functional limitation might be impaired vision so that the individual is unable to view the examination in the standard font size. An appropriate accommodation might be text enlargement. It is essential that the documentation provide a clear explanation of the functional impairment and a rationale for the requested accommodation.

While presumably the use of accommodations in the test activity will enable the individual to better demonstrate his/her knowledge mastery, accommodations are not a guarantee of improved performance, test completion or a passing score.

Quick Links:

1. Request Test Accommodations

2. Guidelines

3. Forms

4. Settlement with Department of Justice

Source: http://www.usmleworldwide.com/blog/?p=852

Overview

Introduction 

The United States Medical Licensing Examination® (USMLE®) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®).

The Composite Committee, appointed by the FSMB and NBME, establishes policies for the USMLE program. Membership includes representatives from the FSMB, NBME, Educational Commission for Foreign Medical Graduates (ECFMG®), and the American public.

Changes in the USMLE program may occur after the release of this Bulletin. If changes occur, information will be posted at the USMLE website. You must obtain the most recent information to ensure an accurate understanding of current USMLE rules. If you are unable to access updated USMLE information via the Internet, you may contact the USMLE Secretariat in writing for updated information.

1. Purpose of the USMLE

2. The Three Steps of the USMLE

3. Examination Committees

4. Ownership and Copyright of Examination Materials

5. CBT – Computer Based Testing

6. Step 2 CS (Clinical Skills)

Source: http://usmleworldwide.com/blog/?p=66

Usmle Step 1 MCQ's # 13

Title: Usmle Step 1 MCQ's # 13

Subject: Behavioral Science

Q NO 13: Over the past 10 years, a 15-year-old boy has been taking medication that has successfully controlled his severe asthma. He has had no exacerbations in the past two years. His parents come to see the boy’s physician seeking her advice. The boy has recently declared that he does not want to take his asthma medication any longer. Instead, he believes that changing his diet to one that is tree of all “toxins” is all that is required to limit his exacerbations. The parents want to know what they should do. What action should the physician take next?

A. Arrange to speak with the boy and ask him the reasons for his decision
B. Arrange to speak with the boy and convince him that he must stay on his medication
C. Have the boy evaluated by a pulmonologist and follow the recommendations of the specialist
D. Take the boy off his medication and monitor him closely in case there are any adverse reactions
E. Tell parents that you will switch the boy to a newly available medication
F. Tell the parents that it is essential that their son stay on his medications and that they must convince him to do so

Explanation:
The correct answer is A. Before reaching any treatment recommendation or encouraging either the parents or the boy to take any particular course of action, the physician needs more information. All he knows is the boy’s views as represented by the parents. The boy is old enough to express himself and articulate his reasons, so the physician should go directly to the source. Getting enough information before you act is a good rule for the exam, and a good rule for medical practice.
Speaking with the boy is the right idea. But walking into the conversation with an agenda of selling a particular course of action (choice B) is likely to lead to confrontation, not communication. Be open-minded and hear what the boy’s experience and reasons have been.
This is your patient, and you should make the required decisions. The rule:” Never pass off,” applies here. Giving your patient to someone else (choice C) will yew rarely be a right answer on the Step 1 exam.
Taking the boy off his medication (choice D) is premature. Talk to the boy and get his views before deciding on any course of action.
Choices E and F not only force a solution before all the relevant information is known, they force the parents to do the work of the physician, namely, talking directly with the patient. Yes, the parents, at this age, have the final say regarding treatment choices, but cooperation of the patient is essential for adequate treatment of asthma.

Source: http://usmleworldwide.blogspot.com/2012/10/usmle-step-1-mcqs-13.html

Usmle Step 1 MCQ's # 12

Title: Usmle Step 1 MCQ's # 12
Subject: Behavioral Science 

Q NO 12: A 15-year-old boy has been treated on an ongoing basis by his physician for type 1 diabetes. During a regularly scheduled evaluation, the patient appears sullen and non-responsive. He slouches in his chair and will not make eye contact with the physician. When questioned about how he is feeling, the boy mumbles something unintelligible and stares at the floor. When told that he was not understood, the boy blurts out, “This treatment is not working. It’s such a pain. I don’t want to come here anymore. I don’t think you know what you are doing.” In response to this out burst the physician’s best reply would be which of the following?

A. "Are you having trouble with the other kids at school?"

B. "I know this is a bother, but your parents have decided on this course of action and they know what is best for you."

C. "If you would be more comfortable with a different doctor, I’ll try to arrange it for you."

D. "I’ll make a deal with you. Keep on with your treatment for six more months, and we’ll see where you are at that point."

e. "In what way is the treatment not working?"

F. "Tell me a little bit about what life has been like for you lately."

G. "When I was younger, I had to do a lot of things that I did not want to, but looking back, I’m glad I did."

H. "When you are old enough, you will get to make these decisions. Until that time, I’m going to do as your parents request."

I. "Without this treatment you will die. Do you understand that?"

Explanation:

The correct answer is E. The key issue here is that the physician does not know exactly what is bothering the boy when he says the treatment is not working. Does he think he should be cured? Does he find the monitoring and treatment regimen to be onerous? Is he subject to criticism from his peers? Or is he just tired of having a medical problem? The physician does not know, and so should ask. When you don’t know exactly what the patient is talking about, ask!

Choice A is not directly responsive to the boy’s outburst and leaps to an assumption about the reason he is upset. Guessing correctly may make the physician seem omniscient, but guessing wrong simply makes him seem foolish. Don’t assume, ask.

Choice B brings the parents, and their authority to make medical decisions for the boy into the discussion. It complicates the gathering of information from the boy, and stresses the authority relations, something that is likely to heighten, not soothe the boy’s anger.

Choice C is incorrect. The physician must form a relationship and solve the presented problem. Getting rid of the problem by getting rid of the patient is nothing more than a dereliction of duty.

Choice D is not a bad tactic for negotiating adherence. Often, seeing treatment stretching out interminably makes patients despair. Breaking it into a bounded time frame makes it seem more manageable. The problem here is that this discussion is premature. The physician is negotiating the solution before having a clear sense what the problem is.

Choice F is a great way to get a sense of how the disease and treatment might be affecting the boy and his relationship with others. But, again, this is premature. Find out what the problem really is before talking about how it has affected the boy’s life.

Choice 0 is meant as fatherly advice, but risks being perceived as condescending and un empathetic. At the very least, find out what the problem is before regaling the boy with what life was like when you were young!

Choice H tells the boy that he has no say, and that the physician is not interested in what he has to say. True, the parents are the ones making the decisions, but there are other reasons to talk to the boy. Only he knows how the treatment makes him feel, and what impact it has on his life. And he is likely to be the first one that knows if something is truly wrong. Don’t lecture ask.

Choice I is a bit harsh, but statements like this can be excellent motivators to foster adherence with treatment. The Health belief model tells us that engendering fear, and then providing a simple solution is empirically a very good way to motivate adherence. But here again, we need to know what the problem is before we seek to work on adherence issues.

Source: http://usmleworldwide.blogspot.com/2012/10/usmle-step-1-mcqs-12_24.html