[USMLE study for IMGs: an Open Access, Systematic approach]
In Development
Pavel Zhelnov, MD
@drzhelnov
Dear Colleagues,
An excerpt from the original publication (accessed on July 7, 2021):
USMLE Physician Tasks/Competencies provides an outline of the tasks and competencies assessed throughout the sequence of USMLE examinations. While this outline is common to all exams, each Step has test specifications specific to that Step. Each Step exam emphasizes certain parts of the tasks/competencies outline, and no single examination includes assessment of all topics in the outline.
Note that Step component specifications next to the task/competencies are not from the original document but from the official Step 1 Content Description (PDF) as well as the Step 2 CK Content Description (PDF) (accessed on July 29, 2021), so please take these accordingly. Alphanumeric codes are also custom. Also, Step 3 was not considered.
Interactive features are under development. I presume this outline as well as the USMLE Content Outline could be nicely aligned with my amalgam USMLE prep schedule made of U.S. med schools syllabi so that each task/competency linked to specific study resources per each content topic. This would effectively create a self-study roadmap with tasks/competencies as its tracks and content topics as the milestones. Naturally, to navigate the roadmap, the prospective Step-taker would need to clear specific resources such as textbook chapters, journal articles, videos, or their glternatives. QBanks would still be required to test one’s competencies and topic knowledge once there is something to test.
I do not own any outline content, just reproduce it for self-learning purposes and in good faith:
Copyright © 2020 by the Federation of State Medical Boards of the United States, Inc. (FSMB), and National Board of Medical Examiners® (NBME®). All rights reserved. The United States Medical Licensing Examination (USMLE®) is a joint program of the FSMB and NBME.
⚠ Disclaimer: This is an unofficial publication neither affiliated with nor endorsed by the FSMB, NBME®, or USMLE® program. For official information please visit usmle.org or other relevant resources.
View this page on GitHub to create a custom copy (also to track versions). Feedback is always welcome via GitHub or Twitter. Enjoy!
⚠ Task/competency information formatted as blockquotes, like this one, is per the NBME Item-Writing Guide, 6th Edition—Version November 2020.
Applying Foundational Science Concepts
MK1 Identifies the cause/infectious agent or predisposing factor(s) or, given an effect, determines the cause.
Sample MK1 Lead-ins:
- Which of the following pathogens is the most likely cause of this patient’s condition?
- Which of the following is the most likely infectious agent?
- This patient most likely acquired the infectious agent via which of the following modes of transmission?
- This patient most likely has a defect in which of the following?
- Which of the following is the most likely cause/mechanism of this effect?
MK2 Identifies the underlying processes/pathways that account for, or contribute to, the expression or resolution of a given condition.
Sample MK2 Lead-ins:
- Which of the following is the most likely underlying cause of this patient’s condition?
- Which of the following is the most likely explanation for this patient’s condition?
- Which of the following cell types most likely played a primary role in the development of this lesion?
- Which of the following immune system mediators plays a critical role in the pathogenesis of this patient’s current condition?
- This patient most likely has a deficiency in which of the following enzymes?
- Which of the following cytokines is the most likely cause of this condition?
- Which of the following processes is most likely impaired in this patient?
MK3 Recognizes or evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location.
Sample MK3 Lead-ins:
- The most likely cause of the findings in this patient is damage to which of the following structures?
- Which of the following structures is at greatest risk for damage during this procedure?
- Which of the following nerves is most likely carrying the sensation for this patient’s pain?
- The most likely cause of these findings is dysfunction of which of the following structures?
- Which of the following developmental abnormalities is the most likely cause of the findings in this patient?
MK4 Recognizes the mechanisms of action of various drugs; selects from an option set list of drugs based on mechanism of action.
Sample MK4 Lead-ins:
- Which of the following is the most likely mechanism of the beneficial effect of this drug?
- Which of the following is the most appropriate management? (response options would be drug classes or mechanisms of action)
- Which of the following is the most likely mechanism of action of the therapeutic effect of this drug?
- The most appropriate medication for this patient will have which of the following mechanisms of action?
Obtaining and Predicting History and Physical Examination
HP1 Knows signs/symptoms of selected disorders.
Response options are signs and symptoms. The item asks which signs and symptoms are characteristic of the patient’s condition. Typically used when patient presents with the condition.
Sample HP1 Lead-ins:
- Which of the following signs/symptoms is most consistent with the underlying diagnosis in this patient?
HP2 Knows individual’s risk factors for development of conditions. Given current symptoms in presented history, identifies other pertinent factors in the history.
Typically used when patient presents with the condition.
Sample HP2 Lead-ins:
- Which of the following factors in this patient’s history most increased the risk for developing this condition?
HP3 Given a specific problem, knows what to ask in obtaining further pertinent additional history.
The response options should not be referenced in the vignette and should not include details that would be obtained during initial history-taking. If asking about information that was already obtained and is mentioned in the vignette, use the following lead-in.
Sample HP3 Lead-ins:
- It is most appropriate to obtain specific additional history regarding which of the following?
HP4 Predicts the most likely additional physical finding; selects either the finding itself or the appropriate examination technique that would result in the finding.
The options are findings or directed physical examination techniques.
Sample HP4 Lead-ins:
- The remainder of the physical examination is most likely to show which of the following? (ensure all options are portions of the physical examination that would not yet have occurred in the patient scenario)
- It is most appropriate to direct the physical examination toward which of the following? (sample options: “Auscultation of the lungs,” “Palpation of the abdomen,” “Rotation of hip joints”)
- Which of the following signs or symptoms is most indicative of the need for further studies?
Selecting and Interpreting Laboratory and Diagnostic Studies
LDS1 Selects most appropriate laboratory or diagnostic study, including neuropsychiatric testing, or study most likely to establish/confirm the diagnosis.
LDS2 Interprets laboratory or other study findings.
LDS3 Predicts the most likely laboratory or diagnostic study result.
LDS4 Selects most appropriate laboratory or diagnostic study after a change in patient status.
Formulating the Diagnosis
DIA1 Selects the most likely diagnosis.
- Which of the following is the most likely diagnosis?
- Which of the following is the most likely working diagnosis?
- Which of the following best explains these findings? (options would be diagnoses; correct answer could be “Normal finding(s)”)
- Which of the following infectious agents is the most likely cause of this patient’s pneumonia?
DIA2 Assesses the developmental level of the patient.
⚠ No mention of this task/competency in the NBME Item-Writing Guide, 6th Edition—Version November 2020.
Determining Prognosis/Outcome
PRO1 Recognizes factors in the history, physical or laboratory study findings that affect patient prognosis or outcome or determine therapy.
PRO2 Interprets laboratory or other diagnostic study results and identifies current/future status of patient.
PRO3 Recognizes associated conditions of a disease, including complications, or indicators of potential complications, of a given disease.
PRO4 Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration, and transmission of disease from a specific patient.
HMP1 Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient, or knows the potential condition for which the patient may be at risk.
HMP2 Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptoms/dangerous disorders among various groups.
HMP3 Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population.
HMP4 Selects appropriate preventive agent or technique (eg, contraception, vaccines, vitamins).
HMP5 Knows appropriate counseling of patient or family regarding maintenance of current and future problems, including risk factors related to present encounter.
HMP6 Educates patients on screening, health maintenance, self-care.
HMP7 Assesses the developmental level of a healthy patient.
HMP8 Knows the indications for surveillance for recurrence or progression of disease following treatment. Monitoring chronic disease in a stable patient where a change in patient status might cause a change in therapy.
HMP9 Knows appropriate long-term surveillance goals.
Selecting and Monitoring Pharmacotherapy
PHA1 Selects most appropriate pharmacotherapy.
PHA2 Assesses patient adherence with treatment regimen, recognizes techniques to increase adherence or understanding of the disease state, and knows how adherence may be affected by providing instructions with therapy.
PHA3 Recognizes factors that alter drug dosing requirements for a patient.
PHA4 Knows adverse effects of various drugs, or recognizes signs and symptoms of drug (and drug-drug) interactions resulting from polypharmacy in the therapeutic regimen and knows steps to prevent polypharmacy including lab studies to monitor drug therapy.
PHA5 Knows contraindications of various medications.
PHA6 Modifies therapeutic regimen within the context of continuing care; selects appropriate modifications in therapeutic regimen.
PHA7 Knows appropriate monitoring to evaluate effectiveness of drug therapy or to monitor for the adverse effects of drug therapy in a patient that has not had a recurrence or progression of disease.
Clinical Interventions/Treatment
CLI1 Knows most appropriate management of selected conditions, including recognizing misuse of medication or drug or alcohol use.
CLI2 Knows immediate management or priority in management, specifically in emergency or acute cases.
CLI3 Knows most appropriate follow-up or monitoring approach regarding the management plan.
CLI4 Knows current/short-term management of patients.
CLI5 Evaluates severity of patient condition in terms of need for referral for surgical treatments/procedures versus other nonsurgical options.
CLI6 Knows appropriate surgical management.
CLI7 Knows pre/post surgical or procedural management.
CLI8 Knows indications for admission to the hospital or to other appropriate setting (eg, ICU). Knows appropriate non-hospital health care settings.
CLI9 Knows most appropriate discharge planning.
CLI10 Knows components of rehabilitation program.
CLI11 Knows appropriate use and procedures regarding hospice care.
CLI12 Educates patient or family regarding self-care.
CLI13 Knows relevant roles of allied health personnel.
Selecting Clinical Interventions
MIM1 Selects most appropriate management option from set of mixed management options (eg, mix of diagnostic studies, pharmacotherapy, procedures, observation, or referral).
COM1 Fostering the Relationship
COM2 Gathering Information
COM3 Providing Information
COM4 Making Decisions
COM5 Supporting Emotions
COM6 Enabling Patient Behaviors
COM7 Using an Interpreter or Surrogate
Sample COM Lead-ins:
- Which of the following is the most appropriate opening remark to this patient?
- Which of the following is the most appropriate response by the provider?
- Which of the following statements by the provider is most appropriate to…?
Understanding and Applying Principles of Professionalism, Legal and Ethical Issues in Interactions with Patients and Families
PLE1 Understanding and applying principles of professionalism, legal and ethical issues in interactions with patients
PLE2 Knows the guidelines for obtaining informed consent for treatment including children and adolescents, third-party permission, and emergent situations.
PLE3 Recognizes need for third-party permission for treatment in medical emergencies.
PLE4 Knows guidelines for treatment of minors with/without notification of parents.
PLE5 Knows definitions of competence and sanity.
PLE6 Knows the guidelines for involuntary admission.
PLE7 Knows guidelines for confidentiality of medical records.
PLE8 Knows guidelines for physician-patient relationship.
PLE9 Knows issues related to cultural competence and can apply knowledge in specific patient situations.
Understanding and Applying Principles of Professionalism, Legal and Ethical Issues Related to Death and Dying
PLE10 Assesses degree of disclosure to terminally ill patients.
PLE11 Recognizes patient’s right to refuse treatment or testing (patient autonomy); knows issues of advance directives and living wills.
PLE12 Assesses quality-of-life decisions.
PLE13 Knows appropriate prescriptive practices; knows appropriate use of opioids in terminally ill patients.
PLE14 Knows definition of and legal issues regarding brain death.
PLE15 Knows management of terminally ill patients related to treating chronic pain, and recognizing patient’s expression of fear of pain, injury, or death; knows how to comfort patient or family during crisis such as trauma or death.
Understanding and Applying Professionalism, Legal, and Ethical Issues in Dealing with Physicians and Other Health Professionals
PLE16 Knows guidelines for reporting findings to proper authorities.
PLE17 Knows Good Samaritan laws.
PLE18 Recognizes physician error and negligence.
PLE19 Recognizes and deals appropriately with impaired physician.
SBP1 Understands basic concepts and terminology, principles, and application of quality improvement science and outcome analysis.
SBP2 Recognizes and optimizes human and environmental factors (eg, workplace design, standardization, processes).
SBP3 Understands the role and characteristics of teams and communication strategies.
SBP4 Anticipates, recognizes, analyzes, and mitigates risk (sources of error).
SBP5 Evaluates, reports, and responds to near-misses and system errors.
SBP6 Identifies sources of error and suggests appropriate measures to evaluate or reduce the likelihood of specific errors.
Understanding and Application of the Principles of Biostatistics and Epidemiology
PBL1 Understands and can apply principles of epidemiology and population health, including health status indicators, outbreak investigation, points of intervention.
PBL2 Understands and can apply principles of study design and study flaws.
PBL3 Understands and can apply the principles of screening and other tests.
PBL4 Understands use and interpretation of statistical principles and measures of association.
PBL5 Is able to make decisions about patient care based on results of study or other written materials
PBL6 Understands the principles of research ethics and regulatory issues