Master the board step 3

Master the Boards: USMLE Step 3
Clinical Encounter Frames
Multiple-choice and case-simulation questions are presented in one of three
clinical encounter frames: initial care, continuing care, and urgent care. The
encounter frame determines the amount of history, as well as clinical and laboratory
test results, that are available to you. More importantly, the encounter
frame influences how you’ll proceed with management. For example, a longstanding
patient with a history of repeated hospitalizations for asthma who
presents with shortness of breath would be approached differently than if she
were presenting for the first time to a clinic complaining of periodic dyspnea
or if she presented to the emergency department with an acute asthma attack.
The majority of test items (50 to 60 percent) in Step 3 involve the management
of continuing-care patients. In the continuing-care setting, you are tested on
your ability to recognize new problems in an existing condition, assess severity,
establish prognosis, monitor therapy, and perform long-term management.
Clinical Settings
There are 3 clinical settings in Step 3: office/health center, inpatient facility,
and the emergency department. As with the encounter frame, knowing the
clinical setting influences your management decisions. As will be discussed in
the “Examination Structure” section, test questions will be arranged in blocks
based on one of the three clinical settings.
Physician Tasks
For any given clinical encounter frame in a clinical setting, you’ll be challenged
with a finite number of skills. The 6 physician tasks that are tested on the Step 3
exam are representative of what all physicians practicing unsupervised medical
management are expected to know.
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