Changes to USMLE procedures for reporting scores

“Changes on December 26, 2012″

As previously reported, the USMLE program has begun the process of eliminating the reporting of results on the 2-digit score scale to parties other than the examinee and any state licensing authority to which the examinee sends results. This process began on July 1, 2011 with elimination of 2-digit scores from USMLE transcripts reported through ERAS.

The USMLE program will extend this change in reporting to include ALL score recipients (e.g., examinees, state medical boards). This means that scores on the 2-digit scale will no longer be calculated or reported. We expect to eliminate the 2-digit score on or about April of 2013. This change pertains to the Step 1, Step 2 CK, and Step 3 examinations only; Step 2 CS will continue to be reported as pass or fail.

 

Background

Since its beginning in the 1990s, the USMLE program has reported two numeric scores for the Step 1, Step 2 CK, and Step 3 examinations, one on a 3-digit scale and one on a 2-digit scale. The 3-digit score scale is considered the primary reporting scale; it is developed in a manner that allows reasonable comparisons across time. The 2-digit scale is intended to meet statutory requirements of some state medical boards that rely on a score scale that has 75 as the minimum passing score. The process used to convert 3-digit scores to 2-digit scores is designed in such a way that the 3-digit minimum passing score in effect when the examinee tests is associated with a 2-digit score of 75.

The USMLE program requires its governing committees to reevaluate the minimum passing score for each Step every three to four years. This process has, at times, resulted in changes in the minimum passing score, expressed on the 3-digit scale, and an accompanying change in the score conversion process, to ensure that a 2-digit score of 75 is associated with the new minimum passing requirement. A by-product of the adjustment of the score conversion system over time has been a shift in the relationship between the two score scales. This shift has no impact for USMLE score users who use the 3-digit scoring scale or for those using the 2-digit scale with a primary interest in whether the examinee has a passing 2-digit score of at least 75. However, it may create challenges in interpretation for score users who are focusing on 2-digit scores, other than 75, and are doing so for purposes of comparing USMLE scores that span several years.

To eliminate the misuse of and confusion surrounding the 2-digit scale, the USMLE Composite Committee, the governing body of the USMLE program, directed staff to discontinue its reporting.

Source: http://www.usmleworldwide.com/blog/?p=1018

Additional changes to USMLE procedures for reporting scores

“Changes October 03, 2011″

As was reported previously, the USMLE program has begun the process of eliminating the reporting of results on the 2-digit score scale to parties other than the examinee and any state licensing authority to which the examinee sends results.

Because USMLE will continue to report the 2-digit score to examinees and to state licensing authorities, the program will be making changes in scoring procedures to minimize the impact of future shifts in the relationship between 2-digit and 3-digit scores that result from USMLE’s periodic review of standards. The new scoring procedures will be implemented with the reporting of results for examinees who take a Step 1, Step 2 CK, or Step 3 examination on or after October 1, 2011.

The change in scoring procedures will introduce a more stable relationship between score scales in the future. Those receiving 2-digit score results under the new system will note that, in most instances, the 2-digit score associated with a specific 3-digit score will be substantially lower than it was prior to this change.

The change in scoring procedures described above does not correct the challenges associated with using the 2-digit score scale for decisions other than those that use a score of 75 or higher to identify examinees who have passed the examination. It is highly recommended that the 3-digit score scale be used for comparisons among examinees, especially for examinees who have tested at different points in time.

Source: http://www.usmleworldwide.com/blog/?p=1013

Changes to USMLE procedures for reporting scores

“Changes on May 04, 2011″

Starting July 1, 2011, USMLE transcripts reported through the ERAS reporting system will no longer include score results on the 2-digit score scale. USMLE results will continue to be reported on the 3-digit scale. This affects the Step 1, 2 CK, and 3 examinations only; Step 2 CS will continue to be reported as pass or fail. These changes do not alter the score required to pass or the difficulty of any of the USMLE Step examinations.



Since its beginning in the 1990s, the USMLE program has reported two numeric scores for the Step 1, Step 2 CK, and Step 3 examinations, one on a 3-digit scale and one on a 2-digit scale. The 3-digit score scale is considered the primary reporting scale; it is developed in a manner that allows reasonable comparisons across time. The 2-digit scale is intended to meet statutory requirements of some state medical boards that rely on a score scale that has 75 as the minimum passing score.  The process used to convert 3-digit scores to 2-digit scores is designed in such a way that the 3-digit minimum passing score in effect when the examinee tests is associated with a 2-digit score of 75.

The USMLE program requires its governing committees to reevaluate the minimum passing score every three to four years. This process has, at times, resulted in changes in the minimum passing score, expressed on the 3-digit scale, and an accompanying change in the score conversion process, to ensure that a 2-digit score of 75 is associated with the new minimum passing requirement. A by-product of the adjustment of the score conversion system over time has been a shift in the relationship between the two score scales. This shift has no impact for USMLE score users who use the 3-digit scoring scale or for those using the 2-digit scale with a primary interest in whether the examinee has a passing 2-digit score of at least 75. However, it may create challenges in interpretation for score users who are focusing on 2-digit scores, other than 75, and are doing so for purposes of comparing USMLE scores that span several years.

To simplify matters and make interpretation of USMLE information more convenient for score users, the USMLE Composite Committee has asked staff to report 2-digit scores only to those score users for whom the scale is intended, i.e., the state medical boards. The Committee also asked that examinees continue to receive scores on both scales so that they are fully informed about the information that will be reported when they ask that results be sent to a state medical board. When examinees request that their results be sent to other score users, only the 3-digit score will be reported. Current plans call for these changes to begin with the elimination of the 2-digit score from USMLE transcripts reported through the ERAS reporting system starting July 1, 2011. Other systems and procedures for reporting results will be similarly modified as soon as possible after the July 1, 2011 date.

Source: http://www.usmleworldwide.com/blog/?p=1010

Usmle Step 1 MCQ’s # 42

Title: Usmle Step 1 MCQ’s # 42
Subject: Behavioral Science

Q NO 42: While driving home at the end of an evening on call, a second year resident encounters an automobile accident. She decides to stop and render whatever aid she can. The accident involves two cars. In the first car, the driver was cushioned by an airbag and suffered only minor bruises and abrasions. In the second car, the driver was thrown against the steering wheel and against the wind shield, causing severe thoracic and closed head trauma. Fearing a fire, the resident pulls the driver out of the second car, and proceeds to do what she canto stop the loss of blood. In spite of her best efforts, the second driver dies. Subsequent autopsy determines that moving the driver from the car exacerbated a spinal injury and contributed to the driver’s death. The driver’s family sues the resident and the hospital at which she works, claiming negligence. The complaint states that the resident should have known not to move the patient and that the hospital bears responsibility for not training the resident adequately, and the lack of sleep resulting from the night on call. The most likely outcome for this legal case is which of the following?

A. Civil, but not criminal penalties, for both the resident and the hospital
B. Civil, but not criminal, penalties for the hospital, and no penalties for the resident
C. Civil, but not criminal, penalties for the resident, and no penalties for the hospital ‘O
D. Criminal and civil penalties for both the resident and the hospital
E. Criminal and civil penalties for the hospital, but not for the resident
F. Criminal and civil penalties for the resident, but not for the hospital
G. Neither civil nor criminal penalties for either the resident or the hospital

Explanation:
The correct answer is G. The issue here is a simple one the Good Samaritan law says that physicians do not have to stop to help in a non-medical situation like an accident. However to encourage them to stop, the physician is shielded from legal liability as long as he or she: 1) acts within their area of competency 2) does standard procedures, 3) stays until relieved by competent medical personnel and 4) receives no compensation. The physician can still be sued but is protected from any adverse judgment. In the present case all four of these conditions are met. Moving the patient when there is a threat of fire is perfectly reasonable. The physician is shielded from liability.
The hospital is also shielded from liability. The resident is technically an employee but was traveling home alter a night on call and therefore “off duty.”
Finally neither the physician nor the hospital is subject to any criminal charges. There was no malicious conduct nor any perverse neglect nor anything else that would rise to the level of criminal action.

Source: http://www.usmleworldwide.com/blog/?p=957

Usmle Step 1 MCQ’s # 41

Title: Usmle Step 1 MCQ’s # 41
Subject: Behavioral Science

Q NO 41: A 47-year-old man comes to the physician 1 year after his wife died in an automobile accident. Ever since the accident, he has had feelings of worthlessness, self-blame, insomnia, and fatigue. He does not go out with friends and never goes to football games anymore, formerly his favorite pastime. He is “sad all the time1” has lost 15 pounds frequently spends nights and weekends crying on the couch, and finds it difficult to move. Sometimes he cannot even get up to go to work. He says that his symptoms have been worsening over time. He is not so sure that wants to “be around” without his wife anymore. Which of the following is the most likely diagnosis?
A. Conversion disorder
B. Dysthymic disorder
C. Major depressive disorder
D. Normal grief
E. Separation anxiety disorder

Explanation:
The correct answer is C. This patient most likely has major depressive disorder. He has had depressed mood insomnia fatigue, weight loss anhedonia, psychomotor retardation, feelings of worthlessness, and suicidal ideation for a year. These symptoms are causing severe distress and functional impairment. They are severe enough to meet the criteria for a major depressive episode and are not better accounted for by normal grief and bereavement. Normal grief (choice D) is usually characterized by a depressed mood, feelings of loss crying spells, and decreased enjoyment in life. Dysfunction may occur, however alter several months the individual should led less sad and become more functional with time. Suicidal ideation, psychomotor retardation, and marked functional impairment are consistent with depression and not normal grief.
Conversion disorder (choice A) is characterized by the sudden onset of motor or sensory symptoms and dysfunction that are without an identifiable physical cause. The symptoms are temporally related to a psychological stressor, however the deficit is not intentionally produced. This patient does not have motor or sensory symptoms.
Dysthymic disorder (choice B) is a chronic, persistent feeling of mild depression that lasts for more than 2 years. These patients do not meet the criteria for a major depressive episode. The patient in this case meets the criteria for major depression.
Separation anxiety disorder (choice E) is an anxiety disorder that occurs when the individual leaves home or relatives. It is most common in children and often presents with headaches stomach cramps nightmares and school avoidance. The patient in this case is not experiencing anxiety, he is depressed.

Source: http://www.usmleworldwide.com/blog/?p=861

Usmle Step 1 MCQ’s # 40

Title: Usmle Step 1 MCQ’s # 40
Subject: Behavioral Science

Q NO 40: A 5-year-old girl is brought by her parents to the emergency room because she is complaining of stomach pain. Physical examination reveals multiple bruises on the child’s body in different stages of healing. X-ray examination of the chest demonstrates two cracked ribs and the child says. “Mommy hit me.” The parents deny any abuse of their children. The physician’s most appropriate response would be which of the following?

A. Call the police immediately
B. Hospitalize the child for further studies
C. Notify Child Protective Services
D. Tape her ribs and make the parents promise me that they will not strike the child again
E. Tape her ribs and tell the parents to bring the child to the outpatient clinic in the morning

Explanation:
The correct answer is C. All signs, including the child’s report, suggest child abuse; however, there can be mitigating circumstances that are present. All states have laws requiring everyone to protect children by reporting the suspicion of child abuse to Child Protective Services. It is the responsibility of this agency to prove or disprove the suspicion, and to establish supervision of the child if abuse is verified.
“I am going to call the police right now” (choice A), is only appropriate if the Child Protective Services is not available immediately.
Choices B, D, and E do nothing to address the issue of the mandatory report of the suspicion of child abuse to the appropriate authorities.

Source: http://www.usmleworldwide.com/blog/?p=857

Usmle Step 1 MCQ’s # 39

Title: Usmle Step 1 MCQ’s # 39
Subject: Behavioral Science

Q NO 39: A nurse on an inpatient internal medicine ward comes to see the attending physician. While drawing blood for routine laboratory tests ordered by the medical staff, the nurse inadvertently stuck herself with a hypodermic needle, in which were several drops of the patients blood. The nurse is anxious, and wants the physician to order that the patient’s existing blood sample be tested for HIV. The physician is aware that the patient has a history of homosexual encounters, although neither the physician nor the nurse are aware of the patient’s HIV status. At this point, the physician should do which of the following?

A. Assure the nurse that the probability of contracting HIV by this method is relatively low, but that she should be more careful in the future.
B. Convene a meeting of the nursing staff and ask it anyone on the ward is aware of the patient’s HIV status.
C. Order the test, as the nurse requests.
D. Review the patient’s chart and medical histor’ for clinical signs consistent with HIV infection.
E. Talk to the patient and order the test only if the patient gives his permission.
F. Tell the nurse that you will order the test if she can obtain the patient’s permission.

Explanation:
The correct answer is C. The general rule is that patient’s conl9dentialitv is to be respected at all times. This means that no medical procedure, including laboratory tests, can be run on a patient without his or her consent. There is one exception: threat of harm to self or others. The guidelines of the American Medical Association explicitly state that the exception applies in this case. The nurse may be at risk. If the patient is HIV-positive, treating her quickly greatly reduces the chance of becoming HIV-positive and increases her life span should she become HIV-positive.
The nurse has aright to treatment and the right to know if she needs treatment. She needs more than reassurances (choice A). She needs the test performed to know the patient’s HIV status.
This is an escalation that breaks the confidentiality of both the patient and the nurse. Simply running the screening test constitutes much less of a breach than initiating a general discussion with in the hospital staff (choice B)
Knowing that the patient is homosexual already places him in one of the high-risk groups. It is unlikely that reviewing the medical chart (choice D) will produce information that would obviate the need for HIV testing.
Because of the threat of harm clause the patient’s permission is not required (choices E and F).

Source: http://www.usmleworldwide.com/blog/?p=769