Reduction in number of Step 1 items presented without a clinical vignette

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Reduction in number of Step 1 items presented without a clinical vignette; updated Step 1 practice items available
Posted April 21, 2010

Most examinees who take a Step 1 examination after May 15, 2010 will see fewer items presented in a non-clinical vignette format.

Efforts to assess basic science knowledge in a clinical context in the Step 1 examination have been underway for several years. This work is part of the ongoing Comprehensive Review of USMLE (CRU). One of the recommendations emerging from the CRU process is that USMLE emphasize the importance of the scientific foundations of medicine in all components of the assessment process and that the assessment of these foundations occurs within a clinical context or framework, to the greatest extent possible.

The changes planned for Step 1 are consistent with this recommendation. Although the overall balance of content areas will remain comparable to recent Step 1 examinations, non-clinical presentations will be reduced. Step 1 practice items available on the USMLE website have been updated to reflect this change. Click here to see updated practice items.

The difference between an item presented in the context of a clinical vignette and one presented in non-vignette style can best be seen through examples.

Example # 1

Non-vignette item
Which of the following causes hypotension in the presence of sepsis?
(A) Endothelial cell cytotoxin
(B) Endotoxin
(C) Hemolysin
(D) Protease
(E) Superantigen
Answer: B

Clinical vignette item
A 37-year-old man with pancreatic cancer is brought to the emergency department because of fever and muscle aches for 4 days. His temperature is 39.7°C (103.5°F), and blood pressure is 70/40 mm Hg. Physical examination shows no other abnormalities. Blood cultures grow lactose-positive, motile, gram-negative rods. Which of the following is the most likely cause of this patient’s hypotension?
(A) Endothelial cell cytotoxin
(B) Endotoxin
(C) Hemolysin
(D) Protease
(E) Superantigen
Answer: B


Example #2

Non-vignette item
Which of the following drugs will cause acute hepatitis in a therapeutic dose in the presence of chronic liver disease?
(A) Acetaminophen
(B) Aspirin
(C) Cimetidine
(D) Diphenhydramine
(E) Triazolam
Answer: A

Clinical vignette item
A 52-year-old man comes to the emergency department because he has had vomiting, nausea, and abdominal pain for the past 12 hours. He says he attempted suicide 3 days ago by “taking everything in the medicine cabinet.” He was stuporous for approximately 12 hours after the overdose but felt better the following day. At this time, he has jaundice and pain in the right upper quadrant. Which of the following drugs is most likely to have caused the pain, vomiting, and jaundice?
(A) Acetaminophen
(B) Aspirin
(C) Cimetidine
(D) Diphenhydramine
(E) Triazolam
Answer: A

See additional information on changes to the examination on or about May 15, 2010 here.

 

[njmedstudent87]

I studied wrong the whole time!

No, but the clincal vignette method is so much more intriguing and dare I say sexy. I will actually enjoy the 8 hrs and 300+ questions that'll be shot at me.

 

[DrTacoElf]

So far just this year

1) passing has moved from 185-->188
2) total questions have changed from 336 ---> 322 (thats now 46
questions x 7 blocks instead of 48 questions per block)
3) More clinical vignette based questions will be introduced


Wonder what else is in store.....😱

 

[illixir]

Those vignettes in the examples aren't even that long and I think the counter-examples of the current questions weren't very representative...

 

[DRJJ1]

Those vignettes in the examples aren't even that long and I think the counter-examples of the current questions weren't very representative...

whats next? 200 pass soon enuff

 

[MilkmanAl]

I actually think the vignette is the easier question in both scenarios. I guess this news is bad if you're a slow reader, but anything that boosts my score is fine by me.

 

[turkeyjerky]

I actually think the vignette is the easier question in both scenarios. I guess this news is bad if you're a slow reader, but anything that boosts my score is fine by me.

I agree with you. This is good news in my mind and fits with the recent decrease in the number of questions. I was worried about that cause it'd make the curve harder, but this would seem to offset that.