Changes to the NBME Practice exam forms

On the 3rd of March, 2014 the National board of Medical Examination (NBME) has made some changes in the NBME practice exam forms designed for the preparation of USMLE step 1examination. Because there is a change in the minimal passing score for USMLE step 1, the National board of medical examiners has retired form 5 and 6 of the Comprehensive Basic Science practice exams (CBSSA) for step 1.
Comprehensive Basic Science practice exams (CBSSA) form 16 is now available for regular and expanded feedback from March 3rd. According to the NBME site, the CBSSA started after 3rdMarch will have a different longitudinal profile for performance due to changes in the minimal passing scores in the step 1 of USMLE examination. There are also changes made in the CBSSA scoring scale. The scores of the CBSSA forms completed before this date will not be rescored or compared against those started after March 3rd.
6 forms are available now for CBSSA step1 for 50$/exam. They are form 7, 11, 12, 13, 15 and 16. An expanded feedback form can be obtained for an additional 10$/exam.

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Passing the USMLE exam

The USMLE step 1 examination is designed to assess the understanding and the applicative skills of the candidate regarding basic sciences in medicine. Special emphasis is given on disease, the various modes of therapy and mechanism governing underlying health issues. Step 1 USMLE examination is a one day examination including 322 multiple choice questions. These multiple choice questions are presented in 7 blocks. There are 46 questions in each block. The time allotted to complete each block is 60 minutes and there is a break of 45 minutes in between.

Passing the USMLE exam is mind blowing and needs a thorough knowledge of the subject. The minimum passing score is given forth as a three digit number. The minimum passing score for the USMLE Step 1 is 192. Scores are released every Wednesdays and it usually takes 3 to 4 weeks to receive the score.

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What is the USMLE?

USMLE is the medical licensing examination for the United States, sponsored by Federation of State Medical Boards of the United States and the National Board of Medical Examiners. The USMLE is a three step examination which assess the physician`s skills and ability of applying the knowledge and concepts for an effective patient care and the physician`s capability to demonstrate the fundamental patient- centered skills. This examination has three steps and each of it complement the others in such a way that no one step can stand alone as an assessment of readiness by itself. The three steps of the USMLE examinations are discussed in this article.
The step 1 of the USMLE examination assess the Knowledge and ability of the candidate to apply the basic sciences in the medical practice ensuring that the candidate has mastered the foundation sciences for a successful and competent practice in the field of medicine. This also ensures that the candidate is familiar with all the principles required to maintain the competence through life- long learning.
This is a one day examination, containing 322 multiple choice questions divided into 7 blocks and a maximum time of 60 minutes is allocated for each block. The examinees have a 45 minutes break in between and an optional 15 minutes of tutorial. Each section of this step is focused on the individual organ systems, abnormalities, and cultural, environmental and psychosocial considerations.
USMLE Step -2:
The USMLE step 2 examination is divided into two sections, the step-2 CK, which assess the clinical knowledge and the Step -2 CS, which assess the clinical skills of the candidate. The step-2 CK is a one day examination that assesses the understanding of the clinical skills of the candidate and how much they can be applied under supervision. This also gives much importance to disease prevention and health promotion. The exam is constructed in such a way that it gives more emphasis on two categories such as physician`s task and disease category. Similar to the step-1 examination, this step has 355 Questions divided into blocks and the test item formats may vary within each block.
The USMLE step-2 CS evaluates the clinical skills of the candidate by allowing them to assess and communicate with standardized patients under supervision. In this the physician`s communication and interpersonal skills and spoken English proficiency is assessed. The step-2 CS has three sub-components such as the Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS) and Spoken English Proficiency (SEP).
USMLE Step-3:
The USMLE step-3 mainly emphasize on patient care in ambulatory settings. Step-3 is a two day examination. The first day examination lasts for 8 hours: 7 hours of exam and 45 minutes break in between. The exam contains 336 multiple choice questions divided into 7 blocks and the second day exam comprises of 144 Questions divided into 4 blocks. Apart from this there are 12 simulation cases to be completed within 4 hours. There is also an optional survey at the end of the day.
Completing all three steps is mandatory to be qualified for acquiring the medical licensure in United States. Hence only competent candidates with the highest standards can come out as successful practitioners getting through the USMLE examinations.


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How to become a physician assistant



A physician assistant is a medical professional graduated from a physical assistant educational program that is accredited and is licensed to practice medicine under the direct supervision of a physician. The physician assistant can do physical examinations, diagnose ailments, treat people, assist surgeries, prescribe medications, provide counseling and involve in patient education. The physician and the physician assistant work as a team and provide high quality care for the patients.

The physical assistant education program

The physical assistants are trained similar to the physicians under the accredited physical assistant education program. This program has a curriculum that is similar to the medical school and has both classroom and clinical approach of instructions. This is a rigorous education program for about 27 months equipping the applicant to face any medical situations even in the absence of a physician.

Getting admission for a physician assistant program is very competitive and requires two years of college courses involving basic sciences such as anatomy, physiology, biology, microbiology and chemistry. Also the applicants for a physician assistant education program should have prior experience in health care and should have completed courses on behavioral management. This is similar to the pre-medical studies undertaken by a student of the medical school.

The curriculum in the physician assistant program comprises of various subjects such as anatomy, patho- physiology, physiology, biochemistry, microbiology, diagnosis, behavioral science,pharmacology, medical ethics and clinical lab science. Moreover the physician assistant should undergo clinical rotations for more than 2000 hours. They should also complete 100 credit hours of continuing education every two years.
The clinical rotations mainly give importance to ambulatory clinics, long term and short term care, facilities and physician offices. The clinical rotations include various disciplines such as internal and family medicine, general surgery, obstetrics and gynecology, psychiatry and emergency medicine.
Duties of physician assistant
The physician assistants work as a team with the physician in providing health care to patients. The physician delegates the duties for the physician assistant which is carried out by the physician assistant. The physician assistant can make autonomous decisions of the patient care independent of the physician when needed. Also the physician assistant can provide health care to patients in rural areas even in the physical absence of the physician communicating through telecommunication. As the physician assistants are also trained similar to the physicians they share the same therapeutic and diagnostic reasoning.
The physician – physician assistant team model is an excellent way of dispensing high quality health care to the patients. Some researches even prove that the quality of treatment of the physician assistant is as good as that of the physician and the patient satisfaction is also the same as that of a physician.


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Case 1: Complications of pancreatitis: hyperbilirubinemia

A 49 year old male presents to the ed with c/o epigastric pain radiating to his back. Patient states that pain started 3 days ago and has been radiating to the back. Patient states eating or drinking makes pain worse and he has had no appetite for days. Patient c/o nausea, vomiting. Patient denies any fever, chills, diarrhea., chest pain, or shortness of breath. Patient states he is a chronic alcoholic and drinks 12 packs of alcohol daily. PMHx: chronic pancreatitis. Pt smoke 1 1/2 packs a day.
BILI, TOTAL 5.07 H mg/dL Normal 0.20-1.00
PROTEIN, TOTAL 7.1 g/dL Normal6.4-8.2
ALK PHOSPHATASE 592 H U/L Normal 50-136
ALT (SGPT) 144 H U/L Normal 6-78
AST(SGOT) 57 H U/L Normal 0-45
BILI, DIRECT 3.96 H mg/dL Normal 0.00-0.20
ALBUMIN 1.8 L g/dL Normal 3.5-5.0

Take home lesson
Patient with pancreatitis has many complications such as pseudocyst formation, pancreatic abscess, necrosis, sepsis. Patient will require percutenous drainage of the pseudocyst.

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