New Year, new exam, and a throwback to the basic science…
That’s right…think back to first year of medical school type of basic sciences. We have known about the changes in the USMLE® Step 3 examination for some time. The first announcement of some of these changes came back in 2012 for the 2013 examination and the trend continues for 2014. This trend parallels a growing number of medical schools’ curriculum changes which are attempting to blur the lines between the traditional divide between basic sciences and clinical sciences. No longer are we to furiously memorize and then forget the fundamental mechanisms of biochemistry and pathophysiology. Now, we must integrate our fundamental knowledge with the clinical signs and symptoms of the patient in front of us. I, for one, am a big fan of this…let me tell you why:
- We are scientists: a differential diagnosis is no more than a series of hypotheses. We then go and perform a series of experiments (history, physical examination, laboratory, and radiographic tests) which confirm or refute our hypothesis. We were always meant to learn clinical and basic sciences hand in hand. The traditional divide was a disservice to the training of clinician scientists.
- Up with the independent thinking and down with the knee jerk associations: A firm understanding of basic science allows us to think critically and come to logical solutions. In the clinical sciences we have traditionally been taught “classic triads” which are associated with disease processes. The basic science behind the classic triad isn’t typically recalled from those early medical school classroom days. This process of teaching clinical medicine in a silo produces doctors that simply match triads with diseases without thinking about the underlying pathophysiology. Having a response that leads you to recognize a triad as being associated with a pathophysiologic process which results in the diagnosis (see the subtle but important shift there?) will lead to more accurate diagnosis and more all-inclusive treatment.
- Making the connection: This is hard to do sometimes in medicine. In thinking back to my Step 1 exam (I proceeded through a traditional medical school curriculum where basic sciences ruled for years 1 and 2 and clinical sciences for years 3 and 4) I can remember a lot of questions that I could have easily answered if I better understood clinical sciences and the same could be said about my basic science fund of knowledge on the Step 3 examination. As it turns out, medicine is all about making connections between what we know about the basic science (what goes on at the cellular and tissue level) and the clinical science (the patient who is talking right in front of you). Making those connections are not easy…that is why we go to medical school. The changes in the Step 3 exam will help guide students and educators to make those connections early, as the fund of knowledge if formed, rather than later when you are out in practice.
For any of you who fear the (re)introduction of the basic sciences into your world on the USMLE® Step 3, hold on to that worry. Be on the lookout for updated Kaplan USMLE® Step 3 preparation material which integrates and incorporates basic sciences into the Qbank and the question explanations. For those who feel behind the ball making those connections, this will put you back out in front.
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Learn more about the upcoming Step 3 exam changes. Click here to register.
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