The United States Medical Licensing Board has announced that there will be new items added to the Step 2 CK examination as early as August 3, 2011. These new items’ formats will assess an examinee's ability to appropriately interpret information presented both in the form of a research abstract and a pharmaceutical advertisement.

Students should be prepared to be able to analyze a pharmaceutical advertisement and answer multiple choice questions about the following areas as related to the pharmaceutical covered in the ad:

a) Biostastistics/epidemiology

b) Pharmacology/therapeutics

c) Development and approval of drugs and dietary supplements

d) Medical ethics

e) Decisions about individual patient care

In addition, students will be asked to interpret a clinical or experimental research abstract and answer questions related to:

a) Biostatistics/epidemiology

b) Use of diagnostic studies

c) Pharmacology/therapeutics

d) Decisions about patient care

The USMLE reports that examinees will experience no more than 5 of these questions on their exams. It is highly advised that students become familiar with the format and requirements of these questions by using the practice items on the USMLE website. When this was initially announced, USMLE had samples of each type of question posted, but these have since been removed. However, there may be samples within the USMLE Step 2 CK set of sample questions on the USMLE website at http://www.usmle.org/practice-materials/index.html You will be required to download the newest version of the FRED software before sampling the new questions, but it is definitely worth at least going through the tutorial before your exam day. The Pharmaceutical Advertisement is the 4th sample in the tutorial and the Research Abstract the 5^th.

The Pharmaceutical Advertisement questions use a different tool bar with new selections with which to become familiar. In addition, be aware that the FRED highlighting tool is not functional in the Pharm Advertisement. The student must locate the “View Ad” button to view the advertisement and then toggle back and forth between the ad and questions. There is an option to reduce the size of the ad, but simultaneous viewing of both the question and the ad is difficult.

There were two multiple choice questions associated with the pharmaceutical ad question. One question did not need the ad to answer the question, since to choose the most rigorous research methodology was the focus of the question. The other question required careful scrutiny of the advertisement, and while the ad was only 1 page and reasonable in format, it included a chart and a table and took more than the standard 1 minute to answer.

The Experimental/Clinical Abstract questions are set up with the abstract on the left side of the page and the questions to the right of the abstract. Tables are often included in the abstract requiring that the student scroll up and down to view, but the sample included in the practice materials was easy to work with. Again, there were two questions associated with one abstract. Both questions required careful reading of the abstract and thoughtful consideration, taking more than 1 minute per question.

We make the following suggestions:

1. Practice these items using the USMLE website to become familiar with the format and goals of the test constructors. (Ask yourself, “What do they want me to do with these new formats?” “How do I want to strategically approach these new items on my exam?”)

2. Mark these items and save them to the end of the block. These items count the same amount as all of the other items. If you get behind on these items, you will lose valuable points on several other items. However, if you save these to the end of the block, then you will only miss one question, perhaps two if you do not finish them. (Remember, there will only be a maximum of 5 of these questions on your exam, so perhaps 1-2 on any given block.)

3. Read the question stem and answer selections before going to the pharm ad and abstract so you have a greater awareness of how to approach the task. Practice the strategy with the materials provided by the USMLE to see if this works for you before trying it out on the actual exam.