BOX 7-2
General Principles of Gender, Ethnic, and
Behavioral Considerations for USMLE Step 1

Psychologic and social factors influencing patient behavior:

• personality traits or coping style, including coping mechanisms

• psychodynamic and behavioral factors, related past experience

• family and cultural factors, including socioeconomic status, ethnicity, and gender

• adaptive and maladaptive behavioral responses to stress and illness

• interactions between the patient and the physician or the health care system

• patient adherence, including general and adolescent


SOURCE: FSMB and NBME, undated-a.

health services. However, such test questions would most likely be woven together with questions dealing with chronic diseases instead of making up a separate section devoted to psychological and social factors.9

Similarly, Step 2 of the exam (usually taken after the fourth year of medical school) does not explicitly cover psychosocial health services, but a “broad spectrum of cases reflecting common and important symptoms and diagnoses” (USMLE, 2006:9). It tests clinical knowledge and communication and interpersonal skills using standardized patients.10 Approximately 15–20 percent of the exam addresses “promoting preventive medicine and health maintenance,” as in the assessment of risk factors and application of preventive measures, and approximately 15–25 percent addresses “applying principles of management,” as in the care of people with chronic and acute conditions in ambulatory and inpatient settings (USMLE, 2006:8). Step 3 of the exam may cover psychosocial health services since “test items and cases reflect the clinical situations that a general, as yet undifferentiated, physician might encounter within the context of a specific setting” (FSMB and NBME, undated-b).


9Personal communication, G. Dillon, National Board of Medical Examiners, October 10, 2006.

10USMLE Step 2 assesses whether candidates can “apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention” (USMLE, 2006:2).

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