How to Answer Patient Chart Questions on the USMLE® Step 1, Step 2 CK, & Step 3

Be prepared for every type of question you’ll encounter on the USMLE Step 1, Step 2 CK, and Step 3 exams: AMBOSS now includes a new patient chart-style study plan in its Qbank. 

Check out the study plan here

Medicine is never static. With the constant supply of new research and experiences gathered, medical practice must evolve such that care providers are better able to serve the communities around them.

Of course, that means that medical education and related institutions are never static, either. Institutions like the National Board of Medical Examiners (NBME®) must tailor their testing standards so that you can better realize your potential as a physician or surgeon. This is most apparent in the kinds of questions that have been appearing in Step 1, Step 2 CK, and Step 3 exams and it’s why AMBOSS is making sure you’re getting a chance to practice those kinds of questions while you’re prepping.  

Different types of USMLE and NBME question formats

Questions featuring unexpected examination scenarios and formats are a great way for the writers of USMLE and NBME exams to put your knowledge, and your ability to apply it, to the test. For example, examiners may include questions about patients from marginalized groups or those working in various occupations, like the armed services or military.

Other questions may present information in ways much more similar to patient charts and other clinical documentation. A patient chart question is a question (or history and physical (H&P) question) that doesn’t present you with a scenario distilled down to a paragraph vignette. Instead, it features documentation of a history and physical (H&P) conducted by a physician in a hypothetical patient care scenario.

It is then up to the test-taker to determine which information present in a patient chart question is or isn’t relevant. Namely, only by evaluating a patient’s history, symptoms, and physical exam findings will you be able to reach conclusions about the most likely cause, diagnosis, or treatment. The NBME has significantly increased the proportion of patient chart questions in all three Step exams. For Step 2, roughly 10% of all Qs are now patient chart questions. AMBOSS now has a study plan that features a variety of patient chart questions that you can try for yourself here:

Patient chart questions within AMBOSS are not designed to be any more challenging than any other type of exam question. They may, however, take longer to read and require a little bit of judgment regarding the relevance of the information presented. As a result, getting accustomed to their formatting is essential, especially when you have only about 90 seconds to answer each on the actual exam! Practice your skills with the AMBOSS patient chart study plan!

How to master patient chart questions

1. Understand the format. You can expect the information presented in patient chart questions to be ordered as follows: patient information, history of present illness, past medical history, social history, medications, allergies, and physical exam.
2. Read the final sentence of the question first. Given the large amount of information they present, reading the final sentence of the question (the stem’s actual question) before diving into the patient chart may provide clues as to how you can best approach it. Similarly, reading the answer choices themselves beforehand can also provide an advantage.
3. Give them a quick scan for key information. Of course, some essential information may not jump out to you right away, but becoming broadly oriented to the scenario at hand may be useful when you examine the specifics later on.
4. Not all of the information presented to you is relevant. Keep it simple, and don’t try to include every single piece of information into the broader theory of the patient scenario.
5. Remember the context. Although the information presented to you in a patient chart question looks much like a history and physical you would encounter in the clinical setting, you won’t have time to assess it with the same level of curiosity and scrutiny that you would when reading the chart of a patient you’re treating. Spending more than 5 minutes on a patient chart question may mean that something about your approach should change.

Although the prospect of new question formats and scenarios may be surprising for test-takers, changes within the world of medical examination ultimately reflect changes within the world of practical medicine. As more and more emphasis is placed on the clinical skills of practicing physicians, it makes sense for exam writers to want to assess a student’s application of those skills through new formats. Luckily, we at AMBOSS have got you covered. Our Qbank is always up-to-date and includes question types that help prepare you for anything you might find on your USMLE exam.