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United States Medical Licensing Examination

Obtaining History and Performing Physical Exam

	Knows signs/symptoms of selected disorders.
	Interprets elicited history.
	Knows individual's risk factors for development of condition leading to encounter.
	Interprets patient's habitus, posture, and facial expression.
	Knows commonly associated pertinent history.
	Associates current complaints with presented history and identifies pertinent factor.
	Knows appropriate directed physical examination or required technique.
	Recognizes pertinent physical findings.
	Interprets particular physical finding in order to differentiate one disorder from another.
	Performs or interprets mental status and neurologic exams.
	Recognizes new physical signs and symptoms in a patient with an established disease.

Objectives Related to Using Laboratory and Diagnostic Studies

	Knows when NO diagnostic or laboratory studies are indicated.
	Selects appropriate routine or initial laboratory or diagnostic studies.
	Interprets the clinical impact of laboratory or diagnostic test findings.
	Knows appropriate invasive, special, non-routine, or follow-up studies.
	Knows appropriate common screening tests for conditions related to an encounter or complaint.
	Identifies study/procedure most likely to establish the diagnosis or distinguish one diagnosis from another.
	Predicts the most likely laboratory or diagnostic test result.

Objectives Related to Formulating the Most Likely Diagnosis

	Identifies diagnosis when given a criterion finding.
	Selects the most likely diagnosis or evaluates differential in light of history and/or physical and/or diagnostic test findings.
	Knows the most likely cause or preliminary diagnosis associated with the presented signs and symptoms or physical findings.

Objectives Related to Evaluating the Severity of Patient's Problems (Prognosis)

	Evaluates severity of patient condition and identifies indications for consultation or diagnostic assessment.
	Evaluates appropriateness of available data or therapies.
	Assesses severity of patient condition and makes judgment as to current status, prognosis, or need for further action.
	Recognizes factors in the history (given symptoms) that affect patient prognosis.
	Evaluates patient data in light of management plan.
	Recognizes iatrogenic complications, not drug-related.
	Knows clinically relevant implications of specifically referenced treatment.
	Interprets laboratory or diagnostic results and identifies current status of patient.

Objectives Related to Managing the Patient

Management of Health Maintenance and Disease Prevention

	Recognizes physician's best choice of words in eliciting history or further description from the patient; knows statements that facilitate communication with the patient.
	Knows risk factors for conditions amenable to prevention or detection in an asymptomatic patient.
	Knows pertinent incidence statistics and identifies patient groups at risk; knows incidence of symptomless/dangerous disorders among various groups.
	Identifies organ/system at greatest risk in the patient.
	Knows appropriate directed physical exam in screening an asymptomatic patient during a well-care visit.
	Knows common screening tests for conditions amenable to prevention or detection in an asymptomatic patient or population.
	Knows range and timing of diagnostic study in monitoring for prevention.
	Selects appropriate preventive, therapeutic agent/technique.
	Selects appropriate follow-up management when first plan is not effective.

Clinical Intervention

	Identifies appropriate cost-effective management.
	Evaluates severity of patient condition in terms of need for referral for surgical treatments/procedures versus other nonsurgical options.
	Knows appropriate next step in patient care.
	Knows priority in management, specifically in emergency or acute cases.
	Knows immediate management or medical intervention in emergency situations.
	Knows appropriate present management of selected conditions.
	Knows appropriate long-term treatment or management goals.
	Knows appropriate surgical management among surgical options.
	Knows post-surgical or post-procedural management.
	Knows indications for hospital admission or other appropriate setting.
	Knows appropriate follow-up schedule or monitoring approach regarding the general management plan.
	Knows appropriate discharge planning, e.g., focusing priorities on maximizing benefits of hospitalization.
	Knows components of rehabilitation program.
	Knows various therapeutic modalities for selected behavioral/affective disorders.
	Knows appropriate counseling of patient or family regarding current and future problems, including risk factors related to present encounter.
	Knows importance of educating patient or family regarding self-care.
	Knows relevant roles of allied health personnel.
	Knows issues surrounding management of chronic pain especially in terminally ill patients.
	Recognizes/manages patient's expression of fear of injury or death.

Clinical Therapeutics

	Selects appropriate preliminary steps to ensure effectiveness of intended therapy.
	Knows appropriate management in terms of cost-effectiveness.
	Selects most appropriate pharmacotherapy.
	Knows appropriate follow-up schedule or monitoring approach regarding therapeutic regimen.
	Assesses patient compliance with treatment regimen by recognizing techniques to increase compliance or understanding of the disease state and how therapy may affect compliance with instructions.
	Applies knowledge of drugs to the safe and effective selection and administration of drugs.
	Recognizes factors that alter drug requirements for a patient.
	Recognizes signs and symptoms of drug interactions resulting from polypharmacy in the therapeutic regimen.
	Knows adverse effects of various drugs.
	Knows actions in response to acute, specific drug toxicity.
	Knows contraindications of various drugs.
	Recognizes new signs and symptoms in a patient with an established medication regimen within the context of continuing care.
	Modifies therapeutic regimen within the context of continuing care.
	Knows importance of educating patient or family specifically about medication regimen.
	Applies results of experimental data or biometric studies to the treatment of a patient.

Legal/Ethical and Health Care Systems

	Knows informed consent.
	Recognizes patient's right to refuse treatment or testing (patient autonomy).
	Knows guidelines for treatment of minors with/without notification of parent.
	Knows guidelines for confidentiality of medical records.
	Recognizes opportunities for cost containment.
	Knows guidelines for physician/patient relationship.
	Assesses quality of life decisions.
	Recognizes priorities in decisions to allocate transplant organs and/or other scarce resources.
	Knows use of unorthodox/experimental or folk/alternative therapies.
	Recognizes physician error vs. negligence.
	Knows Good Samaritan laws.
	Knows guidelines for reporting findings to proper authorities.
	Recognizes need for third-party permission for treatment in medical emergencies.
	Assesses degree of disclosure to terminally ill patients.
	Knows definitions of competence and sanity.
	Knows guidelines for commitment.
	Recognizes impaired physician.
	Knows appropriate prescriptive practices.
	Knows definition of and legal issues regarding brain death

Objectives Related to Applying Scientific Concepts

	Identifies the cause/causal agent or predisposing factor(s); or, given an effect, what is the cause.
	Predicts the effect; given a particular cause, identifies what effects may be expected. Given an anatomic, pathologic, physiologic abnormality, predicts the effect on function, including compensatory effects.
	Recognizes associated disease conditions, including complications, or indicators for potential disease complications, of a given disease (excludes iatrogenic complications).
	Identifies the underlying processes/pathways that account for, or contribute to, the expression or resolution of a given condition.
	Recognizes characteristics of disease relating to natural history or course of disease, including progression, severity, duration and transmission of disease.
	Evaluates given clinical or physical findings to identify the underlying anatomic structure or physical location.
	Interprets laboratory or diagnostic studies as to the underlying pathophysiology; predicts expected diagnostic test findings for a given disease.
	Recognizes appropriate methods and techniques related to procedures, artifacts of instrumentation, technical errors/problems contributing to misinformation.
	Interprets results of experimental data or biometric studies.
	Knows design features of clinical studies.
	Knows issues regarding validity of research protocols.
	Recognizes potential bias in clinical studies including the extent to which bias accounts for study results.
	Interprets results of clinical studies.
	Distinguishes clinical importance from statistical significance.
	Knows sensitivity and specificity of selected test

Source: USMLE

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