Presentation: Age, gender → physician/site of care → presenting complaint(s) → duration.Clinical vignettes include some or all of the following components:.Communication/ethics videos (rare): to emphasize response to patient behavior, intonation, body language.Interactive media of avatars for auscultation points: 1–2 questions (i.e., recognize heart murmurs/sounds).Examination video: 1–2 questions (e.g., resting tremor of Parkinson disease).Labeling of anatomy or illustrations as options: up to 1 per block.Patient photos, histology, pathology, radiographic studies.Experimental vignettes ( ∼ 10%): An experiment, study, or lab procedure provides context for testing basic science concepts.Clinical vignette ( ∼ 90%): A patient interaction.Second-order question: Requires reasoning in an intermediate step towards a condition or scenario that enables answering the question, e.g., first determining what condition a patient has to be able to answer a question on how to treat them.First-order question: Can be answered directly from the content provided without an intermediate step, e.g., determining a diagnosis based on the clinical findings.There is a mix of first-order and second-order questions.Identifying: underlying cause or diagnosis, drug, verbal response.Predicting: finding (history, physical, lab) or sequela associated with (most likely) diagnosis.Guessing: drug, toxic exposure, diet, mood.integrating with knowledge, an examinee is usually tasked withing either: Can include graphic or tabular material.Can include an image, audio, or video findings.Range of answer option: 4–10, although rarely > 6.Consists of a vignette, lead-in question, and ≥ 4 lettered options arranged in alphabetical or logical order.Has one best answer (“most likely”), though other options may be partially correct.
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