United States Medical Licensing Examination Step 1 Exam dumps
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USMLE United States Medical Licensing Examination Step 1
Beginning in May 2020, Step 1 examinations will include an increased number of questions that assess communications skills. The tables below provide information on the content weighting for Step 1 examinations administered before and after May 2020.
Table of Contents
- General Principles of Foundational Science
- Immune System
- Blood & Lymphoreticular System
- Behavioral Health
- Nervous System & Special Senses
- Skin & Subcutaneous Tissue
- Musculoskeletal System
- Cardiovascular System
- Respiratory System
- Gastrointestinal System
- Renal & Urinary System
- Pregnancy, Childbirth, & the Puerperium
- Female Reproductive System & Breast
- Male Reproductive System
- Endocrine System
- Multisystem Processes & Disorders
- Biostatistics, Epidemiology/Population Health
- Interpretation of the Medical Literature
- Social Sciences
Biochemistry and molecular biology Gene expression: DNA structure, replication, exchange, and epigenetics (eg, imprinting, Xactivation, DNA methylation) Gene expression: transcription Gene expression: translation, post-translational processing, modifications, and disposition of proteins (degradation), including protein/glycoprotein synthesis, intra-extracellular sorting, and processes/functions related to Golgi complex and rough endoplasmic reticulum Structure and function of proteins and enzymes (eg, enzyme kinetics and structural/regulatory proteins) Energy metabolism (eg, ATP generation, transport chain) Biology of cells Adaptive cell responses and cellular homeostasis (eg, hypertrophy) Mechanisms of injury and necrosis, including pathologic processes (eg, liquefactive necrosis, free radical formation) Apoptosis Cell cycle and cell cycle regulation (eg, mitosis) Mechanisms of dysregulation cell biology of cancer (eg, role of p53, proto-oncogenes) general principles of invasion and metastasis, including cancer staging Cell/tissue structure, regulation, and function, including cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, and receptors Human development and genetics Principles of pedigree analysis inheritance patterns occurrence and recurrence risk determination Population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium Principles of gene therapy Genetic testing and counseling Genetic mechanisms (eg, penetrance, genetic heterogeneity) Biology of tissue response to disease Acute inflammatory responses (patterns of response) acute inflammation and mediator systems (eg, histamine, prostaglandins, bradykinins, eosinophilic basic protein, nitric oxide) vascular response to injury, including mediators principles of cell adherence and migration (eg, ECAMs, selectins, leukocytic diapedesis, and rolling) microbicidal mechanisms and tissue injury (eg, defensins) clinical manifestations (eg, pain, fever, leukocytosis, leukemoid reaction, chills) Chronic inflammatory responses (eg, tumor necrosis factor) Reparative processes wound healing, repair: thrombosis, granulation tissue, angiogenesis, fibrosis, scar/keloid formation regenerative process Pharmacodynamic and pharmacokinetic processes: general principles Pharmacokinetics: absorption, distribution, metabolism, excretion, dosage intervals Mechanisms of drug action, structure-activity relationships (eg, anticancer drugs) Concentration and dose-effect relationships (eg, efficacy, potency), types of agonists (eg, full, partial, inverse) and antagonists and their actions Individual factors altering pharmacokinetics and pharmacodynamics (eg, age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics) Mechanisms of drug adverse effects, overdosage, toxicology Mechanisms of drug interactions Signal transduction, including structure/function of all components of signal transduction pathways such as receptors, ligands (eg, general principles of nitric oxide, autocrine and paracrine signaling) Microbial biology Microbial identification and classification, including principles, microorganism identification, and non-immunologic laboratory diagnosis Bacteria structure (eg, cell walls, composition, appendages, virulence factors, extracellular products, toxins, mechanism of action of toxins) processes, replication, and genetics (eg, metabolism, growth, and regulation) oncogenesis antibacterial agents (eg, mechanisms of action on organism, toxicity to humans, and mechanisms of resistance) Viruses structure (eg, physical and chemical properties, virulence factors) processes, replication, and genetics (eg, life cycles, location of virus in latent infection) oncogenesis antiviral agents (eg, mechanisms of action on virus, toxicity to humans, and mechanisms of resistance) Fungi structure (eg, cell wall, composition, appendages, virulence factors, extracellular products, toxins, mechanisms of action of toxins) processes, replication, and genetics (eg, asexual vs. sexual, metabolism, growth) antifungal agents (eg, mechanisms of action on fungus, toxicity to humans, and mechanisms of resistance) Parasites structure (eg, appendages, macroscopic features, and virulence factors) processes, replication, and genetics (eg, life cycles, metabolism, and growth) oncogenesis antiparasitic agents (eg, mechanisms of action on parasite, toxicity to humans, and mechanisms of resistance) Prions Normal age-related findings and care of the well patient Infancy and childhood (0-12 years) Normal physical changes: linear growth, variations in linear growth, including constitutional delay; weight; head circumference; micturition, defecation,primary incontinence/bedwetting; normal physical examination; screening; sleep; teething syndrome Developmental stages: motor; speech; cognitive; psychosocial; anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, guns, swimming, motor vehicles, car seats); routine vaccinations Adolescence (13-17 years) Normal physical changes: linear growth, variations in linear growth including constitutional delay; weight; puberty; normal physical examination; gynecomastia; autonomy/self-identity; sleep Developmental stages: cognitive (eg, abstract thought); psychosocial (eg, autonomy, role confusion, sexual identity); anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, risk-taking behavior, helmets, safe sex, motor vehicles, seat belts, distractions); routine vaccinations Adulthood (18-64 years) Normal physical changes: weight; normal physical examination; screening; sleep Developmental stages: cognitive; intimacy vs isolation; anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention; routine vaccinations Senescence (65 years and older) Normal physical changes, including normal physical exam for age: weight, height (spinal compression), skin, bruising; normal physical examination; response to temperature; micturition, defecation;sleep Developmental stages: motor; cognitive (eg, benign senescent forgetfulness); psychosocial; integrity vs despair; retrospection; anticipatory guidance Lifestyle and routine preventive health care: nutrition; exercise (eg, benefits of exercise); preventive/travel medicine; risk factors and prevention (eg, falls, general medical condition; polypharmacy, driving, caregiver stress); routine vaccinations Immune System Normal processes Development of cells of the adaptive immune response, including positive and negative selection during immune development Structure, production, and function granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors (eg, complement receptors and toll-like receptors), cytokines, chemokines T lymphocytes, including T-lymphocyte receptors, accessory molecules (eg, CD3, CD4, CD8, B7), cell activation and proliferation, cytotoxic T lymphocytes, and memory T lymphocytes B lymphocytes and plasma cells, including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation, including development of antibodies and memory B lymphocytes host defense mechanisms, host barriers to infection, mucosal immunity (eg, gutassociated lymphoid tissue and bronchus-associated lymphoid tissue), anatomical locations of T and B lymphocytes Cellular basis of the immune response and immunologic mediators antigen processing and presentation in the context of MHC I and MHC II molecules (eg, TAP, beta-2 microglobulin), intracellular pathways, mechanisms by which MHC is expressed on the surface; including distribution of MHC I and MHC II on different cells, mechanisms of MHC I and MHC II deficiencies, and the genetics of MHC regulation of the adaptive immune response (eg, peripheral tolerance, anergy, regulatory T lymphocytes, termination of immune response, and B-T lymphocyte interactions) activation, function, and molecular biology of complement (eg, anaphylatoxins) functional and molecular biology of cytokines (eg, IL 1-15) Basis of immunologic diagnostics (eg, antigen-antibody reactions used for diagnostic purposes, ELISA, immunoblotting, antigen-antibody changes over time, ABO typing) Principles of immunologic protection vaccine production and mechanisms of vaccine action biologically active antibodies (eg, monoclonal antibodies, polyclonal antibodies including IVIG, VZIG, rabies immunoglobulin) Effect of age on the function of components of the immune system Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Disorders associated with immunodeficiency deficiency primarily of humoral immunity: common variable immunodeficiency; hyper IgM syndrome; hypogammaglobulinemia/agammaglobulinemia, X-linked (Bruton); selective immunodeficiency (eg, IgA, IgM, IgE) deficiency/dysfunction primarily of cell-mediated immunity: adenosine deaminase deficiency; DiGeorge syndrome; severe combined immunodeficiency disease (SCID); Wiskott-Aldrich syndrome; granulomatosis; allergic reactions/skin complement deficiency: alternative pathway component deficiency (C2, C3b, C3bB, C36B6); classical pathway component deficiency (C1q, C1r, C1-C5); terminal component deficiency (C5b-C9; terminal complement complex); C1 esterase inhibitor deficiency, hereditary angioedema; mannose-binding lectin (MBL) deficiency; membrane attack complex deficiency deficiency of phagocytic cells and natural killer cells: Chediak-Higashi disease; chronic granulomatous disease and other disorders of phagocytosis; leukocyte adhesion deficiency HIV/AIDS: HIV1 and HIV2; AIDS; AIDS complications (eg, neuropathy, dementia, renal insufficiency); immunology of AIDS; immune reconstitution syndrome (IRS); secondary infections; noninfectious complications Immunologically mediated disorders hypersensitivity reactions: type 1, 2, 3, including anaphylaxis; type 4; drug reactions; serum sickness transplantation: rejection; graft-vs-host disease Adverse effects of drugs on the immune system: Jarisch-Herxheimer reaction; drugs affecting the immune system (eg, prednisone, azathioprine, cyclosporine, methotrexate, monoclonal antibody drugs [eg, abciximab, adalimumab; bevacizumab, infliximab, omalizumab, rituximab]); vaccine adverse effects Blood & Lymphoreticular System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function Cell/tissue structure and function production and function of erythrocytes, including heme and hemoglobin synthesis; hemoglobin O2 and CO2 transport, transport proteins, erythropoietin production and function of platelets production and function of coagulation and fibrinolytic factors; hemostasis Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious and immunologic infectious disorders bacteria viral: hemorrhagic fever (Ebola virus, Marburg virus); chikungunya; dengue fever; Zika virus disease parasitic: malaria (Plasmodium spp); babesiosis (Babesia species) primary infections of lymphoid tissue: lymphadenitis (viral, bacterial, fungal, parasitic); lymphangitis; buboes, bubonic plague (Yersinia pestis); cat scratch disease (Bartonella henselae) immunologic and inflammatory disorders: cryoglobinemia, essential mixed cryoglobinemia; autoimmune hemolytic anemia; paroxysmal nocturnal hemoglobinuria; thrombotic thrombocytopenic purpura; hemolytic uremic syndrome Neoplasms: leukemia, acute (ALL, AML); leukemia, chronic (CLL, CML); lymphomas, Hodgkin disease, non-Hodgkin lymphoma, Burkitt lymphoma, T-cell lymphoma; multiple myeloma, dysproteinemias, monoclonal gammopathy of unknown significance (MGUS); myelofibrosis; myelodysplastic syndrome, myelodysplasias; other immunoproliferative neoplasms (eg, Waldenstrom macroglobulinemia) Anemia, cytopenias, and polycythemia anemias decreased production: anemia of chronic disease hemolysis: glucose-6-phosphate dehydrogenase deficiency; pyruvate kinase deficiency disorders of hemoglobin, heme, or membrane: disorders of red cell membranes; hereditary spherocytosis, elliptocytosis; methemoglobinemia, congenital; sickle cell disease; sideroblastic anemia; thalassemias other causes of anemia: blood loss, acute and chronic as a cause of anemia cytopenias: aplastic anemia; leukopenia; neutropenia, cyclic neutropenia, agranulocytosis; pancytopenia; thrombocytopenia, quantitative; immune thrombocytopenic purpura (ITP) cythemias: leukocytosis; polycythemia vera; secondary polycythemia Coagulation disorders (hypocoagulable and hypercoagulable conditions) hypocoagulable: disseminated intravascular coagulation; hemophilia, congenital factor VIII [hemophilia A] and IX [hemophilia B]; hypofibrinogenemia; von Willebrand disease; platelet dysfunction, qualitative hypercoagulable: heparin-induced thrombocytopenia; other coagulopathies (eg, homocysteinemia, hypoplasminogenemia, antithrombin III, protein C/protein S deficiency, Factor V Leiden, anticardiolipin antibodies, lupus anticoagulant, prothrombin G20210A mutation) reactions to blood components: ABO incompatibility/anaphylaxis; Rh incompatibility/anaphylaxis; hemolysis, delayed; transfusion reaction; transfusion contaminated with bacteria; transfusion-related acute lung injury (TRALI); anaphylactoid reaction (IgA deficiency) Traumatic, mechanical, and vascular disorders: mechanical injury to erythrocytes (eg, cardiac valve hemolysis); disorders of the spleen; splenic rupture/laceration; splenic infarct; splenic abscess; effects/complications of splenectomy (eg, sepsis due to encapsulated bacteria); hypersplenism Adverse effects of drugs on the hematologic and lymphoreticular systems: antiplatelet drugs, antithrombin drugs (eg, dabigatran); chemotherapeutic agents; inhibitors of coagulation factors; methemoglobinemia, acquired; propylthiouracil; tumor lysis syndrome; warfarin Behavioral Health Normal Processes Psychodynamic and behavioral factors, related past experience (eg, transference, personality traits) Adaptive behavioral responses to stress and illness (eg, coping mechanisms) Maladaptive behavioral responses to stress and illness (eg, drug-seeking behavior, sleep deprivation) Patient adherence: general adherence; adolescent adherence Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Psychotic disorders: brief psychotic disorder; delusional disorder; psychotic disorder due to another medical condition; schizophrenia; schizoaffective disorder; substance-induced psychotic disorder Anxiety disorders: acute stress disorder; anxiety disorders (generalized anxiety disorder, anxiety due to another medical condition, social phobia); hyperventilation syndrome; obsessive-compulsive disorder; panic disorder with and without agoraphobia; phobic disorders; post-traumatic stress disorder; separation anxiety disorder; substance-induced anxiety disorder, trichotillomania Mood disorders: major depressive disorder with and without psychotic features, with and without seasonal pattern; major depressive disorder, postpartum, with and without psychotic features, including screening; cyclothymic disorder; persistent depressive disorder (dysthymia); bipolar disorder, manic/depressed/mixed; premenstrual dysphoric disorder; bipolar and related disorder or depressive disorder due to another medical condition; substance/medication-induced bipolar and related disorder or depressive disorder (illegal or prescribed); suicidal ideation/attempt Somatoform disorders: body dysmorphic disorder; conversion disorder, including psychogenic seizures; dissociative disorders; illness anxiety disorder (hypochondriasis); malingering; pain disorder; somatic symptom disorder Factitious disorders: factitious disorder imposed on self Eating disorders and impulse control disorders: anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorder; disruptive, impulse-control, and conduct disorders (eg, gambling, kleptomania, pyromania) Disorders originating in infancy/childhood: reactive attachment disorder; attentiondeficit/hyperactivity disorder; speech sound disorder or language disorder; learning disorder/dyslexia; intellectual developmental disorder and developmental delay, undefined, including school problems, fetal alcohol syndrome; oppositional defiant disorder, conduct disorder; autism spectrum disorder, Rett syndrome; psychoses with origin specific to childhood; elimination disorders (incontinence, encopresis); tic disorders/Tourette disorder Personality disorders: antisocial personality disorder; avoidant personality disorder; borderline personality disorder; dependent personality disorder; histrionic personality disorder; narcissistic personality disorder; obsessive-compulsive personality disorder; paranoid personality disorder; schizoid personality disorder Psychosocial disorders/behaviors: adjustment disorder; grief response/bereavement, normal and persistent complex; parent-child relational problems other than physical or emotional abuse; other psychosocial stress Sexual and gender identity disorders: gender dysphoria; psychosexual dysfunction Substance use disorders: alcohol use disorder/intoxication/dependence/withdrawal; tobacco/nicotine use disorder/dependence/withdrawal; varenicline use; cannabis use disorder/intoxication/dependence; hallucinogen use disorder/intoxication/dependence/withdrawal; inhalant use disorder/intoxication/dependence/withdrawal; opioid, heroin, including prescription drug, use disorder/intoxication/dependence/withdrawal; sedative, hypnotic, including benzodiazepine and barbiturate use disorder/intoxication/dependence/withdrawal; stimulant, cocaine, methamphetamine use disorder/intoxication/dependence/withdrawal; other drugs of use disorders (eg, ecstasy, PCP, bath salts)/intoxication/dependence/withdrawal; polysubstance use disorder/intoxication/dependence/withdrawal Nervous System & Special Senses Normal Processes Embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles, and neural crest derivatives Organ structure and function spinal cord gross anatomy and blood supply spinal reflexes brain stem (eg, cranial nerves and nuclei, reticular formation, anatomy and blood supply, control of eye movements) brain gross anatomy and blood supply higher function: cognition, language, memory, executive function hypothalamic function limbic system and emotional behavior circadian rhythm sleep-wake disorder sensory systems general sensory modalities, including sharp, dull, temperature, vibratory, and proprioception special sensory modalities, including vision, hearing, taste, olfaction, and balance motor systems brain and spinal cord (upper motoneuron) basal ganglia and cerebellum autonomic nervous system peripheral nerves Cell/tissue structure and function, including neuronal cellular and molecular biology axonal transport excitable properties of neurons, axons, and dendrites, including channels synthesis, storage, release, reuptake, and degradation of neurotransmitters and neuromodulators presynaptic and postsynaptic receptor interactions, trophic and growth factors brain metabolism glia, myelin brain homeostasis: blood-brain barrier, cerebrospinal fluid formation and flow, choroid plexus Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: meningitis: bacterial (Actinomyces israelii; Haemophilus influenzae; Listeria monocytogenes; Mycobacterium tuberculosis; Neisseria meningitidis; Staphylococcus aureus, epidermidis; Streptococcus agalactiae; Streptococcus pneumoniae); viral (adenovirus, arboviruses, echovirus and coxsackie A & B viruses, polioviruses, herpes simplex virus, varicella zoster, human immunodeficiency virus, lymphocytic choriomeningitis virus, measles virus, mumps virus, St. Louis encephalitis virus, California encephalitis virus, Western equine encephalitis virus); fungal (Blastomycosis dermatitidis, Cryptococcus neoformans/gattii); spirochetal (Borrelia burgdorferi; Leptospira; Treponema pallidum, including neurosyphilis); protozoal/helminths (Acanthamoeba, Naegleria fowleri, Strongyloides stercoralis, Angiostrongylus cantonensis, Baylisascaris procyonis); encephalitis (herpesvirus [HSVI], varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, mumps virus, enterovirus, West Nile virus, St. Louis encephalitis virus, rabies virus, Eastern and Western equine encephalitis virus, poliovirus, Taenia, Toxoplasma gondii); prion disease (eg, Creutzfeldt-Jakob disease); botulism (Clostridium botulinum), tetanus (Clostridium tetani); CNS disorders associated with AIDS (eg, progressive multifocal leukoencephalopathy) immunologic and inflammatory disorders: myasthenia gravis, including thymoma; multiple sclerosis; transverse myelitis Neoplasms (cerebral, spinal, and peripheral): benign (meningioma, neurofibromatosis); malignant (glioblastoma multiforme, astrocytoma, medulloblastoma, primary CNS lymphoma); metastatic (eg, breast, lung, pancreatic, testicular, melanoma) Cerebrovascular disease: arteriovenous malformations, ectatic cerebral vessels; transient ischemic attack; stroke, thrombotic: cerebral artery occlusion/cerebral infarction; stroke, embolic: cerebral embolism; stroke: intracerebral hemorrhage, including subarachnoid hemorrhage, traumatic intracranial hemorrhage; cerebral artery aneurysm; carotid artery stenosis/atherosclerosis/occlusion/dissection; vertebral artery deficiency/dissection; subclavian steal syndrome; vascular dementia; hypertensive encephalopathy; posterior reversible encephalopathy syndrome; venous sinus thrombosis Disorders relating to the spine, spinal cord, and spinal nerve roots: cauda equina syndrome; spinal artery thrombosis/embolus/infarct; spinal cord compression; spinal cord transection, paraplegia and quadriplegia, acute and chronic effects (eg, autonomic dysreflexia); spinal stenosis (cervical, lumbar); syringomyelia Cranial and peripheral nerve disorders cranial nerve injury/disorders: cranial nerve injury; Bell palsy; anisocoria, miosis, mydriasis; internuclear ophthalmoplegia; nystagmus and other irregular eye movements; vestibular neuritis, labyrinthitis; ptosis of the eyelid; Horner syndrome peripheral nerve/plexus injury/disorders: peripheral nerve injury, including brachial plexus; carpal/cubital/tarsal/peroneal tunnel syndrome; mononeuritis, Guillain-Barré syndrome; Miller Fisher syndrome; neuropathy (eg, Charcot-Marie-Tooth disease); herpes zoster Neurologic pain syndromes: complex regional pain syndrome (reflex sympathetic dystrophy, causalgia); fibromyalgia; postherpetic neuralgia; phantom limb pain/syndrome; thalamic pain syndrome; trigeminal neuralgia Degenerative disorders/amnestic syndromes: Alzheimer disease; frontotemporal dementia, including progressive supranuclear palsy, Lewy body disease; mild neurocognitive disorder, mild cognitive impairment Global cerebral dysfunction: altered states of consciousness; delirium; coma/brain death Neuromuscular disorders: amyotrophic lateral sclerosis/spinal muscular atrophy; muscular dystrophy (eg, Duchenne, myotonic); muscle channelopathies (eg, hypokalemic period paralysis) Movement disorders: acute dystonia; adult tic disease; essential tremor; Huntington disease; Parkinson disease, including Parkinson dementia Metabolic disorders: adrenoleukodystrophy; metabolic encephalopathy Paroxysmal disorders: headache, including migraine, mixed, tension, ice-pick, cluster, medication withdrawal, caffeine withdrawal; seizure disorders, including generalized tonic-clonic, partial, absence, febrile Sleep disorders: cataplexy and narcolepsy; circadian rhythm sleep-wake disorder; insomnia, primary; sleep terror disorder and sleepwalking; REM sleep behavior disorder; restless legs syndrome Traumatic and mechanical disorders and disorders of increased intracranial pressure: anoxic brain damage, cerebral hypoxia; epidural, subdural hematoma (cerebral and spinal); intraparenchymal hemorrhage, traumatic subarachnoid hemorrhage; cerebral edema; pseudotumor cerebri (idiopathic intracranial hypertension); torticollis/cervical dystonia; hydrocephalus, including normal-pressure; traumatic brain injury (concussion)/postconcussion syndrome (dementia pugilistica); traumatic brain syndrome Congenital disorders: Friedreich ataxia; neural tube defects (eg, spina bifida, holoprosencephaly, anencephaly); microcephaly; Sturge-Weber syndrome; tuberous sclerosis, von Hippel-Lindau disease; hydrocephalus, obstructive (Arnold-Chiari) Adverse effects of drugs on the nervous system: acute dystonic reaction; drug-induced meningitis (eg, NSAIDs, sulfa drugs); drug-induced neuropathy (eg, vincristine, isoniazid, metronidazole); extrapyramidal adverse effects (eg, akathisia, dystonia, drug-induced parkinsonism); neuroleptic malignant syndrome; poisoning by psychotropic agents, including antidepressants; serotonin syndrome; tardive dyskinesia Disorders of the eye and eyelid infectious and inflammatory disorders of the eye: blepharitis/eyelid inflammation; chalazion; chorioretinitis; conjunctivitis (adenovirus)/keratoconjunctivitis; dacryocystitis; endophthalmitis; hordeolum; iridocyclitis; optic neuritis; periorbital cellulitis; uveitis neoplasms of the eye: melanoma; retinoblastoma disorders of the eye and eyelid, structural: cataract; glaucoma; lacrimal system disorders; pterygium; refractive disorders (presbyopia, myopia, hyperopia, astigmatism) disorders of the pupil, iris, muscles (extraocular): amblyopia; strabismus disorders of the retina: hypertensive retinopathy; macular degeneration; papilledema; retinal detachment; retinitis pigmentosa; vascular disorders affecting the retina, including central retinal artery embolus, retinal hemorrhage, amaurosis fugax, embolus, carotid artery stenosis, central retinal vein occlusion; visual impairment/blindness, night blindness traumatic and mechanical disorders: black eye; burn of the eye and adnexa; corneal abrasion, ulcer; dislocated lens; foreign body in eye; hyphema; injury to optic nerve and pathways; laceration of the eye and eyelid; ocular open wounds; orbital fracture; subconjunctival hemorrhage adverse effects of drugs on the eyes: ethambutol; hydroxychloroquine; prednisone Disorders of the ear infectious and inflammatory disorders of the ear: chondritis; mastoiditis; otitis, externa, media, interna, serous, suppurative, malignant otitis externa neoplasms: acoustic neuroma, neurofibromatosis type 2; cholesteatoma hearing loss/deafness: hearing loss, including noise-induced; otosclerosis; tinnitus disorders of balance and spatial orientation: Ménière disease; motion sickness; vertigo, including benign positional vertigo traumatic and mechanical disorders: barotrauma; foreign body in ear; impacted cerumen; laceration, avulsion; perforation of tympanic membrane; eustachian tube disorders adverse effects of drugs on the ear: antineoplastic agents, including cisplatin; aminoglycosides; furosemide; salicylates Skin & Subcutaneous Tissue Normal Processes Embryonic development, fetal maturation, and neonatal changes Organ structure and function, including barrier function, thermal regulation Cell/tissue structure and function, eccrine function Repair, regeneration, and changes associated with stage of life (eg, senile purpura, male pattern baldness, postmenopausal hair changes) Skin defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders and infestations bacterial: cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome; abscess, cutaneous, including septic abscess; anthrax (Bacillus anthracis); carbuncle; folliculitis; pilonidal cyst, infected; pyoderma gangrenosum; MSSA and MRSA skin infections; mycobacterial infections (eg, leprosy, draining sinus); scarlet fever (group A Streptococcus) viral: herpes simplex type 1 & type 2, herpes zoster, Ramsay-Hunt syndrome; molluscum contagiosum; hand-foot-and-mouth disease; herpangina; parvovirus; chickenpox, erythema infectiosum (fifth disease), rubella, measles, roseola (exanthema subitum); verrucae vulgaris fungal (deep and superficial): candidiasis, skin; dermatophytosis, tinea corporis; dermatomycoses; diaper rash; onychomycosis parasitic: cutaneous larva migrans; cutaneous leishmaniasis infestations, nonvenomous bites, stings: scabies; lice; insect bites, including bed bugs immunologic and inflammatory disorders papulosquamous and eczematous dermatoses: psoriasis; lichen planus and lichenoid dermatoses; allergic/irritant contact dermatitis (eg, nickel); dermatoses caused by plants (poison ivy, poison oak) vesiculobullous disorders: epidermolysis bullosa; dermatitis herpetiformis; pemphigus; pemphigoid urticaria, erythema, exanthema, and purpura: erythema nodosum; atopic dermatitis; pityriasis rosea; urticaria; Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis autoimmune disorders: vitiligo Neoplasms benign neoplasms, cysts and other skin lesions: actinic keratoses; cysts, including epidermal; hemangiomas; lipoma; pigmented nevi; seborrheic keratosis; xanthomas malignant neoplasms: basal cell carcinoma; squamous cell carcinoma; melanoma, including genital; Kaposi sarcoma; cutaneous T-cell lymphoma, mycosis fungoides Adnexal disorders (hair and hair follicles, nails, sweat glands, sebaceous glands, oral mucous membranes) disorders of the hair and hair follicles: alopecia; seborrhea capitis/seborrheic dermatitis; tinea barbae and capitis disorders of the nails (including ingrowing nail) disorders of sweat and sebaceous glands: acne vulgaris; hidradenitis suppurativa; hyperhidrosis; ichthyosis; rosacea Oral disease: aphthous ulcers (stomatitis, canker sores); leukoplakia Disorders of pigmentation: albinism; lentigo Traumatic and mechanical disorders: animal bites (dogs, cats, etc); burns or wounds affecting the skin or subcutaneous tissue (eg, sunburn, other including blast injuries and burns); cauliflower ear; effects of ultraviolet light; keloids; tattoo; thermal injury, perniosis, frostbite; ulcers, decubitus Congenital disorders: xeroderma pigmentosum; benign lesions in neonates, infants, children (eg, congenital nevi) Adverse effects of drugs on skin and subcutaneous tissue: drug reactions, eruptions, including local reaction to vaccine Musculoskeletal System Normal processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function Cell/tissue structure and function biology of bones, joints, tendons, skeletal muscle, cartilage exercise and physical conditioning/deconditioning Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, inflammatory, and immunologic disorders infectious disorders: gangrene, dry and wet, clostridial myonecrosis (Clostridium perfringens); discitis; myositis, infective; necrotizing fasciitis; osteomyelitis; septic arthritis; spondylitis, tuberculous immunologic disorders: ankylosing spondylitis; dermatomyositis/polymyositis; juvenile idiopathic arthritis; rheumatoid arthritis, Felty syndrome; psoriatic arthropathy inflammatory disorders: adhesive capsulitis of shoulder (frozen shoulder syndrome); ankylosis/spondylopathy (inflammatory); bursitis; fasciitis; osteochondritis, osteochondritis dissecans; tendinitis, supraspinatus syndrome, enthesopathy of spine, elbow, ankle; temporomandibular joint disorders; fibrositis, myofascial pain syndrome; synovitis; tenosynovitis; myositis Neoplasms: benign neoplasms (e.g., ganglion cyst); malignant neoplasms of bone (eg, osteosarcoma, sarcoma, leiomyosarcoma, rhabdosarcoma); metastases to bone, secondary malignant neoplasm of bone Degenerative and metabolic disorders degenerative/metabolic disorders of bone, tendon, and cartilage: chondromalacia; disc degeneration, herniated disc; Legg-Calvé-Perthes disease; Osgood-Schlatter disease; osteodystrophy; osteomalacia; osteonecrosis (avascular), bone infarct; osteoporosis; osteopenia; osteitis deformans (Paget disease of bone); pathologic fracture; radiculopathies; spondylolisthesis/spondylosis (degenerative) degenerative/metabolic disorders of joints: gout, gouty arthritis, pseudogout; joint effusion; osteoarthritis degenerative/metabolic disorders of muscles, ligaments, fascia: Dupuytren contracture; muscle calcification and ossification; muscle wasting and diffuse atrophy; rhabdomyolysis Traumatic and mechanical disorders: amputation and care of amputees; backache, including low back pain; blast injuries; compartment syndrome; contractures, hospital-acquired; contusions; dislocations; fractures; sprains, strains; kyphoscoliosis, scoliosis; rotator cuff syndrome; slipped capital femoral epiphysis; dislocation of hip Congenital disorders: achondroplasia/dwarfism; disorders of limb development (HOX gene mutation, phocomelia); developmental dysplasia of the hip; dislocation of hip in infantile spinal muscular atrophy; genu valgum or varum; foot deformities (flat foot, valgus/varus deformities); osteogenesis imperfecta; McArdle disease; mitochondrial myopathies Adverse effects of drugs on the musculoskeletal system: drug-induced myopathy (eg, steroids, statins, cocaine, AZT); malignant hyperthermia Cardiovascular System Normal Processes Embryonic development, fetal maturation, and perinatal transitional changes Organ structure and function chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including blood volume and systemic vascular resistance circulation in specific vascular beds, including pulmonary and coronary Cell/tissue structure and function heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (eg, atrial natriuretic peptide) endothelium and secretory function, vascular smooth muscle, microcirculation, and lymph flow neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism, and autonomic responses Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: bacterial endocarditis, myocarditis immunologic and inflammatory disorders: atherosclerosis (eg, atherosclerosis of the aorta) Neoplasms: myxoma, metastases Dysrhythmias: premature beats (PACs, PVCs); atrial flutter/fibrillation; multifocal atrial tachycardia; paroxysmal tachycardias; ventricular tachycardia/fibrillation; wide complex tachycardia; torsades de pointes; bradycardias; atrioventricular block (first-, second-, third-degree); conduction disorder (LBBB, RBBB); cardiac arrest; sick sinus syndrome; prolonged QT syndrome; Wolff-Parkinson-White syndrome; carotid sinus hypersensitivity; pacemaker dysfunction, including failure to sense, capture Heart failure: chordae tendineae rupture; congestive heart failure; cor pulmonale; diastolic dysfunction; systolic dysfunction; mitral valve dysfunction; heart failure secondary to myocardial infarction; high-output heart failure, including thyrotoxicosis-induced, anemia-induced; tachycardia-induced; cardiogenic pulmonary edema Ischemic heart disease: acute coronary syndrome, acute myocardial infarction; angina pectoris, stable and unstable/coronary artery disease/coronary insufficiency; coronary artery spasm Diseases of the myocardium: cardiomyopathy, dilated, including alcoholic, viral, takotsubo; cardiomyopathy, obstructive hypertrophic; cardiomyopathy, familial dilated; cardiomyopathy, restrictive; hypertensive heart disease, left ventricular hypertrophy, right ventricular hypertrophy; complications of myocardial infarction; nontraumatic tamponade post-myocardial infarction; papillary muscle rupture/dysfunction; ventricular free wall rupture; myocarditis Diseases of the pericardium: chronic constrictive pericarditis; pericardial effusion; pericardial tamponade; acute pericarditis; pericarditis, following myocardial infarction, surgery, trauma Valvular heart disease: valve disorders, mitral/aortic/tricuspid, pulmonic (eg, regurgitation, stenosis, prolapse, insufficiency, vegetation); functional murmurs; rheumatic heart disease; complications of artificial valves Hypotension: orthostatic hypotension Hypertension: elevated blood pressure practicing without diagnosis of hypertension; essential hypertension; malignant hypertension; secondary hypertension Dyslipidemia: hypercholesterolemia; hyperlipidemia; hypertriglyceridemia; lipoproteins/lipoprotein lipase deficiency Vascular disorders disorders of the great vessels: aneurysm, aortic (abdominal/thoracic), dissection, ruptured; aneurysm, iliac, other peripheral vascular, ruptured; aortoiliac disease peripheral arterial vascular disease: arterial embolus/thrombosis; arteriovenous fistula; atheroembolic disease; claudication; cholesterol emboli; hypertensive vascular disease; peripheral arterial disease; thromboangiitis obliterans diseases of the veins: deep venous thrombosis, venous thromboembolism; phlebitis/thrombophlebitis; varicose veins; venous insufficiency; stasis ulcers, stasis dermatitis Traumatic and mechanical disorders: ventricular puncture; myocardial contusion; myocardial rupture; traumatic aortic dissection; traumatic tamponade Congenital disorders, including disease in adults: anomalous left coronary artery; atrial septal defect; coarctation of the aorta; endocardial cushion defect; patent foramen ovale; patent ductus arteriosus; tetralogy of Fallot; transposition of the great vessels; ventricular septal defect Adverse effects of drugs on the cardiovascular system: adriamycin; cocaine, amphetamine, PCP; ACE inhibitors, calcium channel blockers, alpha blockers, minoxidil Respiratory System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function airways, including mechanics and regulation of breathing lung parenchyma, including ventilation, perfusion, gas exchange pleura nasopharynx, sinuses Cell/tissue structure and function, including surfactant formation, and alveolar structure Repair, regeneration, and changes associated with stage of life Pulmonary defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious, immunologic, and inflammatory disorders of the upper airways: acute upper respiratory infection; viral infections (adenovirus, coronaviruses, coxsackievirus, influenza virus, parainfluenza virus, rhinoviruses); sinusitis; nasopharyngitis; epiglottitis; Bordetella pertussis pneumonia; croup; acute laryngitis; acute laryngotracheitis; tracheitis; pharyngitis; streptococcal throat infections; tonsillitis; peritonsillar abscess; rhinitis, allergic, chronic; ulcers of nasal cavity/sinuses infectious, immunologic, and inflammatory disorders of the lower airways: hospitalacquired pneumonia; ventilator-associated pneumonia, community-acquired pneumonia, acute bronchiolitis; bronchiolitis obliterans with organizing pneumonia (BOOP); anthrax, pulmonary (Bacillus anthracis); aspiration pneumonia, pneumonitis; bronchitis, acute; bronchopneumonia; pneumonia (Burkholderia pseudomallei, Chlamydophila pneumoniae, Coxiella burnetii, Francisella tularensis, Haemophilus influenzae, Klebsiella pneumoniae, Legionella, Moraxella catarrhalis, Mycoplasma pneumoniae, Pseudomonas aeruginosa, Streptococcus, MSSA, MRSA, other gram‐negative bacteria); viral infection (eg, influenza A, B, adenovirus, H1N1, respiratory syncytial virus, parainfluenza virus); fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis, coccidioidomycosis, Pneumocystis jirovecii); pulmonary tuberculosis; lung abscess; viral infection (eg, influenza A, B, adenovirus, respiratory syncytial virus, parainfluenza virus, avian influenza virus); fungal infection (aspergillosis, including allergic bronchopulmonary aspergillosis and aspergilloma, histoplasmosis, coccidioidomycosis, Pneumocystis jirovecii) Neoplasms benign neoplasms: upper airways (eg, vocal cord polyps, nasal polyps, juvenile papillomatosis); lungs and pleura (eg, solitary pulmonary nodule, bronchial carcinoid tumors) malignant neoplasms upper airways: lip, oral cavity, and pharynx; head and neck cancer; larynx; trachea lower airways and pleura: malignant neoplasms of bronchus and/or lung (squamous cell, adenocarcinoma, large cell, small cell); malignant neoplasms of pleura (mesothelioma); secondary malignant neoplasms of lung; secondary malignant neoplasms of pleura metastatic neoplasms including pleural Obstructive airway disease: asthma, reactive airway disease; bronchiectasis; chronic airway obstruction; chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema Pneumoconiosis/fibrosing/restrictive pulmonary disorders/interstitial lung disease: pneumoconiosis; asbestosis; silicosis; silo-filler's lung, byssinosis, bagassosis, berylliosis; hypersensitivity pneumonitis; hypereosinophilic syndromes, Loeffler syndrome; interstitial pneumonia, usual (UIP), desquamative (DIP), nonspecific Respiratory failure/respiratory arrest and pulmonary vascular disorders: acute respiratory distress syndrome (ARDS); pulmonary hypertension; pulmonary vascular disorders, arteriovenous fistula; pulmonary edema, pulmonary cause and unspecified; pulmonary embolism; air and fat embolism; respiratory failure due to enteral feeding Metabolic, regulatory, and structural disorders: disorders of gas exchange; hypoventilation; hypoxia; pulmonary alveolar proteinosis; ventilation-perfusion imbalance Disorders of the pleura, mediastinum, and chest wall: chylothorax; costochondritis; empyema; hemothorax; mediastinitis; pleural effusion; pleuritis; pneumomediastinum; pneumothorax Traumatic and mechanical disorders upper airways: epistaxis; barotrauma, sinus; laryngeal/pharyngeal obstruction; tracheoesophageal fistula; tracheal stenosis; tracheomalacia; trauma (eg, tracheal injury); foreign body (nose, pharynx, larynx, trachea); traumatic/mechanical disorders of the nasal cavity/sinuses (eg, septal perforation) lower airways and pleura: atelectasis; diaphragm/chest wall injury; drowning and neardrowning; foreign body, upper and lower respiratory tract; penetrating chest wounds; pulmonary contusion; sleep apnea, obstructive and central; hypoventilation syndrome, obesity-hypoventilation syndrome Congenital disorders: bronchogenic cysts; congenital cysts; congenital diaphragmatic hernia; pulmonary sequestration; immotile cilia syndrome Adverse effects of drugs on the respiratory system: bleomycin, amiodarone; adverse effects of 100% oxygen; acute effects of tobacco/nicotine, inhalants, cocaine Gastrointestinal System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function anatomy of the alimentary canal, including mouth, pharynx, esophagus, stomach, small intestine, large intestine, anus, peritoneal cavity liver and biliary system, including enterohepatic circulation salivary glands and exocrine pancreas gastrointestinal motility, including defecation digestion and absorption Cell/tissue structure and function endocrine and neural regulatory functions, including GI hormones (eg, gastrin) salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins, bile salts, and processes synthetic and metabolic functions of hepatocytes Repair, regeneration, and changes associated with stage of life Gastrointestinal defense mechanisms and normal flora Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders bacterial: pseudomembranous colitis (Clostridium difficile); enteritis/enteric infections (includes gastroenteritis) (eg, Staphylococcus aureus, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Campylobacter species, Vibrio cholerae, Salmonella species, Shigella species, traveler's/infectious diarrhea); hepatic abscess, subhepatic abscess, subphrenic abscess; peritonitis, primary and secondary; Whipple disease viral: infectious esophagitis (eg, CMV, herpes); hepatitis A, B, C, D, E; coxsackievirus enteritis/colitis; Echovirus enteritis/colitis; rotavirus enteritis; mumps; gingivostomatitis, herpetic fungal: thrush parasitic: Cryptosporidium, Cyclospora, Entamoeba histolytica, Giardia, Isospora belli, Strongyloides stercoralis immunologic and inflammatory disorders: autoimmune hepatitis; celiac disease; eosinophilic esophagitis; granulomatous enteritis; inflammatory bowel disease, including Crohn disease, regional enteritis, microscopic colitis (collagenous and lymphocytic colitis), ulcerative colitis, toxic megacolon Neoplasms benign neoplasms, including polyps, cysts: stomach; small intestine; colon, rectum, and anus, including polyps malignant neoplasms and pre-malignant conditions: oral cancer (eg, lips, mouth, tongue, salivary glands); esophageal, squamous and adenocarcinoma; Barrett esophagus; gastrinoma, Zollinger-Ellison syndrome; gastrointestinal carcinoid tumors; gastrointestinal stromal tumors; small intestine; stomach, adenocarcinoma, lymphoma, MALT; colon, rectum, anus; hereditary colon cancer syndromes, familial adenomatous polyposis (eg, Peutz-Jeghers syndrome, Gardner syndrome, Turcot syndrome, ); MUTYH-associated polyposis; gallbladder, cholangiocarcinoma, adenocarcinoma of the ampulla of Vater; liver, including hepatoma; peritoneal cancer, including metastatic studding with cancer; pancreas metastatic neoplasms Signs, symptoms, and ill-defined disorders: upper gastrointestinal bleeding; lower gastrointestinal bleeding; constipation; diarrhea; hematochezia; bright red rectal bleeding; melena; nausea, vomiting, rumination Disorders of the oral cavity, salivary glands, and esophagus oral cavity and salivary glands: abscessed tooth; dental caries; malocclusion; disorders of the salivary glands (eg, stones, sialadenitis, parotitis) esophagus: achalasia and cardiospasm; dysphagia; diverticulum (eg, Zenker); esophageal periapical abscess without sinus; esophagitis/esophageal reflux (GERD); esophagitis, pill; Mallory-Weiss syndrome; paraesophageal (hiatal) hernia; stricture and stenosis of esophagus Disorders of the stomach, small intestine, colon, rectum, anus stomach: dyspepsia/hyperacidity; gastric ulcer; gastritis; peptic ulcer; peptic ulcer perforation; gastroparesis small intestine, colon: appendicitis; angiodysplasia; diverticula, diverticulitis, diverticulosis; duodenitis, duodenal ulcer, peptic ulcer; gastroenteritis and colitis (noninfectious); granulomatous enterocolitis; Hirschsprung disease; impaction of intestine; intestinal obstruction/stricture; intussusception; irritable colon/irritable bowel syndrome; mesenteric ischemia/ischemic bowel/ischemic colitis; necrotizing enterocolitis; paralytic ileus; volvulus; malnutrition and malabsorption, including lactose intolerance, short bowel syndrome rectum and anus: abscess of anal and rectal regions; anal fissure; anal fistula; ulcer; fecal incontinence; hemorrhage (rectum, anus); proctitis; hemorrhoids; rectal prolapse Disorders of the liver and biliary system, noninfectious liver: cirrhosis; Dubin-Johnson, Rotor syndromes; end-stage liver disease, including indications for transplantation; Gilbert syndrome, Crigler-Najjar syndrome; hepatic coma/hepatic encephalopathy; hepatitis, noninfectious; hepatitis, fatty liver, alcoholic; hepatorenal syndrome; hepatopulmonary syndrome; jaundice; nonalcoholic fatty liver disease; portal hypertension/esophageal varices biliary system: bile duct obstruction/cholestasis; cholangitis, including ascending; choledocholithiasis; cholelithiasis/cholecystitis; cholestasis due to parenteral nutrition; gallstone ileus; Mirizzi syndrome; primary biliary cirrhosis; primary sclerosing cholangitis Disorders of the pancreas: pancreatitis, acute; pancreatitis, chronic; pancreatitis, hereditary; pancreatic cyst/pseudocyst; pancreatic duct obstruction; pancreatic insufficiency Disorders of the peritoneal cavity: ascites Traumatic and mechanical disorders: abdominal wall defects; adhesions, postsurgical; digestive system complications of surgery; post-gastric surgery syndromes (eg, blind loop syndrome, adhesions); duodenal tear; foreign body in digestive system; inguinal, femoral, and abdominal wall hernias; open wound, abdominal; perforation of hollow viscus and blunt trauma; perforation/rupture of esophagus (Boerhaave syndrome); umbilical hernia Congenital disorders: annular pancreas, biliary atresia, cleft lip and palate, esophageal atresia, malrotation without volvulus, Meckel diverticulum, pyloric stenosis, tracheoesophageal fistula Adverse effects of drugs on the gastrointestinal system: drug-induced changes in motility (chronic laxative abuse, opioids); drug-induced gastritis, duodenitis, peptic ulcer disease (NSAIDs); drug-induced hepatitis (eg, acetaminophen, isoniazid); drug-induced pancreatitis (eg, thiazide diuretics) Renal & Urinary System Normal Processes Embryonic development, fetal maturation, and perinatal changes Organ structure and function kidneys, ureters, bladder, urethra glomerular filtration and hemodynamics urine concentration and dilution renal mechanisms in acid-base balance renal mechanisms in body fluid homeostasis micturition Cell/tissue structure and function renal metabolism and oxygen consumption tubular reabsorption and secretion, including transport processes and proteins hormones produced by or acting on the kidney (eg, renin, aldosterone, angiotensin II, vasopressin) Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders upper urinary tract: granulomatous pyelonephritis; perinephric abscess; pyelonephritis; pyonephrosis; renal abscess; renal tuberculosis lower urinary tract and urinary tract infections of unspecified location: cystitis; chlamydial and nonchlamydial immunologic and inflammatory disorders upper urinary tract glomerular disorders: Alport syndrome; glomerular disease due to hepatitis B, C; glomerulonephritis, including poststreptococcal; IgA nephropathy; lupus nephritis; minimal change disease; nephrotic syndrome; thin basement membrane disease tubular interstitial disease: acute tubular necrosis (ATN); acute interstitial nephritis; papillary necrosis; HIV nephropathy lower urinary tract: interstitial cystitis Neoplasms benign neoplasms and cysts: polycystic kidney disease malignant neoplasms: renal (eg, Wilms tumor/nephroblastoma, renal cell carcinoma, renal tumors associated with congenital/hereditary conditions); urinary bladder and collecting system Signs, symptoms, and ill-defined disorders: dysuria; hematuria; oliguria, anuria; proteinuria Metabolic and regulatory disorders: acute kidney injury; renal insufficiency; azotemia, uremic syndrome; chronic kidney disease, including end-stage renal disease; cystinuria; Fanconi syndrome; hypertensive renal disease (renal complications of hypertension); renal calculi, ureteral calculi, nephrolithiasis; renal tubular acidosis Vascular disorders: renal artery stenosis (atherosclerosis, fibromuscular dysplasia, nephrosclerosis); renal vein thrombosis; renal infarction Traumatic and mechanical disorders: bladder rupture; neurogenic bladder; obstructive uropathy; posterior urethral valves; renal laceration; renal vascular injury; ureteral laceration/avulsion/disruption; urethral diverticulum; urethral/ureteral obstruction/stricture/prolapse; urinary incontinence, including secondary enuresis; vesicoureteral reflux Congenital disorders: double ureters/ureteral duplication/double collecting system; horseshoe kidney; hydronephrosis/reflux; renal agenesis, renal hypoplasia, renal dysplasia; single kidney Adverse effects of drugs on the renal and urinary system: ACE inhibitors; aminoglycosides; amphotericin B; cisplatin; furosemide; gadolinium (nephrogenic systemic fibrosis); heroin; iodinated contrast dye; lithium; NSAIDs; penicillins; sulfa drugs; tenofovir; drug - induced urinary retention Pregnancy, Childbirth, & the Puerperium Normal Processes Organ structure and function: pregnancy, including fertilization, implantation, development of embryo, labor and delivery, the puerperium, lactation, gestational uterus, placenta Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Prenatal care preconception counseling and care: folate deficiency prevention; immunizations; nutritional assessment, including vitamins; Rh screening prenatal risk assessment/prevention: adolescent pregnancy; antepartum fetal evaluation, including biophysical profile; genetic screening; α-fetoprotein; diabetes mellitus; neural tube defects; Rh isoimmunization supervision of normal pregnancy: assessment of gestational age; iron deficiency prevention; nutrition, including weight management; surveillance, including ultrasonography and assessment of fetal growth; vitamin deficiency prevention; infections, maternal, fetal, newborn (focus on prevention and screening): cytomegalovirus, coxsackievirus, hepatitis B virus, herpes simplex viruses, HIV, influenza virus, parvovirus B19 virus, rubella virus, varicella-zoster virus, Chlamydia trachomatis, Treponema pallidum, Streptococcus agalactiae, Toxoplasma gondii, amnionitis; asymptomatic urinary tract infection Obstetric complications: abortion, induced, septic, missed, spontaneous, threatened; acute fatty liver of pregnancy; anemia of pregnancy, sickle cell disease, thalassemia in pregnancy; antepartum hemorrhage, including third-trimester bleeding; cardiomyopathy of pregnancy; cervical incompetence, cervical shortening; cholestasis of pregnancy, intrahepatic; congenital abnormalities, maternal (eg, bicornuate uterus); ectopic pregnancy; fetal abnormality affecting management of mother (eg, hydrocephalus, spina bifida); fetal growth restriction; gestational diabetes; maternal mortality; multiple gestation; placental abnormalities (abruptio placentae, placenta previa, premature separation of placenta); polyhydramnios, oligohydramnios; preeclampsia, eclampsia, HELLP syndrome, gestational hypertension; prolonged pregnancy; Rh isoimmunization affecting management of mother; vomiting in pregnancy (morning sickness, hyperemesis gravidarum); trauma in pregnancy; infections complicating pregnancy Labor and delivery: labor and delivery, uncomplicated; labor and delivery, complicated, including shoulder dystocia; cesarean delivery, including complications; cord compression, cord prolapse; fetal malpresentations (eg, breech); intrapartum fetal evaluation, including fetal heart tones; intrapartum prophylaxis (eg, HIV, Chlamydia, gonococcal prophylaxis); premature rupture of membranes; preterm (before 37 weeks' gestation) and postdates labor and delivery; threatened preterm labor Puerperium, including complications: lactation problems; breast-feeding problems; lochia; postpartum cardiomyopathy; postpartum blues; postpartum hemorrhage; postpartum sepsis; retained placenta, products of conception (eg, placenta accreta); uterine atony Newborn (birth to 4 weeks of age) normal newborn examination of liveborn at admission to hospital screening, newborn disorders of the newborn: screening, newborn; ABO incompatibility in newborn; hemolytic disease due to Rh incompatibility; birth asphyxia syndrome (liveborn neonate); birth trauma (eg, cord compression, brachial palsy, lacerations); drug withdrawal syndrome in newborn; feeding problems in newborn; fetal growth and development abnormalities, including fetal growth restriction; gastrointestinal obstruction; hypocalcemia of newborn; infections, congenital or peripartum (cytomegalovirus, herpes simplex viruses, HIV, hepatitis B, rubella virus, parvovirus B19 virus, varicella zoster virus, Chlamydia trachomatis, Streptococcus agalactiae, Treponema pallidum, Toxoplasma gondii); intrapartum fetal distress/death including stillborn; jaundice, fetal/neonatal/perinatal; laryngomalacia; macrosomia (large for gestational age); meconium aspiration syndrome; neonatal acne; neonatal Candida infection (thrush); neonatal hypoglycemia; neonatal conjunctivitis and dacryocystitis; ophthalmic gonorrhea; phenylketonuria; premature infant; postterm infant; pseudomembranous colitis of infancy; respiratory distress syndrome (hyaline membrane disease); respiratory problems after birth (eg, bronchopulmonary dysplasia, tracheomalacia; tracheoesophageal fistula in neonates); retinitis of prematurity; seizures in newborn; sudden infant death syndrome (SIDS), apparent life-threatening event (ALTE); tetanus neonatorum Congenital disorders, neonatal: congenital malformations and anomalies; neonatal hydrocele Adverse effects of drugs on pregnancy, childbirth, and the puerperium: alcohol, tobacco, and other drugs (ATOD); prenatal radiation exposure; teratology (eg, ACE inhibitors, SSRIs, warfarin, infections, toxins) Systemic disorders affecting pregnancy, labor and delivery, and puerperium: appendicitis; asthma; carpal tunnel syndrome in pregnancy; cirrhosis; deep venous thrombosis (DVT); diabetes mellitus; heart failure, valvular heart disease;hypertension; myasthenia gravis; obesity; pancreatitis; psychiatric disorders; renal calculus/calculi; renal failure/renal disease, including SLE; seizure disorders; thyroid disorders, hypothyroidism, hyperthyroidism Female Reproductive System & Breast Normal Processes Embryonic development, fetal maturation, and perinatal changes, gametogenesis Organ structure and function female structure, including breast female function (eg, ovulation, menstrual cycle, puberty) intercourse, sexual response Cell/tissue structure and function: hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones Reproductive system defense mechanisms and normal flora Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Breast infectious, immunologic, and inflammatory disorders: breast abscess; inflammatory disease of breast, fat necrosis; mastitis; nipple discharge neoplasms benign and undefined neoplasms: breast cyst, solitary; fibrocystic changes; fibroadenoma; hypertrophy of breast; intraductal papilloma malignant neoplasms (including screening): breast cancer; intraductal carcinoma; Paget disease of breast; phyllodes tumors Female reproductive system infectious, immunologic, and inflammatory disorders: bacterial vaginosis; Bartholin gland abscess; cellulitis, pelvic; candidiasis of the vulva or vagina; lichen sclerosus; sexually transmitted infections and exposure; cervicitis and endocervicitis; chancroid (Haemophilus ducreyi); genital herpes; gonorrhea (Neisseria gonorrhoeae); human papillomavirus infection, genital/venereal/anal warts, condylomata acuminata; lymphogranuloma venereum (Chlamydia trachomatis), non-lymphogranuloma venereum; pelvic inflammatory disease; Fitz-Hugh–Curtis syndrome; salpingitis and oophoritis; syphilis (Treponema pallidum); trichomoniasis (Trichomonas vaginalis); urethritis; vaginitis; vulvovaginitis Neoplasms of the cervix, ovary, uterus, vagina, and vulva benign neoplasms and cysts: abnormal Pap smear; benign neoplasm of ovary; endocervical and endometrial polyps; leiomyomata uteri; ovarian cyst malignant and precancerous neoplasms: cervical cancer; HPV causing cancer; cervical dysplasia, HPV causing dysplasia; endometrial hyperplasia; endometrial/uterine cancer; gestational trophoblastic disease (hydatidiform mole); ovarian cancer; vulvar dysplasia and cancer Fertility and infertility: assisted reproductive techniques (ART); contraception (eg, oral contraceptives, IUD, vaginal cap, cervical sponge, diaphragm, implant, morning-after pill, male and female condoms); female infertility; gonadal dysgenesis 45,X (Turner syndrome); sterilization; tubal factors; infertility Menopause: ovarian failure, premature menopause; perimenopause; premenopausal menorrhagia; postmenopausal atrophic vaginitis (vaginal atrophy); postmenopausal bleeding; vasomotor symptoms Menstrual and endocrine disorders: abnormal uterine bleeding, including perimenopausal; absence of menstruation (primary amenorrhea, secondary amenorrhea including undiagnosed pregnancy); anovulation; dysmenorrhea; endometriosis; hirsutism, virilization; mittelschmerz; pelvic pain; polycystic ovarian syndrome; postcoital bleeding; premenstrual syndrome Sexual dysfunction: dyspareunia; orgasmic dysfunction; sexual desire/arousal syndrome; vaginismus Traumatic and mechanical disorders: Asherman syndrome; chronic inversion of uterus; chronic pelvic pain syndrome; cystocele; imperforate hymen; injuries, wounds, and burns affecting the female reproductive system and injuries, wounds, burns, and blast injuries; ovarian torsion; pelvic relaxation; prolapse, vaginal walls, uterine, uterovaginal; rectocele; urethrocele Congenital disorders: müllerian agenesis; uterus didelphys, bicornuate uterus; short cervix Adverse effects of drugs on the female reproductive system and breast: antihistamines, H2-receptor blockers; benzodiazepines; beta-adrenergic blockers; hormone replacement; opioids; spironolactone; selective serotonin reuptake inhibitors; tricyclic antidepressants Male Reproductive System Normal Processes Embryonic development, fetal maturation, and neonatal changes, gametogenesis Organ structure and function structure, male genitalia and prostate function, male genitalia and prostate (eg, spermatogenesis, puberty) intercourse, orgasm, erection Cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones Reproductive system defense mechanisms and normal flora Repair, regeneration, and changes associated with stage of life Abnormal Processes: Health and Health Maintenance, Screening, Diagnosis, Management, Risks, Prognosis Infectious, immunologic, and inflammatory disorders infectious disorders: balan
United States Medical Licensing Examination Step 1
USMLE Examination Questions and Answers
Introduction
With the dreaded USMLE Step 1 now always around the corner -- it's now given 6 days a week, every week! -- the test has become a popular Topic of questions on Medscape Med Students' discussion boards. I decided to go straight to the source for some answers, so here's a Q & A with Chirag Amin, MD, and Tao Le, MD, 2 of the authors of that USMLE bible, First Aid for the USMLE Step 1 2001: A Student to Student Guide. Dr. Amin is now Vice President of Content and Community for www.medschool.com, where Dr. Le is Chief Medical Officer.
Medscape: Describe the USMLE.
Drs. Amin and Lee: The USMLE Step 1 computer-based test (CBT) is a 1-day test, taken on a computer, that's administered once a day (except Sunday) on a year-round basis at hundreds of testing centers around the world. The test consists of a total of 350 multiple-choice, single-best-answer questions that are broken down into seven 1-hour blocks, with 50 questions per block. Examinees are given short breaks between blocks, as well as a lunch break.
M: How long in advance of Step 1 should students start preparing? Should they make studying for the USMLE a part of studying for regular courses?
A&L: The USMLE Step 1 was designed to assess medical science knowledge and concepts taught during the preclinical years at a typical medical school. Therefore, medical students who studied diligently during their first- and second-year coursework end up minimizing the stress and workload of a USMLE Step 1 review. Regardless, most students start intensive examination preparation on a full-time basis (ie, 6-8 hours of studying per day) approximately 4-6 weeks before the real examination date. Due to differences in their medical education/training and curriculum as well as the time that often lapses since the completion of basic science coursework, international medical graduates (IMGs) usually need 2-4 months of study before taking the USMLE Step 1.
M: If you have a month, as many schools provide students, what's a good schedule?
A&L: In the month leading up to the exam, the majority of medical students find themselves studying anywhere from 6-12 hours each day, dividing their study time proportionally over the 7 traditional basic science disciplines, which include anatomy, behavioral sciences, biochemistry, microbiology/immunology, pathology, pharmacology, and physiology. In addition, many students devote the last week of their exam preparation to comprehensive review as well as going through demo questions. Many students recommend thorough review of the high-yield facts in First Aid for the USMLE Step 1 during the last week. Generally, students devote more time to the more clinically relevant disciplines, such as pathology, pharmacology, and microbiology/immunology. However, a common mistake that students make is not spending enough time covering all subject disciplines thoroughly.
M: What books can you recommend for general review? For specific subjects?
A&L: Students usually find themselves buying anywhere from 10-25 review as well as question-and-answer (Q&A) books, but most will start with our First Aid for the USMLE Step 1. The major medical publishing companies such as McGraw-Hill, Lippincott Williams & Wilkins, Blackwell Science, and Harcourt Health Sciences have several excellent titles for USMLE review. In addition, many students have benefited from books that present this basic science material from a clinical perspective, such as our Underground Clinical Vignettes series.
M: What kind of surprises, in terms of subject material, have students told you about?
A&L: Many medical students that we have talked to underestimate the amount of clinical material on the USMLE Step 1 examination. For example, a significant portion of the anatomy that is tested on the USMLE exam is based on one's ability to recognize anatomical structures on common radiographic images, such as x-rays, CT, and MRI scans. Furthermore, many students also leave the exam feeling somewhat intimidated regarding the clinical slant of how the basic science material is tested. Knowing specific disease pathophysiology as well as drug mechanism of action in the context of a clinical scenario is essential for doing well on the USMLE.
M: Do courses work?
A&L: This depends on the student's learning style and level of discipline. Only a small percentage of students take a review course for the USMLE Step 1 examination. Many students feel that they can benefit more by organizing a study schedule that is focused around their own strengths and weaknesses. However, there are some students who are not effectively able to manage their own study time. Those students may benefit from a structured review course.
M: What about cramming?
A&L: Because the material tested on the USMLE Step 1 examination covers a large amount of information that is learned over the course of 2 years in medical school, strict cramming is usually not an effective method for USMLE preparation. Furthermore, since many questions on the exam are asked from a clinical standpoint, requiring medical reasoning and problem-solving skills, a structured and disciplined review over the course of several weeks is far more effective in terms of doing well on the exam as compared to cramming. That being said, anecdotes abound about medical students passing just by cramming First Aid for the USMLE Step 1. Again, cramming is not recommended.
M: What kind of advice do you have for international medical graduates?
A&L: The most important advice for international medical graduates is to become familiar with taking exams on the computer. The vast majority of international medical graduates have never taken an exam on the computer, and this is a major obstacle. Factors such as eye strain and mouse dexterity can serve as a major obstacle when taking the examination. The more that one is able to become familiar with the specific test-taking environment, the better that person is able to concentrate on the test itself.
M: Any particular advice for students who are retaking the exam after failing?
Honestly assess your weaknesses and shortfalls in your previous exam preparation, and focus on improving in those areas. Retakers have the advantage of experience, and most use this advantage to their benefit in terms of revising their method of exam preparation when studying the second time around. The good news is that retakers generally have a very high pass rate.
M: Can you list helpful resources?
A&L: There are a number of helpful resources for USMLE preparation. In terms of textbooks, one textbook that gives an excellent overview of the exam, including a database of high-yield facts and a detailed list of useful resources, is our First Aid for the USMLE Step 1. Many students consider this book the best place to start their exam preparation. In addition, Medschool.com's community Web site (https://students.medschool.com) has a USMLE Study Center that provides a wealth of free information, including online USMLE lectures, demo training schedules, simulated exam modules, recommended books, discussion forums, and much more. Another important resource is the National Board of Medical Examiners (NBME) Web site at https://www.nbme.org, which provides students with the most up-to-date information about the examination.
Launched in November 2023, ChatGPT is a chatbot that can not only engage in human-like conversation, but also provide accurate answers to questions in a wide range of knowledge domains. The chatbot, created by the firm OpenAI, is based on a family of "large language models"—algorithms that can recognize, predict, and generate text based on patterns they identify in datasets containing hundreds of millions of words.
In a study appearing in PLOS Digital Health this week, researchers report that ChatGPT performed at or near the passing threshold of the U.S. Medical Licensing exam (USMLE)—a comprehensive, three-part exam that doctors must pass before practicing medicine in the United States.
In an editorial accompanying the paper, Leo Anthony Celi, a principal research scientist at MIT's Institute for Medical Engineering and Science, a practicing physician at Beth Israel Deaconess Medical Center, and an associate professor at Harvard Medical School, and his co-authors argue that ChatGPT's success on this exam should be a wake-up call for the medical community.
Q: What do you think the success of ChatGPT on the USMLE reveals about the nature of the medical education and evaluation of students?
A: The framing of medical knowledge as something that can be encapsulated into multiple choice questions creates a cognitive framing of false certainty. Medical knowledge is often taught as fixed model representations of health and disease. Treatment effects are presented as stable over time despite constantly changing practice patterns. Mechanistic models are passed on from teachers to students with little emphasis on how robustly those models were derived, the uncertainties that persist around them, and how they must be recalibrated to reflect advances worthy of incorporation into practice.
ChatGPT passed an examination that rewards memorizing the components of a system rather than analyzing how it works, how it fails, how it was created, how it is maintained. Its success demonstrates some of the shortcomings in how we train and evaluate medical students. Critical thinking requires appreciation that ground truths in medicine continually shift, and more importantly, an understanding how and why they shift.
A: Learning is about leveraging the current body of knowledge, understanding its gaps, and seeking to fill those gaps. It requires being comfortable with and being able to probe the uncertainties. We fail as teachers by not teaching students how to understand the gaps in the current body of knowledge. We fail them when we preach certainty over curiosity, and hubris over humility.
Medical education also requires being aware of the biases in the way medical knowledge is created and validated. These biases are best addressed by optimizing the cognitive diversity within the community. More than ever, there is a need to inspire cross-disciplinary collaborative learning and problem-solving. Medical students need data science skills that will allow every clinician to contribute to, continually assess, and recalibrate medical knowledge.
Q: Do you see any upside to ChatGPT's success in this exam? Are there beneficial ways that ChatGPT and other forms of AI can contribute to the practice of medicine?
A: There is no question that large language models (LLMs) such as ChatGPT are very powerful tools in sifting through content beyond the capabilities of experts, or even groups of experts, and extracting knowledge. However, we will need to address the problem of data bias before we can leverage LLMs and other artificial intelligence technologies. The body of knowledge that LLMs train on, both medical and beyond, is dominated by content and research from well-funded institutions in high-income countries. It is not representative of most of the world.
We have also learned that even mechanistic models of health and disease may be biased. These inputs are fed to encoders and transformers that are oblivious to these biases. Ground truths in medicine are continuously shifting, and currently, there is no way to determine when ground truths have drifted. LLMs do not evaluate the quality and the bias of the content they are being trained on. Neither do they provide the level of uncertainty around their output. But the perfect should not be the enemy of the good. There is tremendous opportunity to Strengthen the way health care providers currently make clinical decisions, which we know are tainted with unconscious bias. I have no doubt AI will deliver its promise once we have optimized the data input.
More information: Amarachi B. Mbakwe et al, ChatGPT passing USMLE shines a spotlight on the flaws of medical education, PLOS Digital Health (2023). DOI: 10.1371/journal.pdig.0000205
This story is republished courtesy of MIT News (web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.
Citation: Q&A: Three questions on ChatGPT and medicine (2023, February 9) retrieved 19 February 2023 from https://techxplore.com/news/2023-02-qa-chatgpt-medicine.html
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The conversational AI bot ChatGPT is having a moment, promising to transform the ways in which we produce written text, search the web, and educate ourselves.
The latest ChatGPT achievement? Almost passing the US Medical Licensing exam (USMLE).
We're talking about an exam known for its difficulty here, one that usually requires some 300 to 400 hours of preparation to complete and which covers everything from basic science concepts to bioethics.
The USMLE is actually three exams in one, and the competency with which ChatGPT is able to answer its questions shows that these AI bots could one day be useful for medical training and even for making certain types of diagnoses.
"ChatGPT performed at or near the passing threshold for all three exams without any specialized training or reinforcement," write the researchers in their published paper. "Additionally, ChatGPT demonstrated a high level of concordance and insight in its explanations."
ChatGPT is a type of artificial intelligence known as a large language model or LLM. These LLMs are specifically geared towards written responses, and through vast amounts of demo text and some clever algorithms, they're able to make predictions about which words should go together in a sentence, much like the big brother to your phone's predictive text function.
That's something of a simplification, but you get the idea: ChatGPT doesn't actually 'know' anything, but by analyzing a huge amount of online material, it can construct plausible-sounding sentences on just about any topic.
'Plausible sounding' is the key, though. Depending on the probability of various phrasing, the AI can seem uncannily smart or come to the most ridiculous conclusions.
Researchers from the Ansible Health startup tested it using demo questions from the USMLE, having checked that the answers weren't available on Google – so they knew that ChatGPT would be generating new responses based on the data it's been trained on.
Put to the test, ChatGPT scored between 52.4 percent and 75 percent across the three exams (the pass mark is usually around 60 percent). In 88.9 percent of its responses, it produced at least one significant insight – described as something that was "new, non-obvious, and clinically valid" by the researchers.
"Reaching the passing score for this notoriously difficult expert exam, and doing so without any human reinforcement, marks a notable milestone in clinical AI maturation," the study authors said in a press statement.
ChatGPT also proved to be impressively consistent in its answers and was even able to provide reasoning behind each response. It also beat the 50.3 percent accuracy rate of PubMedGPT, a bot trained specifically on medical literature.
It's worth remembering that the information ChatGPT has been trained on will include inaccuracies: if you ask the bot itself, it will admit that more work is needed to Strengthen the reliability of LLMs. It's not going to replace medical professionals at any point in the foreseeable future.
However, the potential for parsing online knowledge is clearly huge, especially as these AI bots continue to get better in the years to come. Rather than replacing humans in the medical profession, they could become vital assistants to them.
"These results suggest that large language models may have the potential to assist with medical education, and potentially, clinical decision-making," write the researchers.
The research has been published in PLOS Digital Health.
Before long, it’ll be easier to list the tasks ChatGPT can’t complete than the ones it can. We have already shared reports about ChatGPT passing law school and business school exams, and now a new study reveals that the AI chatbot can also pass the United States Medical Licensing exam (USMLE), though its score isn’t especially impressive.
Researchers from healthcare startup Ansible Health shared the results of their study in the journal PLOS Digital Health on February 9. They found that ChatGPT was able to score “at or around the approximately 60 percent passing threshold” for the licensing exam.
As the website explains, the USMLE is a three-step exam that physicians are required to take for medical licensure in the US. In addition to testing the skills and medical knowledge of prospective physicians, the test also assesses their values and attitudes.
After eliminating image-based questions, the researchers fed ChatGPT 350 of the 376 questions from the June 2023 USMLE. Across the three exams, ChatGPT scored between 52.4% and 75%. In most years, the passing threshold is around 60%. ChatGPT also outscored PubMedGPT — a model trained exclusively on biomedical literature — which scored 50.8%.
The authors say: “Reaching the passing score for this notoriously difficult expert exam, and doing so without any human reinforcement, marks a notable milestone in clinical AI maturation.”
Shortly after the study was published, the Federation of State Medical Boards and National Board of Medical Examiners, both USMLE co-sponsors, shared a statement of their own. They note that two accurate studies used test prep material and practice questions as opposed to real USMLE exam questions. As such, ChatGPT’s achievement comes with an asterisk:
…it’s important to note that the practice questions used by ChatGPT are not representative of the entire depth and breadth of USMLE exam content as experienced by examinees. For example, certain question types were not included in the studies, such as those using pictures, heart sounds, and computer-based clinical skill simulations. This means that other critical test constructs are not being represented in their entirety in the studies.
“Although there is insufficient evidence to support the current claims that AI can pass the USMLE Step exams, we would not be surprised to see AI models Strengthen their performance dramatically as the technology evolves,” the groups added. “If utilized correctly, these tools can have a positive impact on how assessments are built and how students learn.”
In a accurate study published in PLOS Digital Health, researchers evaluated the performance of an artificial intelligence (AI) model named ChatGPT to perform clinical reasoning on the United States Medical Licensing exam (USMLE).
The USMLE comprises three standardized exams, clearing which help students get medical licensure in the US.
Background
There have been advancements in artificial intelligence (AI) and deep learning in the past decade. These technologies have become applicable across several industries, from manufacturing and finance to consumer goods. However, their applications in clinical care, especially healthcare information technology (IT) systems, remain limited. Accordingly, AI has found relatively few applications in widespread clinical care.
One of the main reasons for this is the shortage of domain-specific training data. Large general domain models are now enabling image-based AI in clinical imaging. It has led to the development of Inception-V3, a top medical imaging model that spans domains from ophthalmology and pathology to dermatology.
In the last few weeks, ChatGPT, an OpenAI-developed general Large Language Model (LLM) (not domain specific), garnered attention due to its exceptional potential to perform a suite of natural language tasks. It uses a novel AI algorithm that predicts a given word sequence based on the context of the words written prior to it.
Thus, it could generate plausible word sequences based on the natural human language without being trained on humongous text data. People who have used ChatGPT find it capable of deductive reasoning and developing a chain of thought.
Regarding the choice of the USMLE as a substrate for ChatGPT testing, the researchers found it linguistically and conceptually rich. The test contained multifaceted clinical data (e.g., physical examination and laboratory test results) used to generate ambiguous medical scenarios with differential diagnoses.
About the study
In the present study, researchers first encoded USMLE exam items as open-ended questions with variable lead-in prompts, then as multiple-choice single-answer questions with no forced justification (MC-NJ). Finally, they encoded them as multiple-choice single-answer questions with a forced justification of positive and negative selections (MC-J). In this way, they assessed ChatGPT accuracy for all three USMLE steps, steps 1, 2CK, and 3.
Next, two physician reviewers independently arbitrated the concordance of ChatGPT across all questions and input formats. Further, they assessed its potential to enhance medical education-related human learning. Two physician reviewers also examined AI-generated explanation content for novelty, nonobviousness, and validity from the perspective of medical students.
Furthermore, the researchers assessed the prevalence of insight within AI-generated explanations to quantify the density of insight (DOI). The high frequency and moderate DOI (>0.6) indicated that it might be possible for a medical student to achieve some knowledge from the AI output, especially when answering incorrectly. DOI indicated the uniqueness, novelty, nonobviousness, and validity of insights provided for more than three out of five answer choices.
Results
ChatGPT performed at over 50% accuracy across all three USMLE examinations, exceeding the 60% USMLE pass threshold in some analyses. It is an extraordinary feat because no other prior models reached this benchmark; merely months prior, they performed at 36.7% accuracy. Chat GPT iteration GPT3 achieved 46% accuracy with no prompting or training, suggesting that further model tuning could fetch more precise results. AI performance will likely continue to advance as LLM models mature.
In addition, ChatGPT performed better than PubMedGPT, a similar LLM trained exclusively in biomedical literature (accuracies ~60% vs. 50.3%). It seems that ChatGPT, trained on general non-domain-specific content, had its advantages as exposure to more clinical content, e.g., patient-facing disease primers are far more conclusive and consistent.
Another reason why the performance of ChatGPT was more impressive is that prior models most likely had ingested many of the inputs while training, while it had not. Note that the researchers tested ChatGPT against more contemporary USMLE exams that became publicly available in the year 2023 only). However, they had trained other domain-specific language models, e.g., PubMedGPT and BioBERT, on the MedQA-USMLE dataset, publically available since 2009.
Intriguingly, the accuracy of ChatGPT was inclined to increase sequentially, being lowest for Step 1 and highest for Step 3, reflecting the perception of real-world human users, who also find Step 1 subject matter difficult. This particular finding exposes AI's vulnerability to becoming connected to human ability.
Furthermore, the researchers noted that missing information drove inaccuracy observed in ChatGPT responses which fetched poorer insights and indecision in the AI. Yet, it did not show an inclination towards the incorrect answer choice. In this regard, they could try to Strengthen ChatGPT performance by merging it with other models trained on abundant and highly validated resources in the clinical domain (e.g., UpToDate).
In ~90% of outputs, ChatGPT-generated responses also offered significant insight, valuable to medical students. It showed the partial ability to extract nonobvious and novel concepts that might provide qualitative gains for human medical education. As a substitute for the metric of usefulness in the human learning process, ChatGPT responses were also highly concordant. Thus, these outputs could help students understand the language, logic, and course of relationships encompassed within the explanation text.
Conclusions
The study provided new and surprising evidence that ChatGPT could perform several intricate tasks relevant to handling complex medical and clinical information. Although the study findings provide a preliminary protocol for arbitrating AI-generated responses concerning insight, concordance, accuracy, and the advent of AI in medical education would require an open science research infrastructure. It would help standardize experimental methods and describe and quantify human-AI interactions.
Soon AIs could become pervasive in clinical practice, with varied applications in nearly all medical disciplines, e.g., clinical decision support and patient communication. The remarkable performance of ChatGPT also inspired clinicians to experiment with it.
At AnsibleHealth, a chronic pulmonary disease clinic, they are using ChatGPT to assist with challenging tasks, such as simplifying radiology reports to facilitate patient comprehension. More importantly, they use ChatGPT for brainstorming when facing diagnostically difficult cases.
The demand for new examination formats continues to increase. Thus, future studies should explore whether AI could help offload the human effort of taking medical tests (e.g., USMLE) by helping with the question-explanation process or, if feasible, writing the whole autonomously.
The USMLE is a crucial step in obtaining a medical license in the country and is known for its rigorous testing standards.
The AI model, known as "ChatGPT," was trained on a vast dataset of medical information and was able to demonstrate an understanding of complex medical concepts and procedures, Sputnik reported.
The research was published in the prestigious peer-reviewed scientific journal PLOS Digital Health.
As the authors of the study noted: "We evaluate(d) the performance of ChatGPT, a non-domain specific LLM, on its ability to perform clinical reasoning by testing its performance on questions from the United States Medical Licensing Examination (USMLE)."
The researchers indicated that ChatGPT passed the medical exam without specialized training. This means that the neural network was not trained on special medical papers, but simply used the information available on the internet. In doing so, researchers made sure that the answers could not simply be googled online. Artificial intelligence not only provided coherent responses but also scientifically grounded them.
ChatGPT scored between 52 and 75 percent across the three tests, while the pass mark is commonly 60 percent. In 88.9% of the responses, artificial intelligence gave answers that were perceived by the researchers as "new, non-obvious, and clinically valid". In other words, the neural network managed to produce medical insight.
The researchers added that the capabilities of the neural network should not be overestimated - it constructs plausible-sounding sentences based on the analyzed material, which means that ChatGPT can generate both extremely non-trivial ideas and complete nonsense.
The article highlighted that ChatGPT was much more effective in its responses than PubMedGPT, a bot specifically trained in medical literature.
Scholars believe that artificial intelligence will not be able to replace doctors in a foreseeable future. However, it may play an important role not only in training future medical students but also as an assistant to a real doctor, leading them to think about non-obvious diagnoses.
A study published in PLOS Digital Health looks at the performance of ChatGPT on US Medical Licensing exam (USMLE).
Prof Nello Cristianini, Professor of Artificial Intelligence at the University of Bath, said:
What was in the article.
“The article describes how chatGPT was applied to generate answers to a 3-part test called USMLE. In the US, Physicians with a Doctor of Medicine (MD) degree are required to pass the USMLE for medical licensure. The minimum passing accuracy is 60% (and the pass rate seems to be well above 90% https://www.usmle.org/performance-data ).”
“The software chatGPT achieved an accuracy “close to” (which means short of) the passing accuracy in most settings, but it was close, and within the passing range for some tasks (see Figure 2a in the paper).
“This does not remotely suggest that chatGPT has any comparable knowledge to a human, since the test might be a good predictor of performance ONLY for those who have already a MD and done a residency, that is for a very pre-selected population. GPT would not be part of it.
“Care was taken to ensure that the test questions were not part of the training set. The way the assessment was done, one could Strengthen it by introducing more “blindness” in the adjudicators, for example mixing GPT answers to human answers, in an anonymized setting, but this does not seem to have been done.”
Why this may be interesting.
“On the one hand we are in the presence of a statistical mechanism trained to generate text (new but ‘similar’ to the one it was trained upon), in the right context and way, so we should not talk about understanding, or related concepts. On the other hand, once this is refined to the point of actually passing an exam, we may want to reconsider how we assess new doctors. It can also be useful for training students.
“Still, it is part of an exciting series of new developments in AI.
“More importantly for me as a scientist: this approach can greatly help us to develop better ways for researchers to process large amounts of literature. I can imagine tools such as this one, summarizing information and answering questions, not actually practicing medicine.”
Dr Stuart Armstrong, Co-Founder and Chief Researcher at Aligned AI, said:
“This is an impressive performance, and we should expect to see more such successes in AI in the future. One caveat, though, is that the US Medical Licensing exam is designed to be hard for humans, not for machines; there are many areas where humans are much more effective than AIs (such as moving about in cluttered spaces or interpreting social cues). This human superiority won’t last forever, though; one day, AIs will be better than us at almost every task.”
Prof Peter Bannister, Biomedical Engineer & Executive Chair, Institution of Engineering and Technology (IET), said:
“While ChatGPT continues to demonstrate an impressive ability to generate logical content in numerous settings, these results serve to highlight the limitations of written tests as the only way of assessing performance in complex and multi-disciplinary professions such as medicine. More generally this research underlines the need to base technology solutions on the full scope of the challenge, in this case providing comprehensive, in-person clinical care to patients from a wide range of populations.”
The following comments are provided by our colleagues at SMC Spain:
Prof Alfonso Valencia, ICREA professor and director of Life Sciences at the Barcelona National Supercomputing Centre (BSC), said:
“ChatGPT is a computational natural language processing system built by OpenAI on top of a GPT3.5 (Generative Pretrained Transformer). The GPT has been trained on large amounts of text to correlate words in context, for which it handles about 175 billion parameters. ChatGPT has been further refined to answer questions by stringing words together, following the internal correlation model.
“ChatGPT neither “reasons” nor “thinks”, it just provides a text based on a huge and very sophisticated probability model.
“The test has three levels: a) second-year medical students who’ve done about 300 hours of study, b) fourth-year medical students with about 2 years of clinical rotations under their belt, and c) students who have completed more than half a year of postgraduate education.
“The test included three types of questions adapted for submission to the ChatGPT system:
– Open-ended questions, e.g. “In your opinion, what is the reason for the patient’s pupillary asymmetry?”
– Multiple-choice questions without justification. A typical case would be a question such as: ” “The patient’s condition is mostly caused by which of the following pathogens?”
– Multiple-choice questions with justification, such as: “Which of the following is the most likely reason for the patient’s nocturnal symptoms? Explain your rationale for each choice.”
“The results were evaluated by two experienced doctors and the discrepancies were evaluated by a third expert.
“Summing up the results, we can say that the answers were accurate to an extent that is equivalent to the minimum level of human learners who passed that year.
“There’s a number of interesting observations:
– It is striking that, in just a few months, the system has improved significantly—partly because it has gotten better and partly because the amount of biomedical data has increased considerably.
– The system is better than other ones trained on scientific texts alone. The reason has to be that the statistical model is more thorough.
– There is an interesting correlation between the quality of the results (accuracy), the quality of the explanations (concordance) and the ability to produce non-trivial explanations (insight). The explanation may be that, when the system is working on a case where it has a lot of data, the correlation model is better, producing better and more coherent explanations. This seems to provide some insight into the inner workings of the system and the importance of the structure of the data it relies on.
“The study is careful in key areas, such as checking that the Dumps were not openly available on the web and could not have been used to train the system, or that it did not retain the memory of previous answers. It also has limitations, such as a limited demo size (with 350 questions: 119, 102 and 122 for levels 1, 2 and 3, respectively). The study also represents a limited scenario as it only works with text. In fact, 26 questions containing images or other non-textual information were removed.
“What does this tell us?
– Exams should not be in written form, since it is possible to answer them without “understanding” either the questions or the answers. In other words, such written exams are useful neither for assessing the knowledge of a student (be it a machine or a human being), nor to measure their ability to respond to a real case (which is nil in the case of the machine).
– Natural language processing systems based on “Transformers” are reaching very impressive levels of writing that are basically comparable to humans.
– Humans are still exploring how to use these new tools.”
Lucía Ortiz de Zárate, pre-doctoral researcher in Ethics and Governance of Artificial Intelligence in the department of Political Science and International Relations at the Autonomous University of Madrid, said:
“The study addresses, experimentally, the potential of ChatGPT (OpenAI) to pass the United States Medical Licensing exam (USMLE). Passing this exam is a prerequisite for acquiring a licence to practice medicine in the United States, and it tests the ability of medical specialists to apply knowledge, concepts and principles that are essential for providing the necessary care to patients.
“The novelty of the paper lies not only in the fact that it is the first experiment to be used for this purpose, but also in its results. According to the researchers, ChatGPT is very close to passing the USMLE test, which would require at least a 60% success rate. The test used in the study contains three types of questions (open response, multiple-choice without justification and multiple-choice with justification). Currently, ChatGPT has achieved an average of between 52.4 % and 75 % correct answers, well above the 36.7 % score achieved only a few months ago with previous models. These rapid improvements of ChatGPT in just a few months make researchers optimistic about the possibilities of this AI.
“While the results may be of great interest, the study has important limitations that call for caution. For the USMLE exam, ChatGPT was tested on 375 exam questions from the June 2023 edition of the exam, published by the official website responsible for the exam. In this sense, we will have to wait and see what results are obtained when ChatGPT is applied to a larger number of questions and, in turn, is trained with a larger volume of data and more specialised content. In addition, the results of the ChatGPT test were evaluated by two doctors. Thus, it is necessary to wait for further studies with a larger number of qualified evaluators to be able to endorse the results of this AI.
“This type of study demonstrates, on the one hand, the potential of AI for medical applications and, on the other hand, the need to rethink knowledge evaluation methods. In terms of medical practice, AI technologies can be a very significant help for doctors when making diagnoses, prescribing treatments and medicines, etc. These changes push us to rethink the relationship between AI, doctors and patients. As for evaluation systems—not only in medicine—the progressive improvement of AI systems such as ChatGPT show that we need to rethink our methods for evaluating the knowledge and skills (and content) that future professionals need.”
The following comments are provided by our colleagues at the New Zealand SMC:
Dr Simon McCallum, Senior Lecturer in Software Engineering, Te Heranga Waka, Victoria University of Wellington:
“This particular study was conducted in the first few weeks of ChatGPT becoming available. There have been three updates since November with the latest on January 30th. These updates have improved the ability of the AI to answer the sorts of questions in the medical exam.
“Google has developed a Large Language Model (the broad category of tools like ChatGPT) called Med-PaLM, which ‘performs encouragingly on the axes of our pilot human evaluation framework.’ Med-PaLM is a specialisation of Flan-PaLM, a system released by Google that is similar to ChatGPT, trained on general instructions. Med-PaLM focused its learning on medical text and conversations. ‘For example, a panel of clinicians judged only 61.9% of Flan-PaLM long-form answers to be aligned with scientific consensus, compared to 92.6% for Med-PaLM answers, on par with clinician-generated answers (92.9%). Similarly, 29.7% of Flan-PaLM answers were rated as potentially leading to harmful outcomes, in contrast with 5.8% for Med-PaLM, comparable with clinician-generated answers (6.5%).’
“Thus, ChatGPT may pass the exam, but Med-PaLM is able to provide advice to patients that is as good as a professional GP. And both of these systems are improving.
“ChatGPT is also good at simplifying content so that individuals can understand medical jargon or complex instructions. Asking the AI to simplify until the language used fits the needs of the patient will change people’s ability to understand medical advice and removes the potential embarrassment associated with saying you do not understand.
“Within university education we are having to pivot almost as fast as at the start of the pandemic to account for the ability of AI to perform tasks which were traditionally a sign of understanding. There is also a massive cultural shift when everybody has access to a tool that can assist in written communication. Careers and jobs which were seen as difficult, may be automated by these AI tools. Microsoft has announced that ChatGPT is now integrated into MS Team Professional and will act as a meeting secretary, summarising meetings and creating action items. Bing will also include a ChatGPT advancement linking the version 4 of ChatGPT with up-to-date search information.”
“Society is about to change, and instead of warning about the hypochondria of randomly searching the internet for symptoms, we may soon get our medical advice from Doctor Google or Nurse Bing.”
Dr Collin Bjork, Senior Lecturer in Science Communication and Podcasting, Massey University, said:
“The claim that ChatGPT can pass US medical exams is overblown and should come with a lengthy series of asterisks. Like ChatGPT itself, this research article is a dog and pony show designed to generate more hype than substance.
“OpenAI had much to gain by releasing a free open-access version of ChatGPT in late 2023 and fomenting a media fervour around the world. Now, OpenAI is predicting 1 billion in revenue in 2024, even as a ‘capped-profit’ company.
“Similarly, the authors of this article have much to gain by releasing a free open-access version of their article claiming that ChatGPT can pass the US Medical Licensing Exams. All of the authors but one work for Ansible Health, ‘an early stage venture-backed healthcare startup’ based in the Silicon Valley. At two years old, this tiny company will likely need to go back to their venture capitalist investors soon to ask for more money. And the media splash from this well-timed journal article will certainly help fund their next round of growth. After all, a pre-print of this article already went viral on social media because the researchers listed ChatGPT as an author. But the removal of ChatGPT from the list of authors in the final article indicates that this too was just a publicity stunt.
“As for the article itself, the findings are not as straightforward as the press release indicates. Here’s one example:
“The authors claim that ‘ChatGPT produced at least one significant insight in 88.9% of all responses’ (8). But their definition of ‘insight’ as ‘novelty, non-obviousness, and validity’ (7) is too vague to be useful. Furthermore, the authors insist that these ‘insights’ indicate that ChatGPT ‘possesses the partial ability to teach medicine by surfacing novel and nonobvious concepts that may not be in the learner’s sphere of awareness’ (10). But how can an unaware learner distinguish between true and false insights, especially when ChatGPT only offers ‘accurate’ answers on the USMLE a little more than half the time?
“The authors’ claims about ChatGPT’s insights and teaching potential are misleading and naive.”
‘Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models’ by Tiffany H. Kung et al. was published in PLOS Digital Health at 19:00 UK time Thursday 9 February 2023.
DOI: 10.1371/journal.pdig.0000198
Declared interests
Dr Stuart Armstrong: “I have no direct interests in OpenAI, ChatGPT, and USMLE. As a human, I am interested in AI safety in general, and as a co-founder of an AI safety startup, I am interested in tools that increase AI safety (though we have no commercial relationships with OpenAI or any of its rivals).”
Prof Alfonso Valencia: “member of the advisory board of SMC Spain.”
Lucía Ortiz de Zárate: “No conflicts to report.”
Dr Simon McCallum: “I am an active member of the Labour Party (Taieri LEC Chair). I am leading Te Heranga Waka Victoria University of Wellington’s response to AI tools.” Expertise and background: “I have a PhD in Computer Science (in Neural Networks like those used in ChatGPT ) from the University of Otago. I have been teaching using Github Copilot last year. Copilot uses the same GTP model as ChatGPT but was focused on programming languages rather than human languages. My research has been in Games for Health and Games for Education, where AIs in games have been part of the tools integrated into research. I have also applied ChatGPT to many of our courses and it passes first year courses and some of our second year courses as of December, and may do even better now.”
Dr Collin Bjork: “No COI.”
For all other experts, no reply to our request for DOIs was received.
Adding to its feat of clearing professional examinations, ChatGPT recently cleared Google’s coding interview for L3 position. Considered one of the toughest interviews to crack, ChatGPT aced the role, whose annual compensation is around $183000. This brings focus back on the discussion of jobs that can be threatened by ChatGPT, and the question of whether AI can truly eliminate human elements.
A few weeks ago, ChatGPT also cleared the coding exam for Amazon interview, but a few flaws were observed with ChatGPT’s answers to the company’s coding questions. They were not efficient and had “buggy” implementation. However, ChatGPT was able to provide the right answers and even Strengthen the codes, explains an Amazon machine learning engineer. “I’m both scared and excited to see what impact this will have on the way we conduct coding interviews,” he said.
As reported by CNBC, the test was part of Google’s experiments conducted on AI chatbots to assess and probably adapt to their chat models. Last month, ChatGPT cleared the United States Medical Licensing exam (USMLE). This is in addition to clearing other professional exams as a series of experiments conducted by researchers and scientists from various fields.
Christian Terwiesch, a professor at the University of Pennsylvania’s Wharton School, tested ChatGPT on his operation management course as part of the MBA curriculum, and it scored B- which is better than average. The chatbot could ace basic operations management and process-analysis questions, but advanced-level prompts and basic math were where it failed. ChatGPT also cleared four law exams from the University of Minnesota Law School with a C grade. Although the bot cleared the exam, it did not fare well in maths and failed to spot issues in open-ended prompts, which is one of the core skills required in law school exams.
While ChatGPT has been able to clear exams related to framed theories and processes from various professional streams, it has struggled with ambiguity elements where reasoning is required.
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ChatGPT can score at or around the approximately 60 percent passing threshold for the United States Medical Licensing exam (USMLE), with responses that make coherent, internal sense and contain frequent insights, according to a study published February 9, 2023 in the open-access journal PLOS Digital Health by Tiffany Kung, Victor Tseng, and colleagues at AnsibleHealth.
ChatGPT is a new artificial intelligence (AI) system, known as a large language model (LLM), designed to generate human-like writing by predicting upcoming word sequences. Unlike most chatbots, ChatGPT cannot search the internet. Instead, it generates text using word relationships predicted by its internal processes.
Kung and colleagues tested ChatGPT’s performance on the USMLE, a highly standardized and regulated series of three exams (Steps 1, 2CK, and 3) required for medical licensure in the United States. Taken by medical students and physicians-in-training, the USMLE assesses knowledge spanning most medical disciplines, ranging from biochemistry, to diagnostic reasoning, to bioethics.
After screening to remove image-based questions, the authors tested the software on 350 of the 376 public questions available from the June 2023 USMLE release.
After indeterminate responses were removed, ChatGPT scored between 52.4% and 75.0% across the three USMLE exams. The passing threshold each year is approximately 60%. ChatGPT also demonstrated 94.6% concordance across all its responses and produced at least one significant insight (something that was new, non-obvious, and clinically valid) for 88.9% of its responses. Notably, ChatGPT exceeded the performance of PubMedGPT, a counterpart model trained exclusively on biomedical domain literature, which scored 50.8% on an older dataset of USMLE-style questions.
While the relatively small input size restricted the depth and range of analyses, the authors note their findings provide a glimpse of ChatGPT’s potential to enhance medical education, and eventually, clinical practice. For example, they add, clinicians at AnsibleHealth already use ChatGPT to rewrite jargon-heavy reports for easier patient comprehension.
“Reaching the passing score for this notoriously difficult expert exam, and doing so without any human reinforcement, marks a notable milestone in clinical AI maturation,” say the authors.
Author Dr Tiffany Kung added that ChatGPT's role in this research went beyond being the study subject: "ChatGPT contributed substantially to the writing of [our] manuscript... We interacted with ChatGPT much like a colleague, asking it to synthesize, simplify, and offer counterpoints to drafts in progress...All of the co-authors valued ChatGPT's input."
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In your coverage, please use this URL to provide access to the freely available article in PLOS Digital Health: https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000198
Citation: Kung TH, Cheatham M, Medenilla A, Sillos C, De Leon L, Elepaño C, et al. (2023) Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models. PLOS Digit Health 2(2): e0000198. https://doi.org/10.1371/journal.pdig.0000198
Author Countries: USA
Funding: The authors received no specific funding for this work.
Journal
PLOS Digital Health
Method of Research
Experimental study
Subject of Research
Not applicable
Article Title
Performance of ChatGPT on USMLE: Potential for AI-assisted medical education using large language models
Article Publication Date
9-Feb-2023
COI Statement
The authors have declared that no competing interests exist.
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