title: Assessing potentially dangerous medical actions with the computer-based case simulation portion of the USMLE step 3 examination.
abstract: BACKGROUND
  The 2000 Institute of Medicine report on patient safety brought renewed attention to the issue of preventable medical errors, and subsequently specialty boards and the National Board of Medical Examiners were encouraged to play a role in setting expectations around safety education. This paper examines potentially dangerous actions taken by examinees during the portion of the United States Medical Licensing Examination Step 3 that is particularly well suited to evaluating lapses in physician decision making, the Computer-based Case Simulation (CCS).
  
  
  METHODS
  Descriptive statistics and a general linear modeling approach were used to analyze dangerous actions ordered by 25,283 examinees that completed CCS for the first time between November 2006 and January 2008.
  
  
  RESULTS
  More than 20% of examinees ordered at least one dangerous action with the potential to cause significant patient harm. The propensity to order dangerous actions may vary across clinical cases.
  
  
  CONCLUSIONS
  The CCS format may provide a means of collecting important information about patient-care situations in which examinees may be more likely to commit dangerous actions and the propensity of examinees to order dangerous tests and treatments.
authors.affiliation: pharik@nbme.org
authors.forename: Polina
authors.initials: P
authors.lastname: Harik
authors.forename: Monica M
authors.initials: MM
authors.lastname: Cuddy
authors.forename: Seosaimhin
authors.initials: S
authors.lastname: O'Donovan
authors.forename: Constance T
authors.initials: CT
authors.lastname: Murray
authors.forename: David B
authors.initials: DB
authors.lastname: Swanson
authors.forename: Brian E
authors.initials: BE
authors.lastname: Clauser
mesh_terms: D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D004521:Educational Measurement; D008007:Licensure, Medical; D019300:Medical Errors; D018570:Risk Assessment; D014481:United States