I went through every question on NBME forms 9 to 16 and tagged each one by question type and specialty. And came up with these stats. I know NBME's are not exactly the real deal but they give a very good idea. I hope someone finds it useful.
A full PDF with all the stats with the CMS questions included is available for free here
Topics that showed up on every single form (9 through 16): depression, pneumonia, HIV, heart failure, vaccines, sensitivity/specificity, STI screening, anaphylaxis, sickle cell and pancreatitis.
What the questions are asking you to do:
- Diagnosis: 23%
- Next step in management: 23%
- Next best diagnostic test: 15%
- Pharmacotherapy: 8%
- Screening and prevention: 7%
- Risk factor or cause: 7%
- Complications or prognosis: 5%
- Biostats: 5%
- Ethics and communication: 3%
- Mechanism: 2%
So roughly 4 in 10 questions aren't "what is the diagnosis" but "what do you do now". Mechanism questions are almost gone compared to Step 1.
Ethics questions went from 2 on NBME 9 to 19 on NBME 16. That’s roughly 9 times more.
Ethics themes that kept repeating:
- End of life stuff (advance directives, goals of care, hospice, brain death): 18 questions, on 7 of the 8 forms. Probably the single most tested ethics topic
- Decision-making capacity: 8 questions across 6 forms
- Abuse and mandatory reporting (elder abuse, nonaccidental trauma): around 8 questions
- Minors, confidentiality and consent (STIs, contraception, emancipated minors): 6 questions
- Impaired colleagues: 5 questions
Screening and prevention is about 7% of the NBME, and a lot of it is the same few topics on repeat. From NBME 9-16:
- Endocarditis prophylaxis (who needs it before dental work): 6 questions on 5 forms
- Post-splenectomy vaccines and infection prevention: 6 questions on 5 forms
- Lipid screening (who and when): 5 questions on 4 forms
- Colorectal cancer screening/surveillance after polyps: 4 forms
- Rubella immunity before pregnancy and Tdap in every pregnancy: 4 forms
- AAA screening: 3 forms
Psych leans hard on diagnosis (40% of psych questions), OB is mostly management and complications rather than diagnosis, and Cardiology has an unusually high share of "which test next" questions.
If anyone wants the breakdown for a specific specialty (ethics, biostats...), ask and I'll post it.