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Date Updated: September 29, 2017

International Foundations of Medicine (IFOM)

The IFOM Clinical Science Exam

The International Foundations of Medicine® (IFOM®) Clinical Science Exam (CSE) assesses the medical knowledge and understanding of clinical science considered essential for the provision of safe and effective patient care.

For What Purpose Is the IFOM CSE Used?

Schools and other organizations use the exam in the following ways:

  • Curriculum/assessment benchmarking/quality control
  • Testing students prior to or after clinical training
  • Medical school exit exam
  • Intern/residency selection
  • Preparation for the United States Medical Licensing Exam® (USMLE®) Step 2 Clinical Knowledge (CK)

IFOM CSE is also used by individual students and graduates for personal benchmarking, to apply to residency programs, and for preparation to take USMLE Step 2 CK.

The exam comprises 160 multiple-choice questions presented in clinical vignette style to assess examinees’ ability to not just recall but also apply their knowledge in clinical contexts. The following content areas are covered:

  • Family Medicine
  • Medicine
  • Obstetrics and Gynecology
  • Pediatrics
  • Psychiatry
  • Surgery

IFOM CSE Content Blueprint

The CSE is built to the following specifications; you can also download a PDF of the content blueprint here.

General Principles: 5%-7%

Infancy and Childhood (normal growth and development)

Adolescence (sexuality, separation from parents/autonomy, physical changes of puberty)

Senescence (normal physical and mental changes associated with aging)

Medical Ethics and Jurisprudence

  • consent to treatment and research issues
  • physician-patient relationship
  • death and dying and palliative care
  • professional conduct/integrity

Applied Biostatistics and Clinical Epidemiology

  • fundamental concepts of study design and interpretation
  • fundamental concepts of data analysis, data interpretation, hypothesis testing, and statistical inference
  • fundamental concepts for drawing conclusions from data (eg, causation, efficacy, effectiveness, subgroup analysis, and safety)
  • clinical applications of decision sciences (eg, sensitivity, specificity, and predictive value)

Public/Population Health

  • communicable disease transmission
  • community approaches to primary health care
  • disease surveillance and outbreak investigation
  • epidemics following natural disasters
  • maternal/child health and breast feeding
  • points of intervention
  • sanitation and water supply/waste water management
  • population pyramids and impact of demographic changes
  • measures of health status
  • measures of disease frequency

Organ Systems: 93%-95%

Immunologic Disorders: 4%-5%

Health and Health Maintenance

  • anaphylaxis and other allergic reactions
  • HIV infection/AIDS
  • immunization against infectious agents

Mechanisms of Disease

  • abnormalities of cell-mediated immunity
  • abnormalities of humoral immunity

Diagnosis

  • anaphylactic reactions and shock
  • connective tissue disorders
  • HIV infection/AIDS and deficiencies of cell-mediated immunity
  • deficiencies of humoral immunity and combined immune deficiency

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Blood and Blood-forming Organs: 4%-5%

Health and Health Maintenance

  • anemia
  • systemic infection

Mechanisms of Disease

  • red cell disorders
  • coagulation disorders
  • white cell disorders

Diagnosis

  • anemia; disorders of red cells, hemoglobin, and iron metabolism
  • bleeding disorders, coagulopathies, and thrombocytopenia
  • neoplastic disorders
  • eosinophilia and reactions to transfusion of blood components, including complications; leukopenic disorders; and agranulocytosis
  • infection

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Mental Disorders: 4%–5%

Health and Health Maintenance

  • early identification and intervention (eg, suicide potential, depression, and alcohol/substance abuse)

Mechanisms of Disease

  • biologic markers of mental disorders and mental retardation syndromes
  • intended/unintended effects of therapeutic interventions, including effects of drugs on neurotransmitters

Diagnosis

  • mental disorders usually first diagnosed in infancy, childhood, or adolescence
  • substance-related disorders
  • schizophrenia and other psychotic disorders
  • mood disorders
  • anxiety disorders
  • child, spouse, and elder abuse
  • adjustment disorder
  • psychological factors affecting medical conditions

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Nervous System and Special Senses: 8%–10%

Health and Health Maintenance

  • cerebrovascular disease and cerebral infarction
  • nutritional deficiencies, toxic injuries, and occupational disorders
  • infection involving the nervous system, eyes, or ears
  • degenerative and demyelinating disorders

Mechanisms of Disease

  • localizing anatomy (brain and special senses, brain stem, spinal cord, and neuromuscular system)
  • anatomy of cerebral circulation
  • increased intracranial pressure and altered state of consciousness
  • infection
  • degenerative/developmental and metabolic disorders

Diagnosis

  • disorders of the eye
  • disorders of the ear, olfaction, and taste
  • disorders of the nervous system
    • headache
    • seizure disorders
    • syncope
    • cerebrovascular disease
    • traumatic and toxic injury
    • infections
    • neoplasms
    • metabolic disorders
    • degenerative/developmental disorders
    • neuromuscular disorders, gait abnormalities, and disorders relating to the spine and spinal nerve roots
    • sleep disorders

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Cardiovascular Disorders: 10%–12%

Health and Health Maintenance

  • arterial hypertension
  • atherosclerosis and coronary artery disease, hyperlipidemia
  • prevention of rheumatic heart disease, thromboembolic disease, pulmonary emboli, and bacterial endocarditis

Mechanisms of Disease

  • cardiac output, resistance, and central venous pressure
  • valvular stenosis and incompetence
  • congenital heart disease
  • regulation of blood pressure
  • disorders of the arteries and veins

Diagnosis

  • dysrhythmias, palpitations, and syncope
  • heart failure, dyspnea, fatigue, and peripheral edema of cardiac origin
  • ischemic heart disease and chest pain of cardiac origin
  • diseases of the myocardium
  • diseases of the pericardium
  • valvular heart disease
  • congenital cardiovascular disease
  • systemic hypotension, hypovolemia, cardiogenic shock, and cyanosis
  • arterial hypertension
  • atherosclerosis - lipoproteins
  • disorders of the great vessels
  • peripheral arterial vascular diseases and vasculitis
  • diseases of the veins, peripheral edema
  • traumatic injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Respiratory System: 9%–11%

Health and Health Maintenance

  • bronchitis, asthma, emphysema, carcinoma of the larynx, carcinoma of the lung, pulmonary aspiration, atelectasis, and tuberculosis

Mechanisms of Disease

  • ventilatory dysfunction
  • respiratory failure, acute and chronic, including oxygenation failure
  • circulatory dysfunction
  • neoplastic disorders

Diagnosis

  • disorders of the nose, paranasal sinuses, pharynx, larynx, and trachea
  • infections of the lung
  • obstructive airways disease
  • atelectasis and pulmonary aspiration
  • pneumothorax, hemothorax, traumatic injury to the lungs, and disorders involving the pleura
  • pneumoconiosis and fibrosing or restrictive pulmonary disorders
  • respiratory failure, hypoxia, hypercapnia, and dyspnea
  • pulmonary vascular disorders
  • neoplastic disorders of the lungs and pleura

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Nutritional and Digestive Disorders: 8%–10%

Health and Health Maintenance

  • screening
  • viral hepatitis and alcohol-related hepatopathy

Mechanisms of Disease

  • malabsorption/malnutrition
  • jaundice
  • infections/parasites
  • obstruction/mechanical

Diagnosis

  • disorders of the mouth, salivary glands, oropharynx, and esophagus
  • disorders of the stomach, small intestine, colon, and rectum/anus
  • disorders of the pancreas
  • disorders of the liver and biliary system
  • traumatic injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Gynecologic Disorders: 7%–9%

Health and Health Maintenance

  • postmenarchal/reproductive
  • peri/postmenopausal

Mechanisms of Disease

  • infections
  • urinary incontinence and obstruction
  • menstrual and endocrinologic disorders, infertility

Diagnosis

  • pelvic relaxation and urinary incontinence
  • neoplasms
  • benign conditions of the breast
  • menstrual and endocrinologic disorders

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Renal, Urinary, and Male Reproductive Systems: 7%–9%

Health and Health Maintenance

  • infection
  • acute and chronic renal failure, including risk factors, prevention, and methods of limiting progression
  • male health maintenance examination

Mechanisms of Disease

  • disorders of the male reproductive system
  • urinary incontinence and obstruction and enuresis
  • renal insufficiency/failure
  • electrolyte and water metabolism and acid‑base balance

Diagnosis

  • disorders of the male reproductive system
  • disorders of the urinary bladder and urinary collecting system
  • disorders of the kidneys
  • traumatic injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Disorders of Pregnancy, Childbirth, and the Puerperium: 4%–5%

Health and Health Maintenance

  • prenatal care (eg, nutrition and prenatal diagnosis/prevention)
  • assessment of the at‑risk pregnancy and risk of preterm labor
  • intrapartum care and signs of fetal compromise
  • contraception, sterilization, and prevention of pregnancy after rape

Mechanisms of Disease

  • placenta and placental dysfunction
  • pregnancy and labor, including infection
  • postpartum disorders, including infection
  • fetus and newborn

Diagnosis

  • pregnancy and labor, including obstetric complications
  • nonobstetric complications of pregnancy
  • complications of the puerperium

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Disorders of the Skin and Subcutaneous Tissues: 4%–5%

Mechanisms of Disease

  • skin disorders, including cancer, infections, and inflammatory disorders

Diagnosis

  • infections
  • neoplasms
  • other skin disorders, including occupational and inflammatory

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Diseases of the Musculoskeletal System and Connective Tissue: 7%–9%

Health and Health Maintenance

  • epidemiology, impact, and prevention of degenerative joint and disc disease
  • prevention of disability due to musculoskeletal disorders or infection

Mechanisms of Disease

  • infections
  • nerve compressions and degenerative, metabolic, and nutritional disorders
  • inherited, congenital, and developmental disorders
  • inflammatory and immunologic disorders

Diagnosis

  • infections
  • degenerative, metabolic and nutritional disorders
  • inherited, congenital, and developmental disorders
  • inflammatory, immunologic, and other disorders
  • neoplasms
  • traumatic injury and nerve compression and injury

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Endocrine and Metabolic Disorders: 8%–10%

Health and Health Maintenance

  • diabetes mellitus, including prevention of morbidity and mortality due to complications
  • screening

Mechanisms of Disease

  • thyroid function
  • diabetes mellitus and carbohydrate metabolism
  • parathyroid and calcium metabolism
  • pituitary and hypothalamic function
  • adrenal function

Diagnosis

  • thyroid disorders
  • diabetes mellitus
  • parathyroid and calcium disorders
  • pituitary and hypothalamic disorders
  • adrenal disorders
  • heat-related illness

Principles of Management (emphasis on topics covered in the Diagnosis section)

  • pharmacotherapy
  • management decision (treatment/diagnosis steps)
  • treatment

Physician Tasks

Promoting Health and Health Maintenance: 8%-10%

Understanding Mechanisms of Disease: 20%-25%

Establishing a Diagnosis: 32%-36%

Applying Principles of Management: 25%-28%

Test Administration Options

The IFOM CSE can be ordered by schools and other institutions for administrations at their sites to cohorts of students that they deem eligible. Institutions can administer the IFOM CSE either on paper or as a web-based test, using desktop or laptop computers on-site. See our For Institutions page for information about the steps that schools and other organizations must take to be eligible to use IFOM exams at their sites.

Individuals can take the IFOM CSE separately from their schools or training programs. Individual administrations are offered at Prometric Test Centers twice a year, once in the spring and once in the fall. See the Test Administrations for Individuals page for information about applying to take the IFOM CSE as an individual and for testing schedules.

Language Availability

The IFOM BSE is available in English, but a Spanish version will be available in early 2018. We can also translate the IFOM exams into other languages in certain circumstances. Contact the IFOM Team if you are interested in administering IFOM exams in a language other than those listed above.

Preparing to Take the IFOM CSE

The National Board of Medical Examiners makes two methods available to help examinees prepare to take the IFOM CSE: a self-assessment and a practice exam.

The IFOM Clinical Science Self-Assessment Examination is an 80-question web-based exam built to the same content blueprint as the IFOM CSE; learn more on the IFOM Clinical Science Self-Assessment Exam web page.

The IFOM CSE Practice Exam is a free 20-question web-based exam that allows examinees to familiarize themselves with the IFOM CSE format, in either timed or untimed test administration conditions. Access the IFOM CSE practice exam.

Note: The practice exam is NOT intended to assist examinees in preparing for the content of the exam; it is only intended to familiarize examinees with the style and format of test questions they are likely to see on the IFOM exams if administered on the web.

Exam Security

Please visit this page for important information about NBME’s rules for examination security and conduct.

 

 

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