Tackling Drug Ad and Research Abstract Questions on the USMLE

Throughout your medical career journey, you may find yourself asking what sort of questions you can expect to see on the USMLE Step 1, Step 2CK, and Step 3. A relatively new pair of similar question styles on the USMLE Step exams have increasingly become among the series’ most feared and notorious: I am talking here of course about the “Drug Ad” and “Research Abstract” questions. In this blog post we will dive into these two USMLE question types; what they are, how they differ from the rest of the questions you can expect to see on the USMLE Step exams, and how to approach studying for them and answering them on exam day!

What Are Drug Ad and Research Abstract Questions on the USMLE?

In brief, Drug Ad questions present the examinee with an informational pamphlet of sorts, the kind that might be handed out in real life by a pharmaceutical representative about the results of a recent clinical trial that establishes or expands an indication for a given medication. Such a question lays out the basic structure of the trial and presents the findings of the study in one or more formats, often using graphs to display the result data similarly to the figures in a medical journal. Research Abstract questions are a similar question style but instead, they are presented like a research study summary that one might read in a medical journal or find presented at a medical conference, with succinct blurbs elaborating on the study population, methods, inclusion/exclusion criteria, and the hard-data results. For both of these USMLE question styles, there are often actually two separate multiple-choice questions facing the examinee based off exactly the same drug ad or research abstract, though notably, these are generally not “sequential questions” (i.e., the examinee’s answer on the first multiple-choice question does not necessarily guide or presage their answer on the second), which however can be found elsewhere on the USMLE Step exams.

There are two main challenges presented by these USMLE question formats that make them particularly challenging for many examinees. One challenge is that the sheer volume of information presented in the ad or abstract is a lot to sift through under time pressure, and this volume of information is almost always much more than a more typical question on one of the Step exams. Frankly put, it is assumed and unavoidable that these two question styles will take the examinee more time than an average question. While the “average time allotted per question” metric is easily calculable, there are some questions on any given exam that can and should take the examinee somewhere in the ballpark of around only 40 seconds to confidently answer, which frees up more time to spend something like 2.5 to 4 minutes on a Drug Ad or Research Abstract question. The other challenge is the sheer variety of content that could be tested by these sorts of question styles. A multiple-choice question could ask a pointed question about calculating biostatistical parameters, interpreting purposely confusing graphs, identifying possible sources of biases, identifying best approaches for further study, differentiating between statistical and clinical significance, resolving ethical issues, and so on. This variety of possible content areas to actually be tested requires extensive practice with the question format. There also are several tips worth knowing when facing these sorts of questions on the exams:

Approaching These Questions on Exam Day

1) As mentioned above, these are usually two-part questions and often at least one of the paired questions requires a more general “full” review of the content to really soak it all in and comprehend it. It is advisable to flag Drug Ad and Research Abstract questions and only do them at the end because an examinee could get stuck in one and then ultimately run out of time for other questions in the block. Remember: these questions are designed to often take longer than other question styles. Remember also that when flagging a question that you intend to re-evaluate, you should also choose a default answer choice (say ‘B’ or ‘C’) so that if you do in fact run out of time and don’t get back to the question, you haven’t left the question unanswered.  There are no penalties for guessing and if no answer is selected you are 100% certain to get the question wrong.

2) As with all other question styles on standardized medical board exams, I still absolutely recommend reading the interrogative (aka “the stem”) and answer options first (and whatever 1-3 brief sentences that frequently accompany the stem for these two specific question styles). This is because on occasion the stem might be asking a very direct and simple question, such as “What was the number needed to treat for the new drug per this study trial abstract?”. This sort of question is purely a biostats calculation question at heart and so in such a case one would know to quickly find the specific pieces of data in the ad or abstract that is necessary to do the calculation (namely, all one would need to find is just the absolute difference in risk percent for control vs intervention groups, take the inverse of that percent as a decimal, and presto!). Simply put, there are times when reading the stem first puts the examinee in a position to really save a lot of time (time that can then be better spent on other difficult questions in the block). Even if one does not find themselves so lucky after reading the stem, having the stem in mind will often guide the examinee as they review the provided information in the Drug Ad or Research Abstract. A great example of this would be a stem asking “What type of bias most likely contributed to these study findings?”. After reading that, the examinee’s mind is now very much clued in to actively sniff out any possible bias sources as they review the information the first time, rather than having to likely peruse back through the ad or abstract for a second time.

3) One thing to be very careful about with Drug Ad and Research Abstract questions are answer options that are non sequiturs. For example, the question stem might be “Which of the following conclusions can best explain these results?”. In such a case, it is very common for all of the answer options to be factually correct standalone statements, but of course only one option actually addresses the question stem as actually stated (as opposed to being a tangential or random non sequitur… ex: “What color is the sky? Non sequitur answer: the grass is green”). This trend requires careful reading of both the stem sentence and all answer options to find the one best answer; selecting and locking in the first “true-sounding” answer option on the list is the pitfall here for which the exam writers are presumably gunning.

Drug Ad and Research Abstract questions have found a home on the USMLE Step exams because they assess practical medical and biostatistical skills that are considered essential for the general practice of the physician. Whether it is the latest copy of a guideline-redefining clinical trial in a medical journal or a sleek pamphlet from a pharmaceutical representative that finds its way onto the desk of a practicing physician, deconstruction and interpretation of published study findings is an inextricable component of the modern medical profession in all levels and settings of care.

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