A Plea to Reassess the Role of United States Medical Licensing Examination Step 1 Scores in Residency Selection.

The three-step United States Medical Licensing Examination (USMLE) was developed by the National Board of Medical Examiners and the Federation of State Medical Boards to provide medical licensing authorities a uniform evaluation system on which to base licensure. The test results appear to be a good measure of content knowledge and a reasonable predictor of performance on subsequent in-training and certification exams. Nonetheless, it is disconcerting that the test preoccupies so much of students' attention with attendant substantial costs (in time and money) and mental and emotional anguish. There is an increasingly pervasive practice of using the USMLE score, especially the Step 1 component, to screen applicants for residency. This is despite the fact that the test was not designed to be a primary determinant of the likelihood of success in residency. Further, relying on Step 1 scores to filter large numbers of applications has unintended consequences for students and undergraduate medical education curricula. There are many other factors likely to be equally or more predictable of performance during residency. The authors strongly recommend a move away from using test scores alone in the applicant screening process and toward a more holistic evaluation of the skills, attributes, and behaviors sought in future health care providers. They urge more rigorous study of the characteristics of students that predict success in residency, better assessment tools for competencies beyond those assessed by Step 1 that are relevant to success, and nationally comparable measures from those assessments that are easy to interpret and apply.

Commentary: Balancing responsibility to patients and responsibility to aspiring physicians with disabilities.

In 2008, Congress amended the Americans with Disabilities Act (ADA) to relax court-imposed limitations on evidence required to warrant protection under the ADA. Since passage of the ADA in 1990, medicine has focused not on evaluating the types of accommodations that would best balance the interests of individuals with disabilities, institutions, and patients but, rather, on the question of whether individuals seeking protection under the law qualify for disability accommodations at all. The medical profession should refocus on the nature of accommodations provided to those with disabilities. In doing so, the intent to support disabled persons seeking careers in medicine must be balanced with ethical obligations to protect patient welfare. Medical schools, graduate medical education programs, licensing and certifying authorities, and assessment organizations should work together to establish evidence-based minimum criteria for the physical and cognitive capabilities required of every physician.

Licensing examinations in North America: is external audit valuable?

The United States and Canada both have long-standing, highly developed national systems of assessment for medical-licensure based outside the institutions of medical education. This commentary reviews those programs and explores some of the reasons for their implementation and retention for nearly a century. The North American experience may be relevant to dialog about national or European assessments for medical practice.

From defending the walls to improving global medical education: fifty years of collaboration between the ECFMG and the NBME.

The author outlines the intertwining roles of the Educational Commission for Foreign Medical Graduates (ECFMG), which is celebrating its 50th anniversary in 2006, and the National Board of Medical Examiners (NBME) in meeting needs for assessment of international medical graduates. Both organizations had early histories focused on a protective role: ensuring that only the most qualified foreign-trained doctors could train or practice in the United States. The two organizations have interacted throughout the ECFMG's 50-year history to improve the assessment of internationally trained doctors. As both the ECFMG and the NBME have matured, their missions have expanded to include improvement of medical education and assessment around the world. Much of the success of each organization in fulfilling its mission can be attributed to their close collaboration through the past 50 years.

Physician performance and assessment and their effect on continuing medical education and continuing professional development.

This article has three key points. The first proposes and illustrates a model for planning effective continuing medical education (CME) and continuing professional development (CPD) and how assessment might fit into it. The second reviews major trends in assessment, particularly with regard to regulation and CME. The third addresses challenges for CME and CPD.