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Perspective: Anticipating the Challenges of Reforming the United States Medical Licensing Examination

McMahon, Graham T. MD, MMSc; Tallia, Alfred F. MD, MPH

doi: 10.1097/ACM.0b013e3181ccbea8
High-Stakes Examinations

The practice of medicine is a shared social contract between the medical profession and the public. Assessments for licensure should reflect competencies that patients expect of their physicians and should be patient-centered and mirror the progressive nature of medical education. The National Board of Medical Examiners recently accepted the recommendations of the Committee to Review the United States Medical Licensing Examination Program to align the examination sequence with two patient-centered decision points: when a student enters into supervised graduate training, and when a physician receives initial licensure for unsupervised practice. The revised examination program would aim to evaluate for the presence of at least minimum proficiency in all competencies that are measurable in a valid, reliable manner at each decision point, including the scientific foundation of medical practice, the application of medical knowledge to patient care, and the clinical skills relevant to practice level, whether measured by standardized patient-based assessments or other formats. Students, educators, educational leaders, and program directors have raised legitimate concerns about the anticipated changes. The anticipated costs, the changes' effect on basic science education, their impact on dual-degree candidates and international medical graduates, and the utility of score reporting are each of concern. Anticipated benefits include a closer alignment of assessments with the expectations of patients and licensing authorities, closer integration of the sciences fundamental to medical practice throughout the examination sequence, and an increased breadth of competency assessment. The authors believe that the benefits to patients and the profession will outweigh the acknowledged challenges the changes will pose to medical education.

Dr. Tallia is professor and chair, Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey.

Dr. McMahon is assistant professor of medicine, Harvard Medical School, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.

Correspondence should be addressed to Dr. Tallia, Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 RWJ Place MEB 288, New Brunswick, NJ 08903; telephone: (732) 235-6029; fax: (732) 246-8084; e-mail:

© 2010 Association of American Medical Colleges