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Beyond the United States Medical Licensing Examination Score

Assessing Competence for Entering Residency

Radabaugh, Carrie L. MPP; Hawkins, Richard E. MD; Welcher, Catherine M.; Mejicano, George C. MD, MS; Aparicio, Alejandro MD; Kirk, Lynne M. MD; Skochelak, Susan E. MD, MPH

doi: 10.1097/ACM.0000000000002728

Assessments of physician learners during the transition from undergraduate to graduate medical education generate information that may inform their learning and improvement needs, determine readiness to move along the medical education continuum, and predict success in their residency programs. To achieve a constructive transition for the learner, residency program, and patients, high-quality assessments should provide meaningful information regarding applicant characteristics, academic achievement, and competence that lead to a suitable match between the learner and the residency program’s culture and focus.

The authors discuss alternative assessment models that may correlate with resident physician clinical performance and patient care outcomes. Currently, passing the United States Medical Licensing Examination Step examinations provides one element of reliable assessment data that could inform judgments about a learner’s likelihood for success in residency. Yet, learner capabilities in areas beyond those traditionally valued in future physicians, such as life experiences, community engagement, language skills, and leadership attributes, are not afforded the same level of influence when candidate selections are made.

While promising new methods of screening and assessment—such as objective structured clinical examinations, holistic assessments, and competency-based assessments—have attracted increased attention in the medical education community, currently they may be expensive, be less psychometrically sound, lack a national comparison group, or be complicated to administer. Future research and experimentation are needed to establish measures that can best meet the needs of programs, faculty, staff, students, and, more importantly, patients.

C.L. Radabaugh is vice president, governance and board relations, American Board of Medical Specialties, Chicago, Illinois.

R.E. Hawkins is president and chief executive officer, American Board of Medical Specialties, Chicago, Illinois.

C.M. Welcher is senior policy analyst, Medical Education Programs, American Medical Association, Chicago, Illinois.

G.C. Mejicano is professor and senior associate dean for education, School of Medicine, Oregon Health & Science University, Portland, Oregon.

A. Aparicio is director, Medical Education Programs, American Medical Association, Chicago, Illinois.

L.M. Kirk is professor, Internal Medicine/Family & Community Medicine, Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, Texas.

S.E. Skochelak is chief academic officer and medical education group vice president, American Medical Association, Chicago, Illinois.

Funding/Support: The development and writing of this article were funded by the AMA.

Other disclosures: Carrie L. Radabaugh, Catherine M. Welcher, Alejandro Aparicio, and Susan E. Skochelak are, or were at the time this was written, employees of the AMA. Susan E. Skochelak and Richard E. Hawkins report being the coeditors of a textbook on health systems science for which the AMA receives royalties from Elsevier. Richard E. Hawkins also reports being the coeditor of a textbook on the evaluation of clinical competence for which he receives royalties from Elsevier.

Ethical approval: Reported as not applicable.

Previous presentations: Some of the information included in this article was presented at a Stakeholders Session hosted by the AMA Council on Medical Education at the AMA annual meeting, June 10, 2016, Chicago, Illinois.

Correspondence should be addressed to Carrie L. Radabaugh, American Board of Medical Specialties, 353 N. Clark St., Suite 1400, Chicago, IL 60654; telephone: (312) 436-2630; email:

© 2019 by the Association of American Medical Colleges