Letters to the Editor
To the Editor:
In their February article, Irby et al1 include a series of thoughtful findings and recommendations about medical education and training but provide an incomplete description of the history of medical licensure in the United States in three important respects.
First, the authors suggest by context that state medical boards began to license practicing physicians shortly after Flexner published his 1910 report. While Flexner deserves much credit for his seminal work, state medical boards began licensing physicians much earlier. In a part of the Bill of Rights, passed in 1791, states were given the right to regulate health and formally began licensing physicians through state medical boards in the 1800s. The North Carolina Board of Medicine just last year celebrated its 150th anniversary, one example of this long history.
Second, it is important to recognize that the Federation of State Medical Boards (FSMB), founded in 1912 through a merger of two existing national bodies for state licensure and discipline, partnered with the National Board of Medical Examiners (NBME) in 1991 to jointly create and sponsor the United States Medical Licensing Examination (USMLE). This collaboration greatly facilitated the acceptance of the USMLE by all state medical boards as a common measure of competence for initial medical licensure. (The COMLEX examination, produced by the National Board of Osteopathic Medical Examiners, is taken by osteopathic physicians for the same purpose.)
Finally, the authors note that one of the purposes of their work, sponsored by the Carnegie Foundation for the Advancement of Teaching, was to learn from the innovations in the continuum of medical education. To this laudable end, I would add the many innovations championed by the FSMB in recent years: enhanced medical license portability through a Uniform Application for State Medical Licensure, an All Licensed Physicians database, a Federation Credentials Verification Service that provides primary source verification for licensure and storage of a physician's core credentials,2 a Physician Disciplinary Alert Service, and, consistent with Irby and colleagues' recommendation to standardize learning outcomes, the adoption of a plan—endorsed by the boards of both the FSMB and the NBME—for a comprehensive overhaul of the USMLE that calls for two patient-centered decision points instead of three, adoption of a general competencies-based schema for exam questions, and the inclusion of the scientific foundations of medicine in all components of the assessment process.3
Humayun J. Chaudhry, DO
President and CEO, Federation of State Medical Boards, Euless, Texas, and Washington, DC; firstname.lastname@example.org.
1 Irby DM, Cooke M, O'Brien BC. Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Acad Med. 2010;85:220–227.
2 Chaudhry H. Charting dynamism in medical education, licensure and regulation. J Med Licensure Discipline. 2009;95:5–8.
3 McMahon GT, Tallia AF. Anticipating the challenges of reforming the United States Medical Licensing Examination. Acad Med. 2010;85:453–456.