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Dear colleagues,

 

Thank you for your willingness to participate in this important survey. This survey should take you approximately 10 minutes to complete.

 

Please read the brief summary of tentatively proposed changes to the USMLE (United States Medical Licensing Exam) test structure. Click here if you would like a more detailed (but still concise) explanation of the changes and links to official USMLE webpages.

 

Here are the main points: (again, see below for the details)

As a student-driven organization, APSA believes that it is important to generate as much student input as possible on this issue. Therefore, we have designed a survey, Student attitudes and perceptions of the proposed changes to the USMLE, to gather information on some of the key aspects of these proposed changes.

 

This is a survey that has been designed by students to gather information from students and residents. Our intentions are to present the tentatively proposed changes to the USMLE Step 1/2 exam and survey students opinions and perceptions of the impact of these changes.

 

Click Here to access the survey if you are a medical student

 

Click Here to access the survey if you are a resident or fellow

 

Thank you,

 

Policy Committee, American Physician Scientist Association

 

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A more detailed explanation regarding the changes to the USMLE

 

Overview:

 

"[The] USMLE (United States Medical Licensing Examination) assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care."¹ The exam currently exists as three separate “Steps”.

• Step 1 assesses understanding and application of basic sciences to the practice of medicine and is typically taken at the end of the second year of medical school.²

• Step 2 assesses application of medical knowledge, skills, understanding of clinical science needed for provision of care under supervision and is typically taken in the fourth year of medical school.²

• Step 3 assesses application of medical knowledge, skills, understanding of clinical science needed for provision of care without supervision and is typically taken during the first or second year of postgraduate training.²

In 2004, the Committee to Evaluate the USMLE Program (CEUP) was formed to review the USMLE—the first such review since the exam’s inception in the early 1990s.³ CEUP has been gathering data using surveys and focus groups from relevant parties (“stakeholders”) including current medical student, residents, student leaders, institutional and national leaders of graduate education.³ The committee’s first priority is to assure the use of the USMLE as a skills and knowledge competency exam. However, it is also recognized that the USMLE has many stakeholders which depend on the exam for other uses (such as residency directors, students,etc). After the information gathering stage, CEUP will make recommendations that will be further evaluated by the organizations that govern the USMLE before implementation.

 

Themes/Concerns that have arisen in review:

• There are two main points in medical education where the exam should be designed to support decision making in medicine—readiness to begin direct patient care under supervision and readiness to provide patient care unsupervised. The exam is used to measure competency of the student. There is a sense by stakeholders that all “valid, reliable, and practical” methods of assessing competency should be incorporated.³

• The separation of clinical and basic science testing is somewhat artificial. The viewpoint of improving education by better integrating clinical and basic science curricula is prevalent among stakeholders, notably clinical and basic science faculty members.^3,4

• Many medical schools rely upon the current format of the USMLE to provide promotion (Step 1) or graduation milestones (Step 2). If Step 1 and 2 are combined, the consensus of stakeholders is that another metric should be created to provide similar assessment.³

• There are conflicting viewpoints by stakeholders regarding the value of providing a numerical score beyond a pass/fail score.³

Proposed changes:

• USMLE Steps 1 and 2 will be combined into a single exam. However, this combination would involve the creation of a new set of questions that test BOTH basic science and clinical science.

• A combination exam will necessitate that the exam be administered earlier in training than the current Step 2 in order for its use in residency applications.

• Pass/fail could replace the current numerical score. This is separate and may be implemented even if a combined exam is not.

• CEUP will deliver its final recommendation by January 2008. After which various USMLE committees and staff will explore implications and feasibility of the recommendations. The Composite committee which governs the USMLE will make the final recommendation to all major organizations involved in the USMLE for their review.³

• Any and all changes would need to be approved by the FSMB (Federation of State Medical Boards) House of Delegates and NBME (National Board of Medical Examiners) members.³

• The earliest year the exam would be affected would be 2011. There likely will be a grace period to allow for students who have passed Step 1 to take Step 2.³

Additional sources of information:

• The USMLE has setup a forum for students to discuss this issue. It is available at http://comprev.usmle.org/ (registration is required)

• Any of the references below:

  1.  http://www.usmle.org/General_Information/general_information_about.html

  2.  http://www.usmle.org/General_Information/general_information_FAQs.html

  3.  http://www.usmle.org/General_Information/review.html

  4.  http://www.usmle.org/img/cru/AAMCFocusSession2007.ppt