USMLE changes in 2014 and beyond

Episode 90: USMLE Step 3 is changing in 2014 and the rest will follow suit. Learn about the changes and new structure in this episode of the Medical School Podcast.

Download transcript: USMLE Changes in 2014 and Beyond

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Dr. Dan:           Welcome to the Medical School Podcast. I’m your host, Dr. Dan, and this is Episode 90.

In this episode, I will be discussing the evolution of the United States Medical Licensing Exam. There are a number of important changes which I am sure you’ve heard about, but I want to clarify and notify those that did not know about this stuff.

Let me set the background a little bit with the USMLE. In the early 1990s, the USMLE exam for the allopathic schools replaced the NBME, the National Board of Medical Examiner certification examinations and the Federation Licensing Examination program called FLEX. It’s been around for a long time as a standalone. That’s gone on 20 plus years now.

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Of course, in 1999, they began those computerized patient simulations in Step 2. Standardized patients were introduced in 2004. That’s only about 10 years now. They’re making a lot more changes which is the purpose of this episode. Also in 2004, the USMLE undertook an in-depth review of the program. Everything is moving towards evidence-based. That’s the underlying theme here with what’s going on with the USMLE. They’re doing feedback on the test to make sure that it’s valid and actually measuring what it’s supposed to measure and that what their targeting is actually relevant to clinical practice today.

There were 5 major recommendations that came back and were adopted in 2009. The first one is to make the USMLE focus on assessments to support state licensing authorities’ decisions about a physician’s readiness to practice patient care at entry into supervised practice, which means beginning a residency, and entry into unsupervised practice, potentially after internship when you get your license and begin [moonlighting 00:02:15].

They’re trying to dovetail with the licensing exam to provide them feedback. That might mean that your individual state board might look closer at the USMLE scores themselves, particularly if they are scrutinizing you for some other kind of behavioral, personality, or disciplinary problem. They might look at your USMLE scores and require some remediation. That’s all down the road. Those aren’t current changes. I’m just trying to set the five major recommendations now as a backdrop and we’ll get to the one big change that they’re doing to the Step 3 examination this year, 2014. That’s going to be their first big kickoff to implement all these changes.

The second big recommendation is to adopt the general competency schema that is consistent with national standards for the overall design, development, and scoring at the USMLE. It looks like they want a competency-based schema. They have, of course, adopted the ACGME core competencies schemas, that is, there are 6 competencies the Accreditation Council for Graduate Medical Education. That is the group that licenses or accredits the allopathic residency programs. When you become a resident, you will know about that.

Those 6 competencies include medical knowledge, patient care, communication and interpersonal skills, practice-based learning and improvement, professionalism, and systems-based practice. They’re trying to get all four of these USMLE Step scores to be ultimately organized around these 6 core competencies that fit in directly with the ACGME competencies.

On a side note,