Multiple United States Medical Licensing Examination Attempts and the Estimated Risk of Disciplinary Actions Among Graduates of U.S. and Canadian Medical Schools.

PURPOSE: The United States Medical Licensing Examination (USMLE) recently announced 2 policy changes: shifting from numeric score reporting on the Step 1 examination to pass/fail reporting and limiting examinees to 4 attempts for each Step component. In light of these policies, exam measures other than scores, such as the number of examination attempts, are of interest. Attempt limit policies are intended to ensure minimum standards of physician competency, yet little research has explored how Step attempts relate to physician practice outcomes. This study examined the relationship between USMLE attempts and the likelihood of receiving disciplinary actions from state medical boards. METHOD: The sample population was 219,018 graduates from U.S. and Canadian MD-granting medical schools who passed all USMLE Step examinations by 2011 and obtained a medical license in the United States, using data from the NBME and the Federation of State Medical Boards. Logistic regressions estimated how attempts on Steps 1, 2 Clinical Knowledge (CK), and 3 examinations influenced the likelihood of receiving disciplinary actions by 2018, while accounting for physician characteristics. RESULTS: A total of 3,399 physicians (2%) received at least 1 disciplinary action. Additional attempts needed to pass Steps 1, 2 CK, and 3 were associated with an increased likelihood of receiving disciplinary actions (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01, 1.13; OR: 1.09, 95% CI: 1.03, 1.16; OR: 1.11, 95% CI: 1.04, 1.17, respectively), after accounting for other factors. CONCLUSIONS: Physicians who took multiple attempts to pass Steps 1, 2 CK, and 3 were associated with higher estimated likelihood of receiving disciplinary actions. This study offers support for licensure and practice standards to account for physicians' USMLE attempts. The relatively small effect sizes, however, caution policy makers from placing sole emphasis on this relationship.

The Role and Value of Public Members in Health Care Regulatory Governance.

American medicine has progressively embraced transparency and accountability in professional self-regulation. While public members serving on health care regulatory boards involved with the accreditation, assessment, certification, education, and licensing of physicians provide formal opportunities for voicing public interests, their presence has not been deeply explored. Using 2016 survey and interview data from health care organizations and public members, the authors explore the value and challenges of public members. Public members were often defined as individuals who did not have a background in health care and provided a patient perspective, but in some instances prior health care experience did not automatically exclude these individuals from serving as public members. Public members served on the majority of national health care regulatory boards and constituted an average 9% to 15% of board composition, depending on how rigidly the organizations defined "public member." Public members were valued for their commitment to the priorities and interests of the public, ability to help boards maintain that public focus, and various professional skills they offer to boards. A main challenge that public members faced was their lack of familiarity with and knowledge of the health care field. The authors suggest several considerations for improved public member integration into health care regulatory organizations: clearly defined roles of public members, including evaluating whether or not previous health care experience either contributes or hinders their role within the organization; greater visibility of opportunities for the public to serve on these boards; and potentially a more intensive orientation for public members.