The design of a new physician licensure examination.

Many health professions include written examinations among their licensing procedures, and constructing these examinations poses special difficulties. For physician licensure the central dilemma is manifested by the longstanding tradition of undifferentiated licensure contrasting with the strong specialty orientation of contemporary physician training. This article details the authors' response to this problem and describes the resulting design of a new physician licensure examination. Using a combination of empirical data and expert judgment, descriptions of selected clinical encounters have been assembled as a practice model of a physician licensed for the delivery of general health care of patients. Application of an explicitly situational framework to the design of a physician licensure examination is unusual, and the approach is advocated for use with other health professions.

Evaluating alcoholism and drug abuse knowledge in medical education: a collaborative project.

A series of six modular examinations, each representing a substance abuse problem, were developed by a National Institute on Drug Abuse task force working with consultants from the National Board of Medical Examiners (NBME). Each examination contained a patient management problem and multiple-choice questions. The examinations were administered to 629 third- and fourth-year U.S. medical students, and the results indicated that students performed less well in this area than on the traditional content of the NBME examinations. Students performed better on items related to pharmacologic effects of drugs of abuse, Alcoholics Anonymous, and the treatment of delirium tremens. Students did less well on items related to metabolic and biochemical areas; emergency room treatment of drug-overdosed, comatose patients; and legal issues in substance abuse. As a result of these data, a syllabus explaining each item in the available modules was developed, score-reporting to participating schools was modified, and the modules were shortened. Implications for medical education in substance abuse are discussed.