Review of the score-reporting policy for the United States Medical Licensing Examination.

In 1998, the authors, acting on behalf of the National Board of Medical Examiners (NBME), undertook a review of the scoring policy for the United States Medical Licensing Examination (USMLE). The main goal was to determine the likely effect of changing from numeric score reporting to reporting pass-fail status. Several groups were surveyed across the nation to learn how they felt they would be affected by such a change, and why: all 54 medical boards; 1,600 randomly selected examinees (including 250 foreign medical graduates) who had recently taken either Step 1, Step 2, or Step 3 of the USMLE; 2,000 residency directors; the deans, education deans, and student affairs deans at all 125 U.S. medical schools accredited by the Liaison Committee on Medical Education; and all 17 members of the Council of Medical Specialty Societies. Responses from the different groups surveyed varied from 80% to a little less than half. The authors describe in detail the various views of the respondents and their reasons. Some members in each group favored each of the reporting formats, but the trend was to favor numeric score reporting. The majority of the responding examinees desired that their USMLE scores be sent to them in numeric form but sent to their schools and to residency directors in pass-fail form. Based on the responses and a thorough discussion of their implications, the Composite Committee (which determines USMLE score-reporting policy) decided that there is no basis at this time for changing the current policy, but that it would review the policy in the future when necessary.

Specialty certification in North America: a comparative analysis of examination results.

The pass/fail results of 44 North American medical specialty certification examinations are compared and analyzed. A calculated annual failure rate was used to equate one- and two-part examinations. Failure rates on American boards generally varied between 8 and 61 percent. Foreign medical graduates (FMGs) had failure rates two to three times higher than those of North American graduates in almost all specialties. Failure rates for comparable North American and FMG candidates tended to be higher on Royal College of Physicians and Surgeons of Canada specialty certification examinations than on equivalent American specialty board examinations. The place of specialty certification in the continuum of American graduate medical education is delineated. Questions are raised concerning the standards required for specialty certification.