THE USMLE, THE NBME SUBJECT EXAMINATIONS, AND ASSESSMENT OF INDIVIDUAL ACADEMIC-ACHIEVEMENT

This second of the four-part set of articles published in this issue examines the appropriateness of using scores on the Step 1 and Step 2 examinations of the United States Medical Licensing Examination (USMLE) to make individual academic achievement decisions (e.g., for promotion or graduation) and the appropriateness of determining course grades by using scores on the National Board of Medical Examiners (NBME) Subject Examinations. The article attempts to make explicit the underlying philosophical and psychometric assumptions involved in using these examinations for such purposes. Specifically, in using the USMLE examinations for promotion and/or graduation, one assumes (1) that the competencies measured by the examinations are essential requirements for graduation or promotion, and (2) that these competencies are not effectively measured by current in-school assessment or that they need an external verification. In using the NBME subject examinations for in-course grading, one assumes (1) that grades should reflect the student's current (end-of-course) knowledge in a subject area; (2) that grades should reflect global content knowledge versus knowledge of content presented during the course; and (3) that grades should be assigned in a normative versus a criterion- or content-referenced manner unless percent-correct scores are specifically requested and properly used. The author argues for and against the viability of the various assumptions stated in the article and concludes that there are dangers and limitations in using the USMLE examinations and the NBME subject examinations for internal academic decision making. The author acknowledges that some in the medical education community may differ with her conclusions, but stresses that all potential users of the examinations should recognize the assumptions they are making, be aware of their implications, and be prepared to justify them.