Correcting a Misperception

To the Editor: In their March article, Kerfoot et al1incorrectly report that [T]he National Board of Medical Examiners, the Educational Commission for Foreign Medical Graduates, and the Federation of State Medical Boards have recently endorsed a plan to replace the current three-step licensure examination system with two gateway examination sequences. These will be administered near the end of medical school and at the end of internship. We wish to correct this misperception. In 2006 the United States Medical Licensing Examination (USMLE) program convened the Committee to Evaluate the USMLE Program (CEUP) as part of a self-study process that yielded recommendations for changes to the USMLE examination sequence. Among its findings,2 the CEUP recommended examinations to support state medical board decisions at two points: as physicians prepare to enter supervised practice, that is, residency (decision point 1), and as physicians prepare for full licensure and unsupervised independent practice (decision point 2). This recommendation has sometimes been misconstrued, as Kerfoot and colleagues did, to mandate two examinations or two sequences of examinations to be completed immediately before the two licensing decisions described above. In fact, no plan has been announced or is under development to aggregate all decision-point-1 assessments or move them to near the end of medical school. State medical boards currently determine readiness for supervised practice during postgraduate training based on knowledge of fundamental science, clinical medicine, and clinical skill. In the current USMLE program, separate examinations provide the basis for these decisions. There will also be multiple components in the new USMLE program. Candidates may elect to take components in closer proximity, given the higher degree of integration of fundamental science and clinical medicine that will be present. The USMLE program provides periodic updates as plans proceed to implement recommendations arising from CEUP's review of the USMLE program. Interested readers are encouraged to view links at www.usmle.org/cru for implementation plans and progress reports. Peter J. Katsufrakis, MD, MBA Vice president for assessment programs, National Board of Medical Examiners, Philadelphia, Pennsylvania; [email protected]. Peter V. Scoles, MD Senior vice president for assessment programs, National Board of Medical Examiners, Philadelphia, Pennsylvania. Donald E. Melnick, MD President, National Board of Medical Examiners, Philadelphia, Pennsylvania.