CRU Updates - February 2008

Posted: February 1st, 2008


In August, 2007, USMLE posted a summary of activities associated with the Comprehensive Review of USMLE (CRU). This is an update to that original report.

Progress to Date

The Committee to Evaluate the USMLE Program (CEUP) has completed its review of information gathered during the early phases of the CRU process and has set a target of mid-March 2008 to complete final recommendations. It is likely that the previously reported themes that were emerging in the CEUP discussions will be reflected in the final report. These include:

  • Provision of assessments that are intended to inform the state licensing authorities in making decisions at two "Gateway" points: 1) entry into supervised practice (typically entry into postgraduate training), and 2) entry into unsupervised practice (at the point of initial licensure). (It is important to note that the Gateways are intended as decision points; it is possible that each Gateway decision will be informed by the results of more than one assessment.)
  • Redesign of USMLE to better reflect the competencies important to medical practice, to the degree that such competencies can be measured in a valid, reliable, and practical manner.
  • Reconsideration of the current, independent assessment of the basic sciences in favor of an integrative approach to the scientific foundations of medicine across all components of the USMLE program.

Next Steps

CEUP recommendations will go the USMLE Composite Committee later this spring and, ultimately, to the governance of ECFMG, FSMB, and NBME late this year. CEUP is not likely to provide specific recommendations on such issues as the number or timing of assessment components required for each licensing decision point, the design and formats of individual assessment components, or score reporting approaches. During 2008, staff from ECFMG, NBME and FSMB will work with existing and new USMLE committees to develop a series of hypothetical models that explore issues ranging from overall program design to individual test item format.

A number of key topics have already been identified for early review as consideration of CEUP recommendations moves forward. They include (but are certainly not limited to:

  • The need to clearly identify those competencies that USMLE believes can be reasonably assessed in the licensing examination process,
  • A consideration of the ways to best assess the elements of basic science, throughout USMLE, that are important to current and future clinical practice,
  • Identification of those knowledge areas and skills that need to stand as independent, non-compensating, requirements for successful progression through USMLE,
  • A review of the potential impact of proposed changes on both the current structure of the medical education continuum and for state medical board licensing processes,
  • Consideration of the possibility of providing the educational community with new assessment tools, independent of USMLE, to fill any perceived "void" created by modifications to the licensing examination system, and
  • A review of the issues around score reporting formats.

The CEUP report and information on the feasibility and implications of the recommendations will receive substantial review by the staff and governing bodies of ECFMG, FSMB, and NBME. Proposals for major changes to USMLE will need to be approved by the house of delegates of FSMB and by the full board of NBME. This will not occur any earlier than spring 2009. If changes are approved, it will take at least two additional years to work out the details for a reasonable transition to the new design and structure, and to begin implementation.