CRU Updates - June 2008

Posted: June 9th, 2008


On June 2, the Composite Committee, which establishes policy for the US Medical Licensing Examination, established a broad framework to guide a potential redesign of the exam. In considering a redesign, the Committee was mindful of the critical role the USMLE plays as a keystone in the licensure of physicians to practice medicine in the United States. Medical practice has evolved fundamentally since the USMLE was designed over 20 years ago. While the USMLE has continually evolved over the years, the Composite Committee judged it vital to reconsider the exam in light of the profound changes affecting medical practice.

Guiding Principles

The Composite Committee identified guiding principles for the USMLE going forward. In broad strokes, these principles state that the primary purpose of the USMLE is to inform the medical licensing process by assessing the competencies of physicians wishing to practice medicine within the United States. The competencies considered central to safe and effective patient care are dynamic; the USMLE should be responsive as national consensus about core competencies evolves. Furthermore, the USMLE must provide reliable measures of an aspiring physician’s competencies and allow reasonable and valid interpretations. Secondary uses of USMLE data should not adversely affect the USMLE Program. Finally, any redesign of the USMLE should remain sensitive to costs and administrative challenges.


In its decisions, the Composite Committee built on the report of the Committee to Evaluate the USMLE Program (CEUP), which was appointed to determine whether the design, structure and format of the USMLE effectively and efficiently support its mission. The CEUP’s members encompassed medical students, residents, fellows, deans and associate deans, basic science and clinical faculty, international medical graduates, state medical board members, practicing physicians, and the public. Staff members from the National Board of Medical Examiners (NBME), Federation of State Medical Boards (FSMB), and the Educational Commission for Foreign Medical Graduates (ECFMG) provided CEUP with data gathered from a broad range of stakeholders.


The Composite Committee broadly concurred with the CEUP’s report, endorsing the first three of its recommendations in their entirety and directing staff to conduct the research necessary to fulfill the others:

Recommendation #1

CEUP recommends that USMLE design a series of assessments that are specifically intended to support decisions about a physician’s readiness to provide patient care at each of two patient-centered points: a) at the interface between undergraduate and graduate medical education (supervised practice), and b) at the beginning of independent (unsupervised) practice.

Recommendation #2

CEUP recommends that USMLE adopt a general competencies schema for the overall design, development, and scoring of USMLE, using a model consistent with national standards.* Further, CEUP recommends that, as the USMLE program evolves, it should foster a research agenda that explores new ways to measure those general competencies, important to medical practice and licensure, that are difficult to assess using current methodologies.

*Such as the six general competencies identified by the Accreditation Council on Graduate Medical Education (ACGME).

Recommendation #3

CEUP recommends that USMLE emphasize the importance of the scientific foundations of medicine in all components of the assessment process. The assessment of these foundations should occur within a clinical context or framework, to the greatest extent possible.

The Composite Committee also directed staff to:

  • Explore means of enhancing the assessment of clinical skills important to medical practice.
  • Develop assessments focusing on the doctor’s ability to access relevant information, evaluate its quality, and apply it to solving clinical problems.
  • The full narrative report is now available.

Next Steps

The Composite Committee’s actions mark the beginning of a new phase, during which staff will create possible models for a potential redesign of the USMLE within the framework recommended by the CEUP. We emphasize that the process will be evolutionary, continually seeking feedback and building on the insights we gain from many stakeholders. We anticipate that the entire process will take a minimum of four years – and quite possibly longer before it will impact any test-takers.

Note: The Composite Committee, comprising members of the Federation of State Medical Boards (FSMB), National Board of Medical Examiners (NBME), and the Educational Commission for Foreign Medical Graduates (ECFMG), establishes policy for the U.S. Medical Licensing Examination. The FSMB and NBME co-sponsor the exam; the ECFMG shares in its administration.

We recognize, and appreciate, the substantial interest of many stakeholders in the USMLE Program. We will keep you informed of our progress in considering a redesign through periodic postings on this Web site.

James N. Thompson, MD
CEO and President
Federation of State Medical Boards
Donald E. Melnick, MD
National Board of Medical Examiners
James A. Hallock, MD
President and CEO
Education Commission for Foreign Medical Graduates