Assessment Briefs

Abstract

As the only peer-reviewed quarterly publication dedicated to topics and issues critical to medical regulation in the United States and around the world, the Journal of Medical Regulation addresses all aspects of this vital element of public protection. This issue of JMR introduces “Assessment Briefs”—a new, periodic update that will offer important developments in the examinations relied upon for medical licensure in the United States and globally.The United States Medical Licensing Examination (USMLE), established in 1991 as a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), is a three-step examination for medical licensure in the United States.The program announced major policy changes in February 2020 and further changes stemming from the disruption created by the COVID-19 pandemic. Several of these policy changes have now, or are about to become, operational. They include:The Special Purpose Examination (SPEX), a joint program of the FSMB and NBME, is a generalist examination for use by medical licensing authorities in evaluating the current medical knowledge of physicians who are some years away from having passed a national medical licensing examination.Recent changes to SPEX include: An updated SPEX exam was introduced in January 2019. Specific improvements included an update of the exam blueprint, an update of the item pool (i.e., new test forms and questions), and implementation of new item formats (e.g., drug ads and abstracts). The exam was also shortened by 2.5 hours (from 8.5 hours to 6 hours) to better accommodate physicians’ busy schedules.Another refresh of the exam will take place in 2021, with changes anticipated to be implemented in 2022.The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three-level, national standardized licensure examination designed for licensure for the practice of osteopathic medicine. The examination is administered by the National Board of Osteopathic Medical Examiners (NBOME). The COMLEX-USA Examination Series is designed to assess osteopathic medical knowledge, knowledge fluency, clinical skills, and other competencies essential for practice as an osteopathic generalist physician. It is also a graduation requirement for attaining a DO (Doctor of Osteopathic Medicine) degree from colleges of osteopathic medicine in the United States.Upcoming changes to the assessment series include: Level 1 is changing to Pass-Fail reporting without numeric scores beginning in May 2022COMLEX-USA attempt limit is changing from six to four effective July 1, 2022The COMLEX-USA Level 2-PE was temporarily suspended in March 2020 due to the COVID-19 pandemic. In February 2021, the NBOME indefinitely suspended the examination and formed a Special Commission for Osteopathic Medical Licensure Assessment. The Commission was first charged with evaluating defensible alternative pathways for verification or assessment of fundamental clinical skills. The Commission is structured to be representative of perspectives from across the UME-GME-Licensure continuum, including state licensing board representatives, student representatives and public members/patient representatives.In the absence of a national clinical skills examination, alternate pathways for osteopathic clinical skills attestation for the Classes of 2020–2022 have been recommended and approved by the NBOME Board of Directors. These will be included with graduation attestation for these classes and will be noted on the NBOME transcript.Phase 2 of the Special Commission began in May 2021 and will continue through April 2022. The Commission will also be reviewing the entire COMLEX-USA examination program to ensure that this licensure examination pathway continues to evolve with the rapidly changing practice of osteopathic medicine, osteopathic medical education and health care. Test content, emerging technologies in test delivery, and attention to diversity, equity and inclusion are key priorities.