Asymmetry And Tension: A Brief History of Medical Student Involvement In the U.S. Licensure Process

Abstract

ABSTRACT A little more than two years ago, the first nationally standardized clinical skills exam was added to the United States Medical Licensure Examination (USMLE) series. The implementation of this exam was troubled by vigorous resistance from medical students whose objections were supported by several prominent and powerful medical organizations. This article suggests that beyond obvious sources of tension inherent in the exam (chiefly, expense and inconvenience) a real and overlooked source of antagonism is the lack of direct involvement by examinees (students and residents) in the licensure process. Students and residents were able to promote a much larger (and acrimonious) debate than anticipated largely because of their recent ascendancy to positions of influence in medical schools and organizations. This article traces the evolution of student and resident involvement in medical schools and organizations and further suggests that the lack of parallel involvement by students and residents in the licensure process creates asymmetry in an otherwise balanced system of professional autonomy. Such asymmetry in a system balanced between medical schools, organizations and licensing authorities has led and can again lead to unproductive tension and undermine efforts on all parts to advance the practice of medicine and assure the best care possible to the American public. The author closes with a call to forum to discuss openly the possibility of increased student and resident participation in the licensure process; details of how, when and where this participation could occur should be the first items of discussion in such a forum.