Dr. Isadore Dyer, Association of American Medical Colleges

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1 Fall/Winter 2013 Volume 60, Number 2 Examiner National Board of Medical Examiners 3750 Market Street Philadelphia, PA NBME Plans Its 100th Annual Meeting On May 5, 2015, the NBME will complete 100 years of service to the public and the health professions. Our centennial celebration begins with the 100th Annual Meeting of the NBME Membership on April 3-4, We have selected the Willard Hotel in Washington, DC as the venue for this milestone meeting. The historic Willard Hotel was the site of the May 5, 1915 Meeting of Organization of the National Board of Medical Examiners. Among the original members of the NBME present at this first meeting were: Major General William C. Gorgas and Colonel Louis A. LaGarde, representing the US Army Rear Admiral William C. Braisted, Surgeon General, US Navy Dr. William L. Rodman, founder of the NBME and then-president of the AMA Dr. Herbert Harlan, representing the Federation of State Medical Boards Dr. Isadore Dyer, Association of American Medical Colleges The minutes of this Meeting of Organization note that the meeting was called to order following a tour of inspection of the laboratories of the Public Health Service, Navy Medical School and Army Medical School. These institutions would later serve (in 1916) as the facilities in which the oral, written, laboratory, and clinical tests of the first examination were held. (continued on page 3) OUT & ABOUT In This Issue: 1 NBME Plans Its 100th Annual Meeting 1 Joining Forces: NBME to Convene Task Forces on Military Health 2 NBME Welcomes Kim Edward LeBlanc 2 Upcoming Changes to USMLE Step 3 4 From the Public Stakeholders Committee 6 Changes to USMLE Joining Forces: NBME to Convene Task Forces on Military Health In the Spring/Summer 2012 issue of the Examiner, NBME announced its commitment to the Joining Forces initiative, a program launched by First Lady Michelle Obama and Dr. Jill Biden to recognize and honor America s veterans and military families. Facilitating and improving wellness among the troops, veterans and their families is a major goal of Joining Forces. In announcing its commitment to Joining Forces, NBME stated NBME will work with other Joining Forces partners to reflect the health issues affecting service members and veterans in the broad range of examinations it prepares for the education and licensure of medical students, practicing physicians, and other healthcare providers. To that end, NBME is very pleased to announce that two task forces of content experts from the Veterans Administration, Uniformed Services University of the (continued on page 5) 2013 NBME

2 INSIDE THE NBME NBME Welcomes Kim Edward LeBlanc Kim Edward LeBlanc, MD, PhD In August 2013, Kim Edward LeBlanc, MD, PhD, joined the NBME staff as Executive Director of the Clinical Skills Evaluation Collaboration, which administers the Step 2 Clinical Skills examination for the United States Medical Licensing Examination (USMLE ). While in private practice, Dr. LeBlanc became involved in academic medicine on a part-time basis until 1999, when he became program director of the Family Medicine Residency in Lafayette, LA. He served as Head of the Department of Family Medicine at the LSU School of Medicine in New Orleans from 2002 to 2013, where he also served as Director of Rural Education and on several committees, including the Admissions Committee. Dr. LeBlanc was appointed to the Louisiana State Board of Medical Examiners (LSBME), serving from 2000 to He served as Treasurer, Vice President, President, and Executive Director during FOR STUDENTS his tenure on the LSBME. In addition, Dr. LeBlanc is on the Board of Directors of the Accreditation Council of Continuing Medical Education. He has served on the USMLE Step 3 Committee and multiple other committees of the NBME, as well as on the Board of Directors of the Federation of State Medical Boards. He has served as team physician for the University of Louisiana Lafayette, several US Olympic teams, and several professional baseball, soccer, ice hockey, and football teams. Dr. LeBlanc is certified by the American Board of Family Medicine, the American Board of Integrative Holistic Medicine and holds a Certificate of Added Qualifications in Sports Medicine. Dr. LeBlanc was born and raised on a farm in rural south Louisiana. He received a Bachelor of Science degree from the University of Southwestern Louisiana. Subsequently, he received his Doctor of Medicine degree from Louisiana State University (LSU) School of Medicine in Shreveport in After completing a residency in Family Medicine in Lake Charles, LA., in 1981, he returned to his home town and began private practice in Breaux Bridge, LA. In 1998, he received a PhD in Exercise Physiology from LSU Baton Rouge. Upcoming Changes to USMLE Step 3 Step 3 of the USMLE is scheduled to undergo changes to its structure and content in This will be the first in a series of changes to the Step examinations that will occur over the next two years (see pages 6-7), as a result of a multi-year project to review the USMLE program, initiated in This review explored the effectiveness of the design and format of the current Step examinations and resulted in five major recommendations, adopted by the program in These recommendations call for assessment of competencies that are under assessed (or not assessed at all) in the current Step 3. The current Step 3 is an assessment of the clinical science and medical knowledge necessary for the unsupervised practice of medicine, with an emphasis on patient management. While the restructured examination will still assess these areas, it will also include increased numbers of items that assess an expanded (continued on page 4) 2

3 (NBME s 100th Annual Meeting, continued from page 1) In his remarks, summarized in the minutes of the May 5, 1915 meeting, Dr. Rodman noted that, with the inclusion of the Surgeons General of the Army, Navy and Public Health Service The Board now seemed to have an unusual opportunity to be of benefit to the general public and the respective services. Plans for the 100th Annual Meeting are taking shape. Much of the meeting will focus on NBME history, and we hope to present it to the audience in ways that are not only educational but entertaining. We will revisit the origins of the NBME and the key players in its founding. Important eras in NBME history, such as the move from the essay format to multiple-choice, will be highlighted in ways that both inform and engage the audience. Lobby of the historic Willard Hotel In the afternoon of April 3, Members and guests will have an opportunity to walk through a centennial OSCE, in which staff will demonstrate some of the newer testing formats and other new products and services of the NBME. During the April 4 sessions, Dr. Ruth Hoppe, Chair of the Centennial Steering Committee, will review NBME s plans for the centennial year, which culminates with the May 5, 2015 Centennial Meeting (NBME s 100th birthday!). Whereas the 2014 meeting will focus on NBME history, the 2015 meeting s theme will be a look to the future. In addition, Dr. Hoppe will preview some exciting new products and services that will launch in the centennial year. We will revisit Dr. Rodman s statement, an unusual opportunity to be of benefit to the general public with a discussion of what that meant in 1915 and what it means today. Please visit for updated information on NBME s centennial plans. 3

4 INSIDE THE NBME From the Public Stakeholders Committee PUBLIC STAKEHOLDERS First convened in 2008, the Public Stakeholders are a group of consumer advocates and health experts brought together to advise the policies of the National Board of Medical Examiners, to represent the public voice in NBME s pursuit of its mission to protect the public health. In each edition of The Examiner we will be sharing news and issues of interest to patients and health advocates. The NBME continues to take measurable steps toward creating opportunities for public involvement. A new milestone in the pilot program of nominating public members to test content committees was recently marked by Pamela Blizzard s participation in the Step 2 Committee s forms review process. The primary purpose of forms review is to obtain general feedback on whether the produced forms are a reasonable representation of what the committee feels should be seen by each examinee. As the public member named to the Step 2 Committee in 2012, Ms. Blizzard had previously participated in standard setting and policy discussions. Ms. Blizzard has drawn on her background as a public member of the North Carolina State Board and her work with science and math at Research Triangle Park. You need quick analytical skills to step into this committee, she said. My experience of 5 years on a state medical board reviewing cases from the perspective of the public--in ethics, patient safety, professionalism and systems thinking--really came to bear in my experience on Step 2. The upcoming changes to the USMLE committee structure include the Step (Upcoming Changes to USMLE Step 3, continued from page 2) committees merging into one USMLE Management Committee, which will have at least two subcommittees on exam design and operations. NBME staff and members of the Public Stakeholders Committee have expressed support for appointing public members to serve on the Management Committee. As the test blueprints are reviewed, (continued on page 5) range of competencies. These competencies relate to biostatistics, epidemiology/population health, interpretation of medical literature, communication and interpersonal skills, medical ethics, systems-based practice/patient safety, and the foundational sciences essential for effective healthcare. In addition to changes in content, Step 3 will also undergo changes in its administration. Currently, the two, eight-hour test sessions of Step 3 must be taken on consecutive days. However, the new, restructured exam will allow examinees to schedule the exam on nonconsecutive days, separated by a yet to be determined period of time. The reasons behind this change are to increase scheduling flexibility for examinees who may wish to separate the two test sessions; the change may also make it easier for examinees to schedule at their preferred testing location. Finally, with the introduction of the restructured Step 3 examination in 2014, the USMLE program will no longer require examinees to apply for Step 3 under the eligibility requirements of a specific medical licensing authority. All other Step 3 eligibility requirements (i.e., medical degree, passing Steps 1-2, ECFMG certification for international medical students and graduates) will remain applicable, as will all other USMLE program requirements (e.g., no more than six attempts at a Step or a Step component). This change in the application process is tentatively scheduled to begin in August

5 (Joining Forces, continued from page 1) Health Sciences, and physicians from all branches of the military will be convened. Each task force will comprise 10 to 12 content experts and will each meet once annually for two years to rapidly develop test questions on the psychological and physical problems of veterans, returning deployed servicemen and women, and the families of deployed servicemen and women, to be included in the USMLE Step examinations and also to develop a medical school subject examination dedicated to this topic. Areas to be included are traumatic brain injury (TBI), blast injuries, military sexual trauma, posttraumatic stress disorder (PTSD), other psychiatric conditions of returning servicemen and women (depression, alcohol and drug abuse, including prescription drug use and abuse), psychological and psychiatric conditions of families of deployed servicemen and women, and infectious diseases affecting servicemen and women returning from western Asia. During the past 12 years, nearly 50,000 servicemen and women have been wounded or injured from warrelated conditions such as TBI, blast injuries, and PTSD. Although many of these conditions also occur in the general population, they either occur much more frequently in the setting of military conflict or may present differently, as is the case with PTSD. Additionally, the Congressional Budget Office reported in February 2012 that many cases of PTSD and TBI may go unrecognized and consequently undiagnosed and untreated, both in the war zone and once the service member returns home. Unemployment is sometimes a result of these conditions; unfortunately, the suicide rate among veterans is at an all-time high. NBME believes that the need to have physicians ready to treat these illnesses is too pressing to wait for enough questions to be generated via the normal committee processes, which would take five to seven years. Further, although current test material development committees have some of the expertise to address this need, additional content experts must be recruited, which would further delay our ability to meet this important need. Creating two task forces specifically to generate a bolus of questions on military health will enable NBME to include an ample number of questions to cover this important topic in all three Steps of USMLE as soon as possible. To sustain this question pool and keep it up-to-date, task force members who generate acceptable numbers of questions and who worked well within the question-writing committee process will be recruited to serve as committee members on our standing committees, enabling them to continue writing in their areas of expertise, as well as in other content areas on the exam blueprints. This approach should continue to generate an adequate number of questions to sustain the question pool within each examination of the USMLE, and on a military health subject examination. For more information on Joining Forces, please visit their website: (From the Public Stakeholders Committee, continued from page 4) the Public Stakeholders Committee noted the benefit of acquiring public member feedback on the direction in which the examinations are moving. The NBME announced that Nicole Taylor Linehan has assumed the role of Program Officer for the newly formed Office of Public Engagement (OPE). Nicole will be responsible for developing and implementing a road map for the NBME s public engagement agenda. These activities will include increasing the role of public members on internal policy and test committees, developing NBME website and social media resources for our public stakeholders and NBME staff, updating and building upon the NBME Health System Reform policies, exploring opportunities for research to better understand trends affecting patient care, and establishing NBME as an influential stakeholder in relevant health and public policy debates. If you have any questions about the OPE, please contact Nicole Linehan at 5

6 FOR STUDENTS Changes to USMLE As medicine and medical education have changed over the years, so have USMLE examinations evolved since they were first administered in This is a brief summary of planned changes for the next few years. USMLE STEP 3 Beginning November 2014, examinees will: Be able to schedule the exam on two nonconsecutive days; NOT need to apply for Step 3 under the eligibility requirements of a specific medical licensing authority; See increased numbers of items that assess an expanded range of competency-based content, including foundational science essential for effective healthcare; biostatistics, epidemiology, and population health; literature interpretation; medical ethics; and patient safety. The two exam days will be named Step 3 Foundations of Independent Practice (FIP) and Step 3 Advanced Clinical Medicine (ACM). The Step 3 exam will continue to: Focus on knowledge and application of the biomedical and clinical sciences necessary for independent patient care; Include multiple-choice questions and computerbased case simulations; Be administered over two days, for a total time comparable to current testing time; Result in a single score (with graphical performance profile information) and a single pass/fail outcome after completion of both examination days. Important to Note Registration for the current Step 3 examination will end July 31, Registration for the restructured Step 3 examination will begin August No Step 3 examinations will be administered during most or all of October There will be a substantial score delay following introduction of the restructured Step 3 examination in November The duration of the score delay will be determined by examinee volume during the early months of exam administration. Based on historic trends, we estimate that the first scores for Step 3 exams taken on or after November 1, 2014 will be released during the first week of April

7 USMLE STEP 2 Clinical Knowledge (CK) In 2014 and 2015, examinees will see an increased focus on quality improvement principles; safety science; epidemiology, biostatistics, and population health; professionalism; and interpersonal and communications skills. These may be tested using item formats currently under development. If new item types are introduced into the examination, sample materials will be available on the USMLE website for examinees to review well in advance. Step 2 CK will continue to focus on patient care and diagnosis. The format will continue to be a computer-administered examination, using multiple-choice questions. USMLE STEP 2 Clinical Skills (CS) Further enhancements to the assessment of communications skills are being piloted. If the pilots are successful, these enhancements to Step 2 CS will be introduced into the exam no earlier than 2015, and will be announced well in advance. Step 2 CS will continue to focus on examinees ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues. The examination will continue to use standardized patients to simulate patient encounters. USMLE STEP 1 In 2014 and 2015, examinees will see an increased focus on quality improvement principles and safety science. Step 1 will continue to focus on traditional content areas in the basic sciences within a clinical context. The format will continue to be a computer-administered examination, using multiple-choice questions. Please check the USMLE website ( for the latest updates and most complete information. 7

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