National Board of Medical Examiners

The National Board of Medical Examiners (NBME), founded in 1915, is a United States non-profit which develops and manages assessments of health care professionals. Known for its role in developing the United States Medical Licensing Examination (USMLE) in partnership with the Federation of State Medical Boards (FSMB), USMLE examinations for medical students and residents are used by medical licensing authorities in the U.S. to help determine qualifications to grant and recognize medical licenses.[1] NBME also creates assessments and materials that are used by medical students, medical educators, practicing physicians, and for state testing of physicians already holding licenses.[2][3]

National Board of Medical Examiners
Founded1915 (1915)
TypeNonprofit educational
Location
President & CEO
Peter J. Katsufrakis, MD, MBA
Websitenbme.org

NBME's stated mission is to "protect the health of the public through state of the art assessment of health professionals" and emphasizes that "while NBME's mission is centered on assessment of physicians, this mission encompasses the spectrum of health professionals along the continuum of education, training and practice and includes research in evaluation as well as development of assessment instruments". NBME is headquartered on and adjacent to the University City Science Center research campus in Philadelphia, Pennsylvania.[4]

During COVID-19 pandemic and George Floyd Protests, the medical community criticized NBME's refusal to accelerate USMLE Step 1 score reporting to pass/fail before 2022 and called for an emergency committee (that included student representatives) who could address these issues in a timely manner without financial or other conflicts of interest.[5][6]

Beginning mid-March 2020, testing centers operated by Prometric were closed based on local health and safety guidelines due to the COVID-19 pandemic. Prometric center administrations for NBME-developed assessments such as USMLE, Health Professionals, and NBME Subject Examinations were suspended completely for several months.[5][7] USMLE waived fees associated with extending testing eligibility periods and changing testing locations.[8][9]

Prometric resumed test administration for "essential services" clients at reduced capacity, which included NBME assessments, in May 2020. The medical community criticized Prometric for the mishandling of testing centers operations during the pandemic, creating "chaos", further "disadvantages", "harm", "bias" and "inequity". Prometric issued an apology to NBME for mishandling communication with students around exam scheduling during the pandemic.[5][7]

History

The NBME was founded in Philadelphia in 1915, with the goal of creating a voluntary medical licensing exam that would be accepted by U.S. states and territories in lieu of their own exams, allowing physicians to practice across state lines.[10] Use of NBME Certifying Examinations ("Part" exams) grew in the years following its founding and in the years leading up to World War II. Prior to the war, states still administered their own exams, and operated agreements to license doctors passed by other state exams through membership in the Federation of State Medical Boards (FSMB).[11] But by 1943, 45 of the 48 states accepted NBME exams for licensure along with their state exams.[10] After the war, states continued to use the results of an NBME exam to decide whether to award medical licenses. This system meant students from different states would sit the same exam.[11] By 1992, 49 of the 50 US states accepted NBME exams for licensure along with their state exams.

The United States Medical Licensing Examination (USMLE), introduced in 1992, is a multi-part professional exam sponsored by the Federation of State Medical Boards (FSMB) and NBME. Medical students attending U.S. institutions are required to pass USMLE Step 1 and Step 2 Clinical Knowledge to enter into residency training where they treat patients under supervision.[12][13][14] Graduates of international medical schools seeking a medical residency in the United States generally take Step 1 and Step 2 CK after obtaining an MD or equivalent degree.[15] USMLE Step 3 must be passed before a Doctor of Medicine can apply to obtain a license to practice unsupervised medicine in the United States.[16] Because medical licenses are awarded by states, the process can vary depending on the state in which an MD or DO holder is seeking licensure. Some states cap the number times the USMLE Step exams can be taken or provide a time limit for completing the sequence of licensing exams.[17]

To assist examinees, NBME maintains a web portal that provides access to self-assessment test forms to help medical students practice for upcoming exams such as the USMLE Step 1, USMLE Step 2 CK, NBME Subject Exams, and the International Foundations of Medicine (IFOM) exams.[18] Beginning in 2021, most self-assessments became available in test forms that provide detailed answer explanations for both correct and incorrect answers.[19] As of March 24, 2021, NBME assessment form numbers 25, 26, 27, 28, 29, and 30 replaced retired form numbers 18 through 24.[18]

Other NBME Exams Used in Medical Education
  • Health Systems Science Exam - developed in cooperation with and at the request of the American Medical Association, the HSS exam measures a physicians knowledge of healthcare economics.[20][21]
  • Basic Science and Clinical Science Exams
  • Advanced Clinical Exams
  • Comprehensive Exams

Current Leadership (as of 2021)
  • President – Dr. Peter Katsufrakis
  • Chair – Dr. Alfred Tallia[22]
  • Vice chair – Dr. Latha Chandran[22]
  • Treasurer – Dr. Reena Karani[22]
  • Executive Board – Suzanne Anderson, Maya Hammoud, Kamili Wilson, Dr. Marie Foley, Dr. David Milling, Dr. Karen Sanders Dr. Danny M. Takanishi, Jr. , and Zach Weismann[23]

Controversies

In 2018, NBME President Peter Katsufrakis and FSMB President Humayun Chaudhry co-authored an invited commentary titled Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs. Their article was in response to a previously published article on the "climate" medical students experienced around Step 1 of the USMLE and use of exam results in residency selection.[24] In one line of the article, Katsufrakis and Chaudhry theorized that pass/fail score reporting for the USMLE Step 1 exam that required less study time could result in a less knowledgeable population of physicians if students used the gained time to binge-watch Netflix or using social media platforms such as Instagram.[25][26]

The National Board of Medical Examiners (NBME) which is responsible for creating and publishing board exams for medical students around the United States conforms to the use of DSM-5 criteria[27] despite the known problems with an unquestioning checklist approach to diagnosis and treatment based on the DSM that have been outlined by critics.[28] Not all providers rely on the DSM-5 for planning treatment as the ICD's mental disorder diagnoses are used around the world[29] and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.[30][31][32][33]

See also

References
  1. Statistics of Land-grant Colleges and Universities (1921) United States Office of Education
  2. "National Board of Medical Examiners® (NBME®)".
  3. "About NBME | NBME".
  4. Kostelni, Natalie (2007-11-23). "Medical examiners to expand HQ". Philadelphia Business Journal. Retrieved 2009-05-16.
  5. "Delays, miscommunications add even more stress to USMLE Step exams". 2 June 2020.
  6. "USMLE Testing Chaos May Harm Current and Future Doctors".
  7. "Medical Licensing Examinations in the COVID-19 Era". 11 May 2020.
  8. "4 questions medical students are asking on the COVID-19 pandemic". 24 March 2020.
  9. "Free NBME Self-Assessments Available Through September 30, 2020 | NBME".
  10. "100 years later, medical licensing exam still a herculean task".
  11. Ludmerer, Kenneth M. Time to heal: American medical education from the turn of the century to the era of managed care (1999), Oxford University Press US, 1999. p. 197-198. ISBN 0-19-511837-5
  12. "Step 1 | USMLE".
  13. "Step 2 CK | USMLE".
  14. "Doctor of medicine profession (MD): MedlinePlus Medical Encyclopedia".
  15. https://www.fsmb.org/siteassets/usmle-step3/pdfs/pathway-to-licensure.pdf
  16. Melnick, Donald E. (December 2006). "From Defending the Walls to Improving Global Medical Education: Fifty Years of Collaboration between the ECFMG and the NBME". Academic Medicine. Association of American Medical Colleges. 81 (12 Suppl): S30–S35, Volume 81 - Issue 12. doi:10.1097/01.ACM.0000243462.05719.e1. PMID 17086043.
  17. "FSMB | State Specific Requirements for Initial Medical Licensure".
  18. "NBME Self-Assessments | NBME".
  19. "Additional Answer Explanations Planned for NBME® Self-Assessments in 2020 and 2021 | NBME".
  20. "AMA Backs More Healthcare Economics Education for Med Students".
  21. https://www.nbme.org/sites/default/files/2020-01/Whats_New_HSS.pdf
  22. "NBME Announces New Members and Officers Elected to Its Board of Directors". 30 March 2021.
  23. "Our People | NBME".
  24. Katsufrakis, P. J.; Chaudhry, H. J. (2019). "Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs". Academic Medicine: Journal of the Association of American Medical Colleges. 94 (3): 305–308. doi:10.1097/ACM.0000000000002559. PMID 30570495. S2CID 58564397.
  25. "Dear NBME and FSMB, I watch HGTV more than Netflix: A Response to the Invited Commentary on USMLE Step 1". 30 December 2018.
  26. "Step 1 vs. Netflix and Instagram".
  27. "Update: Exams to Transition to DSM-5", Psychiatric News, 49 (22): 1, 2014, doi:10.1176/appi.pn.2014.10a19
  28. Wakefield JC (June 2015). "DSM-5, psychiatric epidemiology and the false positives problem". Epidemiology and Psychiatric Sciences. Cambridge University Press. 24 (3): 188–196. doi:10.1017/S2045796015000116. ISSN 2045-7960. PMC 6998664. PMID 25675983.
  29. First M, Rebello T, Keeley J, Bhargava R, Dai Y, Kulygina M, Matsumoto C, Robles R, Stona A, Reed G (June 2018). "Do mental health professionals use diagnostic classifications the way we think they do? A global survey". World Psychiatry. 17 (2): 187–195. doi:10.1002/wps.20525. PMC 5980454. PMID 29856559.
  30. Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, Ogawa Y, Leucht S, Ruhe HG, Turner EH, Higgins JP, Egger M, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Tajika A, Ioannidis JP, Geddes JR (7 April 2018). "Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis". Lancet. 391 (10128): 1357–1366. doi:10.1016/S0140-6736(17)32802-7. PMC 5889788. PMID 29477251.
  31. Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D (July 2015). "Efficacy of treatments for anxiety disorders: a meta-analysis". International Clinical Psychopharmacology. 30 (4): 183–192. doi:10.1097/YIC.0000000000000078. ISSN 0268-1315. PMID 25932596. S2CID 24088074.
  32. Schneider-Thoma J, Chalkou K, Dörries C, Bighelli I, Ceraso A, Huhn M, Siafis S, Davis JM, Cipriani A, Furukawa TA, Salanti G, Leucht S (26 February 2022). "Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis". Lancet. 399 (10327): 824–836. doi:10.1016/S0140-6736(21)01997-8. ISSN 0140-6736. PMID 35219395. S2CID 247087411. Retrieved 1 May 2023.
  33. Gartlehner G, Crotty K, Kennedy S, Edlund MJ, Ali R, Siddiqui M, Fortman R, Wines R, Persad E, Viswanathan M (October 2021). "Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis". CNS Drugs. 35 (10): 1053–1067. doi:10.1007/s40263-021-00855-4. ISSN 1172-7047. PMC 8478737. PMID 34495494.
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