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July 19, 2019

The Conundrum of the United States Medical Licensing Examination Score Reporting Structure

Author Affiliations
  • 1McGovern Medical School, Department of Internal Medicine, UT Health, Houston, Texas
  • 2McGovern Medical School, Medical Sciences, UT Health, Houston, Texas
JAMA. 2019;322(7):605-606. doi:10.1001/jama.2019.9669

The United States Medical Licensing Examination (USMLE) is a 3-part test designed to assess the application of medical knowledge to patient care. Medical students usually complete the first 2 components (Steps 1 and 2) during the second and third years of medical school. Step 3 is taken after graduation, typically after the first year of residency training. The official purpose of the examination is to assist state authorities in granting medical licenses, but it also reassures various groups, including employers, educators, and patients, that licensed physicians have attained a minimum standard of medical knowledge.

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    2 Comments for this article
    Disagree With Changing to "Pass-Fail" Grading of Medical Board Examination
    Thomas Glynn, Undergraduate MA, MD, FACR | Member, Community Faculty, University of Nevada Reno, School of Medicine
    I am a 73 year old radiologist retired from full time practice who continues to work about 8 weeks per year to maintain contact with my profession which I have been fortunate enough to have truly enjoyed since I began my practice in 1976. I have also enjoyed teaching the next generation of young physicians by maintaining a position on the community medical faculty at Indiana University School of Medicine during my years of full time practice and now on the community faculty at the University of Nevada, Reno, School of Medicine. I mention my involvement in medical teaching because it has provided me with many years of experience, not only in terms of teaching young physicians but also in terms of evaluating their medical knowledge and competency. It is my very strong opinion that it would be a MAJOR MISTAKE to change the Medical Licensing Board Exam to a “ pass-fail” format. I am very strongly in favor of keeping the current system in place, which gives a traditional test score for each examination which the graduating medical student is taking. 
    Disagree With Changing to Pass-Fail Grading
    Geetha Krishnamoorthy |
    I believe a physician must be knowledgeable and competent. Though one can "look up" any topic, a broad knowledge base and excellent physical examination skills are essential skills for a good physician. The USMLE score not only tells me knowledge base, but tells me their discipline to read and expand the knowledge base, and motivation and enthusiasm to perform well. In addition, pass-fail score may give advantage to a student at the bottom of the class from a big-name Medical School compared to a top 20 student from an average Medical School. By reducing the skills required and knowledge required, we continue to create a future generation of physicians who are content with order sets and protocols. Are we going to remove medical knowledge and clinical skill from the core competencies? I am afraid of getting admitted under a new-generation physician when I'm old and sick.