Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA.
Acad Med. 2010 Mar;85(3):453-6. doi: 10.1097/ACM.0b013e3181ccbea8.
The practice of medicine is a shared social contract between the medical profession and the public. Assessments for licensure should reflect competencies that patients expect of their physicians and should be patient-centered and mirror the progressive nature of medical education. The National Board of Medical Examiners recently accepted the recommendations of the Committee to Review the United States Medical Licensing Examination Program to align the examination sequence with two patient-centered decision points: when a student enters into supervised graduate training, and when a physician receives initial licensure for unsupervised practice. The revised examination program would aim to evaluate for the presence of at least minimum proficiency in all competencies that are measurable in a valid, reliable manner at each decision point, including the scientific foundation of medical practice, the application of medical knowledge to patient care, and the clinical skills relevant to practice level, whether measured by standardized patient-based assessments or other formats. Students, educators, educational leaders, and program directors have raised legitimate concerns about the anticipated changes. The anticipated costs, the changes' effect on basic science education, their impact on dual-degree candidates and international medical graduates, and the utility of score reporting are each of concern. Anticipated benefits include a closer alignment of assessments with the expectations of patients and licensing authorities, closer integration of the sciences fundamental to medical practice throughout the examination sequence, and an increased breadth of competency assessment. The authors believe that the benefits to patients and the profession will outweigh the acknowledged challenges the changes will pose to medical education.
医学实践是医学专业人员和公众之间的共同社会契约。许可评估应反映患者对医生的期望，并应以患者为中心，反映医学教育的渐进性质。国家医学考试委员会最近接受了审查美国医师执照考试计划委员会的建议，将考试顺序与两个以患者为中心的决策点保持一致：当学生进入监督研究生培训时，以及当医生获得未经监督实践的初始许可时。修订后的考试计划旨在评估每个决策点以有效、可靠的方式衡量的所有能力是否至少达到最低熟练程度，包括医学实践的科学基础、将医学知识应用于患者护理，以及与实践水平相关的临床技能，无论是通过基于标准化患者的评估还是其他形式进行衡量。学生、教育工作者、教育领导者和项目主任对预期的变化提出了合理的担忧。预期成本、这些变化对基础科学教育的影响、它们对双学位候选人以及国际医学毕业生的影响以及分数报告的实用性都是关注的问题。预期的好处包括评估与患者和许可机构的期望更紧密地保持一致，在整个考试序列中更紧密地整合对医学实践至关重要的科学，以及更广泛的能力评估。作者认为，这些变化对医学教育构成的挑战将超过对患者和专业人员的好处。
