Williams R G
Department of Medical Education, University of Illinois College of Medicine at Chicago 60612.
Acad Med. 1993 Oct;68(10):748-52. doi: 10.1097/00001888-199310000-00004.
Criteria are presented for determining whether licensure and/or achievement test results should be used as a basis for making various types of comparisons and judgments about medical education programs for program evaluation purposes. United States Medical Licensing Examination (USMLE) examinations and National Board of Medical Examiners (NBME) subject tests are then considered as sources of evaluation data for medical education programs by evaluating these examinations in the light of the proposed criteria. It is concluded that NBME examination and USMLE results may properly be considered one of several tools to use in an evaluation of medical education programs but are not recommended as the sole basis for a judgment of program effectiveness. However, care must be taken to ensure that test score differences are large enough to be real and to have practical significance. Furthermore, changes in curriculum should not be considered or implemented on the basis of NBME/USMLE results unless the changes in test scores are maintained for at least two years. The focus should generally be on inordinately high failure rates rather than on changes in mean class scores. Efforts to develop objective, standardized, and controlled measures of other clinical competencies for national use should be encouraged to minimize the temptation to use USMLE Step 1 and Step 2 scores as the sole basis for comparisons of medical education programs.
本文提出了一些标准，用于确定执照考试和/或成绩测试结果是否应用作依据，以便就医学教育项目进行各类比较和评判，从而实现项目评估目的。随后，通过依据所提出的标准对考试进行评估，将美国医师执照考试（USMLE）和美国国家医学考试委员会（NBME）的科目考试视为医学教育项目评估数据的来源。得出的结论是，NBME考试和USMLE成绩可恰当地被视为评估医学教育项目时可使用的多种工具之一，但不建议将其作为评判项目有效性的唯一依据。然而，必须注意确保考试分数差异足够大，以使其真实且具有实际意义。此外，除非考试分数的变化至少持续两年，否则不应基于NBME/USMLE成绩考虑或实施课程变革。通常应关注过高的不及格率，而非班级平均分数的变化。应鼓励努力开发用于全国范围的、客观、标准化且可控的其他临床能力衡量方法，以尽量减少将USMLE第一步和第二步成绩作为医学教育项目比较唯一依据的诱惑。
