Hark L A, Iwamoto C, Melnick D E, Young E A, Morgan S L, Kushner R, Hensrud D D
University of Pennsylvania School of Medicine, Philadelphia 19104-6987, USA.
Am J Clin Nutr. 1997 Feb;65(2):568-71. doi: 10.1093/ajcn/65.2.568.
The 1985 National Academy of Sciences report Nutrition Education in US Medical Schools recommended that the National Board of Medical Examiners (NBME), who develops the US Medical Licensing Examination (USMLE), cover basic nutrition knowledge. According to the NBME, the USMLE includes nutrition on their Step 1 and 2 exams; however, this coverage has been questioned. To document whether the NBME adequately addresses nutrition, the 1986 Part I and Part II and the 1993 Step 1 and step 2 exams, which replaced the Part I and II exams, were reviewed by five nutrition professionals. This review identified the nutrition-related areas of the two-part exams and how the extent of nutrition coverage changed from 1986 to 1993. Nutrition items were coded on four dimensions: 1) specific nutrition-related topic area, 2) normal or abnormal scenario, 3) related organ system, and 4) importance in clinical medicine. The percentage of nutrition-related items, as identified by the nutrition professionals, increased from 9% on the 1986 Part I exam to 11% on the 1993 Step 1 exam and from 6% on the 1986 Part II exam to 12% on the 1993 Step 2 exam. The percentage of nutrition items related to vitamin deficiencies increased from 1986 to 1993 on both halves of the exam. Nutrition coverage on the USMLE Step 1 and Step 2 seems adequate in amount, however, the content and appropriateness of the items were not evaluated. The observed increased focus on vitamin deficiencies should be further considered.
1985年美国国家科学院发布的《美国医学院校的营养教育》报告建议，负责开展美国医师执照考试（USMLE）的美国医学考试委员会（NBME）应涵盖基础营养知识。根据NBME的说法，USMLE在其第1步和第2步考试中包含了营养方面的内容；然而，这一覆盖范围受到了质疑。为了记录NBME是否充分涵盖了营养内容，五位营养专业人士对1986年的第一部分和第二部分考试以及1993年取代第一部分和第二部分考试的第1步和第2步考试进行了审查。这项审查确定了两部分考试中与营养相关的领域，以及从1986年到1993年营养覆盖范围的变化情况。营养项目按照四个维度进行编码：1）特定的营养相关主题领域，2）正常或异常情况，3）相关器官系统，4）在临床医学中的重要性。营养专业人士确定的与营养相关项目的百分比从1986年第一部分考试的9%增加到1993年第1步考试的11%，从1986年第二部分考试的6%增加到1993年第2步考试的12%。在考试的两部分中，与维生素缺乏相关的营养项目百分比从1986年到1993年都有所增加。USMLE第1步和第2步考试中的营养覆盖范围在数量上似乎是足够的，然而，这些项目的内容和适当性并未得到评估。所观察到的对维生素缺乏关注度的增加值得进一步考虑。
