National Board of Medical Examiners

The National Board of Medical Examiners (NBME), founded in 1915, is a United States operation which sets state recognised examinations for medical students.[1] The NBME is an independent, not-for-profit organization headquartered on and adjacent to the University City Science Center research campus in Philadelphia, Pennsylvania.[2] NBME states that its mission is to "protect the health of the public through state of the art assessment of health professionals." The board 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".

During COVID-19 pandemic and George Floyd Protests, the medical community criticized the NBME's refusal to revert Step 1 scoring to pass/fail before 2022 and for the gross mishandling of Step examinations during the pandemic, creating "chaos," further "disadvantages," "harm," "bias" and "inequity;" and called for an emergency committee (that included student representatives) who could address these issues in a timely manner without financial or other conflict of interests.[3][4][5]

History

The board rose in prominence in the years after World War II. Prior to the war, states administered their own exams, and operated agreements to license doctors passed by other state exams. After the war, states began to use the results of an NBME exam to decide whether to award a license. This system meant students would sit the same exam.[6]

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 the NBME, and must be passed before a Doctor of Medicine can obtain a license to practice medicine in the United States.[7][8]

The NBME creates self-assessment exams for the programs it runs including USMLE Step 1 and USMLE Step 2 CK.[9] As of February 2018, these assessment tests are available only in expanded feedback version costing $60 and displays the incorrectly answered questions in addition to the analytics.[10] The assessments now provide the correct answer to questions in the expanded feedback version. Prior to this, students frequently discussed the questions among themselves on online forums to reach the correct answer. The latest NBME in the series of NBME tests is NBME 22, with three additional tests to be released in late Spring 2019.

Current Leadership (as of 2020)
  • President – Dr. Peter Katsufrakis
  • Vice president of Licensure Program – Michael Barone
  • Chair – Dr. Alfred Tallia
  • Vice chair – Dr. Paul Wallach
  • Treasurer – Dr. Latha Chandran
  • Executive Board – Suzanne Anderson, Pat Mastors, Kamili Wilson, Dr. Marie Foley, Dr. David Milling, Dr. Karen Sanders, Dr. Reena Karani[11]

Controversies

Katsufrakis & Chaudhry comments against Step 1 changes

In Dec 2018, NBME President Peter Katsufrakis and FSMB President Humayun Chaudhry wrote in opposition of USMLE Step 1 changes in from Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs: "If students reduce time and effort devoted to preparing for Step 1, they may indeed devote attention to other activities that will prepare them to be good physicians. This would arguably be an ideal outcome of such a change. However, if students were to devote more time to activities that make them less prepared to provide quality care, such as binge-watching the most recent Netflix series or compulsively updating their Instagram account, this could negatively impact residency performance and ultimately patient safety. We know that assessment drives learning, so another concern resulting from a shift to pass/fail scoring may be a less knowledgeable physician population."[12] [13]

NBME Executive Salary

The NBME executives received public criticism after their salaries were released after increasing costs for students, showing many executives receiving high said to seven figures. "Former NBME President Dr. Melnick's compensation increased from $399,160 in 2001 to over $1.2 million in 2016, almost perfectly in parallel with the tripling of USMLE costs." [14][15] "As of 2016, NBME President also gets free first-class airfare for himself and his travel partner, as well as a membership to a Philadelphia social club. According to the 2017 Form 990, Schedule J, two lower executives received total compensation over $700,000; another two over $600,000; another three receiving over $500,000; and another 6 receiving over $400,000....Yet, the total number of test-takers for the USMLE Step 1 has been essentially unchanged for the past 10-15 years."[16]

Pricing

NBME and USMLE were met with criticism when they announced their raising cost for standardized tests. Kevin MD wrote, "Safeguards are needed to ensure fees for mandatory testing such as the USMLE do not exceed reasonable operating costs, particularly for financially vulnerable medical students."[17]

As of 2020, the USMLE currently charges:

  • $645 for Step 1
  • $645 for Step 2 CK
  • $1300 from Step 2 CS [18]


As of 2020, Student Assessments costs include:

  • $799 for a two-year subscription to UWORLD
  • $60 for each NBME Self Assessments (access expires after 90 days)

See also

References
  1. Statistics of Land-grant Colleges and Universities (1921) United States Office of Education
  2. Kostelni, Natalie (2007-11-23). "Medical examiners to expand HQ". Philadelphia Business Journal. Retrieved 2009-05-16.
  3. https://www.ama-assn.org/residents-students/usmle/delays-miscommunications-add-even-more-stress-usmle-step-exams
  4. https://www.medscape.com/viewarticle/932366
  5. https://thesheriffofsodium.com/2019/02/01/a-non-mbas-guide-to-nbme-revenue-in-9-simple-charts
  6. 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
  7. United States Court of Appeals for the Third Circuit (1999-12-09). "JOHN DOE, v. NATIONAL BOARD OF MEDICAL EXAMINERS, APPELLANT, D.C. Civ. No. 99-cv-04532". AltLaw. Retrieved 2009-05-16.
  8. 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.
  9. "NBME Self-Assessment Services". nsas.nbme.org. Retrieved 2016-03-02.
  10. NBME. "FAQs about Review | NBME". www.nbme.org. Retrieved 2016-03-02.
  11. https://www.nbme.org/about-nbme/our-people
  12. https://in-housestaff.org/dear-nbme-and-fsmb-i-watch-hgtv-more-than-netflix-a-response-to-the-invited-commentary-on-usmle-step-1-1274
  13. https://opmed.doximity.com/articles/step-1-vs-netflix-and-instagram?_csrf_attempted=yes
  14. https://forums.studentdoctor.net/threads/step-3-trick-works.1271481/page-32
  15. https://projects.propublica.org/nonprofits/organizations/231352238
  16. https://thesheriffofsodium.com/2019/02/01/a-non-mbas-guide-to-nbme-revenue-in-9-simple-charts/
  17. https://www.kevinmd.com/blog/2016/07/cost-taking-usmle-exams-staggering.html
  18. https://www.nbme.org/taking-assessment/united-states-medical-licensing-examr-usmler
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