THIS IS AN IMPORTANT PAPER.
It’s about the NBME, the USMLE, financial conflict of interest, and the current “crisis of trust” in medical education.
It is worth your time to read.
(But for the TL;DR crowd, I’ll quote the high points in this thread.)
journals.lww.com/academicmedici…
It’s about the NBME, the USMLE, financial conflict of interest, and the current “crisis of trust” in medical education.
It is worth your time to read.
(But for the TL;DR crowd, I’ll quote the high points in this thread.)
journals.lww.com/academicmedici…
“The @NBMEnow is a powerful, well-funded organization and gatekeeper to the medical profession....
Over the 5 year period from 2013 to 2017, the NBME’s overall program service revenue was $712.1 million, with an annual growth rate of 5% per year.”
Over the 5 year period from 2013 to 2017, the NBME’s overall program service revenue was $712.1 million, with an annual growth rate of 5% per year.”
“The NBME’s profit margin ratio [over the past 5 years] was approximately 6%. For comparison purposes, the margins of the for-profit companies Walmart, Target, and Ford Motor Company over this same period averaged, respectively, 3%, 4%, and 4%.”
“In 2017, the NBME’s retiring president received over $1 million, and the incoming president received over $820,000 in total compensation...
...Compensation for top NBME executives in 2016-17 was easily in the top 0.5% of charitable nonprofits.”
...Compensation for top NBME executives in 2016-17 was easily in the top 0.5% of charitable nonprofits.”
“While this growth and financial health is in many ways to the credit of NBME management, the figures also highlight the inherent risk of placing the organization at the nexus of key decision-making regarding requirements for the use of its products.”
“Medical students ultimately pay the cost of nearly all of NBME services, in direct and indirect charges...
Not including expenses for CAS, the total fees for @TheUSMLE services are approximately $4,000 (including both indirect and direct costs) per U.S. medical student.”
Not including expenses for CAS, the total fees for @TheUSMLE services are approximately $4,000 (including both indirect and direct costs) per U.S. medical student.”
“The NBME is a self-regulated monopoly...
Most public-service monopolies, whether for-profit or nonprofit, are regulated by an outside impartial board that safeguards the public trust against the risk of abuse...
By contrast, the NBME is regulated by an internal board.”
Most public-service monopolies, whether for-profit or nonprofit, are regulated by an outside impartial board that safeguards the public trust against the risk of abuse...
By contrast, the NBME is regulated by an internal board.”
“In contrast to a public utility that is prevented from monopolistic abuses by external regulation, few checks and balances help control and regulate the NBME...
The prices charged for Step 1 and Step 2 CK examinations... can be raised without extensive justification.”
The prices charged for Step 1 and Step 2 CK examinations... can be raised without extensive justification.”
“The NBME can also raise its passing cut-off score for Step 1 and Step 2 CK without strong, evidence-based justification that a higher number predicts greater clinical success. More exam failures generate more revenue.”
“Given that the NBME benefits from re-testing and test preparation materials, its board members are likely not objective participants or arbiters of the current Step 1 score reporting debate.”
“At Stanford, despite a faculty with 8 Nobel laureates and extensive clinical facilities that include 5 teaching hospitals, some medical students virtually ignore the pre-clinical clerkship curriculum in favor of... First Aid, UWorld, Pathoma, [and] Sketchy Medical.”
“Although this parallel curriculum no doubt has some merit, many of the techniques it inculcates are aimed to improve factual recall rather than understanding... they focus on building ‘information’ rather than the higher goal of building ‘knowledge.’”
“The NBME has a deep an inescapable financial conflict of interest in determining the future direction of the Step 1 exam. Below, I outline 4 steps... that the NBME can take to regain the trust of the medical education community.”
“1. The NBME should recuse itself from current discussions and decision-making about the reorganization of the Step 1 exam...
The NBME may feel that it “owns” the Step 1 exam, but medical educators, students, and state medical boards should be the true owners of the exam.”
The NBME may feel that it “owns” the Step 1 exam, but medical educators, students, and state medical boards should be the true owners of the exam.”
“2. The NBME must be transparent in disclosing its full finances...
Annual reports must also describe the decisions made by the NBME Compensation Committee.”
Annual reports must also describe the decisions made by the NBME Compensation Committee.”
“3. New products, changes in prices for current products, and changes to pass thresholds must be approved by an independent oversight committee... just as an oversight committee reviews and approves changes to prices charged by a public utility company.”
“4. The NBME should not charge a fee for retaking a failed licensing exam.
Failure on a licensing examination achieves its purpose - to identify a student who needs to improve knowledge and/or skills in the tested area - but... adding a steep re-testing fee is unnecessary.”
Failure on a licensing examination achieves its purpose - to identify a student who needs to improve knowledge and/or skills in the tested area - but... adding a steep re-testing fee is unnecessary.”
“Although the NBME... is ostensibly governed by a talented and capable board, the NBEM has inherent financial COI, appears to profit from its status as gatekeeper to the medical profession, and should, therefore, recuse itself (or be forced to be recused).”
“Similar concerns likely apply to the NBME’s partner organization, the @TheFSMB. Next steps should include scrutinizing its practices and any real or apparent conflicts of interest.”
