I recently returned from the first meeting in 2012 of the Composite Committee of the United States Licensing Examination (USMLE), where I completed a 6-year term as a member and a 2-year term as Chairperson. As all US medical students and many international medical graduates know, USMLE is the series of examinations they must take and pass if they want to practice allopathic medicine in the United States and its Territories.  More than 30,000 medical students and international medical graduates enter the USMLE examination process each year.  The Composite Committee is responsible for overseeing the content and format of the USMLE examination process. The membership of the Committee is comprised of a dedicated group of leaders in various fields inside and outside of medicine whose entire purpose on serving the Committee is to protect the public.

At some point all 300 million people in the US are impacted by the competence of their medical practitioner.  The baseline used to judge competency is determined by decisions emerging from the Composite Committee.  Therefore individual Committee members volunteer their time to engage in and oversee a process designed to assure the public that their medical practitioners have achieved a minimum level of competency by developing and implementing standards for those entering the practice of medicine in the United States.  Competency embraces not only medical knowledge, but clinical and communication skills, professionalism, patient care, systems based practice, and practice-based learning and improvement.  This is currently accomplished through a set of 4 examinations interspersed through the medical educational continuum before graduates are fully licensed as independent practitioners.

The USMLE was established about 20 years ago by the National Board of Medical Examiners (NBME) and the Federation of State Medical Licensing Boards (FSMB) to serve as a unified set of examinations that all graduates of US medical schools would need to pass in order to be eligible for state medical licensure.  With the incorporation of the Educational Commission for Foreign Medical Graduates (ECFMG) into a trilateral arrangement, both US and international medical graduates were then required to take and pass the same set of examinations under a single standard used by all States and Territories in the United States for the first time in history. Now, all candidates applying for one of the approximately 24,000 residency slots available in US hospitals are expected to have passed the first three parts of  USMLE prior to acceptance into residency training and the supervised practice of medicine.  This is one of the important steps employed to protect the American public.
 
After 20 years, the USMLE is undergoing a comprehensive review of what it does and how it does it.  A set of recommendations have been developed which, over the next several years will lead to an evolution of the USMLE examination system that the Committee hopes will further enhance the performance of the tools used to evaluate the competencies of the next generation of medical practitioners in the United States.  It has been an honor and privilege to participate in this very important process and I look forward to seeing the implementation of the recommendations approved during my tenure on the Committee.