Imbalanced specialty representation of USMLE and NBME test writers

• Published in: BMC medical education Vol. 24; no. 1; pp. 980 - 6
• Main Authors: Mahoney, Mary T, Linkowski, Lauren C, Mix, Michael D, Wong, Roger, Sim, Austin J, Hoffe, Sarah E, Sura, Karna T
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09-09-2024; BioMed Central; BMC
• Subjects: Anesthesiology; Authorship; Child & adolescent psychiatry; Committees; Critical care; Demographic aspects; Directories; Educational Measurement; Evaluation; Exit Examinations; Family (Sociological Unit); Geriatrics; Goodness of Fit; Gynecology; Health occupations licensing boards; Humans; Internal medicine; Licensing examinations; Licensing Examinations (Professions); Licensure, Medical - standards; Material Development; Medical education; Medical Specialities; Medicine; Neurology; Obesity; Obstetrics; Oncology; Pediatrics; Physicians; Professional examinations; Psychiatry; Radiation; Specialization; Standard Setting; Standard Setting (Scoring); Standardized medical examinations; Standardized Tests; Statistics; Surgery; Task forces; Technical writers; Thoracic surgery; Undergraduate Medical Education; United States; United States medical licensing Exam® (USMLE®); Writers; United States; United States > US; Undergraduate Medical Education; United States medical licensing Exam® (USMLE®); Standardized medical examinations; Medical Specialities
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/s12909-024-05976-0

The United States Medical Licensing Examination (USMLE) is an examination series required for allopathic physician licensure in the United States (US). USMLE content is created and maintained by the National Board of Medical Examinations (NBME). The specialty composition of the USMLE and NBME taskforce members involved in the creation of examination content is currently unknown.
Using the 2021 USMLE and 2021 NBME Committees and Task Forces documents, we determined each member's board-certified primary specialty and involvement in test material development committees who we dubbed "test writers". Total active physicians by primary specialty were recorded from the 2020 Physician Specialty Data Report published by the Association of American Medical Colleges (AAMC). Descriptive statistics and chi-square analysis were used to analyze the cohorts.
The USMLE and NBME test writer primary specialty composition was found to be significantly different compared to the US active physician population (USMLE χ
[32] = 172, p < .001 and NBME χ
[32] = 200, p < .001). Only nineteen specialties were represented within USMLE test writers, with three specialties being proportionally represented. Two specialties were represented within NBME test writers. Obstetrics and Gynecology physicians were proportionally represented in USMLE but not within NBME test writers. Internal Medicine (IM) accounts for the largest percentage of all USMLE test writers (60/197, 30%) with an excess representation of 31 individuals.
There is an imbalance in the specialty representation of USMLE and NBME test writers compared to the US active physician population. These findings may have implications for the unbiased and accurate portrayal of topics in such national examinations; thus, future investigation is warranted.