Recommendation 4. Establish curriculum development demonstration project awards. The National Institutes of Health or private foundations, or both, should establish a program that funds demonstration projects in behavioral and social science curriculum development at U.S. medical schools.

Evaluation, which can occur within a specific course or on a medical licensing examination, is a critical process for determining the extent to which medical students have mastered course objectives. Faculty should be provided with the knowledge and other resources required to develop effective methods for evaluating student competence in the behavioral and social sciences. Provision of these resources should include instruction in the development of quality behavioral and social science examination questions. Because medical faculty members create the test items for the U.S. Medical Licensing Examination (USMLE), improving their test-writing skills at the local level will also serve to improve the quality of the behavioral and social science questions on the licensing exam.

The material covered on the USMLE signals to both teachers and students what is considered important in the field of medicine and thus what should be emphasized in medical school curricula (Elstein, 1993; Swanson et al., 1992). Despite considerable effort, the committee was unable to determine the percentage of USMLE test questions currently devoted to the behavioral and social sciences. It is the impression of a number of informed individuals interviewed by the committee, however, that the amount of test material devoted to the behavioral and social sciences has decreased. Furthermore, it is the belief of this committee that the behavioral and social sciences are underrepresented on the USMLE. The committee does not believe it is necessary to specify a particular number of behavioral and social science questions that should be on the exam. Rather, the designed questions, however many it may take, should sufficiently cover the topics delineated in this report. Likewise, the committee believes the behavioral and social sciences should be part of the new clinical skills exam that will soon be included as part of the USMLE series.

Conclusion 5. The subject matter covered by questions on the U.S. Medical Licensing Examination has a significant impact on the curricular decisions made by U.S. medical schools. The committee believes that the U.S. Medical Licensing Examination currently places insufficient emphasis on test items related to the behavioral and social sciences.

Recommendation 5. Increase behavioral and social science content on the U.S. Medical Licensing Examination. The National Board of Medical Examiners should review the test items included on the U.S. Medical Licensing Examination to ensure that it adequately reflects the topics in the behavioral and social sciences recommended in this report.



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