signals to teachers and students alike 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 what proportion of the content of the exam is currently devoted to the behavioral and social sciences. In part this is due to the exam’s integrative format and the emphasis NBME has placed on the presentation of material in a clinical context, since Step 1 of the USMLE replaced Part I of the NBME examination.1 NBME also cites differences in defining what constitutes a behavioral and social science question as a factor in its inability to quantify behavioral and social science content on the exam (Gerry Dillon, NBME, personal communication, September 2003). It is the impression of a number of informed individuals, however, that the proportion of material on the USMLE devoted to the behavioral and social sciences has declined. Some believe this is due to changes in the overall design of the exam, while others cite difficulty in writing high-quality test questions on the part of experienced faculty who lack formal training in the behavioral and social sciences. 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.