USMLE Step 1 examination: Legal vulnerability

Abstract

Since the passage of the Civil Rights Act of 1964, the courts have ruled that sponsors of job entry assessment procedures must demonstrate the absence of discrimination against minorities. If an assessment discriminates, the courts may prohibit the use of the assessment unless the assessment is linked to a job analysis and exhibits validity. In 1994, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) instituted a three-step USMLE examination program as a single pathway for medical licensure. The Step 1 examination is not linked to a physician job analysis, exhibits lower scores for minority groups, and lacks construct validity. To avoid the chaos and expense of a protracted legal challenge, the FSMB and the NBME may need to revise the Step 1 examination, or discontinue it as a requirement of medical licensure.