Physicians in all subspecialties care for patients with serious illnesses, terminal illnesses, and those near death. There is increasing discussion of the need for all physicians to have basic palliative care skills relevant to their own individual subspecialties, in order to optimally care for patients with serious illnesses. The foundational knowledge necessary to provide this care is laid in medical school and further developed and honed in residency and fellowship training. Passing the USMLE Step Examinations is required to become a licensed physician, and many training programs use those scores as part of their acceptance criteria to residency and fellowship.

In late 2015, AAHPM submitted a request to National Board of Medical Examiners (NBME) requesting that experts in hospice and palliative medicine be given an opportunity to assess the extent to which the United States Medical Licensing Examination (USMLE) Step examinations test essential palliative care knowledge necessary to providing basic care to patients in their care and to identify any critical gaps in test content.

Over the past several months, a small but mighty group of AAHPM members and palliative medicine subspecialists completed a comprehensive review of the USMLE Step examinations. On June 15-16, 2016, the team traveled to Philadelphia to the office of the National Board of Medical Examiners. Participants included: Bob Arnold, MD FAAHPM, Gary Buckholz, MD FAAHPM HMDC, Elise Carey, MD FAAHPM, Jeff Klick, MD, Laura Morrison, MD FAAHPM, Joe Rotella, MD FAAHPM HMDC MBA, Solomon Liao, MD FAAHPM, and Stacie Levine, MD FAAHPM.

The team made recommendations to enhance testing content to better reflect the basic palliative care skills necessary for all licensed physicians practicing medicine. In addition to the content review of test questions, the review team explored strategies currently being used to assess patient-physician communication skills in the Step 2 Clinical Skills Examination, which are essential to the practice of medicine generally and a core competency of hospice and palliative medicine. The hope is that this initial review will lead to further collaborations with NBME on strategies for assessing communication skills in a test format.