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AMA/ASA on board to block use of USMLE content for nurse certification

Discussion in 'Anesthesiology' started by toughlife, Dec 3, 2008.

  1. toughlife

    toughlife Resident
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    AMA HOD Adopts ASA Sponsored Resolution 212
    http://www.asahq.org/news/RESOLUTION_212_adopted.pdf

    At its interim meeting held November 8-11, in Orlando, the American Medical Association House of Delegates responded to strategic lobbying efforts by ASA and state sponsoring societies and adopted Resolution 212: State Legislative Response to NBME Practice of Using USMLE Step 3 Physician Licensing Exam Questions for Doctors of Nursing Practice Certification.

    Resolution 212, introduced by ASA and eight co-sponsors was developed in response to an announcement by the National Board of Medical Examiners that it will use content of its USMLE Step 3, Physician Licensing Exam Questions in its certification exam of Doctor of Nursing Practice (DNP).

    The USMLE Step 3 exam provides a final assessment of physicians assuming independent responsibility for delivering general medical care and assesses whether the examinee can apply medical knowledge essential for the unsupervised practice of medicine.

    ASA urged the adoption of the resolution with concern for patient safety and the physician-patient relationship. Significant confusion and harm to patients could result from DNPs misrepresenting themselves to patients as medical doctors, having been certified in a process similar to or the same as the medical licensure of physicians.

    With the adoption of the resolution, the AMA will work to develop and circulate model state legislation that would prohibit NBME from using content from the USMLE Step 3 exam and National Board of Osteopathic Medical Examiners (NBOME) from using content of the COMLEX Step 3 exam in the certification process of non-physician providers.

    NATIONAL BOARD OF MEDICAL EXAMINERS STATEMENT ON DOCTOR OF NURSING PRACTICE (DNP) CERTIFICATION
    http://www.asahq.org/news/NBOME_STATEMENT_DNP_CERT.pdf
    Earlier this month, the first group of 43 holders of the Doctor of Nursing Practice degree sat for the certifying exam of the American Board of Comprehensive Care. These are among the first recipients of a degree that as many as 200 colleges of nursing plan to confer by 2015.
    The certifying examination, provided under contract by the National Board of Medical Examiners, was originally described as containing content from the U.S. Medical Licensing Examination (step 3). Because of the reputation of the testing vendor and the origin of a portion of the exam content, ASA and other organizations expressed concern to NBME about the potential for public confusion about the significance of this certification and its relation to physician licensing exams.
    In response, the NBME has published a white paper describing the origins of this testing program. The document makes clear that the physician and DNP certifying exams are not comparable:

    "The DNP certifying examination is not designed to replicate the USMLE assessment for medical licensure. It does not include the in-depth assessments of fundamental science, clinical diagnosis, and clinical skills that are provided through USMLE Step 1, Step 2 CK, and Step 2 CS. Similarly, the training leading to the DNP degree is substantially different from the educational experiences that result in the MD or DO degrees. The context and the scope of a DNP certifying examination is materially different from the context and scope of the USMLE.1"

    ASA is concerned that the public will have difficulty distinguishing among the health professionals providing care to them with the proliferation of doctorate-level providers. The distinction between the training and qualifications of M.D./D.O. physicians and other health professionals is important to the public and the NBME statement helps limit confusion about these qualifications.
     
    #1 toughlife, Dec 3, 2008
    Last edited: Dec 3, 2008
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  3. Consigliere

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    Step in the right direction. :thumbup:
     
  4. Taurus

    Taurus Paul Revere of Medicine
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    Right on. :zip:

    Although, I was hoping that the NBME could use this test to compare physicians and DNP's and to show the glaring gaps in knowledge.
     
  5. toughlife

    toughlife Resident
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    I don't think they would want to embarras anyone. :D
     
  6. Bertelman

    Bertelman Maverick!
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    What would be your defense when a number of DNPs score higher than a proportion of MD/DOs? It's bound to happen.
     
  7. usnavdoc

    usnavdoc Senior Member
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    Its not about the outliers. Its about the majority. Remember we also have Physician outliers that fail boards.
     
  8. Bertelman

    Bertelman Maverick!
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    I know it's about the outliers. I just think that when you open a door like that to "compare" how two populations perform on an exam, you're opening it up to poor statistical analysis by the DNP group. Besides, I don't think they're gunning to take Step 1. They are probably trying to develop a test like Step 3. I haven't taken it yet, but from what I've heard it doesn't take a great amount of time for preparation. Granted, we've been "preparing" for this since our clinical clerkships. I really don't think it's too hard to envision a group of DNPs, given the proper resources, to pass Step 3. Of course, maybe I'll have a different opinion after I take it. :D

    Most of us here would agree that board performance has little bearing on how intelligent, resourceful, and successful you will become as a physician. If we've conceded that point, we shouldn't expect to use the same test to demonstrate how much smarter we are.
     
    #7 Bertelman, Dec 5, 2008
    Last edited: Dec 5, 2008
  9. powermd

    Physician Lifetime Donor Classifieds Approved 15+ Year Member

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    I've always thought of the boards in terms of being a negative predictor of performance as a physician- ie, a score of 260 doesn't impress me as much as a failing score. Not being able to cross the minimal threshold for all doctors despite similar training is highly questionable. I have no idea if my opinion has any support in statistical studies of physician performance in residency.

    Viewed in these terms, it wouldn't mean that much to me if a DNP passed step III. Take and pass step 1 and II, and all my medical school exams (which were substantially harder than the steps), round on and present all my patients in a manner that would generate acceptable evaluations, then successfully complete a medical internship, and then we can talk about equivalence.
     
  10. Bertelman

    Bertelman Maverick!
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    :laugh:

    So, you're saying they will only impress you if they get an MD.
     
  11. powermd

    Physician Lifetime Donor Classifieds Approved 15+ Year Member

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    And lick my f'king Danskos.
     
  12. turkeyjerky

    Physician 10+ Year Member

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    Lol

    The problem is that, while physicians won't be impressed that some dnp's could pass step III, the public may be, and the nurse lobby will be able to use it as evidence for Mundringer's claim that dnp's have "the knowledge of a physician with the skills of a nurse."
     
  13. polkadotcap

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    I don't know, I'd be really surprised if they could all pass Step III. I know one very good pediatric NP who works in a PICU and is planning to apply to a DNP program this year (which by the way is about 90% online courses). But she couldn't tell you a damn thing about taking care of anything but critically ill kids. Are DNP curricula setup to fill in these pretty decently sized knowledge gaps to the point that their graduates would be able to take and pass a test that is more broad in scope?
     
  14. Taurus

    Taurus Paul Revere of Medicine
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    Agreed. I sincerely believe that this DNP test is more marketing ploy than anything else. The public doesn't know anything. Mundinger et al would have marketed these DNP's as having "passed the same test that physicians take".

    I think that was the part that concerned the AMA and why they're responding.
     
  15. Bertelman

    Bertelman Maverick!
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    Physicians can't all pass Step 3.

    At the risk of offending my colleagues that studied overseas, I've heard many times that US FMGs can score some pretty impressive numbers on step exams. This despite what is most likely less intense classroom work, and sub-par clinical rotations.

    I'm not about to make any claims about a practicing US grad v. FMG, but if a US citizen that could not gain acceptance to a US program attends a school with less-than rigorous academic demands yet still bust a better step score, then a DNP can do the same on Step 3 if the testing objectives of the USMLE are woven tightly into their curriculum. Even if it's online.
     
  16. Gern Blansten

    Gern Blansten Account on Hold
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    I agree with most on here. In the end, this is simply a test. The nurses that devote a lot of time and practice testing to it will do well on it. Many will score better than some physicians. All that will tell us is that they can study for a do well on a standardized test. Does it mean equivalence of training and knowledge? No! I am happy that the AMA and ASA are fighting this battle.
     
  17. TecmoBowl

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    All this talk about DNPs, and all I can think is this- if the U.S. Political and Health care system fails us as Physicians, and the public in allowing such deceptions to occur, I swear by all the effort it took me to get here in my career that I'd become a Malpractice Lawyer focusing in SOLELY on such deceptions, and I'd bankrupt a Hospital that uses them, and the Insurance Companies that use them. We need to fight fire with fire. Can't wait for the first f'kups to come through.
     
  18. TecmoBowl

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    Just e-mailed ABC News about this impending deception. Tomorrow NBC News, then CBS News, then CNN and so on and so forth. Could you guys also do the same? It would draw more attention you know. I guess the hardest part after getting to the top of the hill is defending it. The journey isn't over after finishing training, we have to protect what we're here for.
     
  19. chemist157

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    http://www.medscape.com/viewarticle/563176
    this article is not great except for the question that inspired it. "...would I be allowed to call myslef Doctor". I think that typifies the reason a lot of nurses want to pursue this degree.
     
  20. toughlife

    toughlife Resident
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    Here's the question: " I am thinking of going back to school to earn a DNP. If I earn this degree, can I be called "Doctor" when I practice? How must I identify myself to the public as a nurse practitioner?"
     
  21. badasshairday

    badasshairday Vascular and Interventional Radiology
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    I wish mudinger would come on this site so we could have a debate with her. That article she made about DNP's is so :thumbdown:
     
  22. krust3

    krust3 medical vagabond
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    no offense taken broseph. in fact, let's also not forget a good number of people can pass just about any test given enough time. i've heard of people taking in excess of 6 months of preparation time (including a formal review course) to pass step 1... barely!

    hell i'm a US FMG and even i'm worried about the quality of docs making it through the system. no way in hell do i wanna be associated with some F-up US FMG dude that embodies all that which is a "minimum passing requirement". Believe me, there is still sufficient evidence to feed the FMG stigma. my point is, even among MD's there are strong and weak clinicians. i'd quit medicine before ever entertaining that the best DNP could even hold a candle to the weakest of our MD/DO brethren. it'll soon no longer gonna be about turf wars between US vs foreign docs, instead it's gonna be any and all MD/DOs vs. all the other "Dr's" out there: DC's, PsyD's, PharmD's, DNP's.

    the unfortunate facts are 1) there is a need for more providers than what's supplied by US schools 2) the masses will flock, like the sheep they are, to support the existance of some medical oppression theory with even shallowest argument that MD's are trying to keep all the medicine "riches" to themselves or some BS like that.

    unfortunately, the voting americans will be either unaware of the facts or too dumb to understand them... or both. if only they knew the countless phone calls and pages i get on every call night from some idiot who in a few years will be applying for that DNP program (likely sponsored by the very university hospital you or i work at) because he/she has been a nurse for x number of years and thinks they can do our job with just one or two more courses.:thumbup:
     
  23. huktonfonix

    huktonfonix board certified!
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    Truth is, I make car parts for the American working man because I'm a hell of a salesman and he doesn't know any better. Well, son, since you're no longer a shareholder, this is where I leave you. Don't feel bad. This chain of events was set in motion a long time ago, and you and bald-headed friend, you did what you could and that's commendable. Marty, have Security see these boys out.


    I think that kinda sums up the philosophy
     
  24. Bertelman

    Bertelman Maverick!
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    Was that a niner?
     

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