ABSTRACT
The formal licensing of physicians in the United States began with the 1889 Supreme Court Decision Dent v. West Virginia. From that time forward, tests, in one form or another, have played a crucial role in medical licensing. In this essay we trace the history of testing from its beginnings in Xia dynasty China, 4000 years ago, though its adoption for the Indian civil service system by the British Raj, and finally ending with the 1992 introduction of the modern United States Medical Licensing Examination (USMLE). The focus here is on the most important development in testing since the Jesuits introduced written exams to the West in 1599 — the substitution of a large number of objectively scored multiple choice exam questions for a relatively small number of essays or interview questions. This approach provided increased reliability and validity of score, broadened the number of topics that could be addressed, diminished the cost of the exam, allowed results to be calculated almost instantly, and, through the use of computerized test administration, provided the opportunity for tests to be individually tailored for each examinee while maintaining comparability of scores across all examinees.
The Route to the USMLE: The Shibboleth of Modern Medical Licensure
