The design of a new physician licensure examination

Many health professions include written examinations among their licensing procedures, and constructing these examinations poses special difficulties. For physician licensure the central dilemma is manifested by the longstanding tradition of undifferentiated licensure contrasting with the strong specialty orientation of contemporary physician training. This article details the authors' response to this problem and describes the resulting design of a new physician licensure examination. Using a combination of empirical data and expert judgment, descriptions of selected clinical encounters have been assembled as a practice model of a physician licensed for the delivery of general health care of patients. Application of an explicitly situational framework to the design of a physician licensure examination is unusual, and the approach is advocated for use with other health professions.