Obesity Coverage on Medical Licensing Examinations in the United States. What Is Being Tested?

Phenomenon. As one of the most common chronic disease affecting adults and children, obesity is a major contributor to noncommunicable diseases, both nationally and globally. Obesity adversely affects every organ system, and as such it is imperative that the United States Medical Licensing Examination (USMLE) adequately assesses students' knowledge about the science and practice of obesity management. The purpose of this study was to evaluate the coverage and distribution of obesity-related items on the three USMLE Step examinations.

Examination items that included obesity-related keywords were identified by National Board of Medical Examiners (NBME) staff. A panel of 6 content experts evaluated all items and coded obesity-relevant items using the American Board of Obesity Medicine (ABOM) test outline rubric into 4 domains and 107 subdomains.

There were 802 multiple-choice items containing obesity-related keywords identified by NBME, of which 289 (36%) were identified as being relevant to obesity and were coded into appropriate domains and subdomains. Among the individual domains, the Diagnosis & Evaluation domain comprised most of the items (174) for all 3 Step examinations. Fifty-eight percent of items were represented by 4 of 17 organ systems, and 80% of coded items were represented by 6 ABOM subdomains. The majority of obesity-coded items pertained to the diagnosis and management of obesity-related comorbid conditions rather than addressing the prevention, diagnosis, or management of obesity itself. Insights. The most important concepts of obesity prevention and treatment were not represented on the Step exams. Exam items primarily addressed the diagnosis and treatment of obesity-related comorbid conditions instead of obesity itself. The expert review panel identified numerous important obesity-related topics that were insufficiently addressed or entirely absent from the examinations. The reviewers recommend that the areas identified for improvement may promote a more balanced testing of knowledge in obesity.