The impact of external examinations on medical education programs and students

The use of externally produced comprehensive examinations by medical schools as assessment instruments for promotion and as mechanisms for curricular evaluation is discussed and assessed for validity in this article. The pros and cons of the development of a single route to licensure by an externally produced series of comprehensive examinations are examined, and potential effects that emphasis on external examinations may have on students' psychological and ethical behavior are discussed. Recommendations for development of a national library test bank are proposed as alternatives to the current dependency on the externally produced comprehensive examinations. The necessity for each individual medical school to validate any external examination being used as an evaluation tool of the school's specific curriculum is stressed. The author recommends criterion-referencing as an appropriate mechanism for test construction and grading and that "passing" an externally produced comprehensive examination be defined in terms of basic minimal competency levels.