Rethinking Postgraduate Training Requirements for Licensure: The Kansas Experience

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The commentaries by Dr. Freeman1 and Dr. Orlowski2 published in Academic Medicine highlight the disconnect between current graduate medical education (GME) experiences and licensure requirements. Changes made in GME training to accommodate the current Accreditation Council for Graduate Medical Education (ACGME) requirements have resulted in residents having less clinical exposure compared with residents trained prior to the implementation of these mandates, when the regulations defining qualifications for licensure were adopted in almost all U.S. states.
Approximately three years ago, the Kansas State Board of Healing Arts (KSBHA) initiated discussions of the gap between experience and requirements. I (K.J.T.) chaired a task force—composed of interested physician and public members of the KSBHA; the dean of one of the regional campuses; the associate deans for student affairs, medical education, and GME of the state medical school; community residency program directors; leaders of the state medical society; and representatives of hospital groups—to address this disconnect.
The task force recommended amending the existing regulations in Kansas that detailed the amount of postgraduate training required for licensure. Requirements for training in an ACGME-accredited training program increased from 12 or 24 months to 36 months for all physicians who graduated from non-disapproved medical schools. The somewhat arbitrary time frame of 10 years to complete all steps of the United States Medical Licensing Examination (USMLE) was modified to also include a limit on the total number of exams attempted (n = 6), such that applicants must successfully complete all steps of the exam within 10 years and/or within 6 or fewer total attempts. This amendment addresses applicants who take the exams multiple times, as well as those who have prolonged periods of time between passing Steps 2 and 3 (due, for example, to immigration issues for international medical graduates).
Members of the GME community believed that “moonlighting” is essential for resident training. The task force drafted language for a new licensure category, patterned after similar licenses in Pennsylvania and South Dakota. This new licensure category will permit residents who are in good standing in a residency program in Kansas to obtain a license to moonlight after successfully completing 12 months of training, passing the USMLE Step 3 exam, and procuring written approval from their residency program director. The license becomes null and void if the resident is no longer in good standing or leaves the program.
Resident education has changed. For state medical boards to continue to fulfill their mission to protect the public, these changes need to be reflected in qualifications for full licensure, especially the required length of ACGME-accredited training.
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