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The aim of this review is to highlight recent and potential future enhancements to the United States Licensing Examination (USMLE) program. The USMLE program is co-owned by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards. The USMLE includes four examinations: Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3; every graduate of Liaison Committee on Medical Education-accredited allopathic medical schools and all international medical graduates must pass this examination series to practice medicine in the United States. From 2006 to 2009, the program underwent an indepth review resulting in five accepted recommendations. These recommendations have been the primary driver for many of the recent enhancements, such as an increased emphasis on foundational science and changes in the clinical skills examination, including more advanced communication skills assessment. These recommendations will continue to inform future changes such as access to references (e.g., a map of metabolic pathways) or decision-making tools for use during the examination. The NBME also provides assessment services globally to medical schools, students, residency programs, and residents. In 2015, >550,000 assessments were provided through the subject examination program, NBME self-assessment services, and customized assessment services., (Copyright © 2017 the American Physiological Society.)

The aim of this study is to predict the core and skin temperatures of human wearing protective clothing in hot environments using the coupling system. The coupling system consisted of a sweating manikin Newton controlled by a multi-node human thermal model, and responded dynamically to the thermal environment as human body. Validation of the coupling system results was conducted by comparison with the subject tests. Five healthy men wearing protective clothing were exposed to the thermal neutral and high temperature environments. The skin temperatures of seven body segments and the rectal temperatures were recorded continuously. The predictions of core temperatures made by the coupling system showed good agreement with the experimental data, with maximum difference of 0.19 °C and RMSD of 0.12 °C. The predicted mean skin temperatures fell outside of the 95% CI for most points, whereas the difference between the simulated results and measured data was no more than 1 °C which is acceptable. The coupling system predicted the local skin temperatures reasonably with the maximum local skin temperature of 1.30 °C. The coupling system has been validated and exhibited reasonable accuracy compared with the experimental results., (Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.)