The ability to adapt to ongoing changes in recommendation guidelines that set new standards in patient care is a common challenge both undergraduate and postgraduate medical licensure boards encounter in their effort to evaluate candidates.

In May of 2013, at the American Psychiatric Association’s Annual Meeting, the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released, setting new guidelines for the diagnosis and management of mental disorders. Highlights of the changes in recommendations from DSM IV to DSM 5 can be found here.

Occasionally, when major guideline changes occur, such as in the case of DSM language, licensure boards will publicly announce (albeit vague) the specific exam cycle that new guidelines will be tested.

Another example of this occurred recently when new JNC 8 guidelines were set in early 2014. Examples of major announcements taking place over the past couple years can be found in this JAMA article describing the JNC 8 recommendations for the management of hypertension.

Every month new manuscripts are released in a myriad of professional journals changing the way medicine is practiced. There are new drugs, new bugs, new names for old bugs, and the list goes on.

So the question is, how do licensure exams handle all of these changes?

Unfortunately, there is no absolute answer to this question or at least none that we know. Based on our estimation of how long it takes to get new test items incorporated into a licensure exam, we estimate it takes approximately two years for new research to be incorporated into most licensure exams. For this article, our goal is to outline the specific position the NBOME has taken in regards to incorporating the new DSM-5 guidelines into the 2015-2016 COMLEX-USA testing cycles.

DSM-5 Update in the 2015-2016 Testing Cycles for COMLEX-USA

For the 2015-16 testing cycles, the NBOME states the following in their formal DSM-5 update published in 2014:

COMLEX-USA Levels 1 and 2-CE will include diagnostic criteria and terminology from both DSM-IV-TR and DSM-5. For items that include respective terminology, the DSM-IV-TR term will appear first, followed by the revised terminology provided by the DSM-5 parenthetically.

Example: Asperger disorder (autism spectrum disorder)
COMLEX-USA Level 2-PE and Level 3 will include diagnostic criteria and terminology from only DSM-IVTR.

COMAT examinations will include diagnostic criteria and terminology from only DSM-5.