The education community has begun to address the challenges involved in implementing CBME. Models and guidance exist to inform implementation strategies across the continuum of education, and focus on the more efficient use of resources and technology, and the use of milestones and entrustable professional activities-based frameworks. Inconsistencies in CBME definitions and frameworks remain a significant obstacle. Evolution in assessment approaches from in vitro task-based methods to in vivo integrated approaches is responsive to many of the theoretical and conceptual concerns about CBME, but much work remains to be done to bring rigour and quality to work-based assessment.

There are 1,018,776 licensed physicians in the United States and the District of Columbia, representing a physician workforce that is 20% larger than it was a decade ago, according to data from 2020 compiled by the Federation of State Medical Boards (FSMB). The licensed physician population has grown in number relative to the total population, but concerns about a doctor shortage remain as both the general and physician populations age. Late career physicians generally work fewer hours and retire at higher rates, while younger physicians place more emphasis on work-life balance that may also limit work hours, even as many older physicians have delayed retirement in recent years. The mean age of licensed physicians is now 51.7 years, a year higher than it was in 2010. The physician workforce is increasingly mixed in gender and type of physician, with more women and more individuals with Doctor of Osteopathic Medicine (DO) degrees, specialty board certification and international medical degrees than a decade ago. The ability to inventory a nation’s health care workforce across all specialties and jurisdictions is essential to the delivery of quality health care where it is needed most. This paper marks the FSMB’s sixth biennial census of licensed physicians in the United States and the District of Columbia and provides valuable information about the nation’s available physician workforce, including information about medical degree type, location of undergraduate medical education, specialty certification, number of active licenses, age and sex. As the impact of the COVID-19 pandemic on the United States is not yet fully known, this report should help state medical boards as they consider changes to their statutes and regulations to facilitate telemedicine and licensure portability after the pandemic ends and before another national public health emergency.

To demonstrate the severity of ocular findings in young children who died of injuries due to motor vehicle crashes. Methods: Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case. Results: Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages. Conclusion: The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.

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