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The Comprehensive Review of USMLE generated recommendations to enhance the value and utility of the USMLE program. One of the five recommendations was that “USMLE emphasize the importance of the scientific foundations of medicine in all components of the assessment process. The assessment of these foundations should occur within the clinical context or framework, to the greatest extent possible.” Between 1975 and 2007, five studies consistently demonstrated a decrease in basic science knowledge between the pre-clinical years and clinical years. This decline has been worsening in recent studies. In the most recent study there was a decline in all discipline scores except behavioral science between Step 1 and Step 3. The decline in scores was >10% in five disciplines. An additional CRU recommendation germane to the scientific foundations recommendation includes assessing an examinee’s ability to define a clinical question, access resources, and interpret and apply the information. Suggestions of three task forces addressing the scientific foundations recommendation including one on Biostatistics and Interpretation of the Literature will be discussed. The focus group session will explore possible reasons for the decline in scientific knowledge and the potential content to be included when assessing the scientific foundations throughout the USMLE process. Discussion will include potential outcomes of including scientific foundations in clinical training, including exploration of unintended consequences. The impact on medical school curriculum and residency education will be discussed, including ways to effectively accomplish the goal of retaining scientific information. To generate and stimulate discussion the presenters will use thought-provoking questions.