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Step 2 Clinical Skills Exam Set for June 2004 Pipeline Programs: Looking Forward to Promote Diversity A Word From the President: Ten Unstoppable Trends Viewpoint: Educating for Professionalism in Medicine Portraits of Medical Education
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Step 2 Clinical Skills Exam Set for June 2004After nearly 15 years of pilot-testing different versions of a new component of the United States Medical Licensing Exam (USMLE), the National Board of Medical Examiners (NBME) has set a June 2004 date for medical students to begin taking the Step 2 Clinical Skills (CS) examination. The medical school class of 2005 will be the first graduating class required to take the new exam, which will be one of two components of Step 2. The other component, a clinical knowledge exam, has been part of the USMLE since the test's implementation in 1992. "Licensure examinations provide independent, external assessments for state licensing authorities that demonstrate whether an applicant for licensure possesses the minimum knowledge and skills needed to practice medicine," said Donald Melnick, M.D., president of the NBME. "Everyone agrees that clinical skills are needed just as much as medical knowledge to practice medicine effectively." From their beginnings in the mid- 1800s until the 1960s, medical licensing examinations included clinical skills tests, but they lacked the reliability and validity to meet contemporary psychometric standards, according to Dr. Melnick. It has taken years of research and massive investments to develop a reliable and objec- tive way to test these skills. "A testing method has now been developed that has been shown to be a reliable, valid, and feasible means of assessing fundamental clinical skills," he said. Mirroring a typical workdayThe CS exam will be a one-day test reflecting a doctor's typical workday, and will aim to measure the ability of medical students to deal with patients in clinical settings. Students will examine 10 standardized patients for about 15 minutes each, and after each examination spend 10 minutes recording pertinent history and physical exam findings, listing their impressions, and outlining plans for any necessary follow-up evaluations. The exam will produce three component scores: an integrated clinical encounter (based on the checklist from the standardized patients and global ratings of the encounter note), an assessment of communication skills, and an evaluation of English language skills. Students must pass all three com- ponents of the CS exam to achieve a passing score and will be able to complete Step 2 only after passing both its CS and clinical knowledge components. This means that schools currently calling for students to pass Step 2 for grad- uation are, by definition, requiring them to take and pass the CS exam. In order to be eligible to take the USMLE Step 3, examinees from the 2005 graduating class and beyond must have passed Step 1 and both Step 2 components. Because of that requirement, state medical licensing authorities will not be allowed to make licensure decisions using only the previous components of the USMLE, except for state medical licensing boards that choose to provide their own examinations for licensure purposes. No clinical skills tests since '64Plans for the inclusion of a clinical skills exam within the USMLE were already in the minds of medical test developers before its launch, but because of concerns regarding the objectivity of such testing, the examination has not yet been implemented. Medical students have not been tested on their clinical skills as part of the licensing process since 1964. The recent decision to make a clinical skills test a requirement for medical licensure was made in light of research showing that such examinations can measure clinical skill sets that traditional multiple-choice exams cannot; specifically, the ability to communicate effectively with patients and colleagues, take patient histories, and perform physical examinations. The USMLE's board has stated that requiring the CSE is "an issue of public safety: poor clinical and communications skills have been linked to higher incidence of mal-practice suits, lower treatment comp- liance by patients and decreased patient satisfaction." "We need a national standard so the American public knows their physicians enter practice with core competencies," said James Thompson, M.D., executive vice president of the Federation of State Medical Boards (FSMB), which has assessed the CS exam along with the NBME and the Educational Commission for Foreign Medical Graduates (ECFMG). "This exam will establish that standard," Dr. Thompson added. An overwhelming majority of Americans consider good clinical and communication skills critical for physicians and believe that students should pass an examination that tests these skills before receiving their medical licenses, according to the USMLE. In addition, two-thirds of Americans believe that state medical boards should add a clinical skills exam component to existing licensing requirements, according to a poll by Harris Interactive - even if it costs students almost $1,000. The exam's cost has been a concern to the AAMC and others reluctant about adding to students' already high debt loads. The AAMC is committed to working with the NBME and the FSMB to minimize the financial burden of licensure on medical students. "Assuring the public that licensed physicians possess basic clinical and communication skills is critically important," said AAMC President Jordan J. Cohen, M.D. "The USMLE's new clinical skill exam is designed for this purpose, and I am confident that our medical schools' graduates will be fully prepared to meet the examination's high standards." - Suria Santana |
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