Hi,
I have heard that the NBME is in the process of developing a standardized patient test as part of the USMLE to test clinical skills.
The American Medical Student Association (AMSA) states that “The National Board of Medical Examiners (NBME) is in the process of developing a standardized patient test as part of the USMLE to test clinical skills. This exam will evaluate communication and information gathering skills. The NBME has deemed that the proposed exam format would be valid and reliable and is currently finalizing the logistics of implementing the standardized patient exam in the year 2004 for the graduating class of 2005.”
They further state “Students will have to pay an estimated cost of $975 each for this exam; students will have to pay travel and lodging expenses because there will be only up to 7 test centers nationwide;” and, that "These exams will probably be scored rather than be pass/fail. Therefore, residency programs may use these scores in evaluating applicants to their programs."
I am curious if anyone else has heard about such testing, and what their opions of such testing was . . .
I am a few years away from the USMLE or the COMLEX, but was curious to see how people felt about this issue. Thanks guys.
Patrick
You are correct! Both the NBME (Nat Board of Med Examiners) & the NBOME (Nat B. of Osteopathic Med. Examiners) are planning to insitute similar testing at about the same time. Toward the end of my second year, representatives from both Boards visited KCOM to explain why they felt it was necessary…much of it boils down to 3rd-party payers, liability and the legal system. They feel that these tests will serve to add credence to the claim that each medical school graduate is sufficiently competent to begin their residency.
At that time, the NBOME was further along in the development of this exam, but was lagging way behind in converting the COMLEX to computer format. The NBME rep implied that the two Boards were considering collaborating in exchanging info so that the COMLEX would become computerized more quickly and the CSE would also come to fruition sooner.
Personally, I feel it is medicine continuing to be reactionary to the situation where our independence and control has been eroded. No matter how many times you give a bully your lunch money, he's not gonna just go away. Physicians need to legally learn to function as a cohesive profession and to thwart further erosion of our ability to function as independent medical professionals.
Hi there,
Clinical Skills Assessment Exams are nothing new to most allopathic medical schools in this country. I was required to take and pass a CSA exam with standardized patients after completing my third year of medical school. My school bore the cost of this exam and transportation as we had to travel to Johns Hopkins University where our test was administered.
We were required to assess a total of 14 patients. We were given 15 minutes to do a focused patient history and physical exam. During that time, we were video-taped. After completing our H & P, we were required to do a brief patient write-up including differential diagnosis and tests that might be needed to make a correct diagnosis. We were graded both by the standardized patients and by clinical faculty. We were required to pass all patient encouters in order to pass the exam. It was a very fun experience. Some of the standardized patients were excellent.
During my fourth year, I helped the faculty at Mayo Medical school develop some of the patient scenarios for their CSA which is given at the end of third year. Their CSA exam is given on-site but in a special testing center where they will undergo the same procedures as I have outlined above. It was an interesting experience to see some of the processing that goes into the development of this manner of testing.
Foreign medical grands have been required to undergo CSA testing before applying for residency in this country. The cost for this exam is around $1,200. It has been administered in Philadelphia. Even Americans who graduate from off-shore medical schools have been required to take and pass this exam.
If you have been alive, during your physical diagnosis and required clerkships, you should have no difficulty with this exam. The patients will present with problems that you should know how to work-up well. 
It seems to me that patient assessment, communication and information gathering regarding a patients condition, history, etc. is extremely important and is the most effective tool for the physician. No mind you, I am speaking from ignorance since I am still quite a ways from the MCAT, much less medical school. I have also been reading Dr. Lown’s book “The Lost Art of Healing” and he even states that good clinical skills/patient assessment can lead to about 70% of all diagnosis. I just do not understand why the AMSA is opposed to such test when it seems (to me at least, with my previous caveat) that it is a very important function of the physician.
| Quote (parchays @ April 03 2002,22:01) |
| It seems to me that patient assessment, communication and information gathering regarding a patients condition, history, etc. is extremely important and is the most effective tool for the physician. No mind you, I am speaking from ignorance since I am still quite a ways from the MCAT, much less medical school. I have also been reading Dr. Lown's book "The Lost Art of Healing" and he even states that good clinical skills/patient assessment can lead to about 70% of all diagnosis. I just do not understand why the AMSA is opposed to such test when it seems (to me at least, with my previous caveat) that it is a very important function of the physician. |
Hi there,
Possibly AMSA is opposed to this test because it is another very expensive addition to this already expensive process of going through medical school. USMLE Step I II and Step III are well over $400 each now. If you fail, you have to re-take, meaning more money. Application to residency can easily run into the $600 range. Add up the cost of airfare and hotels to go on interviews. You may need a rental car in the process. Add in travel, lodging and the stress of another exam, where previously many schools had been providing this exam. The cost of this exam could easily run well into the thousands not to mention the money that many students feel obligated to pay for prep courses. I am willing to bet that Kaplan and TPR are salivating at the prospects of this exam. Watch for jumps in the value of their stock when this change is actually implemented.
Patient assessment and communication are important, but I can promise you that I would not be leaving Howard University College of Medicine if I couldn't assess my patients and communicate with them. With every rotation, these skills have been tested and re-tested. No attending is going to give a passing grade to any student who cannot take a thorough history and do a comprehensive differential diagnosis list. (Yes, students fail and repeat clinical rotations here) Since you, the medical student, are the primary author of this list on the patient's chart, the attendings here take keen interest in what you write. (They are held liable for your work). If you have a weakness in these areas, it is corrected very quickly.
What will this test insure? Will it guarantee that a medical student will always communicate, take a comprehensive history and come up with a differential diagnosis? I don't think so.
Patrick,
I’ve also read Dr. Lown’s “The Lost Art of Healing” and my clinical mentors takes the same approach he does towards history taking and physical assessment. They both feel that if you master the art of history taking and physical assessment that you are ahead of the game as far as diagnosis is concerned. Even though I’m still a pre-med, when I go on clinical rounds, I’m an active participant with my mentors and I’m beginning to learn how to write H&P’s as well as interviewing patients. It’s interesting to see how much you can learn from an accurate history and physicial!!! 