Hypothetical:
What if I was successfully able to pass the USMLE I, II, III + CSA by studying on my own and never going to school or doing any clinical rotations.
Do you think that by itself should be enough to allow me to practice medicine?
Why or why not?
P.S. This is just a hypothetical–I have no intentions of doing this, but I’m curious to see how far the logic of “if they pass the tests, they’re good enough to be licensed” goes
| QUOTE (MD/PhD slave @ Jul 22 2003, 03:38 PM) |
| Hypothetical: What if I was successfully able to pass the USMLE I, II, III + CSA by studying on my own and never going to school or doing any clinical rotations. Do you think that by itself should be enough to allow me to practice medicine? Why or why not? P.S. This is just a hypothetical--I have no intentions of doing this, but I'm curious to see how far the logic of "if they pass the tests, they're good enough to be licensed" goes |
Hi there,
Let's look at the reverse: If you don't pass USMLE I, II and III + the CSA and you attend all of your classes plus clinical rotations, they WON'T let you practice medicine. It doesn't matter where you learn the material (bathroom wall) as long as you get enough to pass each one of the hoops above (thank God, that CSA was paid for by my school). You jump through the hoops, you get to "doctor" on live folks.
Natalie
| QUOTE |
| thank God, that CSA was paid for by my school |
Why did you take the CSA? I thought that it wasnt mandatory for US med students until next year (2004)?
Sorry, what's the CSA?
| QUOTE (StartingOver @ Jul 23 2003, 09:22 AM) |
| Sorry, what's the CSA? |
Clinical Skills Assessment.... its a test currently taken by FMGs but is now going to be required for all US medical graduates starting in 2004.
the really bad news is that you have to travel to Philly or other sites to take it and it costs over $1000 bucks
| QUOTE (njbmd @ Jul 22 2003, 08:50 PM) |
|
MD/PhD slave,Jul 22 2003, 03:38 PM wrote:
Hypothetical:
(thank God, that CSA was paid for by my school). Natalie |
Why did you take the CSA Natalie? As posted, I thought that until 2004 it is only a requirement for FMGs? Just curious.
| QUOTE (dmaes @ Jul 23 2003, 09:18 AM) |
|
njbmd,Jul 22 2003, 08:50 PM wrote:
MD/PhD slave,Jul 22 2003, 03:38 PM wrote:
Hypothetical:
(thank God, that CSA was paid for by my school). Natalie
Why did you take the CSA Natalie? As posted, I thought that until 2004 it is only a requirement for FMGs? Just curious. |
Hi there,
Howard has a requirement that you take and pass the CSA in order to graduate. It was very easy and cost nothing for us. It took one day, we had 15 patients and it was a "walk in the park". If I had to pay for the thing, I would have been angry but since I didn't, it was a free trip. Howard has many extra requirments that other medical schools do not have. Mayo Medical school also has a CSA pass requirement. When I did my acting internships at Mayo, I took their CSA for fun. It was a great experience.
Natalie
Regarding taking the courses vs passing the board exams…there are many reasons why licensure exists for many professions & the board exams are but 1 fundamental component of an arduous licensing process for physicians.
Reasons for licensure: (just off of the top of my head in a list format)
1 - Assurance of a set of minimum competencies: this protects the clientele from too many bozos out there
2 - Protects the integrity of the profession
3 - Sets a minimum threshold for liability underwriters
4 - Provides the framework for a mechanism for evaluation, discipline and critical analysis of a profession
5 - Provides a mechanism to self-police & ensure delivery of a quality product
6 - Formally endorses a mechanism for members of a profession to control who does/does not get into their profession (professions are not public domains that guarantee access to everyone; however, professions are not & should not be allowed to discriminate upon unsubstantiable parameters such as race, religion, ethnicity, gender, sexual orientation…)
Some of this may appear harsh. However, without a licensure process, any old Joe (not just JP) could hang out a shingle, call him-/herself a physician & start diagnosing, treating & prescribing medications. You would not have to be too bright to see many significant disadvantages to both profession & patient here…at least I hope not!!!
Purely from a statistical standpoint, given enough times, some individual could theoretically pass w/o having been through medical school. Now, I would love to meet such a person!!! Much more feasible, none the less highly improbable, would be a highly motivated individual who read his/her derriere off and passed their boards w/o going to med school - again, HIGHLY UNLIKELY but feasible. Now, is this person truly qualified & competent? In my opinion – NO.
Being an effective, competent physician mandates mastery of far more than a specified body of knowledge. The intangibles are too numerous to even consider. A massive %-age of what makes a Doc good or not is gained through experential learning…something that cannot be gained from a book. The mechanism currently in place are the Jr & Sr years of medical school & your time in post-grad training. However, in reality, your learning - both experential & didactic - must continue througout your life as a physician to remain in the effective pack.
All of this is a long-winded way for me to state & substantiate that NO - just passing the boards exams…or for that matter, just passing medical school (situation in reverse) - should not and should never equate to “licensed physician”. Keeping the licensure process both arduous & rigorous protects our patients, ourselves & our profession. In my humble opinion, all of these entities deserve the most protection we can offer them. Of course, that protection should also include objective scrutiny, self-analysis and persistently elevating standards, where applicable.
I agree with you OMD
How's dartmouth by the way? I love their medical center–feels like a rich upscale shopping mall, very nice.
the surrounding countryside is gorgeous as well
OMD,
Just to play devil's advocate then…
Your argument would seem to support the new USMLE Step IIB (patient interview/clinical skills part). Those who wanted to institute the exam feel that the certification by our medical schools that its graduates can adequately conduct patient inteviews/interactions (the way it is now) is no longer good enough and that they must create a standardized test beginning with the Class of 2005 to ensure physician competency and patient safety.
But I thought that you didn't believe that the exam was necessary and was a waste of time and money.
I know this isn't exactly what the original topic started as, but OMD's argument made me think about it. Again, don't shoot the messenger…I just figured I'd throw it out there.
Tara
Tara,
As you have easily surmised from meeting me in DC, I am virtually always game for a good verbal joust. However, I cannot consent to engage you in this one cause I cannot conceive of any logical or legitimate argument to even pretend justifies the 2b step.
Personally, and this is purely opinion mixed w/ conjecture, I think/fear that elements of both the AMA & AOA have become so fearful of the implications of litigation that they are willing to bend over & take what ever is requested by the legal community. The public certainly has a right to demand that students & residents that they will encounter can substantiate a minimum level of competence. The ambulance-chasing sector of the legal profession has leanred to milk the grey areas & areas of public concern to their own fiscal benefit. I cannot but suspect that some of the initial support/demond for this move on the part of the NBME/NBOME was sourced from the ambulance-chasers…it sets up a beautiful realm from which they can profit & afforded them an opportunity to appear as “champions of the common Joe’s rights”.
Were the proponents of this additional step able to legitimately substantiate a benefit, I would support the move. However, in all of the multiple presentations I have endured by both NBME & NBOME, not once have they been able to do so. Believe me, we, as students, heavily questioned them. And, of course, they all claimed to have proof of the massive benefit to patient & physician…but no one ever actually produced said research nor even troubled themselves enough to cite said research. In my humble opinon, it definitely reminds me of the famous scene from the Wizord of Oz: “Pay no attention to the little man behind the curtains. Listen to me, the Great & Mighty Oz”…and like the Great & Mighty Oz, the benefits and jusitifcations for step 2b are just smoke & mirrors…
The addition of that test is just one more problem I'll worry about later.
| QUOTE (Calvin -- in a box by the river @ Jul 28 2003, 11:37 PM) |
| The addition of that test is just one more problem I'll worry about later. |
Hi there,
No one who attends medical school in this country and passes their Physical Assessment course should "worry" about the CSA exam other than shelling out the money to pay for this this thing or getting to a test center. The patients are "professional patients" who have been trained for this type of exam. The test centers also have to paid too. (Though Prometrics should be put out of business as they are always having computer problems).
At this point, you don't have the luxury of "worrying" about USMLE or COMLEX. Your next step is to get in and do well. Believe me, once you start medical school classes, you have plenty to occupy your brain so that your "worry" level will drop to practically zero and your brain will be full of other more fun stuff.
CSA, USMLE and COMLEX tend to take care of themselves if you take care of the other "stuff".
Natalie
Nat,
Excellent way to place things into perspective…these are things that you all must pass along the way to becoming a physician. As with many many other things, they are simply hurdles & hoops. On the route to becoming a physician, you will become a professional hoop-jumper or you will not make it. Yes, the preponderance of your classmates will piss & moan about the hoops & clearing the bar…but, bitch though they may, they will clear the bar no matter how high it is set.
So, those of you not in, don't waste energy worrying over something you cannot change. The journey is long & you must not only keep your vision on the Holy Grail; but also keep a mindful eye on the infinite small goals that must be fulfilled along the way.
Once you have the initial behind your name, then you have the credibility to lobby for reform. At this point in time, that task falls upon the shoulders of folks like Nat, Tony, Meredith, Betsy, myself & the many other physicians out there. You can join our ranks once you get there…as long as you do not stumble along the way by expending too much energy in the wrong direction.