How do you feel about the Clinical Skills Exam?

  • Clinical skills are an important aspect of medical education. I think the exam is a good idea.

    Votes: 16 18.6%
  • It's just another hoop to jump through. Deal with it.

    Votes: 13 15.1%
  • We are already tested on our clinical skills in medical school. I am not in favor of this exam.

    Votes: 57 66.3%

  • Total voters
    86

mpp

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Does anybody know what the outlook is for the implementation of the NBME Clinical Skills Examination in 2004 for all medical students?

According to the NBME website, they plan to begin the test in mid-2004 starting with classes expected to graduate in 2005. They also say that they expect 5 to 7 percent to fail the first time and that 1 to 2 percent (about 500 each year) will not be able to get their medical license as they fail the test multiple times. Cost is expected to be about $1,000 and that there would be regional test centers the first of which will be in Philadelphia and Atlanta.

Thoughts? Comments?
 

carddr

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Well, if we are trying to level the playing field...IMGs' have met this requirement for years, at the tune of $1200. and only one testing place available to them, Phila, Pa. They had a rather low failing rate until someone(?) in the Bureaucracy complainted too many were passing, so they fooled around with the numbers and more failed the test. IMHO you would have to be out to lunch to fail this exam, or wear jeans(and someone failed for that very reason, cost him another $1200. to re-take the exam, so I advise you NOT to wear jeans or anything inappropiate, to those who give the exam). The test was orginally provided to test the Doctor and pts inter-reaction, with a heavy emphasis on communications skills, in other words can an english patient understand the english of this foreign Doctor. And can he/she speak the language so everyone can understand. Once again, IMHO, a PD should be able to evaluate during the interview process and for heaven sakes don't offer someone a contract if they can't speak english,although I was asked to speak my adopted foreign language on the interview where I got the job offer, so you so figure.

IMHO, this is just another way to make $$$$ and plenty of it. How many AMGS" will be taking the test and multiple that by $1000.(which will only go up). They hire actors/pretending to be patients as in the Steinfield show, and some of them are pretty good by the way. But just a passing clue, you only have to please them, because after you leave the room they fill out a form and evauate you immediately and this little form is the p/f you will be counting on. BTW, factor in the expense of flying/driving there and the overnight stay, which can be expensive. Where are they locating the testing places?

One thing I know for sure this is a done deal...you will be required to take the CSA. Good luck to all...as if you don't have enough on your plate.
 

southerndoc

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I see both the good and bad with the clinical skills exam. I see the need for evaluating someone's interpersonal skills, but most of the people who can't effectively communicate are screened in the admissions process.

I think the price should be reduced to below $500. I'm sure it's possible for this to occur.

Many people have complained about a high failure rate with the exam. Keep in mind that Step I has a 5-9% failure rate, so Step IIb is on par with that rate.
 
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mikegoal

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i think the best idea is to require schools to give thier students a csa like many already do. Just make it another requirment of medical school like anatomy
 

carddr

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Then, the schools would get all the $$$. And personally I don't think they would be an objective forum in some cases. There is the need for a third party to evaluate medical students at some level and this is usually where it begins. The BIG question, is it doing the job? Have you ever gone to a Dr and you can't understand why he remains aloof, or you don't quite get the english with such a heavy accent, whatever, and you realize the problem is not you... And you wonder how in the h***did he get his license to practice medicine in America. Perhaps he went through 4 years of medical school and never said a word to the professors... and no CSA to catch the problem if a AMG. Will the CSA clear this up?

The worst is: you are the patient and all the doctors in the room are speaking a foreign language and of course you assume it's all about you...and you are going to die any minute, or you have big C, or you are losing the baby, etc...you just want to scream and you should!! I can tell you this when you are the only one in the room to understand the pt's language it can be a life saver. BE kind to your IMG, they may save your life!! Just some thoughts to chew on.
 

southerndoc

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Originally posted by mikegoal
i think the best idea is to require schools to give thier students a csa like many already do. Just make it another requirment of medical school like anatomy
Schools also require tests through the four years. Basic science tests the first 2 years, and clinical-related written exams the last 2 years. So what's the point in Step I and Step IIa?

The point of using a national Step IIb is to guarantee uniformity in testing.
 
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mpp

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Originally posted by BellKicker
LOL. What?!?

Poll: What the hell is Carddr talking about?:)

The big C?!?
I'll try my best to decipher what Carddr was saying. Perhaps Carddr will enlighten further. It is nice to have doctors that can communicate effectively and the CSE might possibly help this issue. I believe in the second paragraph Carddr is talking about when there is several IMG doctors that don't speak your language and you are worried you might possibly have some dreaded disease (like Cancer, the big C). You still must be kind to them for they may save your life.

I think that's what Carddr is talking about. At least that's what I got out of it.
 

BellKicker

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Ah, that would be a big C.

However, I'm almost certain Carddr was talking about a foreign patient in a US hospital that didn't know what was going on. Hence, the greatness of the IMG, since he/she could tell him what they were talking about.
 

carddr

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You're both right! Just rambling on about a few of the situations I have had to deal with and assume you will too. Central theme, not everything is black and white in real life.

Repeat..big C is Cancer...gotta know that.

Our pt profile has become somewhat global, including people from all over the world. It's a good thing when someone in the room can speak their(pt) language...they are so relieved. However, consider it rude when only the pt is speaking english in a hosp. bed in America. Believe me it plays out differently say in Italy, they don't even attempt to speak YOUR language, they could have just ordered your death for all you know. And Mexico, get real!!! No habla inglish!!! Yea,right. Just saying language skills can be a positive and negative,depending on the situation.
 

jason952

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We have enough unneeded hoop to jump through. These test don't do anything but undermine the eroding respect for our profession. Revolt!

Jason
 

pocwana

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Volume 348:1294-1295 March 27, 2003 Number 13

http://content.nejm.org/cgi/content/full/348/13/1294-a

A Clinical-Skills Examination for Medical Students?

To the Editor: It has been almost 40 years since a medical student was
tested on his or her bedside manner before being licensed to practice
medicine. In 1964, this portion of licensure testing was discontinued
because of questions of fairness and validity. Thirty-one years later,
in 1995, the Federation of State Medical Boards (FSMB) adopted a new
policy calling for the inclusion of such an examination, stating that
implementation should occur when the examination "was shown to be valid,
reliable, and practical."1 Believing that the first two criteria have
been met, the National Board of Medical Examiners (NBME) has gone
forward with the planning.

The proposed examination is the Clinical Skills Assessment Examination.
Examinees will see 10 to 12 standardized patients in one day, having 15
minutes with each patient for the history taking and physical
examination and 10 minutes to write a note. The expected cost of the
examination is $950 - more than the combined costs of Steps 1 and 2 of
the U.S. Medical Licensing Examination ($840). The clinical-skills
examination will be administered at five or six locations, leaving many
students with the burden of significant travel time and costs.

Currently, the average graduating medical student has a debt burden of
nearly $100,000.2 On the basis of the principal and interest accrued on
loans, estimates place the cost of the first two steps of the Medical
Licensing Examination and the Clinical Skills Assessment Examination at
over $5,000 per student. Our question is, does this meet the FSMB's
requirement that the examination be practical? A number of
organizations, all of which support training in clinical skills for
medical students, are opposed to the examination in its current form.
These include the American Medical Association (AMA), the AMA Medical
Student Section, the Association of American Medical Colleges, and the
American Medical Student Association.

The data largely show that current grading strategies used by medical
schools do not accurately measure a student's ability to communicate.3
The data also show that some U.S. medical students are capable of
passing their clinical rotations without adequately developing these
skills4 and that this inadequacy may contribute to the likelihood of
being sued for malpractice.5 The data do not show that requiring
students to take a clinical-skills examination for approximately $1,000
(a total of $3,000 with travel and interest) will prevent this kind of
inadequacy.

We ask that the FSMB and NBME take their time in making sure that this
is the right answer, that students should be shouldering this burden,
and that the benefits outweigh the burden. If they are not sure, the
Clinical Skills Assessment Examination should be put on hold until these
issues can be resolved.


David E. Winchester, B.S.
University of South Florida College of Medicine
Tampa, FL 33617


Kimberly Ruscher-Rogers, B.S.
Florida State University College of Medicine
Tallahassee, FL 32306

References

1. Position of the Federation of State Medical Boards: in support of
a standardized patients component to the USMLE. Dallas: FSMB, 2003.
(Accessed March 7, 2003, at http://www.fsmb.org.)
2. OSR-AAMC resolution on clinical skills exam. Washington, D.C.:
Association of American Medical Colleges, 2003. (Accessed March 7, 2003,
at http://www.aamc.org/members/osr/aamcresolution.htm.)
3. Gomez JM, Prieto L, Pujol R, et al. Clinical skills assessment
with standardized patients. Med Educ 1997;31:94-98.[ISI][Medline]
4. Stillman PL, Regan MB, Swanson DB, et al. An assessment of the
clinical skills of fourth-year students at four New England medical
schools. Acad Med 1990;65:320-326.[Abstract]
5. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The
doctor-patient relationship and malpractice: lessons from plaintiff
depositions. Arch Intern Med 1994;154:1365-1370.[Abstract]
 

MacGyver

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How is one more test going to be a panacea cure-all? The reasons for this test are cloudy, ill-founded, and will hardly do anything to address the issue.

This test will do almost nothing to evaluate true clinical skills. Theres absolutely no way you can measure this over a single day's period.

Why dont we let the people who work with these med students every day for many hours on end be the judge? Dont they have the best vantage point of a students clinical prowess?
 

secretwave101

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At least the idea is more fair than it was. As one poster mentioned, IMG's have had to deal with this test for years. Why have that test when non-English speakers are required to pass the standardized English proficiency test? Clearly they're testing more than just communication skills, and it was demeaning to make IMG's pass more tests than USMG's.

I would have voted for eliminating the expensive test altogether. It won't solve the personality disorders of arrogance and social obtuseness that is rife among doctors - even jerks can be nice for a couple of hours. But at least they made the system more fair.
 

neilc

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why is this an issue???? sure, the money sucks, but hopefully that will get better. but, the test is there for a reason, just like the usmle. clearly there is a problem with verifying that these skills are taught in med school. so, now there is a standard test that everyone must pass. having the school administer the test is not an option. i mean, schools administer tests in anatomy, physio, path, etc. but you still have to take the usmle, right?

basically, the testing should not be an issue at all. if you are skilled enough to pass, you will pass. if not, you should not. the only real issue is the cash, and it will likely get cheaper. and if not, too bad. just another of the many ridiculous expenses on the path to becoming a doctor!
 

Celiac Plexus

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That US MD students are going to get tagged with this exam is ridiculous. It's just another way for someone to milk med students for more money. When are these greedy f***s going to realize that enough is enough? They just keep squeezing and squeezing.

What's worse is that there is no hard evidence that this exam is going to affect the quality of health care at all. For everything that we learn, we are taught to accept evidence-based research/learning. Where is the evidence that shows patients or US MD students will benefit from this exam? There is none. It is simply a manifestation of the NBME's blind belief that the CSA exam is necessary. And 17,000+ US MD students per year are going to have to shell out 1200 dollars + travel costs to take it. That's over 20 MILLION DOLLARS A YEAR in additional costs... What kind of cost/benefit ratio is that? We are expected to pay 20 M + dollars per year because the NBME says so. No evidence, no clear reasoning... Just do it. Thankfully I won't have to get swindled like that.
 

secretwave101

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Right on, Plexus! Couldn't agree more.

I get the feeling someone is gonna cash in big-time on this one. Since there has been basically no evidence showing that the test is helpful, I wonder who made the decisions and how. I wonder what the profit margin is on that test.

Adding costs to medical education affects students in the short run, but is really just passed along to patients. There's lots of reasons why our health care system is so expensive and inaccesible to so many, but stupid things like this is one of them.
 

dermatome S5

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I am not worried about passing this mofo, but at least make it available in more than 5 sites. The travel and its expenditure are what I am pissed about.
 

MacGyver

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neilc,

thats a ridiculous argument. Just because its going to happen doesnt mean we have no right to argue against it.

But if you really feel that way, how about we jack up the IMG app fee to $10,000. AFter all, if thats what you gotta do, then thats just the way it is, right?
 

MacGyver

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Its totally reasonable to expect IMGs to jump thru more hoops than AMGs. Every single nation on earth does this, so its not like the USA is unique in this regard.

Its hard to judge the quality of foreign med schools which operate under different requirements and expectations than american med schools. Thats not to say they are any better or worse; what it DOES mean is that they are an unknown quantity and therefore its reasonable to impose some extra scrutiny to people from these schools.
 

neilc

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a ridiculous argument? why isn't everyone against the usmle step 1 then?

all i am saying is that testing has always occured outside of the med school for the basic sciences, and i think it is also a good idea for clinical skills. just because your med school passed all of you in anat, physio, path, etc..does not mean that everyone can pass the usmle. hence the 5-9% fail rate for us grads. clearly there is a need for outside testing. same is true for clinical skills.

and as for more hoops to jump through for imgs should exist...jeez, that is ridiculous. if you mean there should be a worthwhile extra hoop, then fine. but i can see no reason for requiring fmg's to be required to prove knowledge that a us grad is not required to prove. what is the point of extra hoops?

why is it such a bad idea to test these skills??? money? sure, it sucks. but becoming a doctor is expensive. such is life.
 
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