drkp said:
Dr Nelson,
This acctually is as much, if not more, of a resident forum then a student forum. Granted it is heavier student traffic now with interview season. I am curious why you feel reticent to post on this forum. I, and I bet many others, wish more faculty posted here as they are uniquely qualified to advise students. One notable example is the allways appreciated input of Dr Sierzenski U/S Guru from Christiana. 🙂
Since you did opt to post which I am glad you did. I wonder if you would enter a short discourse with me. I cerainly agree that there are good students (even GREAT students) who make lousy doctors. I would guess fewer of these types do go into EM but I imagine there are still some. My question is do you really think CS tests this concern well or is it just all you have on the application that might hint towards a possible problem?
Having taken the test (and thankfully passed it 🙂 ) in September. I would caution you to put little stock in this test to answer the question as to what type of doctor a student will make. The test is unrealistic, tests interpersonal/communication skills on a subjective basis at best with little to no utility in clinical skill assessment. In comparison to clinical evaluations/LOR the CS seems to me to offer little but another reason to charge students 1000 dollars.
Can you tell this has become a pet peeve of mine. 🙂 Incidently I am a US FMG and would have had to have taken it reguardless of the new US student requirement. So at least I have the consilation that it's something we all now must deal with.
My reticence was that this is your website. Since you invite me to react, I will. I like advising students, but you'll recognize that my opinions are my own. They may not even reflect my colleagues in my own department, let alone the P.D.s around the country.
Most faculty have their own areas of specialty, mine happens to be clinical research designs and statistics. Testing is a part of that. I research and write about it. I also was a ABEM oral examiner for many years. On the clinical side, I've trained about 150 residents and I don't know how many students.
I have a real concern that most subjective social science (read testing) measures have very large variabililty and poor reproducibility. Dean's letters from some institutions are reasonably well done but too often lack information and content. Other letters of recommendation are without exception, supportive. If all dean's letters, and LORs are supportive, without variation, then they are not measures at all. The CORD-EM SLOR was an attempt to get at a student's suitability for EM. I will tell you that the SLOR is only marginally useful. See an abstract by John MacKay and myself in Academic EM. It was about 1998, I think.
Which brings us to the CS. I know you didn't enjoy it and didn't think it was worthwhile. Certainly such tests can be poorly designed and have little validity, but. . .The way you pull out the signal in all the noise in any measure with great variation is to test it repeatedly. The CS is designed for that (that's why you saw a lot of simulated patients). It was designed by psychometricians and clinicians. We'll have to wait, I expect for measures of reliaiblity, but the ABEM Oral Board, which is really the model for a lot of this achieves a Cronbach's alpha of .88, which is higher than almost all written exams ever. I will probably use that P/F grade with about the same weight as the SLOR and the dean's letter. I weight the interviews, (for which my group has high interrater relibility) and the MLE1 and CK more heavily.
Get used to it, simulation testing is used in ACLS, ATLS, OSCE's and in the Oral Boards. Simulation training is the wave of the future in post-grad training. With a human simulator, a bunch of monitors, and some images, I can give you the opportunity to run codes far earlier than we would allow you to do in training. I can also expose you to many emergencies that are rare enough that you would be unlikely to manage them during training.
Boy, you ask a simple question, you get a pageant. That's enough of that. If you want to talk about something else, I'm open to it.
Cheers,
BKN
) I get to interview at Emory maybe ill see if I can take it right before or after.. Anyhow I hope some of the PDs take this into account. We are working under such a tight time frame and if you couple that with the lack of spots it really makes it difficult for us. I hope the PDs change their stance on this at least for this yr and make it well known for next yr. Dr. Nelson, while I am not applying to your program I do want to thank you for coming on here and explaining your rationale.
