stop the clinical skills exam

[rajneel1]

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Dear Fellow Medical Students,

You are probably already familiar with the mandatory Clinical Skills
Exam being proposed by the National Board of Medical Examiners
(NBME). The exam, while designed to test out clinical skills, in
fact does nothing of the sort. We would be evaluated by ACTORS who would check off whether we are testing for physical exam signs in the right places (they obviously have no way of knowing if we actually know anything about how to interpret the signs or their potential significance, so the exam is in fact useless.)
In case you weren't yet told, they want to charge us $1000 to take the exam (not including travel to one of the proposed 5-7 sites around the nation).
This exam is by no means yet a certainty, and we can fight it, but
WE MUST ACT NOW.
Please sign the online petition (link below) to oppose Clinical
Skills Exam being proposed by the NBME. If the Medical Board of
California approves it, you will almost certainly have to take this
nearly useless exam at the COST OF $1000 per person.
The letter is written to UC Deans and to the California Medical
Board. Unfortunately the UC Deans were not all with us and decided not to support our effort to oppose this ridiculous waste of our time and money. However, one of our supporters is going before the California Medical Board late next week (sometime between March 5 and 7 so SIGNATURES ARE NEEDED ASAP ASAP. BEFORE MARCH 5 to be sure the board receives them.
Working together with students from other California medical schools, this petition was created to oppose an exam that is almost certain to have no clinical benefit for us and therefore likely to do nothing to benefit our future patients. In essence, it is the product of a power play by NBME to gain more control and to make $16 MILLION a year FROM MEDICAL STUDENTS.
PLEASE READ AND SIGN THE PETITION
BEFORE TUESDAY, MARCH 4 AT 10 PM
http://www.PetitionOnline.com/NOonCSE/petition.html

ALL YOU NEED TO DO IS TYPE YOUR NAME, MED SCHOOL, YEAR, and EMAIL ADDRESS
(you can hide your email address on the form if you choose to do so).
Thank you for reading,
Medical Students Opposed to CSE

This exam will be required for STEP II, will start in the year 2004 (next year), and has not been proven to work. It will also be eventually required of all physicians for relicensing. This email is California specific but other medical schools around the country should be rallying against it. Thank you.
rajneel1

 

[SomeFakeName]

Rajneel,

A couple of international 4th year student who I'm rotating with have said they must take a clinical exam very similar to the one you are talking about.

It is my understanding that all IMGs must take this clinical exam (in addition to the USMLEs that American students take) in order to be able to do a residency in the U.S...please correct me if I'm wrong.

Do you think it's fair that U.S. students should be exempt from the clinical exam when IMGs are made to do it, even though IMGs take the same USMLE exams that U.S. students take?

 

[southerndoc]

The National Board of Medical Examiners has already approved Step 2b and will begin implementation of testing beginning for the class of 2005.

Sorry guy, you're too late on the protest.

Many schools already have similar exams. This will be a more standardized exam for everyone. Yes, the cost is ridiculous, but it's too late to complain.

 

[Medici]

The related thread is here:
http://www.studentdoctor.net/forums/showthread.php?s=&threadid=59236

 

[leorl]

The CSA has been a requirement for all FMGs wishing to practice or undergo residency in the US for ...like...forever. There's no acting about it. The proposition was to make the CSA standard and require all US graduates to take it as well. I think this is a good move, although very expensive on everyone's pockets. It's not a gimmick, not a sham, but a legitimate way to ensure competency. Now, if they'd only lower the cost.

 

[rajneel1]

what about $1000 for an exam that hasn't been proven to do anything don't you understand?
foreign med schools are usually not accredited by AMCAS so it is okay that they take the exam...none is sure about their medical school curriculums.
and it is not a done deal even though the propaganda that the NBME is giving during press releases claims otherwise. they have spent 15 years researching this exam and are losing money every year that they don't give it. AMA, AMCAS, AMSA, and CMA are all against the exam.

 

[UCLA2000]

Personally I think that the new clinical exam is a good thing!

 

[gwyn779]

Actually, the exam isn't set in stone yet, though nearly so. One of our coordinators is presenting an opposition in a couple weeks, even though it most likely won't do any good. Most schools do their own physical exam anyway, and while the theory of having something standardized is good, the current implementation is not. So, being a member of the class of 2005, I am not looking forward to having to pay a ridiculous sum to take a test that I will _also_ have to take at my own school.

 

[rajneel1]

most medical schools have such an exam in place already.
none is against testing clinical skills....people are against the way that this exam would be conducted. the design of the exam does not test what it claims to. there are only a few testing sites around the country so we would have to pay for our own travel expenses. by the time we pay off this exam (via loans) we would have ended up oweing about $6,000. testing clinical skills should be done at the medical school level with their accrediation on the line. not like this.

 

[UCLA2000]

Originally posted by rajneel1
by the time we pay off this exam (via loans) we would have ended up oweing about $6,000.

exaggerate much?

 

[shag]

I personally don't think medical students receive enough evaluation. The only evaluations I have received so far are: >200 basic science test scores, >30 clinical evals, >20 basic science course grades, 4 clinical course grades, 6 Shelf exam scores, 4 grades for lectures given, 4 OSCE's (clinical exams), and USMLE 1. Can you believe the paucity of evaluation to this point in my 3rd yr (2/3 complete!).

I only have 2 clinical course grades (A - F type), >20 4th yr clinical grades (P/F), 2 shelf exams, 10 clinical exams, 1 OSCE, USMLE 2, USMLE 3, and several things I have likely forgotten or don't know about yet left to complete.

I think the paucity of evaluation is a SERIOUS problem in medical education. The clinical skills of American physicians have been compromised from the Git-go because no standardized clinical skills exam has been available. I don't understand why some of these idiots who are protesting this thing don't get it; There is NO way a person could be adequately prepared for their internship by spending 2+ years on clinical rotations as a medical student. People learn absolutely NOTHING by participating in patient care, writing notes, gathering information, and formulating treatment plans.

My next complaint is that medical students don't pay enough or sacrifice enough time for their education. I've already typed enough, so I won't even begin to go into this travesty.

 

[Dodge This]

Originally posted by shag
My next complaint is that medical students don't pay enough or sacrifice enough time for their education. I've already typed enough, so I won't even begin to go into this travesty.

I'm not getting into this debate about the CSE, but I have a feeling you're going to strike a lot of nerves with this last statement. (Plus, calling people idiots because their opinions are different than yours is downright juvenile.)

What, exactly, should be the price tag for medical education?

 

[leorl]

I think medical students pay far too much for their education, considering that those in Europe or the UK receive the same standard of education (with actually more thorough clinical teaching) for free. Now, I know this goes into different programs for medical care and all the debates going on with socialized medicine, but I think a major problem in the US is cost of medical care.

And that goes right down to the cost of our education. Because we have sacrificed and paid so much for our education, we feel entitled to getting the big pay checks. The higher the pay, the more the common litigious American feels justified in suing our asses off. The more we get sued, the higher our insurance costs. Of course, extremely extremely simplistic view (and never mind about all the problems introduced when you bring in HMO's and Medicare programs), but skyrocketing costs are a major problem in the US healthcare system.

As far as time - I don't think you can tell someone cramming years worth of anatomy in his head in just one semester that he's not spending enough time with his education. In fact, he's not spending enough time doing anything else! That's what I love about the european system - for me, it's a 5 year course vs. a 4 year course, but just that extra year allows material to be spaced out more. My anatomy is spread out over 2 years with basic systems this year, and neuroanatomy next year. Then the extra year is spent in hospital so that we get a year's more hands on experience.

Anyway, disregarding cost, I still maintain that if all fmgs are required to pass the CSE, I don't see any reason why USmgs should be exempt. Would someone like to explain the reasons against the CSE to me? And I mean besides cost?

 

[PediaSure]

I posted a response to this in the USMLE forum. AMGs should not be required to take a CSE b/c our schools are already governed by accrediation bodies. US Med schools have basic curriculum that they must adhere to. Of course some schools are more traditional than others, but we all learn basically the same things. Writing notes, doing h and ps, are very important. they give a foundation. Very few are perfect at it during M3-M4, but that is what intern year is for.

Med schools outside the US may have totally different curriculums. A school in Japan is going to focus on different issues than a school in Europe. IMGs should be required to take the CSE to make sure they they have a grasp on how things are done in America. I am NOT saying that we do things better in America, just different. Lets not turn this into an IMG vs AMG thing. That would be analogous to Mds who graduated 30years ago saying, "I worked 200 hours a week, so everyone else should have to do it?" Also, I am sure that if I as an American wanted to practice medicine in a foreign country, then i would have to go through some channels that citizens would not have to go thru.

The following is a quote from http://www.usmle.org/news/cse.htm


U.S. students in the field trial performed at about the same level as international students whose native language is English. While the mean performance of the U.S. students was slightly lower than the mean for the international graduates in clinical encounter skills, U.S. students scored slightly higher in communications. Had the U.S. students been assessed using the ECFMG pass-fail standard, their pass rate would have been slightly higher than the overall rate for first-time international examinees. The mean pass rate for all international graduates during the time of the field trials was 83.3 percent.

Does anyone have any solid data (not opinions) that shows that there is a sizable number of US grads with poor clinical skills? On the USMLE web site it only states a "small, but significant number."

IMGs, can you give us some details regarding personal experiences with the CSA? Also, it states that med studs in Philly and GA took part in the pilot program. What were some of your personal opinions?

Personally, I will be graduating this year. So this isn't going to affect me. But I think it is BS and another hoop for US grads to jump through. Does anyone feel like a circus animal yet?😛

 

[DW]

Originally posted by shag
I personally don't think medical students receive enough evaluation. The only evaluations I have received so far are: >200 basic science test scores, >30 clinical evals, >20 basic science course grades, 4 clinical course grades, 6 Shelf exam scores, 4 grades for lectures given, 4 OSCE's (clinical exams), and USMLE 1. Can you believe the paucity of evaluation to this point in my 3rd yr (2/3 complete!).

I only have 2 clinical course grades (A - F type), >20 4th yr clinical grades (P/F), 2 shelf exams, 10 clinical exams, 1 OSCE, USMLE 2, USMLE 3, and several things I have likely forgotten or don't know about yet left to complete.

I think the paucity of evaluation is a SERIOUS problem in medical education. The clinical skills of American physicians have been compromised from the Git-go because no standardized clinical skills exam has been available. I don't understand why some of these idiots who are protesting this thing don't get it; There is NO way a person could be adequately prepared for their internship by spending 2+ years on clinical rotations as a medical student. People learn absolutely NOTHING by participating in patient care, writing notes, gathering information, and formulating treatment plans.

My next complaint is that medical students don't pay enough or sacrifice enough time for their education. I've already typed enough, so I won't even begin to go into this travesty.

me thinks this is sarcasm (or at least I hope so) 😕

 

[neilc]

i think a lot of you are missing the point...sure, the us schools have accredidation bodies that dictate how med schools educate the students. the tests upon graduation (usmle, and now the csa) are there to assure that students learned what they were taught. think of the csa as the clinical skills portion of the usmle. do you also think the usmle steps should be banned? why not, if the schools are accredited? i am pretty sure that most agree that the usmle steps are important to verify that a student has learned what was taught, and that a student has a suffecient fund of knowledge to continue training to become a physician. this is the point of the csa, too...

in my opinion, it is simply unfair to hold international grads to a higher standard than us grads. you can say that medicine is taught different everywhere, but the knowledge required to practice medicine is the same everywhere. the same organs have the same functions, the same dysfunctions, etc...it is simply arrogant to say that since you were educated in the us, it is ok to assume that your clinical skills, your medical education and your retention and learning of that material is superior and does not require verification.

the cost sucks, it is a pain in the a$$, all of that i agree with. but, so is the usmle. i just don't see why it is such a big deal that us students are now being held to the same standard as internationa students. as far as i am concerned, any other course of action should be considered discriminatory.

 

[Brewster]

Personally, I think the CSE needs work before it is required of everyone. The USMLE has one bank of questions, each examinee is asked a selection of questions from this bank, and the exam is then scored by a computer. It is an entirely centralized system, ensuring that each examinee is treated fairly. On the other hand, the CSE is scored by mock patients who subjectively rate a medical student's performance...an evaluation system that is entirely different from the one used for the USMLE and one that, to my knowledge, has yet to be proven valid and fair. If anyone has information to the contrary (other than merely "IMGs have been doing it"), I would be interested to hear more.

In addition, the cost of the CSE to the medical student is far higher than the cost of the USMLE. As I recall, the USMLE costs somewhere in the $400-500 range and there are testing sites everywhere so travel expenses are, for the most part, a nonissue. On the other hand, they want to charge $1000 for the CSE plus many medical students would have to pay for airline flights and 2-3 nights in a hotel (as it is planned to be a 2 day exam).

In theory, the CSE sounds like a decent idea. I just don't think it is ready for prime time just yet.

 

[neilc]

i have to agree that the cost is ridiculous, and it is very inconvenient. that should improve.

as far as objective vs subjective nature of the test...as i understand it, you are given 4 patients with 15 minutes to see and evaluate each "patient". the patients are actors which evaluate you via a check list. on the list is what you should do, and they simply mark whether you performed that portion or not...something like, "i have a productive cough", did you listen to the chest (if so, point...if not, no point). so, it seems to just test whether you know what you should do, not even whether you did it correctly. i mean, how on earth can the patient tell wether you even know what you are listening for??

anyhow, have to agree that there is lots to be worked out. but, it is a reality (and has been for a while) for us IMG's, and there is no reason for us to be the only folks required to take it. IMHO, if these skills are important enough for us to show we know, then you guys need to also...but, hopefully for all of us, it will become cheaper and easier to take the stupid thing~!

 

[omores]

Originally posted by Dodge This
... you're going to strike a lot of nerves with this last statement. (Plus, calling people idiots because their opinions are different than yours is downright juvenile.)

I think the only folks who will bridle at that last statement or at being labelled "idiots" are those who didn't recognize the sarcasm in shag's post.

 

[WSUreds]

At my medical school, the University of Cincinnati, we have been required to pass a clinical skills exam for several years now in order to graduate. Also, that will not change even with Step 2b. The cost of the exam is outrageous and as struggling med students most of us can't afford an extra $1000. Plus, that doesn't account for the travel expenses for the trip to the regional test center and it is an inconveniene to take time off during rotations to travel to the sites. The AAMC should make the exam a required part of the curriculum at every US medical school. That makes sense, but probably will not happen. As for the argument that FMG's have to take it why shouldn't USMG's, it summed up by 8 letters AAMC and LCME. All US med schools are accredited by the AAMC and LCME so that every medical student attending school at US institution receives the basically same education . Foreign med schools are not accredited by these agencies and therefore can't be regulated or punished by not following the guidelines. Therefore, in order to insure that FMG's received the proper education, they are administered the CSE to evaluate them.

 

[neilc]

again...accredidation does not mean that everybody at the school learned it! that is why you have the usmle, too! you passed pathology, physiology and pharm, right? so why take the usmle? why ishould the fact that your school tests clinical skills be regarded any different than those other basic science classes that you took? i think you can understand the logic of requiring the usmle...the csa is the exact same thing!

these tests exist to make sure that everyone has the minimal skill set required to move to the next level of education. accredidation provides for a system of education, and only has to do with the school's methods of instruction. testing helps to assure that a minimum standard of knowledge has been obtained and retained.

i think it is pretty clear that accredidation by aamc and lcme and whoever really means nothing on an individual student level, and that it is no reflection on an individual students qualifications. those are institutional accredidations, not a guarantee that the students from these schools have mastered all the material!

again, i agree 100% that the cost is ridiculous, it is a pain in the a$$, it is inconvenient, whatever. i have the same probs paying for it, getting the time to take it and all that. my school also requires me to do several clinical skills exams in order to graduate. but, that is not the point. the powers that be have decided that this is a skill set that needs to be verified through testing. they have required it of foreign students, and they are now rightly requiring it of us students also.

 

[rajneel1]

none is argueing that clinical skills should not be evaluated. i feel like it should be done at the medical school accredidation level and not through a subjective 6 hour exam with actors.

every day that the NBME doesn't give this exam they lose money. they have spent hundreds of millions of dollars researching this exam and buying real estate for it. they believe that they will know whether this exam works or not within 10 years....which is the exact number of years they would need to offer the exam in order to break even of their initial investment (about $250,000,000.

between 1995-2001 20,000 less FMGs (gradually) took the step exams...so the NBME has lost money on that....one reason that the other step exams have been increasing in price.

AMGs vs. IMGs -----very different, accrediation is key. you are lucky NEILC that you can take one extra exam and be able to practice in the US. that is not true for other sectors of the economy where foreign degrees are worthless.

this is the second clinical skills exam that osteopathic students would have to take

most medical schools already have a clinical skills exam

$6,000 is not an exaggeration....it is an official calculation. the cost of this exam will have to be factored into financial aid...which we will all pay interest on.

it is expected that 5-6% of people will fail the test the first time and that 2% will fail forever....that is a certainly a small number of people to dissect out by forcing thousands of students to take this expensive exam (which could be discontinued after 10 years).

this exam will also be required for relicensing of all physicians. so tell your attendings to pay attention!

 

[shag]

Originally posted by DW
me thinks this is sarcasm (or at least I hope so) 😕

Me thinks you are right 🙂.

Originally posted by omores I think the only folks who will bridle at that last statement or at being labelled "idiots" are those who didn't recognize the sarcasm in shag's post.

Thanks for pointing out my feeble attempt at humor to those who didn't quite get it. Was it not obvious I was having a little fun with that post? I thought it was... 🙂

Out of curriosity, do AMGs who wish to practice medicine in Europe, Prague, Japan, Canada, India, Pakistan, or others have to take a test in respective countries to prove credentials? Are there countries that would either not allow AMGs to practice there or would not allow Americans to immigrate there in the first place?

 

[irlandesa]

like rajneel said, no one wants the clinical skills exam to be completly terminated, they just want the cost lowered and more testing sites to be made available. I am at one of the 4 schools (all ranked) in Massachusetts and our closest location will be Philadelphia! ridiculous, especially considering that kids from DMS, UVM, Albany, U Conn, and all the NYC schools have the same predicament. and unfortunately I don't think that rajneel is exaggerating about the loans that much; payback may end up being at least 2.5 or 3K for those of us not on scholarship or in the military.

 

[Dodge This]

Originally posted by shag
Thanks for pointing out my feeble attempt at humor to those who didn't quite get it. Was it not obvious I was having a little fun with that post? I thought it was... 🙂

The way people get on these message boards, you can never tell. Even now that I know it was a sarcastic post, I can still see how disgruntled student would post that as their true opinion.

 

[MD'05]

Just to throw in my $.02 ... the logistics are horrible for this exam. The specifics on how medical students will be cycled through the testing centers has not been communicated. For example, say a passing test score must be registered by a certain date (like the usmle) and there are only 6 or 7 testing sites nationally AND 125 allopathic schools x ~150 students on average per school -- that is approximately 18,750 students to test in approximately 7 centers? 2 days per student * 18,750 students = 37,500 days of testing. 37,500 days of testing / 7 test centers = ~5357 testing day capacity per test center. 52 weeks per year * 5 work days = 260 work days per year. 5357 testing days / 260 work days per year = 20 students per day. To achieve the maximal throughput, students must be PROHIBITED from testing at the closest testing center. It would have to be a lottery system. This means that air travel costs may be excessive. In addition, if osteopathic students and IMG's test at the same location as the allopathic students, the problem is compacted.

I think the test is a good idea, but with the excessive cost (which has not been justified) and with the logistics that have not been communicated, I had hoped the test would have been delayed.

 

[cchoukal]

A few of my classmates have been pretty vocal opponents of the exam for a couple reasons. The thought, as has been expressed already, is that most medical schools already perform similar evaluations of their graduates. This, as many of you have probably figured out, is just a smokescreen; no one really cares that much if you have to spend ANOTHER day working up fake patients. What they mind is the cost. 1000, plus another several hundred to 1000 for airfare and hotel, plus 10 years of interest ends up being a considerable amount, and it's all on the backs of student loans, for most people. Worse, apparently, is that it's not clear to me that the exam will really do anything. I suspect that most people can "put their game face on" for a day (my understanding is that the exam tests not only exam skills but things like empathy, etc, which can be faked for a day).

Okay, so we're pretty smart, so if we've figured out that this might be of dubious benefit, surely the higher-ups in the NBME have had similar thoughts. Why, then, are they pushing this? Couple reasons:

1) people like to piss and moan that they're physicians don't love them enough and don't communicate with them. There is a huge variability in what we expect from out physicians and a lot of people feel they aren't getting enough. I happen to believe that the exam won't make a physician care about their patients more, but it's a nice thing to put on paper to make people feel like something's being done about jerk-physicians.

2) $$$. Where do you think that 1000 fee goes? If you want to take this a little further, consider that every year, 16000 medical students will travel to either Philly or Chicago (I'm pretty sure these are the only 2 sites currently) and stay in hotels and eat in restaurants. A lot of money would be made. And if you want to be a little insane and paranoid, consider how the gov't makes out if all this money is spent via student loans. Even at the 4% loans are currently accruing, Uncle Sam will pocket a lot of extra money as a result of this being implimented. Although I don't believe this conspiracy really exists, I DO believe that $$ drives a lot of decisions and I can see why so many groups would be in favor of this because of their profit.

My understanding is that individual states will have to decide whether or not to require passing this exam in order to be licensed within that state, so this is the next step of protest, I suppose.

Thanks for listening

 

[rajneel1]

cchoukal,
i certainly agree with you.
this exam has not be proven to test clinical skills or weed out bad doctors. it has been proven to be a good exam.

people do complain about their doctors but how will this exam help that? will having passed this exam decrease malpractice lawsuits in this country? probably not.
if patients don't care that doctors are superstars in college, take the MCAT, do community service, do two years of preclinical work, take 3 step exams, do two years of clinical rotations, and then 4 years of residency where they work more than 40 hours a week without extra pay....then why the heck would they care whether we passed this clinical skills exam!!!

if someone wants to sue their doctor, are they really going to retract their lawsuit once they realize that the doc passed the clinical skills exam??? will that be a reason for the judge to throw out the case???

the other concern has been that people can certainly fake it for an exam that is subjective. and imagine kaplan getting in on the act by offering books and lessons.

the NBME realized that students were trying to get the individual state medical boards who are part of the FSMB (federation of state mediacl boards) to vote against the exam so they went over them by having the FSMB's executive council vote for the exam. opponent groups are now trying to get a resolution on the floor at the FSMB meeting in april to overturn that ruling.

the NBME and FSMB co own the exam so both will earn money from it

exams that have tried to do similar things have failed miserably in the past (for example...internal medicine exams for residents, the last clinical skills exam in the 1950s) . it was found that the exams could not measure performance better than written exams and then it was realized that the written exams didn't do much good either and all were abolished.