CSA

[Doc]

(compiled by Dr. Graham McMahon)

The Clinical Skills Assessment is a newer requirement for ECFMG certification. The CSA is an expensive ($1200) examination is held only in Philadelphia and Atlanta throughout the year, and nowhere else (as of Nov 2002). It brings examinees face-to-face with ten simulated ('standardized') patients - ie actors pretending to have specific complaints. You are tested on your ability to rapidly assess a patient, communicate your thoughts to them, and to write a note about your assessment and plans. Application is through the ECFMG only. As of November 2002, the pass rate was 80%, with 60% of failures being due to language difficulties.

[Doc]

(copied from FSMB)

AMERICANS OVERWHELMINGLY SUPPORT NEW MEDICAL LICENSE TEST;
FIELD TRIALS SHOW FAIRNESS, RELIABILITY OF TEST


Posted February 5, 2003

PHILADELPHIA, PA - An overwhelming majority of Americans consider good clinical and communication skills critical for physicians and believe students should pass an examination that tests these skills before receiving their medical licenses.

Two-thirds of Americans also believe state medical boards should add the exam to existing licensing requirements even if it costs students $1,000, according to a poll by Harris Interactive®.

As part of the licensing process, medical students have not been tested on their clinical skills — their ability to gather information from patients, perform a physical examination and communicate their findings — since 1964, when concerns about objectivity ended tests involving real patients.

The board overseeing the United States Medical Licensing Examination™, or USMLE™, voted Jan. 17 to begin requiring students to pass a new clinical skills exam that has undergone 15 years of testing for fairness and objectivity. The USMLE board considers the exam an issue of public safety: Poor clinical and communications skills have been linked to a higher incidence of malpractice suits, lower treatment compliance by patients and decreased patient satisfaction.

The two organizations sponsoring the USMLE plan to implement the clinical skills exam in 2004. It will be required for medical students starting with the graduating class of 2005. The exam will be administered in five cities at a cost of about $1,000 to students.

Unlike the other components of the USMLE, which rely on multiple-choice questions and clinical case simulations administered by computer, the clinical skills exam involves one-on-one personal encounters in a clinical setting.

During field trials last year in Philadelphia and Atlanta, 858 students from seven U.S. medical colleges examined 10 "standardized patients," lay people trained to act like patients. After each 15-minute exam, students had 10 minutes to record pertinent history and physical examination findings, list diagnostic impressions and outline any plans for further evaluation.

The field trial results prove the test can be administered reliably and fairly in multiple centers and in different regions of the country, according to Dr. Donald Melnick, president of the National Board of Medical Examiners®, which develops the USMLE and co-sponsors the exam.

The Harris Interactive survey of more than 1,000 adult Americans, conducted Dec. 12 through Dec. 16, 2002, shows that 97 percent consider clinical skills very important or extremely important when selecting a physician; 87 percent want to see students pass a clinical skills exam before receiving their medical license.

The poll was commissioned by the Federation of State Medical Boards, which also cosponsors the USMLE.

Performance data for international medical graduates who took the same test in the same centers as the US students participating in the pilot exam were also utilized in studying the exam's characteristics. Since 1998, graduates of foreign medical schools who want to enter post-graduate training programs in the United States have faced a clinical skills test administered by the Educational Commission for Foreign Medical Graduates, or ECFMG®.


Under standards established by ECFMG, about 83.3 percent of the international graduates passed. The results mirror the performance of international graduates in previous years, when all tests were administered in Philadelphia.

American students who took the exam as part of the field trials performed at about the same level as the international students whose native language is English. No specific scores for Americans were released because the participating medical schools required their fourth-year students to take the exam but did not grade them on the results. The USMLE has not yet established a pass/fail cutoff.

"We need a national standard so the American public knows their physicians enter practice with core competencies," Dr. James Thompson, Executive Vice President of the FSMB, said. "This exam will establish that standard."

Medical schools vary greatly in the emphasis they place on clinical skills. In a survey of students participating in the field trials, 4 percent said they had never taken a history or conducted a physical examination under the watch of a faculty member, and 20 percent said they had been observed only two or fewer times.

Just over half of US medical schools require students to take a comprehensive clinical skills exam before graduating, according to data published by the American Medical Association.


All state medical boards require physicians to pass a national medical knowledge examination before receiving a license.


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Methodology
The Harris Interactive survey was conducted by telephone within the US between December 12 and 16, 2002, among a nationwide cross section of 1,023 adults (ages 18+). Figures for age, sex, race, education, number of adults and number of voice/telephone lines in the household were weighted where necessary to align them with their actual proportions in the population. In theory, with a probability sample of this size, one can say with 95 percent certainty that the results have a statistical precision of plus or minus three percentage points of what they would be if the entire adult population had been polled with complete accuracy.

Harris Interactive® (www.harrisinteractive.com) is a worldwide market research and consulting firm best known for The Harris Poll®, and for pioneering the Internet method to conduct scientifically accurate market research. Headquartered in Rochester, New York, U.S.A., Harris Interactive combines proprietary methodologies and technology with expertise in predictive, custom and strategic research. The Company conducts international research through wholly owned subsidiaries-London-based HI Europe (www.hieurope.com) and Tokyo-based Harris Interactive Japan-as well as through the Harris Interactive Global Network of local market-and opinion-research firms, and various US offices