After two years of data collection, the CSAE survey is now closed. The MSS looks forward to sharing the results of its analysis of survey answers in the near future.

In June 2004, the National Board of Medical Examiners (NBME) implemented the USMLE Step 2 Clinical Skills exam. According to the NBME, the Step 2 CS “uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.”

Briefly, the examination consists of 12 simulated patient encounters, each lasting 15 minutes. During this period the examinee is to perform a focused history and physical, gathering enough information to develop a differential diagnosis and formulate a work-up plan. Emphasis is also placed on interacting with the patient, communicating everything that is done, answering all questions, explaining diagnoses under consideration, advising about any necessary studies and counseling as appropriate. Each scenario is followed by a 10-minute period for writing a note (much like one of these) on the encounter. The exam costs $975, requires reservation of the desired test date far in advance, travel to one of only five different testing sites and lodging for most.

The AMA has strong policy regarding the Demonstration of Clinical Competence. An important policy of the AMA is to: (1) support continued efforts to develop and validate methods for assessment of clinical skills; (2) continue its participation in the development and testing of methods for clinical skills assessment and (3) recognize that clinical skills assessment is best performed using a rigorous and consistent examination administered by the medical school, and should not be used in evaluation for licensure of graduates of LCME- and AOA-accredited medical schools. The AMA and AMA-MSS had strong concerns regarding the implementation of the Step 2CS exam as evidenced by a letter (Word, 27KB) from our EVP/CEO Dr. Maves to the National Board of Medical Examiners (NBME) and Federation of State Medical Boards (FSMB).

The AMA and AMA-MSS have been closely monitoring the implementation of this exam through various mechanisms. Site visits to CSAE examination centers have taken place with the AMA Board of Trustees, student and resident members, Section leaders and staff. Visits have taken place at the Philadelphia, Atlanta and Chicago testing locations to review the logistics of the exam. We strongly encourage you to keep apprised of the most recent updates to the test by viewing the United States Medical Licensing Examination (USMLE) site. (This link will take you off the AMA Web site. The AMA is not responsible for the content of other Web sites.) We are also continuing to urge medical school deans not to require passage of the Clinical Skills exam in order to graduate medical school.

The MSS has recently undertaken a significant research project to capture the experiences and perceptions of students who have participated in the USMLE Step 2 CS exam. The AMA-MSS national clinical skills evaluation initiative responds to AMA policy “That our AMA monitor in an ongoing fashion, the proposed implementation of the CSAE and COMLEX-PE and its impact on the medical education continuum.”

One component of the initiative is to survey test takers regarding their experiences with the Step 2 CS exam. Central themes of the survey include: 1) test logistics, structure, and function; 2) practical aspects surrounding the entire process and 3) clinical testing trends in medical schools across the country and their resonance with the Step 2 CS exam. Through a comprehensive assessement of these key areas, we hope to be in a position to influence the restructuring of exam and administrative practices as well as the intellectual and practical preparation of students by the medical schools. Since June 2006, over 5,000 students and residents have completed the survey.

Background

Letters, statements and press releases of the AMA on the clinical skills assessment examination.

AMA Policy Relating to the Clinical Skills Assessment Examination

The AMA has passed numerous policies on the clinical skills assessment examination and many of these policies were brought forward by the Medical Student Section.