NBME moves ahead with clinical exam plan

2004 is the target date for the start of testing of clinical skills by the National Board of Medical Examiners.

By Jay Greene, amednews staff. Jan. 21, 2002.

Despite AMA objections, the National Board of Medical Examiners plans to begin giving its clinical skills assessment examination in the summer of 2004.

Preliminary plans also have fixed prices at $1,000 per test and venues at five or six regional locations. But NBME officials say that could change if pilot testing goes sour this year.

"We have satisfied ourselves we can test in a verifiable manner," said Peter Scoles, MD, NBME's senior vice president of assessment programs. "Before we go forward with the clinical skills assessment as part of the [United States Medical Licensing Examination], we need to test our assumptions. If our methods to protect security and cost estimates are way off we would reconsider the exam."

This year, the NBME plans to use between 500 and 1,500 student volunteers to pilot test the exam at unspecified locations, Dr. Scoles said. The exam will feature 10 standardized cases taking about 30 minutes each. Students will be tested on their ability to gather and interpret clinical patient data, communicate effectively and render a differential diagnosis. Failure rate is projected at 5% to 7% for first-time takers and 1% to 2% for repeat takers.

At the AMA's Interim Meeting last December, the House of Delegates approved a resolution from the Medical Student Section asking the NBME to reconsider its plans.

"The current NBME proposal for regional testing centers places unnecessary and unfair financial burden on medical students," said David Buck, chair of the AMA-MSS, in a letter to the NBME.

Public demand for greater physician interpersonal skills and a belief that poor communication can contribute to medical errors led the NBME and the Federation of State Medical Boards in 1999 to approve a plan to require the test as a condition of medical licensure.

That same year the Educational Commission for Foreign Medical Graduates began requiring international medical graduates to pass a similar clinical skills test before taking the final part of the three-step USMLE. Passing all three steps of the USMLE is required for licensure by most states. ECFMG certification is required to enter a U.S. residency program.