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Pilot project on clinical skills testing heads to Atlanta

The proposed licensing program got mixed reviews from medical students in Philadelphia, where testing has been completed.

By Myrle Croasdale, amednews staff. Sept. 2, 2002.

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The National Board of Medical Examiners is winding down a Philadelphia trial of its clinical skills assessment test and is ready to begin another in Atlanta.

Medical students in Philadelphia had varied reactions to the test. Some said it was a helpful experience; others said it merely repeated other evaluations done during the year.

All agreed that the estimated cost of $950 will be hard to bear when the test becomes mandatory for third- year students in 2004.

The AMA and the Assn. of American Medical Colleges have called the cost of the exam burdensome and stated that more scientific analysis needs to be done to confirm its merit.

Meanwhile, NBME is progressing through its pilot tests. Eventually, there will be three to five testing centers. Exactly how many and where has yet to be determined.

In Philadelphia, medical schools at the University of Pennsylvania, Temple University and Thomas Jefferson University participated in the pilot, which ran from May to August.

In Atlanta, the study, set for September through November, will include students at Mercer College of Medicine, Emory University, the Medical College of Georgia and Morehouse University.

While the test is still a pilot, students don't have to pay, but they do have to give their time.

Meenakshi Bewtra, medical student at the University of Pennsylvania, made her displeasure clear. "It was a waste of a day. We do the same standardized patient exam at Penn. It's required. In general, how well you interact with patients is part of our evaluation for our clinical rotations."

Lynn Seng, director of the standardized patient program at the University of Pennsylvania School of Medicine, said the school had done a small pilot with its own cases last year, joined in the national pilot this year and would have its own test again in 2003.

"I have gotten anecdotal reports from a dozen students," she said. "One student said it felt like being a doctor, because he went from room to room, seeing patients and writing up notes, with 15 minutes per patient. None of them felt insecure or afraid that they'd failed."

Students at the Jefferson Medical College of Thomas Jefferson University have had little exposure to standardized patients, said Susan Rattner, MD, senior associate dean for academic affairs at the college. She said the school is gearing up to get students prepared for the mandatory exam and is moving forward with its own version, using real patients.

"I have heard a fair amount from the students, and I'm getting mixed reviews from them," she said. "I've heard it felt artificial. Students said standardized patients were not the same as working with a real person. It's still a good thing to have done. Students get feedback on how they did, and it points them in the direction of what they may need to work on."

Neeraj Bajaj, a Jefferson medical student was looking forward to getting his full evaluation on the test.

"It was definitely a worthwhile experience," he said. "In the clerkship rotations, you don't get a standardized sense of what is expected in histories, write-ups.

"In a standardized format you get that and you get graded on it. You get ideas on what you need to work on compared to everybody else. You can't get that kind of feedback on a rotational exam."

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 ADDITIONAL INFORMATION: 

Patient skills

How: Third-year med students taking the United States Medical Licensing Exam clinical assessment examine 11 standardized patients. They have 15 minutes to take a history, evaluate the patient and write up a prognosis or management plan.
Why: The videotaped test is to evaluate, in a consistent manner, the students' ability to assess patients' problems and manage their therapy. Both common and uncommon conditions are presented.
Estimated cost of test: $950
Estimated travel costs: $1,000

Sources: National Board of Medical Examiners, AMA

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