Blog | Monday, April 15, 2013

The clinical skills exam--feh!


Someone had an idea several years ago that we cannot trust medical schools to evaluate students' proficiency in clinical skills. The national boards decided that they had a testing opportunity. Most observers believe that they developed this test as a hurdle for international medical graduates. To be "fair" they decided to have U.S. grads take the test also.

Now perhaps this is not the truth, this is what most observers believe.

The New England Journal of Medicine has a wonderful analysis showing the problem of this test: The Step 2 Clinical Skills Exam--A Poor Value Proposition.

Medical schools give OSCE to students to test their clinical skills. I have known a few students who failed the exam, and as a long term observer of students I saw no clue to this failure. In fact, other experts have confirmed that while we know who is at risk for Step 1 and Step 2 CK failures, we cannot predict Step 2 CSS failures.

The problem with the test is the unnecessary expense and stress that the test creates. Many residencies will not rank students who have not passed CSS, yet students have difficulty scheduling the test. If you fail the test, then rescheduling is a nightmare.

The National Board of Medical Examiners supports the test, Quality, Cost, and Value of Clinical Skills Assessment, despite almost all observers questioning its value.

And the cost!! During the most expensive year of medical school (because of the cost of interviewing), NBME adds another major cost. They assure us that the test has improved. What does this test really do? What is the emotional impact of this test? What about the 2% who fail one time? The test is not accurate enough to make a difference, and yet there it is, another hurdle.

One commenter likened this test to fraternity hazing. The only difference is that you have to spend $1,500-$2,000 to get hazed.

As I said in the first line--FEH!

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.