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USu MLE United States Medical Licensing Examination TM USMLE Step 2 Clinical Skills ASPE Webinar December 10, 2003 Richard Hawkins, Ann King National Board of Medical Examiners USu MLE United States Overview Medical Licensing Examination • • • • • TM Introduction: USMLE Step 2 CS Step 2 CS design (content, structure, scoring) General policies Exam logistics (dates, exam sites) Effects on medical education USu MLE United States USMLE Purpose Medical Licensing Examination TM • Serves the licensure process – Independent verification of competence – Educational experiences vary • Co-sponsored by FSMB and NBME – Step 2 CS collaboration with ECFMG • Includes essential attributes for practice – Cognitive and clinical skills required for safe and effective patient care USu MLE United States USMLE Step 2 CS Medical Licensing Examination TM • “CSE” – enhancement of Step 2 • USMLE Step 2 – components: –Clinical knowledge (CK) –Clinical skills (CS) • Steps 1 & 2 prerequisite for Step 3 USu MLE United States Purpose: USMLE Step 2 CS Medical Licensing Examination TM Step 2 Clinical Skills assesses whether an examinee has the clinical skills essential to the safe and effective practice of medicine, with a focus on those clinical presentations that are common to patient care under supervision… USu MLE United States Step 2 CS Blueprint Medical Licensing Examination TM • Defines content categories • Individual test form: –Adequate sampling of content domain –Comparable content between test forms USu MLE United States CSE Blueprint: Content Categories Medical Licensing Examination TM • Common and important medical problems / patient presentations • Acuity • Age • Gender • Race / ethnicity USu MLE Case Content United States Medical Case Acuity Licensing Examination TM Acute Subacute / Chronic Test Form Cardiovascular Respiratory Gastrointestinal Musculoskeletal Constitutional Neurological Psychiatric Genitourinary Women’s health Other Patient age Patient Gender Age less than 18 Age 18 – 44 Age 45 – 64 Age 65 + Male Female USu MLE United States Step 2 CS Structure Medical Licensing Examination TM • 12 patient encounters • 15 min. per encounter / 10 min. for patient note • Each encounter: – Elicit pertinent history – Perform appropriate physical examination – Communicate effectively – Document: » Findings from the history and physical » Diagnostic impression / Further work-up USu MLE United States Step 2 CS Structure Medical Licensing Examination TM • Other station formats: – Third party interviews – Telephone encounters – Physical examination stations • Future formats: – Difficult or sensitive communication issues – Synthetic models and mannequins USu MLE United States Step 2 CS Structure: Score Components Medical Licensing Examination TM • Integrated Clinical Encounter (ICE) – Data gathering: History and physical exam – Patient Note • Communication / Interpersonal Skills (CIS) – Gathering/sharing information, manner, rapport • Spoken English Proficiency (SEP) – Listener effort, examinee pronunciation / word choice USu MLE United States Scoring - 2 Medical Licensing Examination TM • In order to Pass Step 2 CS, examinees required to pass all three components: ICE, CIS, SEP • Those who fail and then retake: – Reassessed in all three components – Must pass all three USu MLE United States Standard Setting Medical Licensing Examination TM • Step 2 CS system will be comparable to that used for the rest of USMLE • Decision ultimately made by the Step 2 Committee – Will establish minimum passing point for ICE, CIS, and SEP separately – Will consider data from multiple sources » Survey of stakeholders » Independent review of content/encounters » Performance/reliability data – Closely monitor USu MLE United States Score Reporting Medical Licensing Examination TM • Standard Setting summer – fall 2004 – Adequate numbers of examinees required • Initial score reports fall 2004 USu MLE United States Score Reporting - 2 Medical Licensing Examination TM • To Examinees –Overall pass/fail outcomes –Failing examinees: graphical representation of relative strengths and weaknesses (similar to current USMLE reports) USu MLE United States Medical Sample Performance Report Licensing Examination TM USMLE Step 2 Clinical Skills P/F Outcome Total Test FAIL Examination Components Integrated Clinical Encounter Communication/Interpersonal Skills Spoken English Proficiency Pass Fail Pass USu MLE Performance Profile United States Medical Lower Performance Licensing Examination Borderline Performance Higher Performance TM Integrated Clinical Encounter Data-gathering XXXXXXXXXXXXXXXXXX xxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxx Patient note Communication / Interpersonal Skiills Spoken English Proficiency XXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXX USu MLE United States Score Reporting - 3 Medical Licensing Examination TM • To Schools – Individual student pass/fail outcomes » If student permits – Group summary reported yearly » Including CS components USu MLE United States General Policies (for US/Canadian Students) Medical Licensing Examination TM • Who must take Step 2 CS? – Those who graduate in 2005 or later – Earlier grads if Step 2 CK not passed by June 30, 2005 • What are the eligibility requirements? (no change) – Student/grad of LCME- or AOA-accredited school • Is there a required sequence? (no change) – Step 1, Step 2 CK, Step2 CS in any order • Rules for repeaters (no change) – Wait 60 days between attempts, no more than three times in 12 month period, no USMLE imposed limit on number of takes (but the licensing authority may have limits) USu MLE United States Exam Logistics Medical Licensing Examination TM • First exam administered in June 2004 • Collaboration with ECFMG – Step 2 CS replaces ECFMG CSA for IMGs • Delivered at 5 regional test centers USu MLE United States Test Centers Medical Licensing Examination TM • Current ECFMG CSA test sites » Philadelphia » Atlanta • Under Construction » Chicago » Los Angeles » Houston USu MLE United States Exam Administration Schedule Medical Licensing Examination TM • Centers open in sequence – First Center – June 2004 – All Centers open – September 2004 • Exact dates and sequence TBA • Capacity – 3 examinations/day (33 examinees) – Up to 7 days/week • Equal access to all Centers by US, Canadian and international examinees USu MLE United States Pre-Implementation Pilot Exams Medical Licensing Examination TM • Purpose – Realistic experience for SPs – Test AV and IT systems – Train support staff • Scope – 6-8 weeks prior to implementation at each site – Approximately 400 examinees at each site USu MLE United States Participation in Pilots Medical Licensing Examination TM • Open to all registered examinees – Mechanisms for allocating slots under development • Mock examinations very similar to actual CS – Experience case design, SP interaction, examination logistics, Center – Limited feedback, not meant to be predictive • Mix of US, Canadian and International Examinees • Scheduling details TBA USu MLE United States Registration & Scheduling Medical Licensing Examination TM • Registration and scheduling will become available concurrently in early January • Students and graduates of US and Canadian medical schools will register using the NBME Interactive Website for Applicants and Examinees (telephone registration available) • Detailed information on registration, scheduling and fee structure on USMLE Website USu MLE United States CSE: Effect on Medical Education Medical Licensing Examination TM • Most significant impact at UME level • Consequence of: –Effect of assessment on education –Placement of CSE in USMLE series USu MLE United States CSE: Effect on Medical Education Medical Licensing Examination TM • Accountability for clinical skills acquisition (public and students) • Identifies need for national consensus on objectives for clinical skills teaching and assessment USu MLE United States CSE: Effect on Medical Education Medical Licensing Examination • • • • TM Central role of the patient in medical education Clinical skills – curricular reform / emphasis Implications for resource allocation Faculty participation – Enhanced faculty interest and involvement – Support for faculty development USu MLE United States CSE: Effect on Medical Education Medical Licensing Examination • • • • TM Challenge for Medical Educators: Ensure minimal standard (“teach to the test”), or… Think beyond minimum standards Don’t miss the opportunity to: – Fully explore clinical skills teaching / assessment – Inspire curiosity and enthusiasm for learning around patient encounters – Facilitate development of lifelong learning skills related to patient encounters… USu MLE United States Standardized Patient Educators Medical Licensing Examination TM • Will assume a more significant role • Valued as experts: SP, clinical skills • Role as a consultant • More influence of educational programs • With recognition, comes responsibility USu MLE United States CSE: Other Implications Medical Licensing Examination TM • For Residency Program Directors: – Improved applicant selection – Decreased time with problem residents – Better foundation on which to build • Continued exploration and application of SPs and other simulation methods: – Advantages: faculty sparing, patient (and student) safety, ensure broad exposure… – Applications across continuum of education and practice USu MLE United States Implications for the Profession Medical Licensing Examination TM • For the FSMB, NBME and ECFMG: Values statement • Generation of doctors will understand the relevance and importance of clinical skills • Relationship between NBME and ECFMG and “Medical Education” will continue to grow • Implications for the public are significant