UNIVERSITY OF KENTUCKY

DEC 0 8 2003

Office of the Provost

106 Gillis BuildingLexington, KY 40506-0033(859) 257-2911Fax: (859) 257-1333Email: provost@email.uky.edu

www.uky.eduDecember 4, 2003

TRANSMITTAL

TO: Rebecca ScottSenate Council

FROM: CathYOWenfYMedical Center Academic Council

At its meeting on November 25, 2003, the Academic Council for the Medical Center approved, andrecommends approval by the Senate Council, for the proposal from the College of Medicine tochange the graduation requirements in the College of Medicine. Attached are the materials toimplement this change.

Thank you for your attention to this matter

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Emery A. Wilson, M.D.C. Darrell Jennings, Jr., M.D.

Jacque Hager

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An Equal Opportunity University

October 10, 2003

MEMORANDUM

TO: Cathy Owen

FROM Wanda WhitehouseOffice of Academic Affairs

Attached is a request for change in the College of Medicine graduation requirements. A memoregarding this change has been sent to duplicating and the mailroom for distribution to the properpeople. Please ask Dr. Todd Cheever (3-5261) to the Council meeting. It is felt he will haveinformation that we do not have and could better answer any questions.

Thanks

UNIVERSITY OF KENTUCKY

Dean and Associate VicePresident for Clinical ServicesCollege of MedicineMN 150 Chandler Medical Center800 Rose StreetLexington, KY 40536-0298(859) 323-5567Fax: (859) 323-2039E-mail: ewilson@uky.edu

www.uky.edu

October 1, 2003

MEMORANDUM

David S. Watt, PhDAssociate Provost for Academic MfairsCh.air, Academic Council for the Medical Center

FROM: Emery A.Dean and Associate Clinical Services

Request for Change in College of Medicine Graduation Requirements

The Faculty Council of the College of Medicine has approved and submits for yourconsideration and approval the following new course application(s):

Change in College of Medicine Graduation RequirementDescriRtion: The present policy of the United States Medical LicensingExamination (USMLE) requires only that students have a passing score on awritten examination to graduate from medical school.Justification: The United States Medical Licensing Examination (USMLE) hasissued a new policy, effective with the Class of2005, requiring medical studentsto have passing scores on both a written examination and a clinical skillsexamination in order to receive their diplomas.

An Equal Opportunity University

UNIVERSITY OF KENTUCKY

Dean and Associate VicePresident for Clinical ServicesCollege of MedicineMN 150 Chandler Medical Center

October 1, 2003 800 Rose StreetLexington, KY 40536-0298(859) 323-5567Fax: (859) 323-2039E-mail: ewilson@uky.edu

Deans, Department Chairs and Members of the University Sen~.u?cY.edu

MEMORANDUM

FROM: Emery A.Dean and for Clinical Services

Request for Change in College of Medicine Graduation Requirements

The Faculty Council of the College of Medicine has approved and submits for yourconsideration and approval the following request:

Change in College of Medicine Graduation RequirementDescriRtion: The present policy of the United States Medical LicensingExamination (USMLE) requires only that students have a passing score on awritten examination to graduate from medical school.Justification: The United States Medical Licensing Examination (USMLE) issueda new policy, effective with the Class of2005, requiring medical students to havepassing scores on both a written examination and a clinical skills examination inorder to receive their diplomas.

An Eqllal Opportunity University

Wilson,Associate

OoKUNIVERSITY OF KENTUCKY

College of MedicineChandler Medical CenterAssociate Dean for Academic Affairsand AdministrationMN-I04, UKMCLexington, KY 40536-0298(859) 257-5286Fax: (859) 323-2076

www.uky.edu

August 28, 2003

MEMORANDUM

TO: David Watt, PhDAssociate Provost, Academic Affairs

FROM: Emery Wilson,Dean

Via

C. Darrell Jennings, M.D.Chair, College of Medicine Curriculum Committee

RE: Change in College of Medicine Graduation Requirement

The United States Medical Licensing Examination (USMLE) has issued a new policyeffective with the graduating class of2005. This policy requires students to have apassing score on both a written examination and a clinical skills examination. Passage ofa clinical skills exam is a requirement for licensure by all 50 states. In order for studentsto comply with the new policy, students must fly or drive to a clinical skills testing site;closest testing location for our students is either Chicago, IL or Atlanta, GA.

In order for students to receive financial assistance in the form of federal loans to coverthe cost of taking the clinical skills exam and transportation to and from the testing site,the clinical skills exam must be made a part of graduation requirements. Further, theThird and Fourth Year Course Directors' Committee, the Student Progress and PromotionCommittee, and the Curriculum Committee embrace the concept of clinical competencyassessment for all physicians. Therefore, the College of Medicine is requesting a changein graduation requirements:

Old reQuirement for eraduation from the Colleee of MedicinePassing scores on both the Step 1 (taken at the end of Year 2) and Step 2 writtenexaminations. Students have from the end of their third year through December31 of their senior year to pass Step 2. Students have three attempts to pass beforedismissal, with appeals.

An EqUQI Opportunity University

Page 2Memo-Change in College of Medicine Graduation RequirementAugust 28, 2003

New reQuirement for 2raduation from the Colle2e of MedicinePassing scores on both the Step 1 written examination (taken at the end of Year2), and Step 2 written examination and clinical skills examination. Students havefrom the end of their third year through December 31 of their senior year to passboth parts of the Step 2 examination. Students have three attempts to pass beforedismissal, with appeals. Students are not required to take Step 2 examinations inany particular order.

APPROV AL:

Emery filson, M.D.

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Step 2 Clinical Skills (CS)

Step 2 CS assesses whether an examinee can demon strate the fundamental clinical skills essential for safe

and effective patient care under supervision. These

clinical skills include taking a relevant medical histo-

ry, performing an appropriate physical examination,

communicating effectively with the patient, clearly

and accurately documenting the findings and diag-

nostic hypotheses from the clinical encounter, and

ordering appropriate initial diagnostic studies. --Step 2 CS uses standardized patients, i.e., peopletrained to portray real patients. Examinees areexpected to establish rapport with the standardizedpatients, elicit pertinent historical infoIUlation fromthem, perfoIUl focused physical examinations, answerquestions, and provide counseling where appropriate.After each interaction with a standardized patient,examinees record pertinent history and physicalexamination fmdings, list diagnostic impressions, andoutline plans for further evaluation, if neeessary. Thecases cover common and important situations that aphysician is likely to encounter in a gen~ral ambula-

tory setting.

Further details on the design and content of Step 2CS will be provided at the USMLE website.

Step 3

Step 3 is organized along two principal dimensions:clinical encounter frame and physician task, asshown at the right. Step 3 content reflects adata-based model of generalist medical practice inthe United States.

Encounter frames capture the essential features ofcircumstances surrounding physicians' clinical activi-ty with patients. They range from encounters withpatients seen for the fIrst time for nonemergencyproblems, to encounters with regular patients seen inthe context of continued care, to patient encounters in(life-threatening) emergency situations. Encountersoccur in clinics, offices, skilled nursing care facili-ties, hospitals, emergency departments, and on thetelephone. Each test item in an encounter frame alsorepresents one of the six physician tasks. For exam-ple, initial care encounters emphasize taking a history

and perfonning a physical examination. In contrast,continued care encounters emphasize decisionsregarding prognosis and management.

High-frequency, high-impact diseases also organizethe content of Step 3. Clinician experts assign clinicalproblems related to these diseases to individual clini-cal encounter frames to represent their occurrence in

generalist practice.

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assessment of physicians assuming independentresponsibility for delivering general medical care.

In order to be eligIole to register for US1\.1:LE Step 3, stu-dents and graduates ofLCME- or AOA-accredited med-ical schools will be required to not only meet currentexamination requirements (i.e., passing Step 1 and pass-ing Step 2 CK) but also to pass Step 2 CS if they: (a)have graduation dates in 2005 or later, or (b) have gradu-ation dates prior to 2005 and have not passed the CKcomponent of Step 2 taken on or before June 30, 2005.

Examination Committees

Examination committees composed of medical edu-cators and clinicians prepare the examination materi-als. Committee members broadly represent the teach-ing, practicing, and licensing communities across theUnited States. At least two of these committees criti-cally appraise each test item or case. They revise ordiscard any materials that are in doubt.

When Step 2 CS is implemented, it will replace theClinical Skills Assessment (CSA*) administered bythe ECFMG and required for ECFMG certification ofinternational medical graduates.

Ownership and Copyright of Examination MaterialsIn order to be eligible to register for USMLE Step 3,international medical graduates will be required tonot only meet current requirements (i.e., passing Step1 and Step 2 CK and being certified by ECFMG), butalso to pass Step 2 CS. However, international med-ical graduates who have passed the ECFMG CSAwill not be required to pass Step 2 CS to register forUSMLE Step 3.

The USMLE parent organizations, the FSMB andNBME, own the examination materials used in theUSMLE. The examinations are copyrighted. If youreproduce and/or distribute any examinationmaterials, by any means, including memorizing andreconstructing them, without explicit written permis-sion from the parent organizations, you violate therights of the FSMB and NBME. In addition toactions described on page 25, the FSMB and theNBME will use every legal me~ns available to pro-tect USMLE copyrighted materials and secureredress against those who violate copyright law.

To be eligible to register for Step 3, ECFMG-certi-tied international medical graduates who have notpassed the ECFMG CSA, as well as individuals whosuccessfully complete a "Fifth Pathway"program,may also be required to pass Step 2 CS. These indi-viduals should monitor the USMLE website for theeffective date of this requirement.USMLE Step 2 Clinical Skills (CS) Examination

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A clinical ski1:s examination was part of the o.riginaldesign of USMLE. The NBME was charged withincluding a test of clinical skills using standardizedpatients when such an examination was shown to bevalid, reliable, and practical. NBME research and thework of other organizations administering clinicalskills examinations demonstrate that clinical skillsexaminations measure skill sets different from thosemeasured by traditional multiple-choice questions.Mastery of clinical and communication skills, as wellas cognitive skills, by individuals seeking medicallicensure is important to the protection of the public.

You are responsible for determining whether thisrequirement applies to you, based on the rules statedin the paragraphs above.

This bulletin is written to include infonnation avail-able at the time of publication regarding the CS com-ponent of Step 2. As additional infonnation about theimplementation of Step 2 CS becomes available,details will be provided at the USMLE and your reg-istration entity's websites.

Computer-Based Testing (CBT)~

Parts of the USMLE are administered by compu~er.Prometric@, part of The Thomson Corporation, pro-vides scheduling and test centers for the USMLE.Step 1 and Step 2 Clinical Knowledge Componentare given around the world at Prometric Test Centers(PTCs). Step 3 is given at PTCs in the United Statesand its territories.

Implementation of the clinical skills examination willoccur in the second or third quarter of 2004. The clini-cal skills examination will be a separate component ofStep 2, and will be referred to as Step 2 Clinical Skills,or Step 2 CS. The current Step 2 will be referred to asthe Clinical Knowledge Component, or Step 2 CK

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Obtaining an Eligibility Period for Step 1and Step 2 CK

Testing Regions

Step 1 and Step 2 CK are administered in the UnitedStates and Canada and in more than 50 other countries.International testing locations are distributed amongdefined international testing regions. These regions arenoted in ECFMG application materials along withinstructions for choosing a region and paying the addi-tional international test delivery surcharge. Within eachregion, Prometric has a central scheduling office knownas the "Regional Registration Center" to contact forscheduling test dates.

When applying for Step 1 or Step 2 CK, you mustselect a three-month period, such as January-February-March or February-March-April, duringwhich you prefer to take the Step. A SchedulingPermit with instructions for making an appointmentat a Prometric Test Center will be sent to you after

your registration entity processes your applicationand determines your eligibility. The SchedulingPermit specifies the three-month eligibility periodduring which you must complete the examination. Ifthe processing of your application is not completed intime to allow your preferred three-month period to beassigned, you will be assigned to the next three-month period. Allow approximately four weeks forprocessing of your application. On receipt of yourScheduling Permit, you are able to contact Prometricimmediately to schedule a test date.

Prometric schedules testing appointments forSteps 1 and 2 CK up to six months in advance of theassigned eligibility period. If your application issubmitted more than six months in advance of yourrequested eligibility period, it will be processed, butyour Scheduling Permit will be sent no more than sixmonths before your assigned eligibility period begins.

r'Step 2 CS will be delivered at regional test site:lL:ithin the United States. ~

Obtaining an Eligibility Period for Step 3

If you are unable to take the test within your eligibili-ty period, contact your registration entity to inquireabout a contiguous three-month eligibility periodextension. A fee is charged for this service. Visit:your registration entity's website (see page 26) formore information. If you do not take the test withinyour eligibility period and wish to take it in thefuture, you must reapply by submitting a new appli-cation and fee(s).

Step 3 eligIoility periods are assigned once your appli-cation has been processed and approved. In decidingwhen to apply for Step 3, allow approximately two tofour weeks for processing. Time for processing willvary depending on the particular medical licensingauthority and the volume of applications. Upon com-plete processing of your Step 3 application and conflr-mati on of eligibility, a Scheduling Permit is sent toyou with instructions for making an appointment at aPrometric Test Center. On receipt of your SchedulingPermit, you should contact Prometric immediately toschedule the test dates. The Scheduling Permit speci-fies the eligibility period (beginning immediately andextending for approximately 90 calendar days) duringwhich you must complete the examination. If you areunable to take the test within your eligibility period,contact the FSMB to inquire about a contiguous three-month eligibility period extension. A fee is charged forthis service, and some restrictions may apply. Visit theFSMB website (http://wwwfsmb.org) for moredetailed information. If you do not take the test withinyour original or extended eligibility period and wish totake it in the future, you must reapply by submitting anew application and fee(s).

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