us mle united states medical licensing examination u tm usmle step 2 clinical skills aspe webinar...
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US MLEUnited States
Medical
Licensing
Examination
u
TM
USMLE Step 2 Clinical Skills
ASPE WebinarDecember 10, 2003
Richard Hawkins, Ann KingNational Board of Medical Examiners
US MLEUnited States
Medical
Licensing
Examination
u
TM
Overview
• Introduction: USMLE Step 2 CS• Step 2 CS design (content, structure,
scoring)• General policies • Exam logistics (dates, exam sites)• Effects on medical education
US MLEUnited States
Medical
Licensing
Examination
u
TM
USMLE Purpose
• 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
US MLEUnited States
Medical
Licensing
Examination
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USMLE Step 2 CS
• “CSE” – enhancement of Step 2• USMLE Step 2 – components:
–Clinical knowledge (CK) –Clinical skills (CS)
• Steps 1 & 2 prerequisite for Step 3
US MLEUnited States
Medical
Licensing
Examination
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Purpose: USMLE Step 2 CS
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…
US MLEUnited States
Medical
Licensing
Examination
u
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Step 2 CS Blueprint
• Defines content categories• Individual test form:
–Adequate sampling of content domain–Comparable content between test forms
US MLEUnited States
Medical
Licensing
Examination
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CSE Blueprint: Content Categories
• Common and important medical problems / patient presentations
• Acuity• Age• Gender• Race / ethnicity
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Case Content
CardiovascularRespiratory GastrointestinalMusculoskeletalConstitutional
Neurological Psychiatric Genitourinary Women’s health
Other Test Form
Patient age
Age less than 18Age 18 – 44Age 45 – 64Age 65 +
Patient Gender
Male Female
Case Acuity
Acute Subacute / Chronic
US MLEUnited States
Medical
Licensing
Examination
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Step 2 CS Structure
• 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
US MLEUnited States
Medical
Licensing
Examination
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Step 2 CS Structure
• Other station formats:– Third party interviews– Telephone encounters– Physical examination stations
• Future formats:– Difficult or sensitive communication issues– Synthetic models and mannequins
US MLEUnited States
Medical
Licensing
Examination
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Step 2 CS Structure: Score Components
• 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
US MLEUnited States
Medical
Licensing
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Scoring - 2
• 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
US MLEUnited States
Medical
Licensing
Examination
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Standard Setting
• 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
US MLEUnited States
Medical
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Score Reporting
• Standard Setting summer – fall 2004– Adequate numbers of examinees required
• Initial score reports fall 2004
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Medical
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Score Reporting - 2
• To Examinees–Overall pass/fail outcomes–Failing examinees: graphical representation of relative strengths and weaknesses (similar to current USMLE reports)
US MLEUnited States
Medical
Licensing
Examination
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USMLE Step 2 Clinical Skills
P/F Outcome
Total Test FAIL
Examination Components
Integrated Clinical Encounter Pass
Communication/Interpersonal Skills
Fail
Spoken English Proficiency Pass
Sample Performance Report
US MLEUnited States
Medical
Licensing
Examination
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Performance Profile
Integrated Clinical Encounter
Data-gathering
Patient note
Communication / Interpersonal Skiills
Spoken English Proficiency
Lower Performance
BorderlinePerformance
Higher Performance
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US MLEUnited States
Medical
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Score Reporting - 3
• To Schools– Individual student pass/fail outcomes
» If student permits– Group summary reported yearly
» Including CS components
US MLEUnited States
Medical
Licensing
Examination
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General Policies (for US/Canadian Students)
• 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)
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Exam Logistics
• First exam administered in June 2004• Collaboration with ECFMG
– Step 2 CS replaces ECFMG CSA for IMGs• Delivered at 5 regional test centers
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Test Centers
US MLEUnited States
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Exam Administration Schedule
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Pre-Implementation Pilot Exams
• 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
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Participation in Pilots
• 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
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Registration & Scheduling
• 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
US MLEUnited States
Medical
Licensing
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CSE: Effect on Medical Education
• Most significant impact at UME level
• Consequence of:–Effect of assessment on education–Placement of CSE in USMLE series
US MLEUnited States
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CSE: Effect on Medical Education
• Accountability for clinical skills acquisition (public and students)
• Identifies need for national consensus on objectives for clinical skills teaching and assessment
US MLEUnited States
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CSE: Effect on Medical Education
• 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
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CSE: Effect on Medical Education
• 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…
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Standardized Patient Educators
• 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
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CSE: Other Implications
• 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
US MLEUnited States
Medical
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Implications for the Profession
• 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