Medical students to begin taking clinical skills test

All new physicians must now pass the exam to get their medical license.

By Myrle Croasdale — Posted June 7, 2004

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The much-maligned clinical skills assessment examination is up and running, and every new physician in the United States from the class of 2005 forward will have to pass it to be licensed.

As of June 1, 2004, medical students will be required to take the test. The only open test site is in Philadelphia. A test site in Atlanta is expected to open in July followed by one in Los Angeles in August and ones in Chicago and Houston in September. Peak demand for the test is expected in October and November.

Some 7,000 U.S. medical students have registered for the exam, though only 2,300 have scheduled their tests to date, according to the National Board of Medical Examiners, co-sponsor of the test with the Federation of State Medical Boards. Some 17,000 U.S. and 10,000 international medical graduates are expected to take the test during the 2004-05 academic year, with total exams reaching 30,000 when about 3,000 expected retakes are included. The test is a day-long process and consists of clinical examinations of 12 standardized patients.

Chief complaint: cost

The American Medical Association and the American Medical Student Assn. have been vocal opponents of the test.

"For about 10 years we were on record in favor of it," said Nancy H. Nielsen, MD, PhD, speaker of the AMA House of Delegates. "The policy changed because it became clear that the logistics -- the high cost and the need to travel -- were really prohibitive. We are in favor of an exam but believe these skills should be tested at the medical schools."

At one point a contingent of nine AMA leaders took its objections directly to the NBME and met with officials at the Atlanta testing site.

"We did try very hard to stop this," Dr. Nielsen said. "Now we're into harm reduction."

Chief among complaints is the test's $975 price tag as well as travel costs for any medical student not near one of the testing centers.

Peter Scoles, MD, senior vice president for assessment programs for the NBME, said the cost was discussed in detail with AMA leaders. "We have in our contract that there will be no profit margin at all for either organization involved," Dr. Scoles said.

Discount rates have been negotiated for students at hotels near testing sites, and the AMA Alliance, AMA-Medical Student Section and state medical societies are asking medical students and physicians near test sites to open their homes to students.

Make it mandatory

In another effort to make the cost of the test more manageable, the AMA in November 2003 sent a letter to medical school deans asking that they make the test mandatory so students could qualify for financial aid to cover the cost. At the same time, the AMA asked that graduation not be dependent on a passing CSAE grade, in case scheduling problems make a timely re-taking of the test unfeasible.

The NBME is sending out a similar letter this spring urging resident program directors not to require a passing grade on the exam as a condition of starting residencies for the same reason.

The AMA also wants the NBME to give feedback to students who fail, but that is unlikely to happen at this stage. Unresolved is the AMA's contention that the Philadelphia site won't be able to handle demand for the Northeast and that a second testing site is needed for that region.

Joe McDonald, chair of the AMA's medical student governing council and an MD/PhD student at the University of Kansas School of Medicine, said that as the start date nears, a fresh wave of opposition is rising among students.

The AMA will be watching how the year unfolds.

"We'll be monitoring very closely not only how it works this year and whether students are able to schedule their exam, but if they can retake the exam in time," Dr. Nielsen said.

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External links

U.S. Medical Licensing Examination, Step 2 Clinical Skills (link)

Housing for the clinical skills exam, arranged by the AMA-Medical Student (link)

Section and the AMA Alliance

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