A Burden We Don't Need

Article excerpt

"Would you like some cheese with that whine?"

This appears to be the message that the National Board of Medical Examiners (NBME) is sending to medical students who criticize the implementation of the new clinical skills assessment examination (CSAE). Starting this year, the board will require that all U.S. medical students take this test as part of the United States Medical Licensing Examination.

The CSAE will require students to use abilities acquired during their first 4 years of medical training to conduct a history and physical on standardized patients in a clinical setting. The exam will be administered at five locations--Philadelphia, Atlanta, Los Angeles, Chicago, and Houston--at a cost of $950 to the examinee, not including travel and lodging expenses.

On the surface, the exam sounds great. It will allow medical students to show how well they interact with patients in a standardized setting. It will evaluate whether a student has the information-gathering and communication skills necessary to enter postgraduate training. It will also potentially identify a select number of students who need additional training in these areas.

But many students, especially those attending institutions that already conduct similar tests, feel that the exam is overkill. These students argue that most medical schools have clinical skills assessment as part of their curriculum. The NBME has responded to this criticism by arguing that there is wide variation among school program requirements and that students are not judged by a common standard.

This is not the first time a clinical skills exam has been required. In fact, clinical skills were part of the medical certifying examinations until 1964, when that section was discontinued because of issues regarding validity and reliability of the one-on-one bedside examination process. The NBME assures us that much research has been done and that these problems have been resolved.

Then there is the cost issue. Medical students already make a significant financial and personal sacrifice by forfeiting several years of potential earnings to attend medical school and residency training. …