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Playing Doctor
Stephen G. Henry
Nashville, Tenn
stephen.henry@vanderbilt.edu
JAMA. 2005;294:2138-2140.
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The National Board of Medical Examiners and the Federation of State Medical Boards began administering the Step 2 Clinical Skills Examination (CSE) on July 1, 2004.1 I had no strong feelings about the exam until I took it the following October. My experience revealed important limitations to the exam that, though difficult or impossible to measure, are central to understanding and improving its validity and place in medical education.
According to the United States Medical Licensing Examination (USMLE),2 the CSE evaluates three components: spoken English proficiency, communication and interpersonal skills, and "integrated clinical encounter." This last category comprises gathering relevant information from the history and physical examination and documenting it in a patient note. Physicians evaluate examinees’ written notes, and standardized patients score performance in the exam rooms using checklists to record examinees’ behavior.
My exam went smoothly, but I felt an abiding sense of irony because . . . [Full Text of this Article]
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