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To the Editor: The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills examination (CSE) assesses whether candidates have minimally acceptable information-gathering and communication skills to enter supervised postgraduate practice. In his essay in A Piece of My Mind, Mr Henry¹ argues that the artificial examination setting of a CSE fails to assess tacit knowledge and suggests that standardized patients cannot fully simulate authentic physician-patient encounters.

Standardized patients represent a criterion standard for evaluation of clinical performance.² Physicians often cannot distinguish standardized patients from actual patients when standardized patients are surreptitiously introduced into a practice setting.³ In exit surveys completed by more than 90% of examinees, 87% indicated that the examination is good to excellent as an assessment of clinical skills (overall impression of exam); 90% indicated that the cases represent appropriate challenges (content balance).⁴

Henry's assertion that communication and interpersonal skills are scored using case-specific checklists is incorrect. . . . [Full Text of this Article]

James A. Hallock, MD; Donald E. Melnick, MD
dmelnick@nbme.org
Philadelphia, Pa

James N. Thompson, MD
Dallas, Tex

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