Home > USMLE Scores > What do Program Directors think of the Clinical Skills Exam?

What do Program Directors think of the Clinical Skills Exam?

August 9, 2011

The CS is an expensive exercise but in some ways an important one.

The Step 2 CS has three subcomponents, the Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP).

Both scores from the Step 2 CS prototype significantly correlated with the interns’ quartile ranking and average competency score. See Academic Medicine:May 2005 – Volume 80 – Issue 5 – pp 496-501

There was little overlap between examinees failing Step 2 CK and the different components of Step 2 CS. See Academic Medicine:October 2006 – Volume 81 – Issue 10 – pp S21-S24

“The inclusion of a clinical skills examination in the testing system for medical licensure provides the opportunity to assess history-taking and physical examination skills, communication and interpersonal skills, spoken English proficiency, and documentation of findings in a structured patient note” J Med Licensure Discipline. 2005;91:21-25.

The following data is © 1996-2011 FSMB and NBME®.  First-taker passing rates on each of the CS subcomponents for AMGs and IMGs. For IMGs in 2009-2010 the scores were ICE is 85% for IMGs compared to 98% AMGs, CIS is 87% for IMGs compared to 99% AMGs, SEP is 95% for IMGs compared to >99% AMGs.

The following graph is data on gender differences in the CS exam (click figure to enlarge) from a study published in Academic Medicine:

This is from a sample of 24,000 AMGs and IMGs who took the CS exam.  Fifty-seven percent of the examinees were male, 45% were international graduates, and 42% reported having English as a second language so the data is representable for IMGs.  Looking at the curves, women do better than men in every category.  Candidates do poorly on their first encounter and gradually improve.  Note that there is a dip in performance after the fifth and ninth station, this is the encounter after the breaks.  English language ability was constant.

What can we learn about this that will help IMGs pass the CS?  Well if you are male you need to work on being nice and warm.  You need to get into the right frame of mind before you start, as it looks like everyone starts out “cold.”  Perhaps practicing your greeting over and over just before you begin can help like an actor warming up their vocal cords.  “Hi my name is Kenneth what brings you to the clinic.”  Remember to smile at your patients, be friendly and warm.  You should have practiced the structure of the note while studying.  I suggest writing a note while everyone is talking about nothing and waiting for the exam to begin.  Get your mind and pen  and words warmed up.  After the break again practice your greeting so that you are warmed up.  Don’t let your guard down and stay focused on documentation and data gathering.  Avoiding a poor start and decrease in performance after the breaks may be the difference between passing and not.  In essence the CS is part performance and part being prepared.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

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