Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates

The clinical skills assessment for international medical graduates in The Netherlands

AIM

A need was felt to improve the quality of admission and licensing procedures for international medical graduates in The Netherlands.

METHOD

A clinical skills assessment was designed as part of a new procedure to realize a high-stakes, fair, transparent, and a time-limited path of admission for international medical graduates to the Dutch health care system. Additionally, it should provide a well-founded advice about length and content of additional medical training, should this be indicated by the outcome of the assessment.

RESULTS

The clinical skills assessment procedure was developed as a Dutch variant of the "Step 2 Clinical Skills examination" of the Educational Commission for Foreign Medical Graduates (ECFMG) in collaboration with the United States National Board of Medical Examiners, which has a well-documented validity and reliability. The experience with the new procedure is yet limited, but enough to warrant a report.

DISCUSSION

Worldwide, a number of countries have developed such high-stake assessment procedures, but they show little uniformity and transparency. By describing the design and development of our procedure, we do not pretend to set a standard, but we hope to contribute to more fair, accurate and uniform approaches for doctors moving from one country to another.

New medical licensing examination using computer-based case simulations and standardized patients

PURPOSE

To evaluate a new method, used for the first time in Italy, of administering the Medical Licensing Examination (MLE).

METHOD

Eighty medical school graduates taking the MLE were studied. The MLE was based on the Multimedia Integrated Pilot Project (MIPP), a single two-step examination that combines computer-based case simulations (step 1) and clinical encounters using standardized patients (step 2). Step 1 assessed mainly clinical knowledge and decision-making skills. Step 2 measured the ability to obtain a focused history, perform a relevant physical examination, prioritize a differential diagnosis and management plan, and provide patient education or counseling. The correlations between the total MIPP scores and the exam scores students obtained during the six-year medical school curriculum were evaluated.

RESULTS

The step 1, step 2, and total MIPP scores were moderately correlated with the curriculum scores. A moderate correlation also existed between the scores reported in step 1 and those of step 2.

CONCLUSIONS

The MIPP is a good tool for assessing clinical competence. Internationally, computer-based and standardized patient assessments are being used more often in licensing examinations. Continuous use of this method could improve medical graduates' performances.

A fellowship in the USA: essential information for the Australasian medical graduate

BACKGROUND

There have been many recent changes to the immigration and educational requirements necessary to obtain both clinical and research positions in the USA. This paper describes these requirements in detail and examines the cost of obtaining a position.

METHODS

An extensive review of Medline and relevant documents from educational and immigration bodies is undertaken in addition to personal and peer experience of the processes necessary to fulfil educational and immigration requirements for funded medical positions in the USA. A cost analysis is performed based upon the latest charges for exam requirements and visa fees. A 'minimum' cost for fulfilling exam and visa requirements only and a 'likely' cost (which represents a more realistic appraisal of the expenses likely to be incurred) are investigated.

RESULTS

This review shows that many recent changes have made the attainment of a position difficult and expensive. Much foresight and planning is required to obtain the necessary requirements for medical licensure and to obtain working visa status in addition to the application for the position itself. The cost analysis reveals that the minimum cost is $4050 (AU$) and the 'likely' cost is $8600 (AU$).

CONCLUSION

Australasian trainees and Fellows need to be fully aware of the difficulties and expenses likely to be encountered in order to make an informed decision with regard to overseas training in the USA.

Clinical skills assessment with standardized patients

Previous projects (Combell I & II) to assess clinical skills were conducted in medical schools in Catalonia, in order to introduce a model of such an assessment using standardized patients (SP). The aim of this study (Combell III) was to measure selected characteristics of our model. Seventy-three medical students in the final year at the Bellvitge teaching unit of the University of Barcelona participated in a clinical skills assessment (CSA) project that used 10 SP cases. The mean group scores for the four components of clinical skills for each day of testing were studied, and ratings for each student in the 10 sequential encounters were checked. The study also compared the clinical skills scores with their academic grades. The total case mean score (mean score of history-taking, physical examination and patient notes scores) was 51.9%, and the mean score for communication skills was 63.6%. The clinical skills scores over the 8 testing days showed no day-to-day differences. The study did not find differences among the sequential encounters for each student (training effect). There was a lack of correlation between clinical skills scores and academic grades. The project demonstrated the feasibility of the method for assessing clinical skills, confirmed its reliability, and showed that there is no correlation between scores with this method and academic examinations that mainly reflect knowledge.