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Abstract
The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills (CS) in 2020 in response to the COVID-19 pandemic marked the end of a decades-long debate about the utility and value of the exam. For all its controversy, the implementation of Step 2 CS in 2004 brought about profound changes to the landscape of medical education, altering the curriculum and assessment practices of medical schools to ensure students were prepared to take and pass this licensing exam. Its elimination, while celebrated by some, is not without potential negative consequences. As the responsibility for assessing students' clinical skills shifts back to medical schools, educators must take care not to lose the ground they have gained in advancing clinical skills education. Instead, they need to innovate, collaborate, and share resources; hold themselves accountable; and ultimately rise to the challenge of ensuring that physicians have the necessary clinical skills to safely and effectively practice medicine.
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Affiliation(s)
- Timothy K Baker
- T.K. Baker is senior associate dean for academic affairs and associate professor, Department of Internal Medicine, University of Nevada, Reno, School of Medicine, Reno, Nevada
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2
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Katsufrakis PJ, Chaudhry HJ. Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation. Acad Med 2021; 96:1236-1238. [PMID: 34166234 DOI: 10.1097/acm.0000000000004214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program's sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program's continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.
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Affiliation(s)
- Peter J Katsufrakis
- P.J. Katsufrakis is president and CEO, NBME, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-9077-9190
| | - Humayun J Chaudhry
- H.J. Chaudhry is president and CEO, Federation of State Medical Boards, Euless, Texas; ORCID: https://orcid.org/0000-0003-3356-1106
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North S. These Four Telehealth Changes Should Stay, Even After the Pandemic. Fam Pract Manag 2021; 28:9-11. [PMID: 33973756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Rashid H, Coppola KM, Lebeau R. Three Decades Later: A Scoping Review of the Literature Related to the United States Medical Licensing Examination. Acad Med 2020; 95:S114-S121. [PMID: 33105189 DOI: 10.1097/acm.0000000000003639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To conduct a scoping review of the timing, scope, and purpose of literature related to the United States Medical Licensing Examination (USMLE) given the recent impetus to revise USMLE scoring. METHOD The authors searched PubMed, PsycInfo, and ERIC for relevant articles published from 1990 to 2019. Articles selected for review were labeled as research or commentaries and coded by USMLE Step level, sample characteristics (e.g., year(s), single/multiple institutions), how scores were used (e.g., predictor/outcome/descriptor), and purpose (e.g., clarification/justification/description). RESULTS Of the 741 articles meeting inclusion criteria, 636 were research and 105 were commentaries. Publication totals in the past 5 years exceeded those of the first 20 years.Step 1 was the sole focus of 38%, and included in 84%, of all publications. Approximately half of all research articles used scores as a predictor or outcome measure related to other curricular/assessment efforts, with a marked increase in the use of scores as predictors in the past 10 years. The overwhelming majority of studies were classified as descriptive in purpose. CONCLUSIONS Nearly 30 years after the inception of the USMLE, aspirations for its predictive utility are rising faster than evidence supporting the manner in which the scores are used. A closer look is warranted to systematically review and analyze the contexts and purposes for which USMLE scores can productively be used. Future research should explore cognitive and noncognitive factors that can be used in conjunction with constrained use of USMLE results to inform evaluation of medical students and schools and to support the residency selection process.
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Affiliation(s)
- Hanin Rashid
- H. Rashid is associate director, Office for Advancing Learning, Teaching, and Assessment, and assistant professor, Cognitive Skills Program, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Kristen M Coppola
- K.M. Coppola is assistant professor, Cognitive Skills Program, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Robert Lebeau
- R. Lebeau is director, Office for Advancing Learning, Teaching, and Assessment, and Cognitive Skills Program, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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Caesar S, Layer G, Alexander R, Banks V, Barasi S, Bews S, Chaudhury B, Cockman P, Conlon M, Dasan S, Feltbower T, Fox D, Hughes S, Jani B, Jelley D, Lewis-Barned N, Mead S, Qureshi K, Twomey P, van Woerden H, Woodhouse J, Yuille F. Appraisal needs to re-start now so doctors can reflect on coronavirus experiences. BMJ 2020; 371:m3987. [PMID: 33077426 DOI: 10.1136/bmj.m3987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Susi Caesar
- Professional Development Committee, Academy of Medical Royal Colleges, 10 Dallington Street, London EC1V 0DB, UK
- Medical Appraisal 2020 Task and Finish Group, Academy of Medical Royal Colleges, London, UK
| | - Graham Layer
- Professional Development Committee, Academy of Medical Royal Colleges, 10 Dallington Street, London EC1V 0DB, UK
| | - Regi Alexander
- Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, UK
| | - Vicky Banks
- Faculty of Medical Leadership and Management, 6 St Andrews Place, London NW1 4LB, UK
| | | | - Susan Bews
- Faculty of Pharmaceutical Medicine, 19 Angel Gate, 326a City Road, London EC1V 2PT, UK
| | - Basant Chaudhury
- Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
| | - Philippa Cockman
- NHS England and Improvement London, London, UK
- St Stephen's Health Centre, London E3 5ED, UK
| | - Maurice Conlon
- Professional Standards Team, NHS England and Improvement, Quarry House, Quarry Hill, Leeds LS2 7UE, UK
| | - Sunil Dasan
- Sustainable Working Practices Committee, Royal College of Emergency Medicine, 7-9 Bream's Buildings, Chancery Lane, London EC4A 1DT, UK
| | - Tony Feltbower
- Association of Surgeons in Primary Care and Faculty of Sexual and Reproductive Health, 27 Sunningdale Avenue, Kenilworth, Warwickshire CV82BY, UK
| | - David Fox
- Faculty of Occupational Medicine, 2 Lovibond Lane, London SE10 9FY, UK
| | - Steph Hughes
- Health Education England, Wessex Appraisal Service, Southern House, Otterbourne, Hampshire SO21 2RU, UK
| | - Bov Jani
- Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH, UK
| | - Di Jelley
- NHS England and Improvement Cumbria and North East, UK
- Health Education England (North East and Cumbria), Continuing Practice Department, Waterfront, 4 Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne NE15 8NY, UK
| | - Nick Lewis-Barned
- Patient Feedback Project, Academy of Medical Royal Colleges, 10 Dallington Street, London EC1V 0DB, UK
| | | | - Kashif Qureshi
- Royal College of Ophthalmologists, 18 Stephenson Way, London NW1 2HD, UK
| | - Paul Twomey
- NHS England and Improvement North East and Yorkshire, Health House, Grange Park Lane, Willerby HU10 6DT, UK
| | - Hugo van Woerden
- Public Health Agency, 12-22 Linenhall Street, Belfast BT2 8BS, UK
| | - John Woodhouse
- Faculty of Public Health, 4 St Andrews Place, London NW1 4LB, UK
| | - Frances Yuille
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London WC2A 3JW, UK
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Delman KA, Srinivasan JK. "What Is Old Is New Again" Commentary on "Ensuring That Step 1 Isn't the Next 'Back in My Day"'. Ann Surg 2020; 272:240. [PMID: 32675535 DOI: 10.1097/sla.0000000000004046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
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Affiliation(s)
- Matthew A Crane
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard A Chang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Razvan Azamfirei
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Affiliation(s)
| | | | - Alfred F Tallia
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Affiliation(s)
- Aakash Desai
- Department of Medicine, University of Connecticut, Farmington
| | - Aparna Hegde
- Department of Hematology and Oncology, University of Alabama at Birmingham
| | - Devika Das
- Department of Hematology and Oncology, University of Alabama at Birmingham
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Gardner AK, Cavanaugh KJ, Willis RE, Dunkin BJ. Can Better Selection Tools Help Us Achieve Our Diversity Goals in Postgraduate Medical Education? Comparing Use of USMLE Step 1 Scores and Situational Judgment Tests at 7 Surgical Residencies. Acad Med 2020; 95:751-757. [PMID: 31764083 DOI: 10.1097/acm.0000000000003092] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE Use of the United States Medical Licensing Examination (USMLE) for residency selection has been criticized for its inability to predict clinical performance and potential bias against underrepresented minorities (URMs). This study explored the impact of altering traditional USMLE cutoffs and adopting more evidence-based applicant screening tools on inclusion of URMs in the surgical residency selection process. METHOD Multimethod job analyses were conducted at 7 U.S. general surgical residency programs during the 2018-2019 application cycle to gather validity evidence for developing selection assessments. Unique situational judgment tests (SJTs) and scoring algorithms were created to assess applicant competencies and fit. Programs lowered their traditional USMLE Step 1 cutoffs and invited candidates to take their unique SJT. URM status (woman, racial/ethnic minority) of candidates who would have been considered for interview using traditional USMLE Step 1 cutoffs was compared with the candidate pool considered based on SJT performance. RESULTS A total of 2,742 general surgery applicants were invited to take an online SJT by at least 1 of the 7 programs. Approximately 35% of applicants who were invited to take the SJT would not have met traditional USMLE Step 1 cutoffs. Comparison of USMLE-driven versus SJT-driven assessment results demonstrated statistically different percentages of URMs recommended, and including the SJT allowed an average of 8% more URMs offered an interview invitation (P < .01). CONCLUSIONS Reliance on USMLE Step 1 as a primary screening tool precludes URMs from being considered for residency positions at higher rate than non-URMs. Developing screening tools to measure a wider array of candidate competencies can help create a more equitable surgical workforce.
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Affiliation(s)
- Aimee K Gardner
- A.K. Gardner is assistant dean of evaluation and research, Baylor College of Medicine, and president and CEO, SurgWise Consulting, Houston, Texas. K.J. Cavanaugh is a research analyst, MD Anderson Cancer Center, and senior associate, SurgWise Consulting, Houston, Texas. R.E. Willis is director of surgical education, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, and senior associate, SurgWise Consulting, Houston, Texas. B.J. Dunkin is executive vice president, SurgWise Consulting, Houston, Texas
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Affiliation(s)
- Harris Ahmed
- Fourth-year medical student, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico. Assistant professor, Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia;
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Affiliation(s)
- Jason M Ali
- Director of studies in clinical medicine, Churchill College, University of Cambridge, and specialist registrar in cardiothoracic surgery, Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom;
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MacLean SA. The Gender Gap in Medical Eponyms: A USMLE Step 1 Content Analysis. Acad Med 2020; 95:666-667. [PMID: 32345875 DOI: 10.1097/acm.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sarah A MacLean
- Third-year student, Icahn School of Medicine at Mount Sinai, New York, New York;
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Jurich D, Santen SA, Paniagua M, Fleming A, Harnik V, Pock A, Swan-Sein A, Barone MA, Daniel M. Effects of Moving the United States Medical Licensing Examination Step 1 After Core Clerkships on Step 2 Clinical Knowledge Performance. Acad Med 2020; 95:111-121. [PMID: 31365399 PMCID: PMC6924934 DOI: 10.1097/acm.0000000000002921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.
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Affiliation(s)
- Daniel Jurich
- D. Jurich is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania
| | - Sally A. Santen
- S.A. Santen is senior associate dean of evaluation, assessment and scholarship of learning and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Miguel Paniagua
- M. Paniagua is medical advisor, Test Development Services, National Board of Medical Examiners, and adjunct associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Fleming
- A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Victoria Harnik
- V. Harnik is associate dean for curriculum and associate professor, Department of Cell Biology, New York University School of Medicine, New York, New York
| | - Arnyce Pock
- A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Aubrie Swan-Sein
- A. Swan-Sein is director, Center for Education Research and Evaluation, and assistant professor of educational assessment, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Michael A. Barone
- M.A. Barone is vice president of licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania
| | - Michelle Daniel
- M. Daniel is assistant dean for curriculum and associate professor, Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119
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Ouyang W, Harik P, Clauser BE, Paniagua MA. Investigation of answer changes on the USMLE® Step 2 Clinical Knowledge examination. BMC Med Educ 2019; 19:389. [PMID: 31647012 PMCID: PMC6806526 DOI: 10.1186/s12909-019-1816-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Examinees often believe that changing answers will lower their scores; however, empirical studies suggest that allowing examinees to change responses may improve their performance in classroom assessments. To date, no studies have been able to examine answer changes during large scale professional credentialing or licensing examinations. METHODS In this study, we expand the research on answer changes by analyzing responses from 27,830 examinees who completed the Step 2 Clinical Knowledge (CK) examination between August of 2015 and August of 2016. RESULTS The results showed that although 68% of examinees changed at least one item, the overall average number of changes was small. Among the examinees who changed answers, approximately 45% increased their scores and approximately 28% decreased their scores. On average, examinees spent shortest time on the item changes from wrong to right and they were more likely to change their scores from wrong to right than right to wrong. CONCLUSIONS Consistent with previous studies, these findings support the beneficial effects of answer changes in high-stakes medical examinations and suggest that examinees who are overly cautious about changing answers may put themselves at a disadvantage.
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Affiliation(s)
- Wenli Ouyang
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA.
| | - Polina Harik
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA
| | - Brian E Clauser
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA
| | - Miguel A Paniagua
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA
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Nagoshi K, Zaidi Z, Wright A, Stalvey C. Peer assisted feedback: a successful approach for providing feedback on United States Medical Licensing Exam-style clinical skills exam notes in the United States. J Educ Eval Health Prof 2019; 16:29. [PMID: 31614406 PMCID: PMC6817788 DOI: 10.3352/jeehp.2019.16.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Peer assisted learning (PAL) promotes the development of communication, facilitates improvement of clinical skills, and provides feedback to learners. We utilized PAL as a conceptual framework to explore the feasibility of peer-assisted feedback (PAF) to improve note writing skills without requiring faculty time. The aim was to assess if peer assisted learning was a successful method to provide feedback on USMLE-style clinical skills exam notes by using student feedback on a survey in the United States. METHODS The University of Florida College of Medicine administers clinical skills examinations (CSEs) includes USMLE-like note-writing. PAL, where students support the learning of peers, was utilized as an alternative to faculty feedback. Second (MS2) and third (MS3) year medical students taking CSEs participated in faculty-run note-grading sessions immediately after testing, which included explanations of grading rubrics and the feedback process. Students graded an anonymized peer's notes. The graded material was then forwarded anonymously to its student author to review. Students were surveyed on perceived ability to provide feedback and benefits derived from PAF using a Likert scale (1-6) and open-ended comments during the 2017-2018 academic year. RESULTS Students felt generally positively about the activity with mean score for items related to educational value of 4.49 for MS2 and 5.11 for MS3 out of 6. MS3s perceived peer feedback as constructive, felt benefit from evaluating other's notes, and felt the exercise would improve their future notes. While still positive, MS2 students gave comparatively lower scores than the MS2 students. CONCLUSION PAF was a successful method to provide feedback on student CSE notes, especially for MS3s. MS2s commented that although they learned during the process, they might be more invested in improving their note writing as they approach their own USMLE exam.
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Affiliation(s)
| | - Zareen Zaidi
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ashleigh Wright
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Carolyn Stalvey
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
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Van Meter M, Williams M, Banuelos R, Carlson P, Schneider JI, Shy BD, Babcock C, Spencer M, Chathampally Y. Does the National Resident Match Program Rank List Predict Success in Emergency Medicine Residency Programs? J Emerg Med 2016; 52:77-82.e1. [PMID: 27692649 DOI: 10.1016/j.jemermed.2016.06.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/06/2016] [Accepted: 06/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency medicine (EM) residency programs use nonstandardized criteria to create applicant rank lists. One implicit assumption is that predictive associations exist between an applicant's rank and their future performance as a resident. To date, these associations have not been sufficiently demonstrated. OBJECTIVES We hypothesized that a strong positive correlation exists between the National Resident Match Program (NRMP) match-list applicant rank, the United States Medical Licensing Examination (USMLE) Step 1 and In-Training Examination (ITE) scores, and the graduating resident rank. METHODS A total of 286 residents from five EM programs over a 5-year period were studied. The applicant rank (AR) was derived from the applicant's relative rank list position on each programs' submitted NRMP rank list. The graduation rank (GR) was determined by a faculty consensus committee. GR was then correlated to AR using a Spearman's partial rank correlation. Additional correlations were sought with a ranking of the USMLE Step Score (UR) and the ITE Score (IR). RESULTS Combining data for all five programs, weak positive correlations existed between GR and AR, UR, and IR. The majority of correlations ranged between. When comparing GR and AR, there was a weak correlation of 0.13 (p = 0.03). CONCLUSION Our study found only weak correlations between GR and AR, UR, and IR, suggesting that those variables may not be strong predictors of resident performance. This has important implications for EM programs considering the resources devoted to applicant evaluation and ranking.
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Affiliation(s)
- Michael Van Meter
- University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Michael Williams
- University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Rosa Banuelos
- University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Peter Carlson
- University of Texas Health Science Center McGovern Medical School, Houston, Texas
| | - Jeffrey I Schneider
- Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Bradley D Shy
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christine Babcock
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Matthew Spencer
- University of Rochester School Medical Center, Rochester, New York
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Archer J, Lynn N, Coombes L, Roberts M, Gale T, Price T, Regan de Bere S. The impact of large scale licensing examinations in highly developed countries: a systematic review. BMC Med Educ 2016; 16:212. [PMID: 27543269 PMCID: PMC4992286 DOI: 10.1186/s12909-016-0729-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/08/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND To investigate the existing evidence base for the validity of large-scale licensing examinations including their impact. METHODS Systematic review against a validity framework exploring: Embase (Ovid Medline); Medline (EBSCO); PubMed; Wiley Online; ScienceDirect; and PsychINFO from 2005 to April 2015. All papers were included when they discussed national or large regional (State level) examinations for clinical professionals, linked to examinations in early careers or near the point of graduation, and where success was required to subsequently be able to practice. Using a standardized data extraction form, two independent reviewers extracted study characteristics, with the rest of the team resolving any disagreement. A validity framework was used as developed by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education to evaluate each paper's evidence to support or refute the validity of national licensing examinations. RESULTS 24 published articles provided evidence of validity across the five domains of the validity framework. Most papers (n = 22) provided evidence of national licensing examinations relationships to other variables and their consequential validity. Overall there was evidence that those who do well on earlier or on subsequent examinations also do well on national testing. There is a correlation between NLE performance and some patient outcomes and rates of complaints, but no causal evidence has been established. CONCLUSIONS The debate around licensure examinations is strong on opinion but weak on validity evidence. This is especially true of the wider claims that licensure examinations improve patient safety and practitioner competence.
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Affiliation(s)
- Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Nick Lynn
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Lee Coombes
- Centre for Medical Education, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Martin Roberts
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
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Swanson DB, Roberts TE. Trends in national licensing examinations in medicine. Med Educ 2016; 50:101-14. [PMID: 26695470 DOI: 10.1111/medu.12810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/01/2015] [Accepted: 06/09/2015] [Indexed: 05/09/2023]
Abstract
CONTEXT As a contribution to this special issue commemorating the journal's 50th volume, this paper seeks to explore directions for national licensing examinations (NLEs) in medicine. Increases in the numbers of new medical schools and the mobility of doctors across national borders mean that NLEs are becoming even more important to ensuring physician competence. OBJECTIVES The purpose of this paper is to explore the use of NLEs in the future in the context of global changes in medical education and health care delivery. METHODS Because the literature related to NLEs is so large, we have not attempted a comprehensive review, but have focused instead on a small number of topics on which we think we have something useful to say. The paper is organised around five predicted trends for NLEs. DISCUSSION The first section discusses reasons why we think the use of NLEs will increase in the coming years. The second section discusses the ongoing problem of content specificity and its implications for the design of NLEs. The third section examines the evolution of large-scale, standardised cognitive assessments in NLEs and suggests some future directions. Reflecting the fact that NLEs are, increasingly, attempting to assess more than just knowledge, the fourth section addresses the future of large-scale clinical skills assessments in NLEs, predicting both increases in their use and some shifts in the nature of the stations used. The fifth section discusses workplace-based assessments, predicting increases in their use for formative assessment and identifying some limitations in their direct application in NLEs. The concluding section discusses the cost of NLEs and indulges in some further speculations about their evolution.
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Affiliation(s)
- David B Swanson
- Academic Programmes and Services, American Board of Medical Specialties, Chicago, Illinois, USA
- Department of Medical Education, University of Melbourne Medical School, Melbourne, Victoria, Australia
| | - Trudie E Roberts
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
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Imawari M. [The changes of National Medical License Examination and its future movements]. Nihon Naika Gakkai Zasshi 2015; 104:2527-2532. [PMID: 28530368 DOI: 10.2169/naika.104.2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Knoedler T. Medical licensure and the changing world. An interstate compact could expedite things for physicians who wish to be licensed in other states. Minn Med 2015; 98:34-35. [PMID: 25876320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Hansen MB, Klatt T. The interstate medical licensure compact: what physicians should know. S D Med 2014; 67:378. [PMID: 25244819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Affiliation(s)
- Robert Steinbrook
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Affiliation(s)
- Jordan J Cohen
- Dr Cohen is former president of the Association of American Medical Colleges
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Abstract
In this commentary, the author describes how the meaning of the health care workforce has changed, focusing on the physician workforce. Some questions have been asked consistently over the years: How many should we have? What type? Where should they work? In 1830 there were no licensing laws, and every literate American could be a member of the health care workforce by following detailed instructions in a popular handbook. Subsequent years saw the initiation of state licensing laws and the reform of medical education. Medical specialties and specialty boards were created, although it was not until after World War II that the dominance of the general practitioner gave way to specialists. For over a century, estimates of physician supply have swung between "too many" and "too few." Rural and economically disadvantaged communities have long struggled with access to health care providers. The author also identifies some issues that have only been considered fairly recently, such as the ethnic and gender diversity of the workforce. Wars have played a major role in changing ideas about the workforce, often in ways that long outlast the actual dates of the conflict. The meaning of the health care workforce has always been deeply embedded in a specific social, political, and economic context.
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Affiliation(s)
- Joel D Howell
- Dr. Howell is the Victor Vaughan Professor of the History of Medicine and professor of internal medicine, history, and health management & policy University of Michigan, Ann Arbor, Michigan
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Abstract
Over the past 25 years, three major forces have had a significant influence on licensure and certification: the shift in focus from educational process to educational outcomes, the increasing recognition of the need for learning and assessment throughout a physician's career, and the changes in technology and psychometrics that have opened new vistas for assessment. These forces have led to significant changes in assessment for licensure and certification. To respond to these forces, licensure and certification programs have improved the ways in which their examinations are constructed, scored, and delivered. In particular, we note the introduction of adaptive testing; automated item creation, scoring, and test assembly; assessment engineering; and data forensics. Licensure and certification programs have also expanded their repertoire of assessments with the rapid development and adoption of simulation and workplace-based assessment. Finally, they have invested in research intended to validate their programs in four ways: (a) the acceptability of the program to stakeholders, (b) the extent to which stakeholders are encouraged to learn and improve, (c) the extent to which there is a relationship between performance in the programs and external measures, and (d) the extent to which there is a relationship between performance as measured by the assessment and performance in practice. Over the past 25 years, changes in licensure and certification have been driven by the educational outcomes movement, the need for lifelong learning, and advances in technology and psychometrics. Over the next 25 years, we expect these forces to continue to exert pressure for change which will lead to additional improvement and expansion in examination processes, methods of assessment, and validation research.
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Affiliation(s)
- John J Norcini
- a Foundation for Advancement of International Medical Education and Research , Philadelphia , Pennsylvania , USA
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Go PH, Klaassen Z, Chamberlain RS. An ERAS-based survey evaluating demographics, United States Medical Licensing Examination Performance, and research experience between American medical graduates and United States citizen international medical graduates: is the bar higher on the continent? J Surg Educ 2012; 69:143-148. [PMID: 22365857 DOI: 10.1016/j.jsurg.2011.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/24/2011] [Accepted: 07/31/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To provide an assessment and comparison of the demographics, medical school academic performance, United States Medical Licensing Examination (USMLE) performance, and research experience between American Medical Graduate (AMG) and United States International Medical Graduate (USIMG) candidates who applied for and successfully matched into categorical general surgery residency programs. DESIGN Data were obtained through the Electronic Residency Application Service (ERAS) and a post-match survey distributed to all applicants. SETTING The study was conducted at a community-based, university-affiliated hospital. PARTICIPANTS All United States citizen graduates of allopathic American medical schools or international medical schools, who were applying for a general surgery residency position at our institution. RESULTS A total of 854 candidates applied, including 143 AMGs and 223 USIMGs. Seventy-two AMGs (50.3%) and 41 USIMGs (18.4%) were invited to interview (p < 0.0001). Mean USMLE step 1 scores were higher among USIMG applicants overall (USIMG: 212.1 ± 14.9 vs AMG: 206.9 ± 15.5; p < 0.0005) and among those invited to interview (USIMG: 227.8 ± 16.2 vs AMG: 215.5 ± 16.2; p < 0.0001). Seventy percent of AMGs matched into a categorical surgery residency compared with 31.6% of USIMGs (p < 0.001). Compared with AMGs, USIMGs applied to more programs (USIMG: 90.3 ± 42.8 vs AMG: 52.1 ± 26.4; p < 0.002), were offered fewer interviews (USIMG: 9.0 ± 6.9 vs AMG: 20.9 ± 13.7; p < 0.0001), and subsequently ranked fewer programs (USIMG: 7.5 ± 4.5 vs AMG: 12.5 ± 6.1; p < 0.0008). CONCLUSIONS USIMGs require higher USMLE scores than their AMG counterparts to be considered for categorical general surgery residency positions. However, excellence on the USMLE neither ensures an invitation to interview nor categorical match success. A well-rounded application in conjunction with a practical application strategy is critical for USIMGs to achieve success in attaining a general surgery residency position.
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Affiliation(s)
- Pauline H Go
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
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Vanderburgh AJ. We have met the enemy and he is us. J Am Osteopath Assoc 2011; 111:370-371. [PMID: 21771921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Norman G, Neville A, Blake JM, Mueller B. Assessment steers learning down the right road: impact of progress testing on licensing examination performance. Med Teach 2010; 32:496-9. [PMID: 20515380 DOI: 10.3109/0142159x.2010.486063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Although it is generally accepted that assessment steers learning, this is generally viewed as an undesirable side effect. Recent evidence suggests otherwise. Experimental studies have shown that periodic formative assessments can enhance learning over equivalent time spent in study (Roediger & Karpicke 2006). However, positive effects of assessment at a curriculum level have not been demonstrated. Progress tests are a periodic formative assessment designed to enhance learning by providing objective and cumulative feedback, and by identifying a subgroup of students who require additional remediation. McMaster adopted the progress test methods in 1992-1993, as a consequence of poor performance on a national licensing examination. This article shows the positive effect of this innovation, which amounts to an immediate increase of about one-half standard deviation in examination scores, and a consistent upward trend in performance. The immediate effect of introducing objective tests was a reduction in failure rate on the licensing examination from 19% to 4.5%. Various reasons for this improvement in performance are discussed.
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Affiliation(s)
- Susan Kies
- College of Medicine, University of Illinois at Urbana-Champaign, 190 Medical Sciences Building, 506 South Mathews Avenue, Urbana, IL 61801, USA.
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Haase J, Boisen E. Neurosurgical training: more hours needed or a new learning culture? ACTA ACUST UNITED AC 2009; 72:89-95; discussion 95-7. [PMID: 19559933 DOI: 10.1016/j.surneu.2009.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 02/11/2009] [Accepted: 02/11/2009] [Indexed: 11/16/2022]
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Antonelli MA. Medical licensure in the United States: past, present, and future. Hawaii Med J 2008; 67:162-163. [PMID: 18678208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- Stephen J Ziegler
- Assistant Professor of Public and Environmental Affairs, Indiana University-Purdue University, Fort Wayne, Indiana, USA
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Abstract
This report explores the movement of physicians to, from, and within Canada and identifies recurring patterns of migration. The primary position of the report is that physician movement is part of reality both internationally and within Canada, and that movement of Canadian-trained physicians creates a need for international medical graduates (IMGs) in "physician-losing" locations. The report's argument is based on data retrieved from public sources on aggregate physician practice patterns in Canada and analyzed for migration patterns. In addition, literature was reviewed on factors affecting the migration patterns being described.Canadian-educated physicians have tended to move from less prosperous to more prosperous provinces and from rural to urban areas; because of the resulting need, the physician-losing locales generally have the highest proportions of IMGs. Physicians traditionally have tended to emigrate from Canada to the United States, thus increasing Canadian demand for IMGs, but recently this movement has slowed and even reversed. In Canada, liberalized immigration policies for physicians combined with a shortage of postgraduate training positions to create a serious bottleneck early in the current decade. However, this problem is now being resolved. In summary, physician migration within Canada shows specific long-term patterns, and IMGs will be needed in underserved areas for years to come. Well-informed policies for workforce management are essential in Canada to ensure an adequate physician supply consisting mainly of Canadian-educated physicians but also including IMGs. A role for nonadvocacy groups such as the Educational Commission for Foreign Medical Graduates may be to help ensure that recruitment of physicians from developing countries follows accepted ethical principles.
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Abstract
Medical licensure in the United States is undergoing significant change. With calls for greater accountability and transparency, state medical boards and their membership association, the Federation of State Medical Boards (FSMB), are seeking ways to assure the public that physicians are maintaining their competence throughout the lifetime of their practice of medicine. At present, competence in cognitive, clinical, and communicative skills is regularly measured only at initial licensure. Yet, the public and policy-related organizations are demanding ongoing assessment of physicians' ability to safely and competently practice medicine. The author reports on activities that involve the FSMB and other national organizations, including the Educational Commission for Foreign Medical Graduates, in planning for a future of increased accountability and transparency of the licensing and regulatory communities that oversee the practice of medicine. He notes that topics of discussion include possible nationalization of what has been traditionally state-based licensure. He raises questions about a future that may include specialty-based licensure and greater national and even international license portability.
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Cuddy MM, Swanson DB, Dillon GF, Holtman MC, Clauser BE. A multilevel analysis of the relationships between selected examinee characteristics and United States Medical Licensing Examination Step 2 Clinical Knowledge performance: revisiting old findings and asking new questions. Acad Med 2006; 81:S103-7. [PMID: 17001117 DOI: 10.1097/00001888-200610001-00026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study examines: (1) the relationships between examinee characteristics and United States Medical Licensing Examination Step 2 Clinical Knowledge (CK) performance; (2) the effect of gender and examination timing (time per item) on the relationship between Steps 1 and 2 CK; and (3) the effect of school characteristics on the relationships between examinee characteristics and Step 2 CK performance. METHOD A series of hierarchical linear models (examinees-nested-in-schools) predicting Step 2 CK scores was fit to the data set. The sample included 54,487 examinees from 114 U.S. Liaison Committee on Medical Education-accredited medical schools. RESULTS Consistent with past examinee-level research, women generally outperformed men on Step 2 CK, and examinees who received more time per item generally outperformed examinees who received less time per item. Step 1 score was generally more strongly associated with Step 2 CK performance for men and for examinees who received less time per item. School-level characteristics (size, average Step 1 performance) influenced the relationship between Steps 1 and 2 CK. CONCLUSION Both examinee-level and school-level characteristics are important for understanding Step 2 CK performance.
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Affiliation(s)
- Monica M Cuddy
- National Board of Medical Examiners, 3750 Market St., Philadelphia, Pennsylvania 19104, USA.
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von Jagow G, Lohölter R. [New licensing regulations for physicians. Main areas of reform and first results of the implementation process]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:330-6. [PMID: 16528545 DOI: 10.1007/s00103-006-1245-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Since October 2003 medical education in Germany has been given a new more up-to-date basis, the "New Licensing Regulations for Physicians". They represent a reform of both the structure and the content of medical education making great demands on medical faculties and medical students; e.g. elective courses during the first and second cycles of the curriculum, interdisciplinary courses (so-called 'cross-sectional courses'), practical clinical courses of several weeks in five specialties, and family medicine as an option for choice during the last year are central issues of the reform. The number of state-controlled medical examinations has been reduced from four to two. It is now the responsibility of medical faculties to assess the knowledge, clinical skills and professional attitudes of students with respect to the numerous specialties which are part of medical education. This paper presents the essential innovations and describes the current state of the implementation process. It also points out problems that deserve reconsideration. Although the full implementation of the new licensing regulations is still in progress, it might be said that they have already initiated important changes in medical education in Germany.
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Affiliation(s)
- G von Jagow
- Präsident des Medizinischen Fakultätentages, Theodor-Stern-Kai 7, 60590 Frankfurt am Main.
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Burger W. [The Berlin reformed medical curriculum at the Charité. Experiences with the first cohort]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:337-43. [PMID: 16528546 DOI: 10.1007/s00103-006-1242-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At the end of the 2004 summer term the first students of the Berlin reformed curriculum finished their education and took their first state examination. With regard to the questions to be answered by the "Berlin Model" the results of the first cohorts were presented and discussed. Overall the Berlin curriculum was successful. The results led to some important considerations concerning adaptation by other faculties, the requirements to start off a problem-based curriculum or an enlargement of the class.
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Affiliation(s)
- W Burger
- Reformstudiengang Medizin, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117 Berlin.
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Abstract
Abolishment of the time as a physician in training (intern) in Germany on 1 October 2004 completed the reform of the education of doctors and the total time of education was reduced to 6 years. So the wages of young doctors could be raised and the aim is that these doctors will begin their jobs in hospitals in Germany and not abroad, so that this will be a measure to counteract the regional shortage of doctors. To finance the difference between the wages of the former trainees and now the young doctors in the hospitals, the German law about modernisation of the social health security system ("GKV-Modernisierungsgesetz") ensured that a budget of about 300 million euros would be provided to the hospitals by German health insurance companies. Implementation of this reform in general caused no problems. This can be ascribed to the fact that there are more than 3,000 open jobs for young doctors in German hospitals today.
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Affiliation(s)
- H Haage
- Referat 316, Bundesministerium für Gesundheit, 53108 Bonn.
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Abstract
The reform of the education of doctors with the regulation for licensing of doctors (Approbationsordnung) of 27 June 2002 was a fundamental one. The results of the reform are a better practical training, a better link between theoretical and practical education, a better training in general medicine and a reform of the examinations. As a further result of the reform the additional practical training of 18 months could be abolished with the law from 26 July 2004. Now the universities must transform the regulation into practice and evaluate it. The universities must implement the federal regulation in their university educational regulations and in their day-to-day practice. The further changes in Europe, in the German regulations of specialisation and in the German health security system will create new needs for forthcoming reforms.
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Affiliation(s)
- H Haage
- Bundesministerium für Gesundheit, 53108 Bonn.
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Romano M. Disciplinary actions dropped in 2005. Group concerned that numbers don't accurately reflect physicians' records. Mod Healthc 2006; 36:32. [PMID: 16711238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
The so-called Bologna process was initiated by the political agreement of ministers of education of different European countries with the objective of creating a common European area of higher education. The content of the agreement was laid down in the declaration of Bologna. Despite lacking legal obligations the implementation of a two-cycle system and the realisation of a general framework for study courses and graduation gained rapid dynamism. Parts of the Declaration of Bologna are without controversy, for example the promotion of mobility by overcoming obstacles to the freedom of movement within the European Union. The structuring of university studies in an undergraduate and a graduate cycle (bachelor/master) may make sense for some study courses but it would be a disaster for medical studies. Not only that the integrative efforts laid down in the new regulation of basic medical studies would be reversed. Much more alarming is the fact that, against the background of a lack of physicians and financial shortages, the two-cycle system would favour the trend to fall back on graduates of paramedical studies in order to ensure medical care. Last but not least the one who has to suffer for it would be the patient.
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Affiliation(s)
- S Katelhön
- Auslandsdienst, Bundesärztekammer, Herbert-Lewin-Platz 1, 10623 Berlin.
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Strauss B. [Selection of medical students by medical faculties. Problems and advantages for universities]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:344-50. [PMID: 16523324 DOI: 10.1007/s00103-006-1238-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Due to the amendment of the framework act for higher education in summer 2004, the German universities have to select 60% of the students within all disciplines with limited access (including medicine) by themselves. This requirement fits with the political intention to enhance the achievement of a specific profile and competition among the universities. The first implementation of the legal requirement has shown that the universities were insufficiently prepared to apply selection criteria amending high school grades. Theoretically, a variety of criteria could be considered whose suitability has to be evaluated carefully. Existing evidence related to these criteria is summarized in this article. The implementation of new tools for student selection will raise a variety of problems related to the quality of organisation, but also other aspects of quality assurance. It can be assumed that, in the long run, centrally developed tests will be applied within medicine that might be completed with other selection tools locally.
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Affiliation(s)
- B Strauss
- Institut für Medizinische Psychologie, Klinikum der Friedrich-Schiller-Universität Jena, Stoystrasse 3, 07740 Jena.
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Lohse CM. Readers' response to "Time to reform physician relicensure". MedGenMed 2006; 8:63; author reply 64. [PMID: 17427299 PMCID: PMC1868333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Romano M. Getting tougher. Punishments by state medical boards up nearly 20%. Mod Healthc 2005; 35:4. [PMID: 15852766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Hoegerl C. Kudos on electronic-only COMLEX-USA. J Am Osteopath Assoc 2005; 105:124. [PMID: 15863728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Johnston S. Medical training in Canada. Can J Rural Med 2005; 10:183. [PMID: 16079036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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