Global Health: Answering AIDS Molecular Genetics: Myelin Cells Reveal Unexpected Genealogy Toxicology: Cause Described for Botched DNA Repair Leadership: Administrative Changes Underscore Scientific Opportunities for Harvard Medicine Memory T Cell Test Distinguishes Type 1 Diabetes Poor Working Mothers with Family Health Problems More Likely to Lose Jobs Speech and Music Conveyed by Different Parts of Sound Wave Proceedings of the HMS Faculty Council Gimbrone to Keynote Soma Weiss Research Day Health Sciences and Technology Holds Bioinformatics and Genomics Seminar Series Primate Center Completes New Animal and Veterinary Facility Symposium Shows Biomedical Research Imaging Technologies In Memoriam: Merton Bernfield Harold Chandler Angelo Eraklis Vladimir Fencl Charles Weingarten Honors and Advances News Briefs Clinical Skills: Toward Meeting National Standards Locally Front Page

Clinical Skills: Toward Meeting National Standards Locally Photo by Jeff Cleary It's that time of year again: trees are budding, daffodils are bravely blooming despite the mercurial New England weather, and 50-degree days are becoming more and more common. Spring has arrived and with it, familiar to this and other medical campuses, a phalanx of boards-studying second-years. Forget spring fever. These boards-driven students, armed with note cards, wacky mnemonics, and the ever trusty First Aid for the Boards, spend most of their waking hours hunched over diagrams of the essentials of purine metabolism and the like in preparation for the Boards Step 1 exam. Current schoolwork is (nearly) forgotten as students try to memorize, relearn, or learn for the first time most of the "important" concepts of the preclinical years. With this assessment looming as a requirement for clinical rotations, many students ease the pressure by complaining that the test, which seems to focus on a great deal of minutiae, does not predict how they will do on the wards and does not test the clinical skills they have been gaining--skills that are a foremost concern for many rising third-years. Of course, at HMS, there is the Objective Structured Clinical Examination (OSCE), which serves to test incoming third-years' clinical skills, as well as the comprehensive examination for new fourth-years. Nationally, however, there is no test that standardizes clinical skills for medical students. The National Clinical Exam Recognizing this problem, the National Board of Medical Examiners (NBME) has begun trial studies to institute what will become, in mid-2004, a national standardized patient examination following Step 2 (www.nbme.org/research/ spupdate.htm). This isn't an entirely new phenomenon for the NBME. A similar test with standardized patients has been utilized for licensing foreign medical graduates for the past several years. At this point, the preliminary plan is for the new exam to have a minimum of 10 standardized clinical situations lasting about 30 minutes each, for a total exam time of five to six hours. The plan is to administer the exam to the class of 2005 near the start of their fourth year of training. The logistics of taking the exam have not yet been fully established; however, it seems most likely, based on preliminary information from the NBME, that the test will be given at five to six sites across the country and will cost around $1,000, not including travel and lodging. At first glance, the test seems to be a reasonable step. But a controversy surrounding the new exam, besides the cost, centers on the issue of redundancy. Like HMS, many medical schools already have clinical skills examinations that are required prior to graduation or clinical rotations or both. These schools have designed curriculum, trained standardized patients, and set aside faculty and staff time to coordinate the exams. Given that many schools already have these assessments, it would seem a viable alternative to make clinical-skills examinations an accreditation issue, validating student skills by evaluating existing medical school assessments against NBME standards. The NBME is now considering using medical schools as "supplemental test sites" in order to deal with some of the redundancy issues, but whether this means utilizing a school's standardized patients, exam rooms, or actual curriculum is unclear. Student Preparation Of course, medical schools without a formal clinical-skills assessment might find it more convenient to participate in a national NBME program. Yet they, too, will likely have to revamp their curriculum in order to prepare students for the national exam and may very well end up designing new curriculum and training standardized patients, mirroring the national exam. Overall, although the new clinical evaluation is symbolically important because it introduces a set of national criteria for clinical skills, focusing an accreditation process on clinical-skills assessments at medical schools may be a better way to both standardize student skill levels and utilize existing school programs. Otherwise, the new exam may be just an added expense for students whose skills are already well vetted by their academic institutions. --Tarayn Grizzard, a second-year medical student at HMS