Starting this year, medical school students will need to pass a new $975 exam in order to receive their license. In mid-2004, the National Board of Medical Examiners will introduce the Step 2 Clinical Skills Examination to the United States Medical Licensing Examination.
This one-day test is designed to be similar to a physician's typical workday in a clinic. Each medical student will examine 10 "standardized patients" -- people trained to act like real patients -- for 15 minutes each, according to the NBME's Web site.
During the 15 minutes, the medical student has to be able to obtain the patient's medical history relating to the ailment, give a sharp physical examination and answer the patient's medical questions.
After the examinations, the student has 10 minutes to record the patient's medical history and prescribe a proper diagnosis and methods for the patient's future treatment.
The new exam will only be offered at five cities in the nation, requiring students to pay travel expenses in addition to the cost of the exam itself. Luckily for Penn students, one of the five cities is Philadelphia.
Many medical schools, including Penn's, already require clinical skills for graduation, but each medical school prepares, administers and scores their students for the clinical exam differently.
The Clinical Skills Test will set a national standard for all potential doctors.
NBME Senior Vice President for Assessment Programs Peter Scoles predicted in July in the Summer Pennsylvanian that the CSE "will remove from practice 75 to 125 people per U.S. graduation year who lack even the basic abilities to speak with patients and gather information."
The new test has been met with criticism from the American Medical Association. They see the $975 exam as an overwhelming expense to the already financially burdened medical students.
Speaker of the AMA House of Delegates, Nancy Nielsen explained her position on the topic.
"An exam that measures a medical student's clinical skills is a good thing," Nielsen said in the SP. "We don't think it should be a part of licensure."
The test can only be taken at certain test sites in Los Angeles, Chicago, Philadelphia, Atlanta and Houston.
For students who do not live in these areas, the traveling expenses place another obstacle in their pursuit of a doctoral degree. This obstacle has nothing to do with their knowledge in the field of medicine, but depends on the cash in their pocket, the AMA argues.
The new test has been met with support from the Medical School's Vice Dean for Education Gail Morrison.
"This forces medical schools to be sure that [clinical training is] within their curriculum -- if not, those students are not going to pass," she said.
Morrison's confidence is bolstered by the fact that Penn's Medical School has had a standardized patient program similar to the one now being required in place since 1997.
Penn had exceptional test scores as a test site for the Clinical Skills Test, Morrison added.
John Jung, a current Medical School student and vice chairman of policy for the executive board of the Graduate and Professional Student Assembly, said he believes that the two years of on-site hospital training required for medical students well prepares them for becoming licensed physicians.
Jung has had rotations for almost two years at a local outpatient facility.
"Seeing fake patients when you have already seen real ones is redundant," he said. He went on to say that a medical student with sufficient on-site hospital experience would know that the "standardized patients'" symptoms are not genuine.
"I think all students would agree to study with actual clinicians in actual clinical situations," said Jung.
Morrison said that the usefulness of hospital experience depends on "how many faculty you have in a school to monitor the students."
"The big problem is the cost of the test."
Morrison believes this is the main reason why medical students are complaining about it.
She added that when the test was being developed a few years ago, most people believed it was not going to cost much.
The new testing facility in Philadelphia should be open next spring near 40th and Market streets. Only two of the five projected sites are near completion.
The NBME will have a meeting in November to announce the starting dates of the Step 2 Clinical Skills Examination.
