Standardized Patients & the Clinical Skills Exam (CSE)

This morning we had our monthly Clinical Skills Exam Committee meeting. For students & faculty who are not familiar, this group is tasked with reviewing all the Standardized Patient and Clinical Skills that are assessed throughout the 4 years of medical school. In the first 2 years in POM (Practice of Medicine), students are involved in multiple formative SP encounters where they practice the art of History taking and Physical Exam skills. There are also summative SP encounters called CCEs where students do the entire H&P encounter, and write a Post Encounter note in the NBME format similar to what students will do during the USMLE Step 2 CS exam they take in the 4th year of medical school.

Students take formative and summative Standardized Patient Encounters (SPE) in each of the required 3rd year clerkships in a similar format, but with more time constraints than in the first 2 years. Lastly, at the end of 3rd year, all Upstate students are expected to take a high stake Summative Clinical Skills exam we refer to as the CSE (Clinical Skills Exam). Utilizing all the clinical skills they've obtained in the first 3 years, they go through each case, get scored on their History & Physical, Communication Skills, and Post-Encounter Note (again in the NBME Format). Again, this is similar to the USMLE Step 2 CS Format, and students are required to pass this in order to graduate.

To make a long story short, the CSE Committee this morning is in the process of reviewing each of the cases used in the summative CSE exam, as well as each SPE encounter that students do in the Clerkship. Each case scenario, checklist, and evaluation from the previous year is scrutinized by the committee and changes are made to the next year exam. So we take this task and exam quite seriously, and invest quite a bit of time into this process!

There is a saying that 'assessment drives teaching' and in this case, we hope to have CSE assessment as a culmination of what our students have learned and should be able to do before graduation from our medical school. Emphasis and gaps in our teaching can often be seen when we analyze the results of these exams annually. As we move towards Core Entrustable Professional Activities for Entering Residency (CEPAER), a list of expectations for graduating medical students, we hope to incorporate more of these skills and assessment into our CSE exam.

-Paul