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Summary of 11-8-01 CME Minutes 

  1. Dr. LaManna welcomed former CWRU faculty member and medical student Alan L. Hull, M.D., Ph.D., who is now Director of the Center for Medical Education, Research, and Development at the Cleveland Clinic.  Along with Dr. Andrew Fishleder (Chairman for the Division of Education at the Cleveland Clinic), Dr. Hull is a welcome guest at CME meetings as the Clinic pursues its initiative to establish a College of Medicine.
  2. Flexible Program Update by Dr. Charles Malemud, Associate Coordinator
    Dr. Malemud distributed a handout compiled with the help of Registrar Mr. Joseph Corrao, listing the Ten Most Popular Type A Electives in 2000-2001 (based on number of students taking them).  They reflect a definite trend toward clerkship preparatory electives.  There are 164 Type A electives listed in the CWRU School of Medicine Flexible Program Catalog.  We need to devise a record keeping system to compute total number of students taking basic science electives.  The many value-added basic science electives do not appear on the “most popular” list, because they are unique and tailored to the one or two individuals that take them.  In addition, there are many Type B electives, but currently we do not have an exact count; a significant number of Type B electives take place away from CWRU.  The Flexible Program is trying to come up with a strategy to evaluate the effectiveness of the electives.  One of the immediate goals before the Flexible Program is improvement in the record keeping of electives taken, a better accounting strategy.
  3. Dr. LaManna welcomed back former CWRU faculty member and CME chair, Peter V. Scoles, M.D., now Vice President for Assessment Programs at the National Board of Medical Examiners.  Dr. Scoles conducted a two-part presentation:  1) CWRU USMLE Performance, and 2) USMLE Standardized Patient Clinical Skills Examination Update.

CWRU USMLE Performance

  • Percent of CWRU first-time test-takers passing the USMLE Step 1 has been at or above the national averages consistently since 1993.
  • Percent of CWRU first-time test-takers passing the USMLE Step 2 during the 1992-2001 period has been consistently above the national performance.
  • CWRU USMLE Step 3 Aggregate Score performance for 1998-2000 is higher than national pass rates for both first-time test-takers and repeat test-takers.  (The data will always focus on the last three years.)
  • Revisiting minimum passing scores every three years in order to maintain an equivalent level of difficulty has resulted recently in raising all standard score thresholds.  In the opinion of experts, what was once “cutting edge” is now considered mainstream.  The USMLE Step 1, 2, and 3 passing scores were revisited during a one and one-half year period between 2000 and 2001 and raised.  These are the new pass marks:

USMLE Step 1            182

USMLE Step 2            174

USMLE Step 3            182

Concern was expressed among discussants over the USMLE Step 1 96% CWRU pass rate in 2000 declining to a 90% CWRU pass rate in 2001.  Dr. Scoles explained that the bar has been raised in determining physician standards for minimum competency.  These judgments are made by people who are not medical school faculty.  Discussants noted that CWRU students perform better on our own Year I comprehensive exam than the 90% pass rate.  A 10% failure on the USMLE Step 1 may indicate that the Step 1 contains material that we do not cover in our curriculum.

USMLE Standardized Patient Clinical Skills Examination Update

  • Rationale:  Fundamental clinical and communication skills are essential for physicians and represent a domain distinct from cognitive skills and therefore merit a separate uniform test.

  • Purpose of clinical skills examination:  to insure that potential physicians have the clinical, interpersonal, and communication skills necessary to begin supervised medical practice

  • Precedents:  The Educational Commission for Foreign Medical Graduates (ECFMG) and the Medical Council of Canada (MCC) currently require satisfactory completion of standardized patient clinical skills examinations for certification or licensure.

  • Description of exam:  5-6 hours in length, 10-12 cases (each case a 12-15 minute patient encounter) followed by a 10-12 minute interval where a student prepares a SOAP note.  (Subjective/Objective Assessment and Plan note contains history and physical examination findings, diagnostic impressions, and management plans.)  Each case to assess clinical, interpersonal, and communication skills of the student.  Standardized patients to complete assessment instruments; however, students’ notes to be independently evaluated.

  • Projected delivery models:  4 to 6 continuously operating fixed sites in different geographical regions

  • Projected cost of clinical skills assessment exam ranging between $950 to $1,000

  • Tentative timetable:  The NBME and ECFMG are collaborating on the development of the USMLE Standardized Patient Clinical Skills Exam.  They plan to begin to conduct pilot tests in the summer of 2002.  Official start date targeted for 2004 for the Class of 2005 (our current first year students).  Exam to be taken between the middle third of Year III and the end of Year IV.

  • Reporting of test results:  If the clinical skills exam becomes part of the USMLE, then it will be required for licensure.  Results of licensure examinations need to be reported as a score—they cannot be “pass/fail.”  No final determination has been made as to how test results will be reported.

  • Current status:  At this time, the dates for implementation of live test administration, the number and location of test centers, and the cost of the examination have not been established.

See Curriculum Revision Update

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This page was last updated on 12/12/01 by John Graham.

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