the pursuit of parkinson's - The University of Alabama at Birmingham

New Licensing Requirements
STAYING AHEAD OF THE CURVE
By Dawn Mesa
In 1968 the Federation of State Medical Boards
(FSMB) and the National Board of Medical
Examiners (NBME) got together to create the
Federation Licensing Examination (FLEX),
which remained the national standard by which physicians
became licensed to practice medicine in the
United States until 1994. At that time, the FSMB and
NBME integrated a new three-part examination
known as the United States Medical Licensing
Examination (USMLE) to replace the FLEX as well as
the certifying exams of the NBME.
ADDRESSING CONCERNS
More recently, both the FSMB and NBME voiced
concern that the three written tests that make up the
USMLE weren’t adequately testing the clinical skills,
professionalism, and communication abilities of medical
students. To address this problem, a new component—the
Clinical Skills Examination (CSE)—was
added to the second part of the USMLE in early
2003. This action was taken in response to extensive
research showing that poor physician communication,
interpersonal skills, and clinical skills are directly
related to a higher incidence of malpractice suits, as
well as poor patient compliance and lower rates of
patient satisfaction. The CSE is scheduled to be rolled
out in 2004 and will be required for the class of 2005
and subsequent years.
“The UASOM participated as a subcontractor for
the NBME when they were developing the CSE,” says
Dennis W. Boulware, M.D., FACP, senior associate
dean of medical education. “We were a beta site; we
knew how the cases were going to be constructed, we
knew what they wanted, and we put our students
through it and added our own cases to see how the students
were doing and how—consequently—our curriculum
was doing.”
FROM VOLUNTARY TO MANDATORY
Before anyone could have predicted such a development,
the UASOM had already instituted its own exam
to test the clinical skills of its medical students. Known as
the Objective Structured Clinical Examination (OSCE),
the exam was a voluntary effort for senior students when
it was introduced in the early 1990s. The senior OSCE
became standard in 1994 when the UASOM decided to
make passing it a requirement for all graduates beginning
with the class of 1997.
Once the exam became mandatory at the UASOM,
it became necessary to centralize the location of the
test’s administration. After several years of students
from the Birmingham and Huntsville schools having to
travel to various locations in Tuscaloosa for the exam, it
was moved to Birmingham in late 2003—and space
was designated specifically for administration of the
OSCE. Housed on the third floor of Volker Hall, the
space consists of 20 exam rooms, each of which is
designed “in much the same manner as exam rooms
found in a typical physician’s office,” notes Boulware.
An OSCE is administered several times a year. First- and
second-year students take the test early on as part of the
Introduction to Clinical Medicine course; and fourth-year
students take it as a “high stakes” exam, since they must
pass it to graduate from the UASOM. According to
Boulware, each fourth-year student being tested must
rotate through 10 stations—or “patients” in exam rooms
who’ve been trained in what to disclose for purposes of
diagnosis and what to keep in mind in evaluating the student’s
contact with them. The entire process is videorecorded.
“Each ‘patient’ completes a checklist for each student;
the checklists are then scored and later evaluated to
see that the student meets the criteria necessary to pass,”
says Pat Norton, Ed.D., director of the standardized
patient content and administration of the program. The
senior OSCE is managed by Roger Berkow, M.D., assistant
dean for clinical curiculum, who chairs a faculty
OSCE committee.
Given the fact the national CSE will soon be required
for all medical students, the UASOM will need to
rethink how it administers and counts the OSCE
toward graduation. “When the new USMLE requirements
go into effect, we may change the UASOM’s
requirements so that students have to pass our OSCE
but have to take the CSE as well. Afterward, when we
can compare the results, we may even end up changing
ours so that students need to pass the national CSE to
graduate from the UASOM, but use our OSCE to help
them get ready for that exam,” Boulware says.
(Top and bottom) First-year
UASOM students took part in the
introduction to clinical medicine
test in the newly renovated space
in Volker Hall on October 25.
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