Friday, April 22, 2016

An objective national standard for clinical skills is critical. Heres why.

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How do you learn to be a good doctor? Sure, you study anatomy, and make flashcards, and memorize nerve pathways, but what makes someone a good doctor is the way they apply all that knowledge to real patients with compassion and diagnostic expertise. Strong “doctoring” skills, like listening carefully, taking a comprehensive history, explaining medication and treatment options clearly and patiently, and writing notes that colleagues can understand, are what add the art to the science of medicine.

In my role as Senior Associate Dean for Graduate Medical Education and Accreditation at the Medical College of Wisconsin, I see firsthand just how important it is to train our students in all of these critical skills. But we can’t just show them, we have to make sure they can demonstrate their competence in all aspects of a physician’s role, so that wherever they match, whoever they work with, they can be sure that they share the same baseline of knowledge and know-how.  That’s where the USMLE comes in. None of us looks forward to an expensive series of high-stakes exams, but those exams are there to protect the public, and to ensure that all of our future colleagues will have the required skills and judgment we can rely on, and are practitioners we would entrust with our own families if need be.

In the past several weeks, a group of Harvard medical students have launched the “End Step 2 CS” campaign, an effort to do away with the portion of the U.S. Medical Licensing Exam that tests clinical and communications skills in a hands-on, day-long clinic simulation using standardized patients.  The students cite the test as being too expensive and too inconvenient, and having little proof that the exam improves practice. While I sympathize with the burden felt by students who already carry the much greater weight of their medical school costs, their petition fails to recognize a point of critical importance: Not only is the Step 2 CS exam a necessary public safeguard, it has greatly strengthened the curriculum of medical schools nationwide.

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