Donald E. Melnick

Computer-Based Clinical Simulation State of the Art

CBX, a clinical simulation model developed by the National Board of Medical Examiners, was studied as an evaluation instrument. These studies show that CBX measures need not be influenced by prior experience with or anxiety about computers. However, a practice effect was observed that was independent of prior computer experience or anxiety. Complex sets of actions can be recorded and used in developing scores. Scores developed for CBX differentiate among physicians at different levels of training. They correlate modestly with multiple-choice question tests and written clinical simulations. Computer-based simulation systems like CBX could become valuable methods for the study and assessment of problem-solving and patient management skills of physicians.

Licensing examinations in North America: Is external audit valuable?

The United States and Canada both have long-standing, highly developed national systems of assessment for medical-licensure based outside the institutions of medical education. This commentary reviews those programs and explores some of the reasons for their implementation and retention for nearly a century. The North American experience may be relevant to dialog about national or European assessments for medical practice.

Commentary: Balancing responsibility to patients and responsibility to aspiring physicians with disabilities.

In 2008, Congress amended the Americans with Disabilities Act (ADA) to relax court-imposed limitations on evidence required to warrant protection under the ADA. Since passage of the ADA in 1990, medicine has focused not on evaluating the types of accommodations that would best balance the interests of individuals with disabilities, institutions, and patients but, rather, on the question of whether individuals seeking protection under the law qualify for disability accommodations at all. The medical profession should refocus on the nature of accommodations provided to those with disabilities. In doing so, the intent to support disabled persons seeking careers in medicine must be balanced with ethical obligations to protect patient welfare. Medical schools, graduate medical education programs, licensing and certifying authorities, and assessment organizations should work together to establish evidence-based minimum criteria for the physical and cognitive capabilities required of every physician.

Reevaluation of Medical Education A Behavioral Model to Assess Health Promotion/Disease Prevention Instruction

More than half of graduating seniors rate their curricula inadequate in health promotion and disease prevention (HPDP) topics, and available data suggest that current medical school curricula turn students away from career choices that foster prevention. Data are needed to show that prevention education works to encourage students to pursue HPDP in practice and thus support greater emphasis on prevention in medical school curricula. This article presents a model that relates health promotion and disease prevention education to desired characteristics of medical school graduates including knowledge and sense of ability in HPDP, specialty preference, and residency choice, while accounting for other factors that influence those characteristics. The model willfacilitate evaluation ofprograms by using NBME, AAMC, and other standardized datasets and may be used to find exemplary programs from among experimental efforts in U.S. medical schools and to evaluate their replication.

Quality, Cost, and Value of Clinical Skills Assessment

The introduction of the Step 2 Clinical Skills program to the United States Medical Licensing Examination was a vital step in assuring that physicians seeking a license to practice medicine in this country demonstrate the patient-centered skills that are essential to practice.

Conceptual Perspectives: Emerging Changes in the Assessment Paradigm

Standardized testing and methods, such as the use of multiple-choice questions (MCQs) introduced in the 1950s, have undergone progressive development and refinement over the years but have also fed an increased realization that the focus of education and assessment has rested more on factual knowledge and problem solving and less on proficiency in the real-world application of those and other skills and behaviors in the daily run of settings that constitute the workplace. Emerging trends in assessment in the workplace setting is the focus of this chapter and the authors examine parallels across professions. While competence testing that predicts aspects of performance will undoubtedly continue and be further refined, explicitly designed performance assessment holds considerable promise for contributing to improvements in healthcare delivery. Measurement in other related and essential domains such as communication skills, professionalism, teamwork, leadership, and cultural sensitivity has lagged, yet researchers and practitioners increasingly have begun to explore assessment of such areas more systematically. The introduction of comprehensive measurement methods for both competence and performance across the full spectrum of knowledge, skills, and behaviors highlights the need for tighter coordination of the processes of education and assessment.

In Reply to Mehta et al and to London et al

We appreciate the letters in response to our recent Commentary.1 We hope that our Commentary and this exchange continue to stimulate others to consider strategies that enhance medical education while clarifying the role of standardized testing in the holistic review of applicants for residency. A br