Miriam Friedman

Scoring and Standard Setting with Standardized Patients

The purpose of this study was to compare the continuous method of scoring a performance test composed of standardized patients with a derivative method that assigned each examinee a dichotomous score and to explore the use of Ang off s method at the case level with these two scoring methods. Both scoring systems produced reasonable means and distributions of scores. The continuous scores were somewhat more reproducible than the dichotomous scores although neither was very relay?ducible. Pass rates for both scoring systems were appropriately very high and thus the reproducibility of the pass/fail decisions was also high. Regardless of the scoring system, the application of Angoffs method reported in this article has the advantages of efficiency and enhanced credibility to the experts.

The relationship of spoken-English proficiencies of foreign medical school graduates to their clinical competence

No abstract available.

Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates

&NA; PURPOSE. To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS. In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first‐year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken‐English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first‐year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION. The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.

The use of a patient note to evaluate clinical skills of first-year residents who are graduates of foreign medical schools.

No abstract available.

International use of standardized patients

The Educational Commission for Foreign Medical Graduates (ECFMG) Clinical Competence Assessment (CCA) study established the reliability, validity, and feasibility of the ECFMG CCA with graduates of medical schools in 50 countries around the world in U.S. residency programs. The first pilot project provided a profile of clinical competencies of graduates of foreign medical schools for a residency program director. The ECFMG CCA is now being introduced in pilot projects outside the United States to address the needs expressed by ministries of health, organizations, and institutions in several countries. A bank of globally relevant cases is being assembled. The separate pilot projects will be modified by the development of cases with medical faculty members of each country to establish a regional context. It is hoped that the pilot projects will ultimately result in the establishment of global standards for the use of all nations to meet their individual and collective needs.

A preliminary study of the validity of scores and pass/fail standards for USMLE steps 1 and 2.

No abstract available.

Influence of Candidates' Test Selection on Pass Rates on Examinations for Certification by the Educational Commission for Foreign Medical Graduates.

BACKGROUND. Parts I and II of the National Board of Medical Examiners (NBME) examination were first offered to graduates of foreign medical schools in 1989 as an alternative to the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS). This study was designed to determine whether differences in pass rates and scores were related to differences in the populations selecting one or the other examination. METHOD. (1) Combined pass rates on the FMGEMS and NBME in 1989 and 1990 were compared with pass rates in previous years. (2) The proportion of NBME takers in 1989 was compared with the proportion in 1990. (3) Respective pass rates on the FMGEMS and NBME in the first NBME administration in 1989 were compared with pass rates in 1990. (4) The percentage of repeaters taking the FMGEMS was compared with the percentage taking the NBME in 1989 and 1990. (5) The distribution of repeaters by number of previous takes was compared between the FMGEMS and NBME in 1989 and 1990. RESULTS. (1) Combined pass rates were similar to the pass rates of previous years. (2) The proportion of NBME takers declined in 1990. (3) The pass rates for the FMGEMS were higher in both 1989 and 1990, but the difference in pass rates between the two examinations narrowed in 1990. (4) The percentage of repeaters taking the NBME was high in 1989 and declined in 1990. (5) The number of previous takes among repeaters was higher for the NBME than for the FMGEMS in 1989 and became equal in 1990. CONCLUSIONS. Some students probably opted to take the NBME in 1989 in the belief that it might be easier than the FMGEMS, resulting in lower pass rates for the NBME. The NBME pass rates rose in 1990 after the differential pass rates had become public.

The Globalization of Medical and Dermatologic Education

The world is rapidly becoming a global community with similar patterns of living and working and similar problems to address.1 These changes have an impact on how medicine is practiced, with a resultant need to redefine the goals and methods of medical education. Health care needs are international, and many diseases are rapidly becoming global in distribution.2 The universal availability of advanced technology further contributes to the globalization of health care. International collaboration in biomedical research has been long-standing, partly related to global research technology.3 Similar comments can be made about health care delivery systems.4