New Clinical Skills Center

The new Clinical Skills Center on the third floor of Volker Hall boasts 20 patient examination rooms outfitted with exam tables, diagnostic equipment, and unobtrusive ceiling-mounted cameras that allow faculty and evaluators in a central viewing room to assess medical students' clinical skills.

Objective structured clinical exams (OSCE), simulated clinical encounters that use standardized patients to test students' history taking, physical examination, and communication skills, have been part of UAB undergraduate medical education since 1985, Introduction to Clinical Medicine Program Director Pat Norton, EdD, says.

"Before the new center, we conducted OSCEs anywhere we could find space — at the VA, on the coliseum concourse in Tuscaloosa, even in an abandoned pharmacy," she says. "We are thrilled to have a permanent, state-of the-art facility."

The Step 2 component of the United States Medical Licensure Examination (USMLE) now includes an OSCE-type assessment, called the clinical skills exam (CSE). The graduating classes of 2005 are the first who must pass the CSE as part of licensure requirements. Since 1998, the Education Commission for Foreign Medical Graduates has required that medical school graduates from other countries pass a similar exam to ensure minimum proficiency in patient interaction.

Not all medical students are happy about the new licensure requirement. A recent Medscape editorial by two fourth-year Harvard students noted that while OSCEs provide detailed feedback and are generally considered valuable by students, many feel the pass-fail CSE provides "no helpful information of any kind" and "adds little to education or training at [a cost of ] over $1,000 per student." Med Gen Med. 2005;7(2) is available at medscape.com/viewarticle/503527.

"The USMLE CSE is designed to evaluate three areas of proficiency for medical licensure that are not tested in other licensing exams. These are integrated clinical exam skills, communication and interpersonal skills, and spoken English proficiency," Roger L. Berkow, MD, professor and vice chair of pediatrics and assistant dean for clinical education, says.

"The exam was developed to demonstrate to the public that physicians who obtain a license are competent in these important skill areas. Student discontent with the exam is understandable as the cost is high and students must travel to take the exam. In the end, the public benefits by having confidence that physicians are skilled, not only in the knowledge of medicine, but also in the clinical application of that knowledge."

Despite any perceived shortcomings, students need to be prepared for the requirement, which can be anxiety-provoking. "The new skills center gives UAB medical students a competitive advantage for this high-stakes, expensive exam," Dr. Norton says.

The center also is available for teaching activities for residents and others, she says. "Six of our exam rooms have video playback capabilities, making them ideal for educational programs. We hope to expand the center's activities, and that requires more standardized patients — we're always on the lookout for people who are interested in helping train the physicians of the future."

Standardized patients are paid $10 an hour for training and testing time. Interested individuals aged 18 to 70 years should contact Dr. Norton at pnorton@uab.edu.