CLINICAL SKILLS ASSESSMENT (CSA) Part II

Communication Skills Rating Scale The following scale is used by the SPs to rate your communication skills performance. A rating scale is completed for each of the eleven stations. Item 1. Skills in Interviewing and Collecting Information (clarity of questions; open vs. closed questions, verification, summarization, transitions) Unsatisfactory
Marginally Satisfactory
Good
Excellent 1
2
3
4 Item 2. Skills in Counseling and Delivering Information (giving information, counseling, closure, language and speech, summarization and connection) Unsatisfactory
Marginally Satisfactory
Good
Excellent 1
2
3
4 Item 3. Rapport (connection between doctor and patient) (attentiveness, body language, confidence, attitude, empathy and support) Unsatisfactory
Marginally Satisfactory
Good
Excellent 1
2
3
4 Item 4. Personal Manner (hygiene, draping, physical examination, demeanor, introduction) Unsatisfactory
Marginally Satisfactory
Good
Excellent 1
2
3
4 Item 5. Spoken English Proficiency (ability to communicate understandably, pronunciation and grammar, amount of effort required by patients to understand you) Low Comprehensibility
Medium Comprehensibility
High Comprehensibility
Very High Comprehensibility 1
2
3
4 Back to Contents General Information on Scoring and Score Reporting Overview In order to pass CSA, you must pass pre-defined performance standards set by medical experts in two separate components. The first component, called the Integrated Clinical Encounter (ICE), is a combination of the Data Gathering (DG) and Patient Note (PN) scores. The second component, Communication Skills (COM), is derived from the SP evaluations of interpersonal skills and spoken English language proficiency. You will have eleven patient encounters, ten of which will be used to derive your scores. Scoring Components Data Gathering (DG) Using the history taking and physical examination checklists, the SP documents your ability in each station to gather data relevant to the clinical encounter. Your DG score for a particular encounter is the percentage of checklist items that you were given credit for in the history taking and physical examination. The SP does not evaluate your medical performance, but simply documents whether or not you successfully obtained relevant information or correctly performed the case-specific physical examination maneuvers. Your final DG score is the average of your DG scores over ten CSA encounters in the assessment form. Patient Note (PN) Following the encounter with the SP, you will be required to complete a patient note. Physicians are trained to rate these notes based on predefined criteria that include: organization;
quality of information;
interpretation of data;
egregious/dangerous actions;
legibility.
Your final PN score is the average score you earned across the ten scored exercises. Integrated Clinical Encounter (ICE) Score The DG and PN scores are combined to form an ICE score. Your final DG and PN scores reflect your average performance across ten scored encounters. Therefore, you may compensate for poor performance in one encounter with excellent performance in another. Communication Skills (COM) Following each encounter the SP will also evaluate your COM skills along five dimensions: interviewing;
counseling and delivering information;
rapport;
personal manner;
spoken English proficiency.
For each of these dimensions, the SP assigns a score. SPs make these evaluations according to a scoring system that is fair, consistent and objective. Your COM score for the encounter is the sum of the five COM dimension scores. Over the ten scored encounters, the average of these COM scores makes up your final Communication score. Your score must meet or exceed a performance standard predefined by physician experts. Score Reporting An overall pass/fail designation will be reported to you six to eight weeks after your CSA administration. ECFMG reserves the right to delay the reporting of CSA pass/fail designations if additional data and/or analyses are required to assure the validity of the assessment scores. Candidates who pass the standards on both the Communication and Integrated Clinical Encounter components will receive a "PASS" designation for the CSA. Substandard performance on either the Communication or the Integrated Clinical Encounter component will result in a "FAIL" designation. To avoid misinterpretation and to protect your privacy, CSA results will not be provided by telephone, facsimile, or E-mail. Score Rechecks Standardized procedures ensure that your scores are an accurate reflection of your performance, so a change in your CSA pass/fail designation based on a recheck is an extremely remote possibility. However, if you would like a recheck of your CSA designation, you must submit an Examinee Request for Score Recheck Form (Form 751) and payment for this service to ECFMG. The recheck will consist of recalculating the component scores on which your CSA pass/fail designation is based. Please send your request to the following address: ECFMG
Attention: CSA Score Inquiry
3624 Market Street
Philadelphia, PA 19104-2685 USA The Day of the Assessment When you arrive at the CSA Center on the day of your assessment, please be prepared to present valid, government-issued photo identification and your admission permit. Arrive at the CSA Center no more than 30 minutes prior to your scheduled assessment. If you are traveling a long distance, consider arriving in Philadelphia at least a day before your CSA session. Please do not bring anything other than necessary personal items with you to the Center. Coat racks are available, and each candidate will be assigned a small open storage cubicle in which personal belongings must be stored during the assessment. However, these cubicles are not secure, and ECFMG assumes no responsibility for your personal items. Luggage cannot be accommodated, so other arrangements must be made for its storage during the assessment. We also have no waiting facilities for spouses, family, or friends, so please plan on meeting them elsewhere after the assessment. Wear comfortable professional clothing and a white laboratory or clinic coat. The only piece of medical equipment you need to bring is your stethoscope. All other necessary medical equipment is provided in the examination rooms. Throughout the assessment day CSA staff, who will be wearing identifying nametags, will direct you through the examination. Please follow their instructions at all times. Each assessment session will begin with an orientation. This on-site orientation is in addition to this manual and the videotape that ECFMG will send you when you are registered for CSA. The orientation will familiarize you with the equipment in each examination room and the nature of typical encounters. It is also intended to inform you about examination procedures and regulations. During the orientation, you will be asked to sign a confidentiality agreement. It stipulates that you, as a CSA examinee, will not reveal case information to anyone at any time. This agreement is a way to ensure that each examinee has the same opportunity as all others. If you disclose information to prospective candidates, there is no guarantee that the information you supply will aid them. In fact, it may confuse subsequent candidates because different sets of cases are used each day. In addition to the confidentiality agreement, there will be a demographic questionnaire for you to fill out before the assessment and a feedback questionnaire afterwards. The CSA Center is a secured facility. Once you enter the secured area of the Center for orientation, you may not leave that area until CSA has been completed. Since the assessment lasts approximately eight hours, two breaks will be provided. The first break is thirty minutes long and takes place after your fourth encounter; the second break is fifteen minutes long and occurs after the eighth encounter. At break time, you are free to relax, use the rest rooms, and have refreshments. A light meal will be served, and there are vending machines available for drinks. You may also bring your own food provided that no refrigeration or preparation is required. Smoking is prohibited throughout the Center. You cannot, during breaks or at any time, discuss the cases with your fellow candidates. Conversation among candidates in languages other than English about any subject is strictly prohibited at all times during these breaks. Examination proctors will be with you to monitor activity. To maintain security and quality assurance, each examination room is equipped with video cameras and microphones to record every encounter. Please conduct yourself as you would during a normal day in a clinic. Preparing for CSA History taking, physical examination, spoken and written English, and interpersonal behavior are all skills that can be improved by training, practice, and critique. You can refer to the multiple texts and other media sources that address these skills. Practice with colleagues, teachers, or mentors who would portray patients could be useful, provided such role-plays are realistic and represent common complaints. Perhaps the best preparation of all is to see actual patients in a real clinical setting, especially if this is done under the supervision and/or review of a competent clinical teacher. CSA is designed to simulate an actual clinical experience, so the more clinical experience you have, the more comfortable you will feel during the examination. You will find additional test-taking strategies in the videotape that accompanies this manual. The videotape gives more information on CSA and demonstrates a typical patient encounter. Test of Spoken English It is not required that you speak English comparable to that of a native speaker. However, if you are uncertain of your spoken English language proficiency, you are encouraged to take the Test of Spoken English (TSE?) as a screening test prior to registration for CSA. The TSE was developed by the Educational Testing Service (ETS) and is administered in a number of sites around the world. Studies indicate that candidates who obtained a score of 35 and lower on the TSE are not likely to pass CSA; however, a TSE score above 35 does not ensure passage of CSA. A TSE score of 35 represents a speaker who generally does not communicate effectively and cannot compensate for weaknesses in language. For information about TSE administration dates and locations, contact: TOEFL/TSE Services
P.O. Box 6151
Princeton, NJ 08541-6151 USA Telephone: 609-771-7100 E-mail: toefl@ets.org Internet: http://www.toefl.org/ General Comments Greet the patient and state your name.
Elicit or confirm the patient?s name.
Never attempt to communicate with the patient other than as a physician to a patient.
Feel free to take notes during the encounter. (Blank paper will be provided.)
Don?t make assumptions about what you will see in each encounter.
There may be more than one case testing related or similar clinical entities.
Concentrate on the case on which you are working.
Notify proctors of any problems.
History Taking Begin with broad questions and then focus your inquiries.
Don?t rush the patient?s answers.
Don?t cut the patient?s answer off with another question.
Repeat your questions in different terms if necessary.
Ask follow-up questions.
Physical Examination Do a focused examination based on the patient?s complaint, symptoms, and history.
Wash your hands between patients, preferably before touching the patient or beginning the physical examination.
Tell the patient when you are going to begin the physical exam.
Describe the maneuvers either before or as you do them.
Always use patient gowns and drapes appropriately to maintain patient modesty and comfort, but never examine through the gown.
Use the examination table extension when the patient reclines.
If you ask a patient to get off the examination table, offer to assist him or her.
Look for physical findings.
Do not perform rectal, pelvic, genitourinary, or female breast examinations.
Tell the patient your initial impressions and your plan for the diagnostic work-up.
Ask for and answer any additional questions.
Note the time warning for 5 minutes remaining in the encounter.
Close the encounter when the "End of Encounter" signal is given.
Communication Skills Make eye contact.
Ask clear questions and speak understandably.
If you use medical terms, explain yourself.
Be direct and honest, but also be sensitive.
If you don?t know the answer to an SP?s question, say so.
Don?t give false reassurance or a premature diagnosis.
Acknowledge the patient?s concerns or worries.
Patient Note Approach the note as if you are communicating with another health professional.
Write legibly.
If necessary, refer to the notes you took during the encounter.
Group similar data together.
Write out information in a logical sequence.
Clearly portray the patient problem.
Be accurate.
Be specific.
Identify critical elements.
Include pertinent positives and negatives.
Make sure your plans for further diagnostic work-up are reasonable.
Do not include treatment in your plans for diagnostic work-up.
Back to Contents REGISTRATION AND SCHEDULING Application Form Registration for CSA requires submission of the CSA application (Form 706). Form 706 is included in the ECFMG Information Booklet and may also be downloaded from the ECFMG web site at http://www.ecfmg.org. To register for CSA, you must complete Form 706 and send it, with full payment of the assessment fee, to ECFMG by mail (or courier service), following the mailing instructions on the application form. You cannot register by facsimile, letter, postcard or e-mail message. Detailed application instructions are included with the application form. Follow the instructions carefully and answer all questions completely. You should review the instructions before you begin working on the application. If your application is not complete or if the required fee is not submitted, it will be returned to you. Scheduling CSA To be registered for the CSA, you must first meet all eligibility requirements as listed in the appropriate edition of the ECFMG Information Booklet, submit a completed CSA application, and pay the current CSA fee. After you are registered, ECFMG will mail you a Notification of Registration for CSA. Once you receive this notification, you may schedule an assessment date. You should be aware of two windows of time relative to CSA registration. The first is the period of time in which you must schedule a date to take CSA. This period of time is four months from the date of your Notification of Registration. You must schedule an assessment date within this four month period. The assessment date does not need to be within this four month period, but the selection of a date must be completed within this time frame. The second window of time is one year from the date of your Notification of Registration. Within this twelve month period, you must come to the CSA Center in Philadelphia and take the CSA. Your Notification of Registration will clearly indicate the dates by which you must schedule and take the CSA. To schedule an assessment date, contact the CSA Scheduling Program. This can be done in either of two ways. You may telephone 1-215-970-1982 (Monday through Friday, 0800-2400 EST) to have an operator assist you with scheduling. You should be prepared to give your name, USMLE?/ECFMG identification number, and date of birth as it appears on your Notification of Registration. Remember that you will only be able to schedule if you have received official Notification of Registration. Have several preferred dates in mind, all within one year from the date of your Notification of Registration. The operator will indicate which dates are available. When an acceptable date is found, the operator will formally schedule you and give you a confirmation number. An admission permit will be mailed to you the next business day. Once an assessment date is scheduled, it cannot be canceled or rescheduled. You should also be aware that scheduling operators only assist in scheduling, and cannot answer any other questions or provide additional information regarding CSA or ECFMG. They will refer any such inquiries to the ECFMG Applicant Information Services at 1-215-386-5900. If you have access to the Internet, you may also schedule directly through the CSA Scheduling Program on the ECFMG Web Site at http://www.ecfmg.org/. If you choose to access the web site, you will receive step by step directions on how to schedule an assessment date. Again, be prepared to provide your name, USMLE/ECFMG identification number, and date of birth as it appears on your Notification of Registration. If you select an assessment date through the Internet, you will be given a confirmation number, and an admission permit will be mailed to you the next business day. You will be committed to that date. Assessment dates and sessions will be opened depending on demand. If no acceptable dates are available when you first call or access the web site to schedule, you may decide not to schedule at that time. You may check again later to find out if additional dates or sessions have opened. However, be aware that there is still a requirement to schedule an assessment date within four months from the date of your Notification of Registration. Every effort will be made to accommodate your scheduling preferences. However, due to the volume of candidates and limited Center capacity, ECFMG cannot guarantee the availability of specific dates you may request. It is the sole responsibility of the candidate to complete CSA in time to meet deadlines imposed by the National Resident Matching Program (NRMP) and/or GME programs. Since the number of candidates seeking to complete CSA may exceed the spaces available in time to meet those deadlines, there is no guarantee that sufficient spaces will be available for all candidates to meet deadlines imposed by NRMP and/or GME programs. ECFMG assumes no liability of any kind if a candidate does not complete CSA in time to meet NRMP and/or GME program deadlines. CSA Cancellation and Rescheduling Policies If a registered CSA candidate fails to schedule a CSA assessment date within four months of notification of registration, or fails to take the CSA within one year of that notification, the registration will become invalid and the assessment fee will be forfeit. Once scheduled, a CSA assessment date cannot be rescheduled or cancelled. Cancellation of a scheduled CSA will result in forfeit of the assessment fee, as will failure to appear on the date of a scheduled CSA. In either case a new application must be submitted with the full assessment fee. In extraordinary circumstances, appeals for exceptions to these policies will be considered on a case by case basis. Candidates wishing to appeal should contact ECFMG and request the CSA Scheduling Exceptions Appeal Form (Form 745) that contains instructions for completion, documentation and submission. Form 745 is also available on the ECFMG web site at http://www.ecfmg.org/. However, no consideration for cancellation or rescheduling will be considered within 30 days of the scheduled CSA date. Submit your appeal to the following address: ECFMG
Attention: CSA Scheduling Exceptions Appeals
3624 Market Street
Philadelphia, PA 19104-2685 USA CSA Center Location The CSA is administered only at the following location: ECFMG
3624 Market Street
CSA Center: 3rd Floor
Philadelphia, PA 19104-2685 USA Examinees with Disabilities The CSA Center is wheelchair accessible, and reasonable accommodations will be made for the administration of CSA to candidates with documented disabilities. For instructions on requesting test accommodations, refer to the Guidelines and Questionnaire for ECFMG/CSA Applicants Requesting Test Accommodations (Form 756). Such requests, including the completed Questionnaire, should be made as soon as possible, and must be received by ECFMG no later than the application for the CSA itself. Scheduling CSA means accepting ECFMG?s conditions for the assessment; therefore no requests for test accommodations will be accepted after scheduling has occurred. When the CSA is administered with test accommodations, performance reports and transcripts will not include any annotation that an accommodation was granted. Requests should be sent to the following address: ECFMG
Attention: CSA Test
Accommodations Committee
3624 Market Street
Philadelphia, PA 19104-2685 USA Back to Contents TEST REGULATIONS Irregular Behavior Since CSA is a high stakes examination which must be passed to receive ECFMG certification, ECFMG reserves the right to enforce necessary security measures to protect test materials and to ensure the integrity of the testing process. Irregular behavior includes any action, committed or solicited by a candidate, which subverts or could subvert the CSA examination process or the ECFMG certification process. Examples of such behavior include, but are not limited to: Falsification of information on the application form;
Failing to comply with any CSA policy, procedure, or rule while at the CSA Center;
Interacting with any standardized patients in an unprofessional manner and/or outside of that standardized patient?s given case portrayal, before, during or after the examination;
Entering restricted areas;
Leaving the test area unescorted by a designated CSA staff member;
Possessing and/or using recording devices;
Possessing and/or using study aids;
Conversing with other CSA candidates in any language other than English at any time while at the CSA Center;
Giving or receiving aid during the examination;
Disruptive behavior which affects other candidates, SPs, or ECFMG staff.
Seeking and/or obtaining access to examination materials prior to a test administration;
Impersonation of an examinee or engaging a substitute to take the examination;
Sharing information about any of the cases presented during the CSA;
Possessing unauthorized materials during an examination;
Making reference notes of any kind during the examination, except on the blank, numbered sheets provided;
Altering or misrepresenting examination scores;
Theft of examination materials;
Unauthorized reproduction and/or dissemination of copyrighted materials.
Instances of irregular behavior relating to CSA, whether in connection with applying for the examination or as reported by CSA staff or standardized patients, will be investigated and reviewed initially by CSA staff. Those instances where staff concludes that there is reasonable evidence of irregular behavior will be presented to the CSA Committee on Irregular Behavior. Any Committee finding of irregular behavior may be annotated on the CSA Performance Report and in the candidate?s ECFMG record. If, after due consideration, the Committee determines that the irregular behavior threatened the integrity of CSA or the ECFMG certification process, or affected the validity of the performance measure, it may order that no result be released. The Committee may then order that the examinee either retake CSA, with or without special conditions, be barred from CSA, or be barred from ECFMG certification. Back to Contents COMMON QUESTIONS 1. If an applicant?s CSA date on the Standard ECFMG Certificate has expired for the purpose of entering graduate medical education, will the applicant be required to pass a subsequent CSA before entry into GME? Yes. The Standard ECFMG Certificate may be used for entry into accredited programs of graduate medical education as long as the program start date is not later than either of the valid through dates (English test and CSA) indicated on the Standard ECFMG Certificate. The CSA date indicated on the Standard ECFMG Certificate is valid for three years from the most recent date of passing performance on CSA. If the CSA date has expired, an applicant will be required to pass a subsequent CSA before entering graduate medical education. 2. What are the eligibility requirements for taking CSA? To be eligible to take CSA, an applicant must meet the following requirements at the time that the application is submitted and at the time CSA is taken: Be either a medical student officially enrolled in a foreign medical school listed in the current edition of the World Directory of Medical Schools published by the World Health Organization and be within 12 months of completion of the full didactic curriculum or a graduate of a medical school which was listed in the World Directory of Medical Schools at the time of graduation. A graduate of a foreign medical school must have had at least four credit years (academic years for which credit has been given toward completion of the medical curriculum) in attendance at a medical school that is listed in the World Directory of Medical Schools at the time of graduation.
Have passed USMLE Step 1 or its equivalent and the English language proficiency test.
Applicants who, as of June 30, 1998, had met all ECFMG certification requirements in effect through this date are not required, but are permitted, to take CSA. 3. Is USMLE Step 3 a certification requirement and, thus, a prerequisite to CSA? No. Passing USMLE Step 3 is not a requirement for ECFMG certification. Individual state medical boards, not ECFMG, administer USMLE Step 3 as part of their licensing examination requirements. Questions regarding Step 3 should be addressed to the Federation of State Medical Boards (FSMB). Refer to the ECFMG Information Booklet for contact information. 4. What is the application procedure for CSA? Registration for CSA requires submission of the CSA application (Form 706). Form 706 is included in the ECFMG Information Booklet and may also be downloaded from the ECFMG web site at http://www.ecfmg.org. To register for CSA, you must complete Form 706 and send it, with full payment of the assessment fee, to ECFMG by mail (or courier service), following the mailing instructions on the application form. You cannot register by facsimile, letter, postcard or e-mail message. Detailed application instructions are included with the application form. Follow the instructions carefully and answer all questions completely. You should review the instructions before you begin working on the application. If your application is not complete or if the required fee is not submitted, it will be returned to you. Once the completed application form and payment are received at ECFMG, and the applicant is determined to be eligible to take CSA, the Notification of Registration, which includes information on scheduling CSA, will be sent to the applicant. Applicants must schedule CSA within four months of, and must take CSA within one year of, the date indicated on the Notification of Registration. Failure to schedule CSA within four months, or to actually take CSA within one year, will require submission of a new application and fee. An admission permit confirming the date, time and location of the assessment will be mailed to applicants as soon as they schedule CSA. Applicants must present this admission permit at the Clinical Skills Assessment Center. 5. What is the application deadline for CSA? Since CSA is offered throughout the year, there is no deadline for submitting the application form to register for CSA. 6. What is the fee for CSA? The CSA fee is $1,200 (U.S. dollars) which must be included with the CSA application. Refer to the ECFMG Information Booklet for payment information. 7. How often is CSA administered? Daily, depending on demand, except for major U.S. holidays. 8. How long do CSA administrations last? The duration of CSA, including orientation, testing, and breaks, is approximately eight hours. 9. Does CSA require candidates to diagnose and treat real patients? No. CSA consists of encounters with standardized patients (SPs), lay persons trained to accurately and consistently portray patients. SPs will respond to questions from candidates with answers appropriate to the case and, upon physical examination, will demonstrate appropriate physical findings. Candidates will be expected to proceed through each encounter with an SP as they would with a real patient, but treatment of any kind is not to be done. 10. Is a proctor present during the candidates? encounters with SPs? No. However, all encounters are videotaped for research and quality control purposes. In addition, all encounters can be observed in real time by both video and one-way mirror. 11. Following an encounter with an SP, are the candidates required to present the case history, diagnosis, management plan, or other material related to the encounter, in writing or orally? Candidates are required to compose a written record of each patient encounter. 12. How soon after the CSA are results available? Reports of performance on CSA are normally mailed to candidates within six to eight weeks after the examination date. 13. Do scores consist of a PASS/FAIL designation or numeric value? A report of performance on CSA consists of a pass/fail designation. 14. How does a failing applicant retake CSA? For the purpose of ECFMG certification, there is no limit on the number of attempts to pass CSA. Once you pass CSA, you may only repeat it to revalidate your CSA date. If you fail the CSA and wish to retake it, you must submit a new application and assessment fee. You may not take CSA within three months of your last attempt on the CSA. Registration and scheduling procedures will be the same as for all other examinees. 15. How does a holder of a Standard ECFMG Certificate which includes a CSA date that will expire before entry into a GME program revalidate the Certificate? A passing CSA performance is valid for three years for purposes of entry into graduate medical education. If an applicant enters an ACGME-accredited program of graduate medical education in the United States, permanent validation of the Standard ECFMG Certificate can be requested. Permanent validation means that the CSA valid-through date (and the English language proficiency valid-through date) is no longer subject to expiration. Holders of Standard ECFMG Certificates that include CSA may revalidate their CSA date at any time by retaking CSA. Passing CSA will revalidate the CSA date for a period of three years from the date on which CSA is taken. Registration and scheduling procedures will be the same as for all other examinees. 16. What are the qualifications of the SPs who document the clinical skills and evaluate communication skills of candidates? The SPs are lay people who undergo extensive training and evaluation prior to participation in CSA. 17. How many SP encounters need to be passed in order to obtain a passing performance on CSA? Passing performance on CSA is not based on passing any specific number of encounters, but rather overall performance on the CSA components. 18. What is the difference between Standard ECFMG Certificates issued to applicants who met all certification requirements on or before June 30, 1998 and those issued to applicants who complete the certification requirements after this date? Standard ECFMG Certificates issued to applicants who met the certification requirements subsequent to June 30, 1998, will indicate the dates of a passing performance of CSA and the duration of its validity for entry into GME, as well as the date of passing performance and duration of the validity of the English test. 19. Will applicants who are certified but have not taken CSA be at a disadvantage in obtaining a residency compared to applicants who have passed CSA? The criteria for selecting applicants for residency positions are determined by individual graduate medical education programs. However, the number of applicants frequently exceeds the number of residency programs available. Historically, programs select from the pool of applicants those individuals who have met the requirements that are current at the time of selection. This does not necessarily mean that applicants who were certified under a previous set of requirements will not be selected for residency positions at such programs. 20. Is CSA required to participate in the NRMP Match? In order to participate in the Match, students/graduates of foreign medical schools must have passed the examinations necessary for ECFMG certification. Therefore, applicants who are required to pass CSA for ECFMG certification must pass CSA in order to participate in the Match. 21. Where is CSA administered? CSA is given throughout the year only at the following location: ECFMG
3624 Market Street
CSA Center: 3rd Floor
Philadelphia, PA 19104-2685 USA Back to Contents REFERENCES Educational Commission for Foreign Medical Graduates: Clinical Skills Assessment Prototype
Gerald P. Whelan. Medical Teacher 1999;21: 156-160. Lessons Learned from Six Years of International Administrations of the ECFMG?s SP-Based Clinical Skills Assessment
Amitai Ziv, Miriam Friedman Ben-David, Alton I. Sutnick and Nancy E. Gary. Academic Medicine. 1998;73:S83-S90 Use of Standardized Patients in Clinical Assessments: Recent Developments and Measurement Findings
Nu Viet Vu and Howard S. Barrows. Educational Researcher. 1994;23;3:23-30 ECFMG Assessment of Clinical Competence of Graduates of Foreign Medical Schools
Alton I. Sutnick, Paula L. Stillman, John J. Norcini, Miriam Friedman, Mary Beth Regan, Reed G. Williams, Elizabeth K. Kachur, Mary A. Haggerty and Marjorie P. Wilson. Journal of the American Medical Association. 1993;270:1041-1045 An Overview of the Uses of Standardized Patients for Teaching and Evaluating Clinical Skills
Howard S. Barrows. Academic Medicine. 1993;68:443-451 Measurement Characteristics of Examinations Using Standardized Patients
Arthur I. Rothman, Robert Cohen, Beth Dawson-Saunders, Peeter P. Poldre and John Ross. Academic Medicine. 1992;67:S40-S41 The Use of Standardized Patients to Evaluate the Spoken-English Proficiency of Foreign Medical Graduates
Miriam Friedman, Alton I. Sutnick, Paula L. Stillman, John J. Norcini, Susan M. Anderson, Reed G. Williams, Grant Henning and Marcia J. Reeves. Academic Medicine. 1991;66:S61-S63. Results of a Survey on the Use of Standardized Patients to Teach and Evaluate Clinical Skills
Paula L. Stillman, Mary Beth Regan, Mary Philbin and Heather-Lyn Haley.Academic Medicine. 1990;65:288-292 TSE? Score User?s Manual: 1995 Edition
Educational Testing Service, Princeton, NJ
Back to Contents GLOSSARY OF TERMS AND COMMON ABBREVIATIONS TERMS USED IN THIS MANUAL ACGME
Accreditation Council for Graduate Medical Education CSA
Clinical Skills Assessment ECFMG
Educational Commission for Foreign Medical Graduates FSMB
Federation of State Medical Boards GME
Graduate Medical Education LCME
Liaison Committee on Medical Education NRMP
National Resident Matching Program SP
Standardized Patient TOEFL
Test of English as a Foreign Language TSE
Test of Spoken English USMLE
United States Medical Licensing Examination TERMS USED IN CSA (the following lists will be available on-site for reference during CSA administrations) UNITS OF MEASURE kg
Kilogram g
Gram mg
Milligram lbs
Pounds oz
Ounces m
Meter cm
Centimeter min
Minute hr
Hour C
Centigrade F
Fahrenheit VITAL SIGNS BP
Blood pressure P
Pulse R
Respirations T
Temperature COMMON ABBREVIATIONS FOR THE PATIENT NOTE (this is not intended to be a complete list of acceptable abbreviations, but rather is representative of the types of common abbreviations that may be used on the patient note) yo
Year-old m or G
Male f or E
Female b
Black w
White L
Left R
Right hx
History h/o
History of c/o
Complaining of NL
Normal limits WNL
Within normal limits ?
Without or no +
Positive -
Negative Abd
Abdomen AIDS
Acquired Immune Deficiency Syndrome AP
Anteroposterior BUN
Blood urea nitrogen CABG
Coronary artery bypass grafting CBC
Complete blood count CCU
Cardiac care unit cig
Cigarettes CHF
Congestive heart failure COPD
Chronic obstructive pulmonary disease CPR
Cardiopulmonary resuscitation CT
Computerized tomography CVA or TIA
Cerebrovascular accident OR Transient ischemic attack CVP
Central venous pressure CXR
Chest x-ray DM
Diabetes mellitus DTR
Deep tendon reflexes ECG
Electrocardiogram ED
Emergency department EMT
Emergency medical technician ENT
Ears, nose, and throat EOM
Extraocular muscles ETOH
Alcohol Ext
Extremities FH
Family history GI
Gastrointestinal GU
Genitourinary HEENT
Head, eyes, ears, nose, and throat HIV
Human immunodeficiency virus HTN
Hypertension IM
Intramuscularly IV
Intravenously JVD
Jugular venous distention KUB
Kidney, ureter, and bladder LMP
Last menstrual period LP
Lumbar puncture MI
Myocardial infarction MRI
Magnetic resonance imaging MVA
Motor vehicle accident Neuro
Neurologic NIDDM
Non insulin-dependent diabetes mellitus NKA
No known allergies NKDA
No known drug allergy NSR
Normal sinus rhythm PA
Posteroanterior PERLA
Pupils equal, react to light and accommodation po
Orally PT
Prothrombin time PTT
Partial prothrombin time RBC
Red blood cells SH
Social history U/A
Urinalysis URI
Upper respiratory tract infection WBC Back to Contents
White blood cells --------------------------------------------------------------------------------