NYU Comprehensive Clinical Skills Exam CCSE

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NYU Comprehensive Clinical Skills Exam (CCSE)

• Linda Tewksbury, MD
• Adina Kalet, MD
• Julie Chase, PhD
• Colleen Gillespie, PhD
• Regina Richter
• Clerkship Directors
• February 3, 2005

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Goals of CCSE

• Assess core clinical skills
• Communication skills (data gathering, rapport
  building, education)
• Physical examination skills
• Synthesis and clinical reasoning skills
• Prepare students for USMLE Step II CS
• Evaluate curriculum in preparing clinically
  competent graduates

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Methods

• Case Development (7 cases)
• Collaborative process involving all Clerkship
  Directors
• Integrate core clinical skills from each
  clerkship
• Checklist Development
• Performance-based checklist measuring skills
  performed not done, done minimally, and done
  well
• Standardized Patient (SP) Training
• Standardized training in student evaluation
• Case-by-case training with a faculty member

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Structure

• 6 stations
• 15 min. patient encounter
• 10 min. post-encounter
• Each station
• Elicit pertinent history
• 3/6 stations physical examination
• Communicate effectively
• Post encounter
• Document HP, diagnostic impression, Further
  work-up (5 stations)
• Present case to attending (1 station)
• Interpret laboratory data (2 stations)

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Structure

• Administered over last 2 weeks of June (during
  4th year Selective)
• 8 half-day sessions at VA Hospital
• Faculty observed 1/3 cases
• Student debriefing/feedback session provided at
  the end of each day

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Results

• 147 (92) 4th year students tested
• Reliability
• Class Results
• Individual Results
• Student Satisfaction

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Reliability

• Internal consistency (Cronbachs Alpha)
• Communication .91
• History-taking .80
• Physical Examination .60 (3 cases only)

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Patient Note/Oral Presentation

• Each note graded specific parameters
• Clinical Reasoning
• Biomedical Information
• Psychosocial Information
• Internal Consistency
• Comprehensibility

• Chief Complaint
• HPI
• Pertinent neg and pos

• PE
• Interpretation of provided medical tests

Treatment/ Workup
DD
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Remediation

• Remediation offered to those students performing
  in the bottom decile in at least two of the skill
  areas
• Individualized sessions with a faculty member to
  review problems and create plan for improvement
• Filmed SP encounter to review with faculty member
• Future offer workshop sessions

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Conclusions

• The CCSE
• Wide spectrum of clinical abilities
• Identifies outliers
• Was appreciated by most students
• Identifies curricular needs
• PE (i.e. Fundoscopic exam)
• Exposure to undifferentiated cases
• EKG/CXR interpretation

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Next Steps

• How will this count?
• Adjust or Create new Cases
• Focus Groups (with mix of students)
• Work to foster clinical reasoning
• Establish Validity (IRB approved study)
• Clerkship grades/ranks
• Students perceived competence
• Clerkship exposure
• USMLE Step 2 CS

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Updates for 2005

• CCSE is now required of all students entering the
  fourth year (including MD/PhD students)
• CCSE is graded (pass/fail) and will appear on
  transcripts
• Two stations added for a total of 8
• Held 9 half-day sessions at Bellevue