Certification

Clinical Skills Assessment

The Clinical Skills Assessment is designed to evaluate an examinee's clinical and communication skills. It is a multi-station exam in which examinees encounter standardized patients, lay persons trained to accurately portray patients with common medical problems. ECFMG administers the CSA at Clinical Skills Assessment Centers in Philadelphia, Pennsylvania, and Atlanta, Georgia. The CSA test centers simulate large medical clinics with twenty-four fully-equipped doctor's office examination rooms in each center.

The skills evaluated by the CSA include obtaining a relevant medical history, performing a focused physical examination, and communicating in spoken English. Examinees are also required to compose a written patient note that summarizes pertinent medical history and physical findings, and proposes a differential diagnosis and diagnostic work-up plan. To pass the CSA, examinees must concurrently meet two separate standards: one for the skills involved in taking a medical history, performing the physical examination, and composing the patient note, and another for communication skills including proficiency in spoken English.

The cases used in the CSA represent the types of patients that would typically be encountered during the core clinical clerkships included in the curriculum of medical schools accredited by LCME in the United States. Those clerkships include: Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Family Medicine. The cases presented in CSA administrations are authored, reviewed, and validated by a Test Development Committee composed of practicing physicians and medical educators. Members of the Test Development Committee include both generalists and specialty physicians from throughout the United States.

Passing performance on the CSA is valid for three years for the purpose of entering accredited U.S. programs of graduate medical education. Once expired, the CSA pass date must be revalidated by passing a subsequent CSA before applicants may enter such programs.

In anticipation of the 2003 National Resident Matching Program, ECFMG administered more than 9,000 assessments from February 1, 2002 through January 31, 2003. Approximately 25 percent of examinees were U.S. citizens, while the remainder represented countries from around the world. Approximately 80 percent of those taking CSA for the first time during this period received passing decisions.

Since the CSA was introduced as a requirement for ECFMG Certification in mid-1998, ECFMG has administered nearly 30,000 assessments to international medical students and graduates. ECFMG's experience in developing and administering the CSA is a focal point for research and collaboration with organizations concerned with medical education and assessment. During 2002, ECFMG continued to collaborate with the National Board of Medical Examiners in developing a clinical skills examination that could be incorporated into the USMLE. For additional information, refer to Assessing Clinical Skills.