W.P. Burdick is vice president of education, Foundation of Advancement of International Medical Education and Research, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-6040-6112. J.R. Boulet is vice president of research and data resources, Educational Commission for Foreign Medical Graduates, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0003-3703-5613. K.E. LeBlanc is executive director, Clinical Skills Evaluation Collaboration, National Board of Medical Examiners and Educational Commission for Foreign Medical Graduates, Philadelphia, Pennsylvania.
Acad Med. 2018 May;93(5):690-692. doi: 10.1097/ACM.0000000000001867.
Although the authors do not agree with medical students' bid to end the United States Medical Licensing Examination Step 2 Clinical Skills or Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation tests, they concur with Ecker and colleagues that conducting further research to support the validity argument, providing greater feedback on performance, and exploring options to reduce costs are important for addressing students' concerns. Evidence to support the validity of clinical skills exam scores and associated inferences already exists. What is lacking, and would help further justify the use of these examinations, is more evidence to support the "extrapolation" argument-that is, is performance on these examinations related to actual patient care? Enhanced feedback on exam performance should also be considered. While performance data from licensing examinations should be used judiciously given the primary purpose of these tests, additional data would be helpful to learners and their institutions. Centralized testing remains the least costly design, but efficiencies of standardized patient training, case development, and scoring can be reviewed. Scoring modifications made in the past several years at substantial cost should be evaluated to determine whether they have achieved desired goals. Testing organizations can and should embrace these essential elements of transparency and accountability to address concerns about the value of clinical skills examinations.
尽管作者不同意医学生取消美国医师执照考试第 2 步临床技能考试或全面骨科医师执照考试第 2 级-表现评估考试的要求，但他们同意 Ecker 及其同事的观点，即进行进一步的研究以支持有效性论证，提供更多关于表现的反馈，并探索降低成本的选择，这些对于解决学生的担忧很重要。支持临床技能考试成绩和相关推论有效性的证据已经存在。目前缺乏的是，支持“推断”的证据——即这些考试的表现与实际的患者护理相关，而这将有助于进一步证明这些考试的使用合理性。也应考虑对考试表现进行增强反馈。虽然鉴于这些测试的主要目的，应该谨慎使用考试表现数据，但额外的数据对学习者及其所在机构会有帮助。集中测试仍然是成本最低的设计，但标准化患者培训、案例开发和评分的效率可以进行审查。过去几年进行了大量成本的评分修改，应进行评估，以确定这些修改是否达到了预期目标。考试组织可以而且应该接受这些透明度和问责制的基本要素，以解决对临床技能考试价值的担忧。
