The relationship between USMLE Step 2 CS patient note ratings and time spent on the note: do examinees who spend more time write better notes?

BACKGROUND: During the United States Medical Licensing Examination Step 2 Clinical Skills examination, examinees rotate through 12 standardized patient (SP) encounters. Examinees have 25 minutes per encounter to interact with SPs and complete postencounter patient notes (PNs), and they may end the SP interaction early to spend extra time on the PN. The current work assesses the time examinees are spending on PNs and whether this is related to performance on the PN. METHOD: Encounters from 2,479 examinees' videos were time-stamped to indicate total encounter time and PN time. Hierarchical linear modeling was employed to assess how well total and PN time, along with other examinee and case-rater variables, predicted PN scores. RESULTS: Examinee variables explained a significant portion of within-case-rater variability, but while PN time was significantly related to PN ratings, the effect was small. CONCLUSIONS: The results suggest that spending additional time on the PN does not translate to a meaningful score increase.

The relationship between USMLE step 2 CS communication and interpersonal skills (CIS) ratings and the time spent by examinees interacting with standardized patients.

BACKGROUND: During the United States Medical Licensing Examination Step 2 Clinical Skills exam, examinees rotate through 12 standardized patient (SP) encounters. SPs rate examinees on Communication and Interpersonal Skills (CIS). Examinees have at most 15 minutes to interact with each SP, but can end the encounter sooner. The current work assesses the relationship between CIS ratings and time examinees spend interacting with the SP. METHOD: A total of 5,955 encounters from a fall 2007 sample of examinees were time-stamped to indicate total encounter time and closure time. Hierarchical linear modeling was employed to assess how well total and closure time, in conjunction with other examinee- and SP-case-related variables, predicted CIS scores. RESULTS: Time spent on closure had a larger impact on CIS scores than overall time used. Other variables, such as examinee gender, Spoken English Proficiency, and SP stringency, were also significantly related to CIS scores. CONCLUSIONS: Both time measures were significantly positively related to the CIS outcome variable, indicating a link between time used and SP satisfaction with communication, with closure time having the larger coefficient. This finding suggests that a good closure may be a lengthy one.

An examination of the relationship between clinical skills examination performance and performance on USMLE Step 2.

PURPOSE: To examine the relationship between performance on a large-scale clinical skills examination (CSE) and a high-stakes multiple-choice examination. METHOD: Two samples were used: (1) 6,372 first-taker international medical graduates (IMGs); and (2) 858 fourth-year U.S. medical students. Ninety-seven percent of IMGs and 70% of U.S. students had completed Step 2. Correlations were calculated, scatter plots produced, and regression lines estimated. RESULTS: Correlations between CSE and Step 2 ranged from .16 to .38. The observed relationship between scores confirms that CSE score information is not redundant with MCQ score information. This result was consistent across samples. CONCLUSIONS: Results suggest that the CSE assesses proficiencies distinct from those assessed by current USMLE components and therefore provides evidence justifying its inclusion in the medical licensure process.