Due to a recent policy change, medical students will soon have to pass a national clinical skills examination to earn their degree.

The graduating class of 2005 will be the first to take this new exam, which will supplement the already mandatory written components of the United States Medical Licensing Examination (USMLE). Pre-medical students at Washington University will have to deal with the implementation of this policy in the coming years.

The change is motivated by surveys suggesting the majority of Americans believe that a doctor’s communication and examination skills are of critical importance. Further motivation draws on studies that link poor clinical skills to a higher incidence of malpractice suits and patient dissatisfaction.

Under the new exam structure, fourth-year medical students will be asked to examine and interact with a living person, an actor posing as a patient, who will simulate scripted, standardized symptoms. Students will be given the opportunity to perform a 15-minute physical examination, with extra time provided to record the results, the patient’s medical history, and diagnostic options. The criteria judging passing and failing scores have yet to be determined.

Dr. Allison Whelan, WU School of Medicine’s associate dean of curriculum, said she understands the rationale behind the obligatory testing.

“There has been an increase in attention to all areas of education,” said Whelan. “A judgment of a student’s competency should take into account all forms of knowledge. Written tests, alone, cannot do that.”

The USMLE has served as the lone measuring stick for medical students’ skills since 1964, when the previous clinical skills examination procedures were removed in favor of the more objective written assessment. Reinstating the practical exam may invoke a subtle shift in the mentalities of WUSM students, but the current curriculum will not change.

“At WUSM, we already focused on clinical skills,” said Whelan. “First, second, and third-year students must pass clinical skills exams on standardized patients. They conduct interviews and exams, and instructors give them feedback.”

Studying and working next door to Barnes-Jewish Hospital provides WU medical students more opportunities to hone their clinical skills and participate in hands-on learning.

Given the resources and the already clinically-focused curriculum of WUSM, some WU medical students have mixed feelings about the new exam.

“The students’ response to the new Clinical Skills Exam requirement is negative,” said Tiffany Deshazo, a first year WUSM student. “I am against the new requirement because my clinical skills are already evaluated by the faculty at WUSM. The additional level of administration will just increase the inefficiency and inaccuracy of the evaluation.”

Other medical students object to the sizable financial burdens of the new clinical component. In addition to application fees and travel expenses associated with the residency placement process, fourth-year medical students will now incur the expense of the additional exam, which includes the $1,000 exam fee and the cost of traveling to one of the five U.S. exam sites.

“Trying to objectify the skills you should have [is a good idea], but it adds a great deal to exam costs,” said Jerry Chang, a fourth-year student at WUSM. “Looking at the costs and benefits, I’m not really sure if it’s a good idea.”

Advocates of the examination stress that more thorough and comprehensive examinations beget more competent and quality physicians. According to the Web site of the Federation of State Medical Boards, Dr. James Thompson, executive vice president of the organization, said that a national standard of basic clinical capabilities is needed for the benefit of the American public.

Currently, clinical examinations are a standard component of the training and certification of numerous other health professionals, such as nurses and paramedics.

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