Skip to main content
PMC home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2004 Oct;13(Suppl 1):i41–i45. doi: 10.1136/qshc.2004.010025

Simulations in the United States Medical Licensing ExaminationTM (USMLETM)

G Dillon, J Boulet, R Hawkins, D Swanson
PMCID: PMC1765788  PMID: 15465954

Abstract

Over the last several years there has been much attention focused on the detection and remediation of problems that pose potential threats to patient safety and that interfere with the provision of effective care. It has been noted that changes in medical education and assessment are integral to eventual improvement in this area. Within the assessment system used to licence physicians in the United States, there has been an evolution of assessment formats intended to improve the measurement of knowledge and skills, including the recent development of computer based patient simulations and clinical skills assessments. A number of new testing formats intended to further enhance assessment of critical knowledge and skills will be available in the near future.

Full Text

The Full Text of this article is available as a PDF (66.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beckman H. B., Markakis K. M., Suchman A. L., Frankel R. M. The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994 Jun 27;154(12):1365–1370. [PubMed] [Google Scholar]
  2. Beers M. H., Munekata M., Storrie M. The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc. 1990 Nov;38(11):1183–1187. doi: 10.1111/j.1532-5415.1990.tb01496.x. [DOI] [PubMed] [Google Scholar]
  3. Boulet John R., McKinley Danette W., Whelan Gerald P., Van Zanten Marta, Hambleton Ronald K. Clinical skills deficiencies among first-year residents: utility of the ECFMG clinical skills assessment. Acad Med. 2002 Oct;77(10 Suppl):S33–S35. doi: 10.1097/00001888-200210001-00011. [DOI] [PubMed] [Google Scholar]
  4. Boulet John R., Murray David, Kras Joe, Woodhouse Julie, McAllister John, Ziv Amitai. Reliability and validity of a simulation-based acute care skills assessment for medical students and residents. Anesthesiology. 2003 Dec;99(6):1270–1280. doi: 10.1097/00000542-200312000-00007. [DOI] [PubMed] [Google Scholar]
  5. Boulet John R., Rebbecchi Thomas A., Denton Elizabeth C., McKinley Danette W., Whelan Gerald P. Assessing the written communication skills of medical school graduates. Adv Health Sci Educ Theory Pract. 2004;9(1):47–60. doi: 10.1023/B:AHSE.0000012216.39378.15. [DOI] [PubMed] [Google Scholar]
  6. Clauser B. E., Ross L. P., Fan V. Y., Clyman S. G. A comparison of two approaches for modeling expert judgment in scoring a performance assessment of physicians' patient-management skills. Acad Med. 1998 Oct;73(10 Suppl):S117–S119. doi: 10.1097/00001888-199810000-00065. [DOI] [PubMed] [Google Scholar]
  7. Clauser B. E., Subhiyah R. G., Piemme T. E., Greenberg L., Clyman S. G., Ripkey D., Nungester R. J. Using clinician ratings to model score weights for a computer-based clinical-simulation examination. Acad Med. 1993 Oct;68(10 Suppl):S64–S66. doi: 10.1097/00001888-199310000-00048. [DOI] [PubMed] [Google Scholar]
  8. Clauser B. E., Subhiyah R. G., Piemme T. E., Greenberg L., Clyman S. G., Ripkey D., Nungester R. J. Using clinician ratings to model score weights for a computer-based clinical-simulation examination. Acad Med. 1993 Oct;68(10 Suppl):S64–S66. doi: 10.1097/00001888-199310000-00048. [DOI] [PubMed] [Google Scholar]
  9. Clauser Brian E., Margolis Mellissa J., Swanson David B. An examination of the contribution of computer-based case simulations to the USMLE step 3 examination. Acad Med. 2002 Oct;77(10 Suppl):S80–S82. doi: 10.1097/00001888-200210001-00026. [DOI] [PubMed] [Google Scholar]
  10. Cox Jafna L., Zitner David, Courtney Krista D., MacDonald Dara Lee, Paterson Grace, Cochrane Bonnie, Mathers Jim, Merry Heather, Flowerdew Gordon, Johnstone David E. Undocumented patient information: an impediment to quality of care. Am J Med. 2003 Feb 15;114(3):211–216. doi: 10.1016/s0002-9343(02)01481-x. [DOI] [PubMed] [Google Scholar]
  11. De Champlain A. F., Margolis M. J., King A., Klass D. J. Standardized patients' accuracy in recording examinees' behaviors using checklists. Acad Med. 1997 Oct;72(10 Suppl 1):S85–S87. doi: 10.1097/00001888-199710001-00029. [DOI] [PubMed] [Google Scholar]
  12. Dillon Gerard F., Clyman Stephen G., Clauser Brian E., Margolis Melissa J. The introduction of computer-based case simulations into the United States medical licensing examination. Acad Med. 2002 Oct;77(10 Suppl):S94–S96. doi: 10.1097/00001888-200210001-00029. [DOI] [PubMed] [Google Scholar]
  13. Good M. L. Patient simulation for training basic and advanced clinical skills. Med Educ. 2003 Nov;37 (Suppl 1):14–21. doi: 10.1046/j.1365-2923.37.s1.6.x. [DOI] [PubMed] [Google Scholar]
  14. Levinson W., Roter D. L., Mullooly J. P., Dull V. T., Frankel R. M. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997 Feb 19;277(7):553–559. doi: 10.1001/jama.277.7.553. [DOI] [PubMed] [Google Scholar]
  15. Melnick Donald E., Dillon Gerard F., Swanson David B. Medical licensing examinations in the United States. J Dent Educ. 2002 May;66(5):595–611. [PubMed] [Google Scholar]
  16. Morgan P. J., Cleave-Hogg D., DeSousa S., Tarshis J. High-fidelity patient simulation: validation of performance checklists. Br J Anaesth. 2004 Jan 22;92(3):388–392. doi: 10.1093/bja/aeh081. [DOI] [PubMed] [Google Scholar]
  17. Nackman Gary B., Bermann Mordechai, Hammond Jeffrey. Effective use of human simulators in surgical education. J Surg Res. 2003 Dec;115(2):214–218. doi: 10.1016/s0022-4804(03)00359-7. [DOI] [PubMed] [Google Scholar]
  18. Norcini John, Boulet John. Methodological issues in the use of standardized patients for assessment. Teach Learn Med. 2003 Fall;15(4):293–297. doi: 10.1207/S15328015TLM1504_12. [DOI] [PubMed] [Google Scholar]
  19. Peterson M. C., Holbrook J. H., Von Hales D., Smith N. L., Staker L. V. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992 Feb;156(2):163–165. [PMC free article] [PubMed] [Google Scholar]
  20. Reilly Brendan M. Physical examination in the care of medical inpatients: an observational study. Lancet. 2003 Oct 4;362(9390):1100–1105. doi: 10.1016/S0140-6736(03)14464-9. [DOI] [PubMed] [Google Scholar]
  21. Reznick R. K., Blackmore D., Cohen R., Baumber J., Rothman A., Smee S., Chalmers A., Poldre P., Birtwhistte R., Walsh P. An objective structured clinical examination for the licentiate of the Medical Council of Canada: from research to reality. Acad Med. 1993 Oct;68(10 Suppl):S4–S6. doi: 10.1097/00001888-199310000-00028. [DOI] [PubMed] [Google Scholar]
  22. Reznick R. K., Blackmore D., Dauphinée W. D., Rothman A. I., Smee S. Large-scale high-stakes testing with an OSCE: report from the Medical Council of Canada. Acad Med. 1996 Jan;71(1 Suppl):S19–S21. doi: 10.1097/00001888-199601000-00031. [DOI] [PubMed] [Google Scholar]
  23. Schuwirth L. W. T., van der Vleuten C. P. M. The use of clinical simulations in assessment. Med Educ. 2003 Nov;37 (Suppl 1):65–71. doi: 10.1046/j.1365-2923.37.s1.8.x. [DOI] [PubMed] [Google Scholar]
  24. Soto Carlos M., Kleinman Kenneth P., Simon Steven R. Quality and correlates of medical record documentation in the ambulatory care setting. BMC Health Serv Res. 2002 Dec 10;2(1):22–22. doi: 10.1186/1472-6963-2-22. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Stewart M. A. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995 May 1;152(9):1423–1433. [PMC free article] [PubMed] [Google Scholar]
  26. Stillman P., Swanson D., Regan M. B., Philbin M. M., Nelson V., Ebert T., Ley B., Parrino T., Shorey J., Stillman A. Assessment of clinical skills of residents utilizing standardized patients. A follow-up study and recommendations for application. Ann Intern Med. 1991 Mar 1;114(5):393–401. doi: 10.7326/0003-4819-114-5-393. [DOI] [PubMed] [Google Scholar]
  27. Suchman A. L., Roter D., Green M., Lipkin M., Jr Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care. 1993 Dec;31(12):1083–1092. doi: 10.1097/00005650-199312000-00002. [DOI] [PubMed] [Google Scholar]
  28. Tombleson P., Fox R. A., Dacre J. A. Defining the content for the objective structured clinical examination component of the professional and linguistic assessments board examination: development of a blueprint. Med Educ. 2000 Jul;34(7):566–572. doi: 10.1046/j.1365-2923.2000.00553.x. [DOI] [PubMed] [Google Scholar]
  29. Whelan G. High-stakes medical performance testing: the Clinical Skills Assessment program. JAMA. 2000 Apr 5;283(13):1748–1748. [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES