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Purpose of the CSA Historical Perspective on the CSA An Introduction to Taking the CSA CSA Case Development CSA Case Content Selection |
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Purpose of the CSAThe purpose of the CSA is to ensure that international medical graduates can demonstrate the ability to gather and interpret clinical patient data and communicate effectively in the English language at a level comparable to students graduating from United States medical schools accredited by the Liaison Committee on Medical Education (LCME). The CSA is only one of the test elements leading to ECFMG certification. Historical Perspective on the CSAThere are approximately 1,600 medical schools outside of the United States and Canada, each with varying educational standards and curricula. Currently, no universal system exists to compare the quality and characteristics of these medical schools with those of U.S. medical schools accredited by the LCME. The LCME requires that the assessment of clinical skills be part of the overall evaluation of U.S. medical students. However, in the absence of any single set of international accreditation standards for medical schools, the only viable alternative is to assess students graduating from those medical schools using a standardized assessment, the CSA. In 1980 ECFMG introduced the concept of testing the clinical skills of international medical graduates as part of the ECFMG certification process. ECFMG initiated an extensive program of planning and research to develop a CSA prototype that would provide an objective and consistent evaluation of the readiness of international medical graduates to enter graduate medical education (GME) programs in the U.S. Pilot projects were conducted around the world, and, as a result of those studies, the current CSA prototype was developed. The prototype consists of clinical encounters with standardized patients (SPs) that integrate history taking, physical examination, interviewing and interpersonal skills, as well as the ability to communicate effectively in written and spoken English. The current CSA prototype was tested in the U.S. and abroad to compile data and demonstrate its validity and reliability. Effective July 1, 1998, applicants who had not met all requirements for ECFMG certification in effect through June 30, 1998, are required to pass the CSA, as well as the basic medical and clinical science components of the medical science examination and the English language proficiency test. Applicants for ECFMG certification must also document the completion of all requirements for, and receipt of, the final medical diploma. The incorporation of the CSA into the certification process helps to ensure that international medical graduates certified by ECFMG possess the necessary basic clinical skills for entry into supervised GME training programs in the U.S. An Introduction to Taking the CSAThe elements of the CSA, including the patients, medical presentations, and the CSA Center, simulate common medical practice in clinics, doctors' offices and emergency departments in the U.S. The CSA is used to assess your ability to consider reasonable diagnostic possibilities by presenting a set of common clinical scenarios. In addition, you must demonstrate an acceptable level of professionalism and rapport, as well as written and spoken English language skills. By gathering relevant medical history and performing a focused physical examination, you will be demonstrating your ability to collect information unique to the presentation of each patient. Taking a relevant medical history means that it relates specifically to the chief complaint of the patient. A focused physical examination consists of maneuvers that reveal information in direct relation to the same patient's chief complaint, age and gender, and medical history. You will be required to write a legible patient note indicating the pertinent positive and negative historical and physical findings that relate to your potential diagnoses. Once you list the possible differential diagnoses that relate to the patient's complaint, you will also list the diagnostic studies that you would use to pursue these diagnoses. A listing of treatment procedures or medications will not be required. When you take the CSA, you will have the same opportunity as all other candidates to demonstrate your clinical skills proficiency. The assessment is standardized so that upon asking the same or similar questions, all candidates receive the same information from each patient. An ongoing mechanism of quality control is employed to ensure that the assessment is fair to all. A videotape monitoring system documents each encounter and ensures the safety of the patients and candidates, and is an additional quality control procedure. The patients you will see are lay people trained to portray a clinical problem. This method of assessment is referred to as a standardized patient (SP) based examination. Ninety-five percent of LCME-accredited medical schools in the U.S. and Canada use SPs for instruction. About seventy-four percent of these same institutions use them for evaluation. Standardized patients have also been incorporated into the Medical Council of Canada's medical licensure examination for Canadian and international medical graduates. The SP-based testing method was established more than thirty years ago, and its procedures have been tested and validated in the U.S. and internationally. The CSA is designed as a standards-based (criterion-referenced) examination, meaning that specific scores are set for passing performance. Committees of physicians review the case materials and determine the essential skills and behaviors that must be demonstrated by candidates for each case. You are evaluated only with reference to this standard, so there is no predetermined number or percentage of examinees who will pass. Pass rates for CSA candidates are solely a function of performance. Consequently, anyone can pass, depending on his or her level of proficiency relative to the standard. For purposes of entry into graduate medical education, a passing performance on the CSA is valid for three years from the date passed. CSA Case DevelopmentPracticing physicians and medical educators write and review cases to ensure that they are fair and valid. These cases represent the kinds of patients and problems you would normally encounter while training in a U.S. GME program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Cases are specially designed to elicit a process of history taking and physical examination that demonstrates your ability to list and pursue various possible diagnoses. The cases that make up each administration of the CSA reflect a balance of presenting complaints as well as a diversity of patient age, gender, and ethnicity. There is also a mix of acute, subacute and chronic problems. On any assessment day, the set of cases will differ from the combination presented the day before or the following day, but each set of cases has a comparable degree of difficulty. The CSA includes test cases representing the major clinical education programs encountered at medical schools accredited by the LCME in the U.S. These disciplines include:
CSA Case Content SelectionThe CSA case content area is the universe of clinical symptoms (cases) that will be represented by standardized patients. The selection of clinical cases from the larger pool of CSA content area is guided by the CSA assessment form specification that defines five main content areas:
The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.
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