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March 8, 2006

The Step 2 Clinical Skills Examination—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(10):1123-1124. doi:10.1001/jama.295.10.1123-b

In Reply: Drs Hallock, Melnick, and Thompson provide helpful clarification regarding the methods that standardized patients use to evaluate communication and interpersonal skills in the USMLE Step 2 CSE. Having argued that global rating scales provide more valid and meaningful assessments in this area than do narrow checklists, I am encouraged by this information.

Physicians are often unable to distinguish actual patients from standardized patients when the latter arrive unannounced, but this phenomenon is irrelevant to the CSE. The examination requires an elaborate artificial testing environment that cannot possibly be mistaken for an actual clinic; examinees will never confuse these standardized patients with real ones. The survey data that Hallock, Melnick, and Thompson cite do not address the question of whether differences in motivation and intention make encounters in the CSE qualitatively different from encounters with actual patients.