Innovating Clinical Skills Assessment: Lessons from Medicine & Osteopathy

The COVID-19 pandemic has catalyzed significant reforms in how clinical skills are assessed in medical and osteopathic education, leading to innovative and flexible solutions that ensure the competency of future healthcare professionals. The elimination of the Step 2 Clinical Skills (CS) exam for MDs and the Level 2 Performance Evaluation (PE) for DOs (Similar to Part IV) has prompted a closer look at how these fields are adapting—and what the chiropractic profession can learn from these changes.

Reforms in Medical Education

Elimination of Step 2 CS:

The Step 2 CS exam, a critical component of the United States Medical Licensing Examination (USMLE), was eliminated in March 2020 due to the pandemic. This exam assessed students' ability to gather patient information, perform physical exams, and communicate findings through standardized patient encounters. In response to its elimination, medical schools have ramped up their internal assessments to ensure graduates meet all necessary competencies.

Enhanced Clinical Skills Training:

• - Increased Use of OSCEs: Medical schools have significantly increased the use of Objective Structured Clinical Examinations (OSCEs). These exams involve multiple stations where students interact with standardized patients and perform specific clinical tasks, providing a robust and practical assessment of their skills.
• - Direct Faculty Observation: Faculty members now play a larger role in directly observing students during clinical rotations. This hands-on approach ensures that students receive immediate feedback and thorough evaluations of their clinical competencies.
• Innovative Assessment Methods:
• - Simulation-Based Assessments: Advanced simulation labs using high-fidelity manikins and virtual reality (VR) technology allow for realistic clinical scenarios. These simulations provide a controlled environment for students to practice and be assessed on their skills.
• - Virtual Patient Encounters: The rise of telemedicine has led to the use of virtual patient encounters. Students interact with standardized patients via telehealth platforms, and these sessions are recorded and reviewed for assessment purposes.

Reforms in Osteopathic Education

Elimination of Level 2 PE:

Similar to Step 2 CS, the Level 2 Performance Evaluation (PE) of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) was eliminated due to the pandemic. This exam assessed clinical skills, including osteopathic manipulative treatment (OMT), through standardized patient interactions.

Enhanced Internal Evaluations:

• - Expanded OSCEs: Osteopathic medical schools have increased the frequency and rigor of OSCEs, ensuring students are assessed on a wide range of clinical skills.
• - Direct Faculty Observation: Enhanced direct observation by faculty during clinical rotations provides comprehensive feedback and ensures that students are proficient in essential clinical competencies.
• Exploring New Methods:
• - Simulation Centers: Investments in advanced simulation centers allow for realistic and standardized clinical assessments.
• - Telemedicine-Based Assessments: Virtual patient encounters using telemedicine platforms ensure students can be assessed remotely, maintaining flexibility and accessibility.

Implications for Chiropractic Education

Chiropractic colleges already employ many of these innovative assessment methods, including OSCEs and direct faculty observations, to ensure their students are clinically competent. These internal evaluations are rigorous and aligned with best practices in healthcare education, further questioning the necessity of the NBCE's Part IV exam.

Redundancy of NBCE's Part IV:

• - Existing Competency Assessments: Chiropractic colleges, accredited by reputable bodies, already perform comprehensive assessments of their students' clinical skills. The Part IV exam adds an unnecessary layer of redundancy, implying that the rigorous evaluations conducted by these schools are insufficient.
• - Financial and Logistical Burdens: The Part IV exam imposes significant financial and logistical burdens on students, including travel and accommodation expenses. These burdens are particularly onerous given that students' competencies have already been thoroughly assessed by their educational institutions.

A Call for Change:

Given the successful adaptations in medical and osteopathic education, the chiropractic profession should implement similar reforms immediately and shutter any plans to centralize Part IV testing to NBCE headquarters. Eliminating the NBCE's Part IV exam and relying on the comprehensive assessments conducted by accredited chiropractic colleges would streamline the licensure process, reduce unnecessary burdens on students, and reinforce the authority and credibility of chiropractic educational institutions.

Conclusion

The innovative approaches adopted by medical and osteopathic schools in response to the elimination of Step 2 CS and Level 2 PE exams provide a compelling case for rethinking the NBCE's Part IV exam. Chiropractic colleges already utilize rigorous assessment methods, making the Part IV exam redundant. By embracing these lessons, the chiropractic profession can enhance the efficiency and fairness of its licensure process, ultimately benefiting students and the broader healthcare community.