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UNIVERSITY OF KENTUCKYOfficeDEC0 8 2003December4, 2003of the Provost106 Gillis BuildingLexington, KY 40506-0033(859) 257-2911Fax: (859) 257-1333Email: cca ScottSenate CouncilFROM: CathYOWenfYMedical Center Academic CouncilAt its meeting on November 25, 2003, the Academic Council for the Medical Center approved, andrecommends approval by the Senate Council, for the proposal from the College of Medicine tochange the graduation requirements in the College of Medicine. Attached are the materials toimplement this change.Thank you for your attention to this matterIcoi:\home \aad ata \co unci I\senate. docattachmentsc:Emery A. Wilson, M.D.C. Darrell Jennings, Jr., M.D.Jacque HagerAn Equal OpportunityUniversity

October 10, e of AcademicAffairsAttached is a request for change in the College of Medicine graduation requirements. A memoregarding this change has been sentto duplicating and the mailroom for distribution to the properpeople. Please ask Dr. Todd Cheever (3-5261) to the Council meeting. It is felt he will haveinformation that we do not have and could better answer any questions.Thanks

UNIVERSITY OF KENTUCKYDean and Associate VicePresident for Clinical ServicesCollege of MedicineMN 150 Chandler Medical Center800 Rose StreetLexington, KY 40536-0298(859) 323-5567Fax: (859) 323-2039E-mail: ewilson@uky.eduOctober1, 2003MEMORANDUMDavid S. Watt, PhDAssociate Provost for Academic MfairsCh.air,Academic Council for the Medical CenterFROM:www.uky.eduEmery A.Dean and AssociateClinical ServicesRequest for Change in College of Medicine Graduation RequirementsThe Faculty Council of the College of Medicine has approved and submits for yourconsideration and approval the following new course application(s):Change in College of Medicine Graduation RequirementDescriRtion: The present policy of the United StatesMedical LicensingExamination (USMLE) requires only that students have a passing score on awritten examination to graduate from medical school.Justification: The United StatesMedical Licensing Examination (USMLE) hasissued a new policy, effective with the Class of2005, requiring medical studentsto have passing scores on both a written examination and a clinical skillsexamination in order to receive their diplomas.An EqualOpportunityUniversity

UNIVERSITY OF KENTUCKYOctober1, 2003MEMORANDUMDeans, DepartmentFROM:Emery A.Dean andChairs and MembersWilson,Associateof the UniversityDean and Associate VicePresident for Clinical ServicesCollege of MedicineMN 150 ChandlerMedical Center800 RoseStreetLexington,KY 40536-0298(859) 323-5567Fax: (859)323-2039E-mail: ewilson@uky.eduSen .u?cY.edufor Clinical ServicesRequestfor Changein Collegeof Medicine GraduationRequirementsThe FacultyCouncil of the Collegeof Medicinehasapprovedandsubmitsfor yourconsiderationand approvalthe following request:Change in College of Medicine Graduation RequirementDescriRtion: The present policy of the United StatesMedical LicensingExamination (USMLE) requires only that students have a passing score on awritten examination to graduate from medical school.Justification: The United StatesMedical Licensing Examination (USMLE) issueda new policy, effective with the Class of2005, requiring medical students to havepassing scores on both a written examination and a clinical skills examination inorder to receive their diplomas.An EqllalOpportunityUniversity

OoKUNIVERSITYOF KENTUCKYCollege of MedicineAugust28, 2003MEMORANDUMTO:David Watt, n,DeanChandler Medical CenterAssociate Dean for Academic Affairsand AdministrationMN-I04, UKMCLexington, KY 40536-0298(859) 257-5286Fax: (859) 323-2076www.uky.eduViaC. Darrell Jennings, M.D.Chair, College of Medicine Curriculum CommitteeRE:Changein Collegeof Medicine GraduationRequirementThe United StatesMedical Licensing Examination (USMLE) has issued a new policyeffective with the graduating class of2005. This policy requires studentsto have apassing score on both a written examination and a clinical skills examination. Passageofa clinical skills exam is a requirement for licensure by all 50 states. In order for studentsto comply with the new policy, students must fly or drive to a clinical skills testing site;closest testing location for our studentsis either Chicago, IL or Atlanta, GA.In order for students to receive financial assistancein the form of federal loans to coverthe cost of taking the clinical skills exam and transportation to and from the testing site,the clinical skills exam must be made a part of graduation requirements. Further, theThird and Fourth Year Course Directors' Committee, the StudentProgressand PromotionCommittee, and the Curriculum Committee embrace the concept of clinical competencyassessmentfor all physicians. Therefore, the College of Medicine is requesting a changein graduationrequirements:Old reQuirement for eraduation from the Colleee of MedicinePassing scores on both the Step 1 (taken at the end of Year 2) and Step 2 writtenexaminations. Studentshave from the end of their third year through December31 of their senior year to pass Step 2. Students have three attempts to pass beforedismissal, with appeals.An EqUQIOpportunity University

Page2Memo-Change in College of Medicine Graduation RequirementAugust 28, 2003New reQuirement for 2raduation from the Colle2e of MedicinePassing scores on both the Step 1 written examination (taken at the end of Year2), and Step 2 written examination and clinical skills examination. Studentshavefrom the end of their third year through December 31 of their senior year to passboth parts of the Step 2 examination. Students have three attempts to passbeforedismissal, with appeals. Studentsare not required to take Step 2 examinations inany particular order.APPROV AL:Emeryfilson, M.D.

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Step 2 Clinical Skills (CS)strateStep2 gfromskillsexaminee ndencounter,studies.diagand-Step2 CS usesstandardizedpatients,i.e., peopletrained to portray real patients. Examineesareexpectedto establishrapport with the standardizedpatients, elicit pertinent historical infoIUlation fromthem, perfoIUl focused physical examinations,answerquestions,and provide counselingwhere appropriate.After each interaction with a standardizedpatient,examineesrecord pertinent history and physicalexamination fmdings, list diagnostic impressions,andoutline plans for further evaluation, if neeessary.Thecasescover common and important situations that aphysician is likely to encounterin a gen ralambulatory setting.Further details on the design and content of Step2CS will be provided at the USMLE website.Step3Step 3 is organized along two principal dimensions:clinical encounterframe and physician task, asshown at the right. Step 3 content reflects adata-basedmodel of generalistmedical practice inthe United States.Encounterframes capture the essentialfeatures ofcircumstancessurrounding physicians' clinical activity with patients. They range from encounterswithpatients seenfor the fIrst time for nonemergencyproblems, to encounterswith regular patients seeninthe context of continued care,to patient encountersin(life-threatening) emergencysituations. Encountersoccur in clinics, offices, skilled nursing care facilities, hospitals, emergencydepartments,and on thetelephone. Each test item in an encounterframe alsorepresentsone of the six physician tasks.For example, initial care encountersemphasizetaking a historyand perfonning a physical examination. In contrast,continued care encountersemphasizedecisionsregarding prognosis and management.High-frequency, high-impact diseasesalso organizethe content of Step3. Clinician experts assignclinicalproblems related to thesediseasesto individual clinical encounterframesto representtheir occurrenceingeneralistpractice.8

assessmentof physicians assumingindependentresponsibility for delivering general medical care.In order to be eligIole to register for US1\.1:LEStep 3, students and graduates ofLCME- or AOA-accredited medical schools will be required to not only meet currentexamination requirements (i.e., passing Step 1 and passing Step 2 CK) but also to pass Step 2 CS if they: (a)have graduation dates in 2005 or later, or (b) have graduation dates prior to 2005 and have not passed the CKcomponent of Step2 taken on or before June 30, 2005.ExaminationCommitteesExamination committees composed of medical educators and clinicians prepare the examinationmaterials. Committee membersbroadly representthe teaching, practicing, and licensing communities acrosstheUnited States.At leasttwo of these committeescritically appraiseeach test item or case.They revise ordiscard any materials that are in doubt.When Step2 CS is implemented, it will replace theClinical Skills Assessment(CSA*) administered bythe ECFMG and required for ECFMG certification ofinternational medical graduates.Ownership and Copyright of Examination MaterialsIn order to be eligible to register for USMLE Step3,international medical graduateswill be required tonot only meet current requirements(i.e., passing Step1 and Step2 CK and being certified by ECFMG), butalso to pass Step2 CS. However, international medical graduateswho have passedthe ECFMG CSAwill not be required to pass Step2 CS to register forUSMLE Step3.The USMLE parent organizations,the FSMB andNBME, own the examinationmaterials used in theUSMLE. The examinationsare copyrighted. If youreproduce and/or distribute any examinationmaterials, by any means, including memorizing andreconstructing them, without explicit written permission from the parent organizations, you violate therights of the FSMB and NBME. In addition toactions described on page 25, the FSMB and theNBME will use every legal me nsavailable to protect USMLE copyrighted materials and secureredress againstthose who violate copyright law.To be eligible to register for Step 3, ECFMG-certitied international medical graduateswho have notpassedthe ECFMG CSA, as well as individuals whosuccessfully complete a "Fifth Pathway"program,may also be required to pass Step 2 CS. These individuals should monitor the USMLE website for theeffective date of this requirement.USMLE Step 2 Clinical Skills (CS) Examination.l.A clinical ski1:sexamination was part of the o.riginaldesign of USMLE. The NBME was chargedwithincluding a test of clinical skills using standardizedpatients when such an examination was shown to bevalid, reliable, and practical. NBME researchand thework of other organizations administering clinicalskills examinationsdemonstratethat clinical skillsexaminationsmeasureskill sets different from thosemeasuredby traditional multiple-choice questions.Mastery of clinical and communication skills, as wellas cognitive skills, by individuals seeking medicallicensure is important to the protection of the public.You are responsiblefor determining whether thisrequirementappliesto you, basedon the rules statedin the paragraphsabove.This bulletin is written to include infonnation available at the time of publication regardingthe CS component of Step2. As additional infonnation about theimplementation of Step2 CS becomesavailable,details will be provided at the USMLE and your registration entity's websites. Implementationof the clinical skills examinationwilloccur in the secondor third quarter of 2004. The clinical skills examinationwill be a separatecomponentofStep 2, and will be referredto as Step2 Clinical Skills,or Step2 CS. The current Step2 will be referredto asthe Clinical Knowledge Component,or Step2 CK :-Computer-BasedTesting(CBT)Parts of the USMLE are administeredby compu er.Prometric@,part of The ThomsonCorporation, provides schedulingand test centersfor the USMLE.Step 1 and Step2 Clinical Knowledge Componentare given around the world at Prometric Test Centers(PTCs). Step 3 is given at PTCs in the United Statesand its territories.