The cultural competence of health care professionals: conceptual analysis using the results from a national pilot study of training and assessment.

The cultural competence of health professionals affects the satisfaction with, and outcomes of, patient care. Patient-centered cultural training was implemented with 76 trainees. Four months later, they were assessed using standardized patient scenarios and their performance compared to a control group.

Does composition medium affect the psychometric properties of scores on an exercise designed to assess written medical communication skills?

The ECFMG Clinical Skills Assessment (CSA) was developed to evaluate whether graduates of international medical schools are ready to enter graduate training programs in the United States. The performance-based patient note exercise is specifically used to assess an examinee's ability to summarize, synthesize and interpret the data collected in a patient interview. The purpose of this study was to investigate whether choice of composition method (typing or writing) affected the psychometric properties of the scores.

The international medical graduate pipeline: recent trends in certification and residency training.

International medical graduates (IMGs) represent a large proportion of the population entering graduate medical education (GME) programs. Many of these internationally trained physicians go on to practice medicine in the United States. To be eligible for GME, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG).

Commentary: Coming to America: the integration of international medical graduates into the American medical culture.

This Commentary is a companion piece to two Research Reports appearing in this issue: "Behavioral Science Education and the International Medical Graduate," by Searight and Gafford, and "International Medical Graduates and the Diagnosis and Treatment of Late-Life Depression," by Kales et al. International medical graduates (IMGs) come to America from diverse cultures around the world to complete their graduate medical education (GME). These residents are and will continue to be a fundamental part of the American health care delivery system.

Specialty board certification among U.S. citizen and non-U.S. citizen graduates of international medical schools.

Background: Graduates of international medical schools (IMGs) make up approximately one-quarter of the physician population and play a key role in the provision of health care in the United States. This study investigated whether they differ from U.S.

Scoring standardized patient examinations: lessons learned from the development and administration of the ECFMG Clinical Skills Assessment (CSA).

Throughout the 40 year history of standardized patient assessments and OSCEs, there have been numerous advancements, including many that involve scoring the simulated clinical encounters. While there is no clear agreement on how examinees' performance should be documented or scored in an encounter, there is a consensus that several well-chosen SP encounters are required to produce reliable examinee scores. There also continues to be some debate as to who should do the scoring on an SP-based assessment.

Assessing competence in communication and interpersonal skills: the Kalamazoo II report.

Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002.

Assessing the written communication skills of medical school graduates.

The ECFMG Clinical Skills Assessment (CSA) was developed to evaluate whether graduates of international medical schools (IMGs) are ready to enter graduate training programs in the United States. The patient note (PN) exercise, conducted after a 15-minute interview with a standardized patient (SP), is specifically used to assess a candidate's ability to summarize and synthesize the data collected. On a yearly basis, approximately 75,000 patient notes are reviewed and scored by physician raters.

The effect of task exposure on repeat candidate scores in a high-stakes standardized patient assessment.

Background: Failing candidates often make multiple attempts on licensure and certification examinations. For performance-based assessments, where available test material is often limited, overlap in examination content is frequently inevitable.

Purpose: The purpose of this study was to investigate the performance of repeat candidates, both on new and exposed material, on a standardized patient clinical skills assessment.

Quality assurance methods for performance-based assessments.

Performance assessments are subject to many potential error sources. For performance-based assessments, including standardized patient (SP) examinations, these error sources, if left unchecked, can compromise the validity and reliability of scores. Quality assurance (QA) measures, both quantitative and qualitative, can be used to ensure that candidate scores are accurate and reasonably free from measurement error.

Evaluating the spoken English proficiency of international medical graduates: detecting threats to the validity of standardised patient ratings.

Purpose: To investigate potential threats to the validity of the spoken English proficiency ratings provided by standardised patients (SPs) in high-stakes clinical skills examinations.

Method: Spoken English ratings from 43 327 patient encounters were studied. These involved over 5000 candidates, 40% of whom were female and 33% of whom self-reported English to be their native language.

The changing pool of international medical graduates seeking certification training in US graduate medical education programs.

International medical graduates (IMGs) consistently represent approximately one fourth of both the physician workforce and the graduate medical education (GME) population of the United States. To enter into accredited US GME programs, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). Changes in the number and characteristics of those seeking certification directly affect the GME population and the future physician workforce in the United States.

Attrition rates of residents in postgraduate training programs.

Background: One goal of program directors is to attract and retain high-quality residents. It is therefore important to study attrition of residents to determine specific cohorts that may be less likely to complete residency training.

Purpose: The purpose of this study was to investigate attrition rates in targeted programs.

Assessing the comparability of standardized patient and physician evaluations of clinical skills.

Accumulating evidence to defend decisions based on scores from evaluations is an ongoing process. The purpose of this investigation was to gather additional data to support the validity of inferences made from scores on the Educational Commission for Foreign Medical Graduates' Clinical Skills Assessment (CSA). This was accomplished by contrasting CSA candidate scores, and pass/fail decisions, with those obtained from the American Board of Internal Medicine's Mini-CEX (Clinical Evaluation Exercise).