Please review the following information in order to prepare for the upcoming Clinical Skills Assessment IV.

What is the CSA IV?

Overview

The Clinical Skills Assessment IV, or CSA IV, uses standardized patients (SP’s) to test medical students on their ability to gather information from their patients, perform physical exams and communicate findings to patients and colleagues.

The purposes of the CSA IV are as follows: 

1. To provide an objective measure of medical students' clinical skills following the successful completion of the third year of medical school.
2. To provide students information about their strengths and weaknesses in clinical sciences and patient-centered skills that are the foundation of safe, effective, medical practice.
3. To provide feedback about existing curricula to the Executive Curriculum Committee (ECC).

Cases

The cases are representative of the types of clinical encounters experienced by primary care physicians as reported in several national databases.

Cases reflect common and important symptoms and diagnoses from areas that include, but are not limited to ENT, respiratory, cardiovascular, gastrointestinal, genitourinary, reproductive, musculoskeletal, endocrine, hematopoietic, neurological, psychiatric, and women’s health. Cases may include an emphasis on health promotion and disease prevention.

Skills to be assessed:

• History
• Physical Exam
• Assessment
• Plan
• Communication Skills

Standardization

Both physician raters and Standardized Patients receive specific training to standardize rating and portrayal respectively. During the assessment, a physician rater will observe all students on a given case, and the patient presentation is standardized for all students. All student examinees will receive the same information when they ask SP’s the same or similar questions.

Quality control is employed to ensure that the exam is fair to all via consistency in SP portrayal and accurate rating of individual cases. This assures fairness and consistency in presentation and scoring across students.

Grading

During each encounter, a physician rater observes your performance and records data on a checklist which may include items in history taking, physical exam, assessment, plan, and communication skills. Each area of the assessment is weighted differently depending on the objectives of the given case and its complexity. Standardized Patients rate communication and interpersonal skills. 

The Acceptable Level of Performance (ALP)

The ALP is the minimum acceptable performance level for the overall case and each section of the case. For example, for a particular case, the history has 10 important items, yet only requires a student to identify 7 out of 10 to meet the minimally acceptable level of performance.  Therefore, for this case the ALP for the history section is set at 7 out of 10, or 70 percent.  The overall case ALP is the arithmetic sum of the ALPs of individual sections.

The CSA IV is a Pass/Fail test. 

To pass the CSA IV, your average overall case score must be at or above the average overall ALP of the eight SP cases.

What happens on the day of the CSA IV?

Overview

Please arrive at A-72, 30 minute prior to your scheduled start time to receive additional important instructions. 

You will be asked to see eight SP cases during your scheduled CSA IV time.  Each SP case will present in an ambulatory setting, such as a primary care doctor's office, clinic, emergency room, or in a hospital setting. These patients represent common clinical scenarios you should have received education about or exposure to sometime during your first three years of medical school.

You will complete four stations, take a 10-minute break, and then complete four more stations.

Timing of encounters

Items that you need to bring:

• A clean white coat
• Your ID badge
• A stethoscope

Testing Regulations and Professional Conduct (Student Honor Code)

1) No reference materials, pre-printed notes or PDAs can be taken into the patient rooms or used during the assessment.  You are permitted to jot down notes before you enter an exam room.

2) Do not discuss/communicate about cases with your fellow students before, during or after the CSA IV.  This includes class e-mails, individual e-mails, blogs, text messages, etc...

3) Do not attempt to discuss anything unrelated to the case with any of the standardized patients.  Please do not ask SPs to disclose real name, why they do this etc...

4) No food or beverage is allowed in the Wasson Center. Food and beverage are permitted in A-72 during orientation and break session.

5) No cell phone calls or pagers are permitted in the Wasson Center.

Professionalism

Be respectful to proctors and Wasson Center staff.  You are being evaluated on your professionalism with respect to SPs, faculty raters and Wasson Center staff.

Note:  Any student violating regulations and/or professional conduct will be subject to warning and/or dismissal from the CSA IV. 

What if I do not pass the CSA IV?

If you do not pass the CSA IV, we will contact you regarding scheduling a time to review your recorded performance and critique yourself at the Wasson Center. After reviewing and providing written comments on your performance, you will meet with the Wasson Center’s medical director or executive director to set up an educational plan in preparation for the remediation assessment.

Guidelines for Optimal CSA IV Performance:

Remember: This is an academic perfomance exam of clinical skills.  Demonstrating anecdotal "short-cuts" learned from actual clinical practice settings will most likely negatively impact performance.

Who can I contact with questions or concerns about the CSA IV?

The staff at the Wasson Center for Clinical Skills is prepared to assist you.

If you have any further questions, please contact Administrative Coordinator Jinny Fedorchak at 330.325.6750.

We wish you well.

Paul J. Lecat, M.D.
Medical Director, Wasson Center for Clinical Skills

Holly A. Gerzina, M.Ed.
Exec. Director, Wasson Center for Clinical Skills