Related AMA Policies

The AMA recognizes that the development of competent clinical skills is an essential part of the medical student's training. Indeed, the AMA has long encouraged medical schools to include clinical skills training in their curricula and to evaluate their student's development in this area.

H-295.960 Broadly Based Clinical Experience and Clinical Proficiency Standards
It is the policy of the AMA: (1) to direct its representatives on the LCME to continue to monitor the educational content of the final year of educational programs accredited by the LCME so that the standards, and their application to accredited programs, will provide a broad clinical experience; and (2) to reaffirm existing policy that the first year of graduate medical education should provide the resident physician with a broad clinical experience. (CME Rep. H, A-90; Reaffirmed: Sunset Report, I-00)
H-295.887 Clinical Skills Assessment During Medical School
Our AMA encourages medical schools that do not already do so to implement valid and reliable methods to evaluate medical students’ clinical skills. (CMS Rep. 7, I-99)
D-295.965 Clinical Skills Assessment As Part Of Medical School Standards
Given the importance of assessing clinical competency, our AMA strongly urge the Liaison Committee on Medical Education and the American Osteopathic Association to modify and enforce uniform accreditation standards as soon as possible to require that all medical schools rigorously and consistently assess clinical skills of all students as a requirement for advancement and graduation. (Sub. Res. 821, I-02)
D-295.960 Clinical Skills Training in Medical Schools
Our AMA will encourage medical schools to reevaluate their educational programs to ensure appropriate emphasis of clinical skills training in medical schools. (Res. 324, A-03)
D-295.977 Implementation of NBME Clinical Skills Assessment Exam
Our AMA representatives to the Liaison Committee on Medical Education (LCME) will indicate that the teaching and assessment of clinical skills should be a high priority in the accreditation process. (Res. 311, I-01)

The AMA also believes that assessment of student clinical skills development is most appropriately handled by medical schools and not by various governing and accrediting bodies.

H-275.956 Demonstration of Clinical Competence
It is the policy of the AMA to (1) support continued efforts to develop and validate methods for assessment of clinical skills; (2) continue its participation in the development and testing of methods for clinical skills assessment; and (3) recognize that clinical skills assessment is best performed using a rigorous and consistent examination administered by medical schools and should not be used for licensure of graduates of Liaison Committee on Medical Education (LCME)- and American Osteopathic Association (AOA)-accredited medical schools or of Educational Commission for Foreign Medical Graduates (ECFMG)-certified physicians. (CME Rep. E, A-90; Reaffirmed: CME Rep. 5, A-99; Modified: Sub. Res. 821, I-02; Modified: CME Rep. 1, I-03)

The AMA strongly opposed the implementation of the Clinical Skills Assessment Exam (CSAE) and its use in the licensure and relicensure processes.

H-295.881 Clinical Skills Assessment Exam
Our American Medical Association opposes the implementation of the Clinical Skills Assessment Exam as part of the United States Medical Licensing Examination by any means, including possible legal action. (Res. 304, A-03)
H-275.930 Opposition to Clinical Skills Examinations for Physician Medical Relicensure
Our AMA: (1) opposes clinical skills examinations for the purpose of physician medical relicensure; (2) reaffirms its support for continuous quality improvement of practicing physicians, and supports research into methods to improve clinical practice, including practice guidelines; and (3) continues to support the implementation of quality improvement through local professional, non-governmental oversight. (Res. 307, A-04)

Recognizing that, despite strong opposition, the CSAE would most likely be implemented, the AMA adopted policy to monitor the exam and advocate strongly to improve testing conditions. It continues to do so to this day.

D-275.990 Implementation of NBME Clinical Skills Assessment Exam
Our AMA will: (1) request an itemized rationalization from the National Board of Medical Examiners (NBME) for the proposed cost of $1000 for the Clinical Skills Assessment Exam (CSAE) and the number and location of the testing sites; (2) take all steps necessary to delay implementation of the CSAE as the NBME has not developed an implementation plan that involves reasonable geographic and financial structures; and (3) express deep concern to the NBME that the proposed CSAE imposes unacceptable costs and travel burdens on examinees. (Res. 311, I-01)
D-295.968 Proposed Implementation of Clinical Skills Assessment Exam
(1) Our AMA shall urgently contact the National Board of Medical Examiners (NBME), all organizations represented on the NBME Governing Board, and the Federation of State Medical Boards to request suspension of the implementation of the proposed Clinical Skills Assessment Examination (CSAE) until such time as: (a) The examination has been demonstrated to be statistically valid, reliable, practical, and evidence-based;( b) Scientific studies have been published in peer review journals validating the examination for US medical students and graduates and demonstrating that the fiscal and societal benefits of the examination justify the costs; and (c) Testing sites are available in more reasonable geographic locations than currently proposed by the NBME. (2) Our AMA and state medical societies shall encourage state medical licensing boards to exclude the CSAE from state medical licensure requirements until the above conditions are met. (3) Our AMA shall continue the dialogue with the NBME and the Federation of State Medical Boards concerning the implementation of the CSAE. (4) Our AMA shall ask its representatives to the Liaison Committee on Medical Education to ensure that medical students’ clinical skills are assessed regularly during their clinical training. (Sub. Res. 308, A-02)
D-275.985 Clinical Skills Assessment Exam and College of Osteopathic Medicine Licensing Exam-Physical Exam Implementation
Our AMA will: (1) study mechanisms for providing feedback to medical students on their performance on the proposed United States Medical Licensing Exam Clinical Skills Assessment Examination (CSAE) and College of Osteopathic Medicine Licensing Exam-Physical Exam (COMLEX-PE) including but not limited to written narrative feedback, and access to video recording of the exam for possible review with their medical school and communicate these findings to the National Board of Medical Examiners (NBME) and National Board of Osteopathic Medical Examiners (NBOME); (2) encourage medical schools to develop mechanisms to assist medical students to meet financial obligations associated with the requirements for participation in the CSAE and COMLEX-PE; (3) encourage medical schools to avoid linking passage of the CSAE and COMLEX-PE to graduation requirements for at least the first five years after the implementation of the proposed exam; (4) in conjunction with the National Resident Matching Program, the American Osteopathic Association, the Accreditation Council for Graduate Medical Education, and other interested organizations, study the potential impact of the CSAE and COMLEX-PE on undergraduate and graduate medical education and report back at the 2004 Annual Meeting; (5) strongly encourage the NBME and NBOME to develop policies to ensure adequate capacity for registration and administration of the proposed CSAE and COMLEX-PE in order to accommodate all students testing for the initial time as well ensuring students failing the exam can retest within 60 days; (6) monitor in an ongoing fashion, the proposed implementation of the CSAE and COMLEX-PE and its impact on the medical education continuum; and (7) involve all interested groups at the AMA in any AMA deliberations regarding the CSAE as well as utilization of this or a similar test for recertification purposes, to ensure that the perspectives of all physicians are reflected. (Res. 324, A-03)