December 2, 2005

VUSM student’s JAMA essay garners attention

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Stephen Henry

VUSM student’s JAMA essay garners attention

A fourth-year Vanderbilt University School of Medicine student is receiving attention for his critical review of a new clinical skills test that took nearly 15 years in pilot testing and millions of dollars in funding to develop.

Stephen Henry, 28, was published in the Nov. 2 issue of the Journal of the American Medical Association (JAMA). His essay, “Playing Doctor,” labels the Step 2 Clinical Skills Examination (CSE), a new component of the United States Medical Licensing Exam (USMLE), as “artificial.”

The National Board of Medical Examiners and Federation of State Medical Boards began administering the CSE test in July 2004, marking the first time since 1964 that medical students had their clinical skills considered as part of the licensing process.

“The test itself does not evaluate clinical skills in any meaningful way. It was originally designed to be and remains a very good test of English language proficiency,” said Henry, who passed the test.

“I described in my essay an experience of 'mutual pretense' in which the standardized patients pretended to be ill and I pretended to interview and examine them.

“The standardized patients and examinees are both acting, and this make-believe quality was clear to me when taking the exam.”

Henry's research involves using Michael Polanyi's philosophy to demonstrate why medicine must be grounded in the physician-patient encounter rather than in abstract statistical models.

“It is phenomenal that his essay was published in JAMA,” said Bonnie Miller, M.D., associate dean for Undergraduate Medical Education.

“It is quite an honor and obviously a reflection on the quality of the piece. I consider it a fairly esoteric essay, actually. It is well-referenced and thoughtful.”

The new test has been controversial in medical circles, Miller said, but mainly for its $975 registration fee and other costs incurred by students who travel to one of five exam sites in the country.

Henry said the financial issues and testing sites were not a problem for him, which is why he did not consider them for his essay.

“If the test really measured what it purports to measure, its value in medical education and licensure would be far more than $1,000,” he said.

The USMLE's board has stated that requiring the CSE is an “issue of public safety” because “poor clinical and communication skills have been linked to higher incidence of mal-practice suits, low treatment compliance by patients and decreased patient satisfaction.”

Henry said he has received about a dozen e-mails from people around the country, including several faculty involved in medical education, since the article was published.

“All the responses I've seen have been positive, he said. “People with negative reactions may have written to JAMA directly, but I've not been notified of any negative reactions.”

To read the essay, go to