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Vital Signs

Putting students' clinical learning to the test nationally

By Rosemary Lunardini

The Class of 2006 has posted the best-ever mean score for a DMS class on a national test of clinical knowledge. According to a report from the National Board of Medical Examiners, it is also the highest DMS has been above the national mean since results have been tracked. The test is part of Step II of the national boards, which each class takes during its fourth year. A total of about 17,000 students took the test last year, and the 56 DMS '06s had a mean score of 229—well above the national mean of 221.

Score: Yet it's not the score but the learning behind it that pleases Dr. David Nierenberg, senior associate dean for medical education. "I don't want to oversell this," he says. "It's only one of three parts of the boards, only one of 15 things we look at. But with all of that, this is really impressive."

Every way this exam could be looked at was impressive for DMS. In terms of the test's core clinical areas—psychiatry, obstetrics, medicine, surgery, and pediatrics, plus the 12 organ system areas—many results were "dramatically above the national average," says Nierenberg.

Step II is an important way station for students, but not the only one, on their journey to becoming licensed physicians. The national boards begin with Step I after they complete their second year. Step II is composed of two parts—clinical knowledge (CK) and clinical skills (CS). Step II CK is an all-day, multiple- choice test taken on a computer in a locked room. Step II CS requires students to diagnose 12 patients played by actors. They have 15 minutes to complete each case. This test has been required for only two years, and DMS students have been doing very well in it.

These members of the DMS Class of 2006 are pictured on the day of their White Coat Ceremony in 2002. The '06s recently passed another milestone, getting the results of a national exam testing their clinical knowledge; the class did very well.

Licenses: Finally, the Step III board exam comes at the end of their internships, before they apply for medical licenses to practice independently.

But recent changes across much of the country are speeding up the testing timetable. Step II formerly could be taken any time during fourth year, but it was recently moved to the fall at DMS so students have their scores in hand when they apply for residencies. Earlier testing also helps students obtain a training medical license before beginning internship—a fairly new requirement in 41 states, including New Hampshire.

DMS does everything it can to help students prepare for the boards. One new aid is a computer program called Exam

Master so they can review thousands of practice questions of the type that appear on these exams.

"I suggest to students they may want to take a few days off to review material," says Nierenberg. "You do want to pass it on your first attempt."

Prepare: "I'm very proud of how our medical students are doing," he adds. He explains that DMS hasn't broken into the "top 10" tier of medical schools because such rankings are based heavily on research funding and DMS is not as big as many research universities. But, Nierenberg concludes, "I honestly believe that if you measure medical schools by how well they prepare students . . . we're a 'top 10' medical school."

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