CSA Orientation

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CSA Candidate Orientation Manual

CLINICAL SKILLS ASSESSMENT (CSA ® )

CANDIDATE ORIENTATION MANUAL

Copyright © 2000 by the Educational Commission for Foreign Medical Graduates

CONTENTS

PREFACE

GENERAL INFORMATION

● Purpose of CSA

● Prerequisites to CSA ● Historical Perspective on CSA

● An Introduction to Taking CSA

● CSA Case Development

● CSA Case Content Selection

DESCRIPTION OF THE CSA

● CSA Prototype● Sample Opening Scenarios● Case Background Information

❍ Doorway Information❍ History Taking and Physical Examination Checklists❍ Patient Note❍ Communication Skills

● General Information on Scoring and Score Reporting● The Day of the Assessment ● Preparing for CSA

❍ Test of Spoken English

REGISTRATION AND SCHEDULING

● Application Form ● Scheduling CSA● CSA Cancellation and Rescheduling Policies ● CSA Center Location ● Examinees with Disabilities

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TEST REGULATIONS

● Irregular Behavior

COMMON QUESTIONS

REFERENCES

GLOSSARY OF TERMS AND COMMON ABBREVIATIONS

PREFACE

This Candidate Orientation Manual is intended as a guide for graduates of foreign medical schools

who plan to take the Clinical Skills Assessment (CSA®) as part of their ECFMG® certificationprocess. In the pages that follow, there is general information and a description of the CSA, itscomponents and the method by which scores are derived. Also included are registration andscheduling procedures as well as practical information on preparing to take CSA. In addition, themost commonly asked questions about CSA are discussed. This manual will be periodicallyupdated. Visit the ECFMG web site for the most current information.

GENERAL INFORMATIONPurpose of CSA

The purpose of CSA is to ensure that graduates of foreign medical schools can demonstrate theability to gather and interpret clinical patient data and communicate effectively in the Englishlanguage at a level comparable to students graduating from United States medical schoolsaccredited by the Liaison Committee on Medical Education (LCME). The CSA is still only one of thetest elements leading to ECFMG certification.

Prerequisites to CSA

The ECFMG Information Booklet describes the prerequisites to CSA.

Historical Perspective on CSA

There are approximately 1,600 medical schools worldwide, each with varying educational standards


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and curricula. No universal system currently exists to compare the quality and characteristics of these medical schools with those of U.S. medical schools accredited by the LCME. The LCMErequires that the assessment of clinical skills be a part of the overall evaluation of U.S. medicalstudents. However, in the absence of any single set of international accreditation standards for medical schools throughout the world, the only viable alternative was to assess students graduatingfrom those medical schools with a standardized assessment, the CSA.

As early as 1980 ECFMG introduced the concept of testing the clinical skills of graduates of foreign

medical schools as part of ECFMG certification requirements. ECFMG initiated an extensiveprogram of planning and research to develop a CSA prototype that would provide an objective andconsistent evaluation of the readiness of graduates of foreign medical schools to enter graduatemedical education (GME) programs in the U.S. Pilot projects were conducted around the world, andas a result of those studies the current CSA prototype was developed. It integrates clinicalencounters with standardized patients to assess history taking, physical examination, interviewingand interpersonal skills, as well as the ability to communicate effectively in written and spokenEnglish. The current CSA prototype was tested in the United States and abroad to compile data anddemonstrate its validity and reliability.

Effective July 1, 1998, applicants who had not met all requirements for ECFMG certification by June30, 1998 are required to pass CSA, as well as the basic medical and clinical science components of the medical science examination and the English language proficiency test. Applicants must alsodocument the completion of all requirements for, and receipt of, the final medical diploma.

The incorporation of CSA into the certification process helps to ensure that graduates of foreignmedical schools achieving ECFMG certification possess the necessary basic clinical skills for entryinto supervised GME training programs in the U.S.

An Introduction to Taking CSA

The CSA is designed to evaluate the basic clinical skills you will need to gain entry into asupervised GME training program in the U.S. The attributes of CSA, including the patients, medicalpresentations, and the CSA Center, simulate common medical practice in clinics, doctors’ officesand emergency departments in the U.S. The CSA is used to assess your ability to consider reasonable diagnostic possibilities by presenting a set of common clinical scenarios. In addition,you must demonstrate an acceptable level of professionalism and rapport, as well as written andspoken English language skills.

By gathering relevant medical history and performing a focused physical examination, you will be

demonstrating your ability to collect information unique to the presentation of each patient. Taking arelevant medical history means that it relates specifically to the chief complaint of the patient. Afocused physical examination consists of maneuvers that reveal information in direct relation to thesame patient’s chief complaint, age and gender, and medical history.

You will be required to write a legible patient note indicating the pertinent positive and negativehistorical and physical findings that relate to your potential diagnoses. Once you list the possibledifferential diagnoses that relate to the patient’s complaint, you will also list the diagnostic studiesthat you would use to pursue those diagnoses. A listing of treatment procedures or medications willnot be required.





When you take CSA, you will have the same opportunity as all other candidates to demonstrateyour clinical skills proficiency. The assessment is standardized so that upon asking the same or similar questions, all candidates receive the same information from each patient. An on-goingmechanism of quality control is employed to ensure that the assessment is fair to all. A videotapemonitoring system documents each encounter and ensures the safety of the patients andcandidates, and is an additional quality control procedure.

The patients you will see are lay people trained to portray a clinical problem. This method of assessment is referred to as a standardized patient (SP) based examination. Ninety-five percent of LCME accredited medical schools in the U.S. and Canada use SPs for instruction. About 74% of these same institutions use them for evaluation. SPs are also incorporated into the Medical Councilof Canada’s (MCC) medical licensure examination for Canadian and foreign medical graduates.The SP-based testing method was established more than 30 years ago, and its procedures weretested and validated in the United States and internationally.

The CSA is designed as a standards-based (criterion referenced) examination, meaning thatspecific scores are set for passing performance. Committees of physicians review the case

materials and determine the essential skills and behaviors that must be demonstrated bycandidates for each case. You are evaluated only with reference to this standard, so there is nopredetermined number or percentage of graduates of foreign medical schools who will pass. Passrates for CSA candidates are solely a function of performance. Consequently, anyone can pass,depending on his or her level of proficiency relative to the standard. For purposes of entry intograduate medical education, a passing performance on the CSA will be valid for three years fromthe date passed.

CSA is offered at a single site in Philadelphia, Pennsylvania, USA. The complex testing systeminvolves a specially designed facility and trained personnel. Therefore, specific strategies for quality

control were designed initially for only one site. In the future, consideration may be given toestablishing another site outside of the United States.

Back to Contents

CSA Case Development

Practicing physicians and medical educators write and review cases to ensure that they are fair andvalid. These cases represent the kinds of patients and problems you would normally encounter

while training in an accredited U.S. GME program. Cases are specially designed to elicit a processof history taking and physical examination in a clinical encounter that will demonstrate your ability tolist and pursue various possible diagnoses.

The eleven cases that make up each administration of CSA reflect a balance of presentingcomplaints as well as a diversity of patient age, sex, and ethnicity. There is also a mix of acute,subacute and chronic problems. On any assessment day, the set of cases will differ from thecombination presented the day before or the following day, but each set of eleven cases will havecomparable degrees of difficulty.


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CSA includes test cases representing the major clinical education programs encountered at medicalschools accredited by the LCME in the United States. These disciplines include:

● Internal Medicine ● Surgery ● Obstetrics and Gynecology ● Pediatrics ● Psychiatry ● Family Medicine

CSA Case Content Selection

The CSA case content area is the universe of clinical symptoms (cases) that will be represented bystandardized patients. The selection of eleven clinical cases from the larger pool of CSA contentarea is guided by the CSA assessment form specification that defines five main content areas:

● Cardiovascular/Respiratory ● Digestive/Genitourinary ● Neurologic/Psychiatric ● General symptoms ● Other (ear, eyes, nose, throat, musculoskeletal)

The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.

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CSA Prototype

In your CSA administration you will have eleven patient encounters, ten of which will be scored.Non-scoreable patient-encounter stations are added to the CSA rotation for research and other purposes, but those encounters are not counted in determining your score.

Before you enter each examination room, you will have a few moments to review information thatwill be posted on the examination room door. This information gives you specific instructions, andtells you the patient’s name, age, gender, and reason for visiting the doctor. It will also indicate hisor her vital signs, including pulse rate, blood pressure, temperature (Centigrade and Fahrenheit),and respiratory rate. You can accept these as accurate and do not need to repeat unless youbelieve the case specifically requires it.

Upon entering each room, you will encounter an SP. By asking this patient the relevant questionsand performing a focused physical examination, you will be able to gather enough information todevelop preliminary differential diagnoses and a diagnostic work-up plan. You will also be expected


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to communicate in spoken English with the patients in a professional and empathetic manner. Youare to answer any questions they have, tell them what diagnoses you are considering, and advisethem on what tests and studies you will be ordering to clarify their diagnoses.

The kinds of medical problems that your patients will be portraying are those you would commonlyencounter in a clinic, doctor’s office or emergency department. There are no children presenting asSPs. However, there may be cases dealing with pediatric issues in which you may encounter a sickchild’s parent or caretaker. In such cases, physical examination is obviously not possible and will

not be expected.

The elements of medical history you need to obtain in each case will be determined by the nature of the patient’s problems. Not every part of the history needs to be taken for every patient. Somepatients may have acute problems, while others may have more chronic ones. You probably will nothave time to do a complete physical examination on every patient, nor will it be necessary to do so.Pursue the relevant parts of the examination, based on the patient’s problems and other informationyou obtain during the history taking.

The key to interacting with the SPs is to relate to them exactly as you would to any patients that you

may see with similar problems. The only exception is that certain parts of the physical examinationmust not be done: rectal, pelvic, genitourinary, or female breast examinations. If you believe theseare indicated, you may include them in your proposed diagnostic work-up.

You will have fifteen minutes to spend with each patient. An announcement will tell you when tobegin the encounter, when there are five minutes remaining, and when the encounter is over. Insome cases you may complete the encounter in less than fifteen minutes. If so, you may leave theexamination room early, but you are not permitted to re-enter. Be certain that you have obtainedall of the necessary information before leaving the examination room.

Immediately following each encounter you will have ten minutes to complete a patient note. You willbe asked to write a patient note similar to the medical record you would compose after seeing apatient in a clinic, office or emergency department. You should record pertinent medical history andphysical examination findings, as well as your initial differential diagnoses. Finally, you will list thediagnostic studies you would order next on that particular patient. If you think a rectal, pelvic,genitourinary, or female breast examination would have been indicated in the encounter, then list itas part of your diagnostic work-up. Treatment, consultations, or referrals should not beincluded in your work-up plan.

Most cases are designed to present more than one diagnostic possibility. Based on the patient’s

presenting complaint and the additional information you obtain as you begin taking the history, youshould consider all possible diagnoses and explore the relevant ones as time permits.

Perform physical examination maneuvers correctly and expect that there will be positive physicalfindings in some instances. Some may be simulated, but you should accept them as real and factor them into your evolving differential diagnosis. However, be considerate of the patients and alwayskeep them comfortable and properly draped as you perform the physical examination.

The testing area of the CSA Center consists of a series of examination rooms equipped withstandard examination tables, commonly-used diagnostic instruments (blood pressure cuffs,





otoscopes, and ophthalmoscopes), latex gloves, sinks, and paper towels. The orientation givenimmediately before you take CSA will include a brief demonstration of the instruments andequipment that you will be using in the actual patient encounters.

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Sample Opening Scenarios

So that you have a better understanding of the typical mixture of case scenarios presented in oneCSA administration, below are ten sample opening scenarios. This is the basic information that isposted on the doorway of each examination room prior to your seeing the patient. The scenarioslisted below are representative of, but are not the exact cases you will see in your assessmentsession.

1. 50 year-old female complaining of chest painBlood pressure = 138/92 Pulse = 80 Respirations = 18 Temperature = 98.6

2. 35 year-old female complaining of abdominal painBlood pressure =146/88 Pulse = 92 Respirations = 20 Temperature = 99.1

3. 75 year-old male brought to see you because of a fallBlood pressure =155/75 Pulse = 68 Respirations = 14 Temperature = 98.2

4. Mother of 1 year-old child with diarrhea(child not available for physical examination)

5. 46 year-old male complaining that he has no energy for the past three monthsBlood pressure = 122/70 Pulse = 70 Respirations = 12 Temperature = 98.7

6. 18 year-old female complaining of vaginal bleeding for two daysBlood pressure = 95/65 Pulse = 84 Respirations = 14 Temperature = 98.6

7. 63 year-old male with history of diabetes; new to your practice; here for medication refillBlood pressure = 140/75 Pulse = 76 Respirations = 18 Temperature = 99.0

8. 24 year-old female brought in by colleagues because of a seizure at workBlood pressure = 155/85 Pulse = 100 Respirations = 24 Temperature = 99.2

9. 59 year-old male complaining of blurry visionBlood pressure = 138/82 Pulse = 88 Respirations = 14 Temperature = 98.6

10. 79 year-old female complaining of shortness of breath since last nightBlood pressure = 158/90 Pulse = 92 Respirations = 20 Temperature = 98.6


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Sample Case

Case Background Information

The case excerpts you will see on the following pages were selected to familiarize you with thecontent and evaluative objectives that provide the basis for scoring. This information is used to trainSPs. When you come to take the CSA, you will not have access to the information below. The

background information presented here is simply an example of the materials on which a typicalcase is based.

Most CSA cases incorporate patient history, physical examination, examinee communication skills(including spoken English proficiency), and a post-encounter patient note. You should becomeacquainted with the following examples of the doorway information, the checklists SPs use todocument your actions during the encounter, the patient note format, and the evaluative tools usedto derive communication skills ratings.

● Chief Complaint

Jolene Brown is a 48 year-old female complaining of chest pain.

● History of Present Illness

The patient is a 48 year-old female complaining of burning chest pain thatbegan one and a half hours prior to presenting to the EmergencyDepartment. The pain began 30 minutes after a heavy lunch. Nausea, slightsweating and dyspnea accompanied the pain. The pain passed

spontaneously 20 minutes after its onset. She presently feels fine and wishesto be immediately discharged. She describes several similar episodes in theprevious two to three months, especially after heavy meals or physicalexertion, continuing for two to three minutes and passing spontaneously.Prior to this period Ms. Brown had no chest pain. She is not working harder nor experiencing any specific stress lately. She plays tennis once a week; noother physical activity. Lately, during matches, Ms. Brown complains of mildretrosternal burning sensation. Over the past two to three months, during theburning episodes, she used antacids, with partial relief of symptoms. For thepast three to four years, the patient has had occasional heartburn after heavymeals and antacids gave partial relief. But now the pain is different. Her painis not related to breathing or changes in body position. She has had nochange in bowel movements, no melena. She has no symptoms of congestive heart failure or arrhythmias (no orthopnea, paroxysmal nocturnaldyspnea or palpitations).

● Past Medical History

Hyperlipidemia: Ms. Brown had cholesterol checked on routine blood testsdone two years ago. She was told that her cholesterol was high, but does not





remember any specific values. A low cholesterol diet was suggested at thetime, but she did not follow this advice. Otherwise, the patient is completelyhealthy. She has not seen a physician in two years.

● Medication, Allergies, Diet, Immunization

Medications: The patient takes no prescribed medication. Occasional use of over the counter antacids.

Allergies: Penicillin caused her to break out in a rash.

Diet: Unremarkable.

Immunization: Unremarkable.

● Family History

Older brother : Diagnosed with some sort of ‘heart problem,’ but never treated (patient does not know exact details).

Father : Peptic ulcer disease.

Mother : Non insulin-dependent diabetes mellitus (NIDDM) treated by dietalone.

● Social History and Habits

Smoking: She stopped smoking three years ago, and until then she smokedtwo packs a day for 15 years.

Alcohol: Occasionally drinks socially, but takes in small amounts.

Occupation: Executive Vice President of a not-for-profit charitableorganization.

Marital Status: Single heterosexual female.

Sample Case

Doorway Information





Before entering the examination rooms, you will be given some basic information. This doorwayinformation is posted on the examination room door and is similar to a triage note that a nursenormally gives a physician. Please read it carefully before seeing the patient because it will tell youhis or her name, gender, age, presenting complaint, and the tasks you are to complete. You shouldaccept the doorway information as accurate, though in some cases reexamination of vital signs maybe appropriate. Most CSA stations will have the same types of tasks listed, but some may includespecific, unique tasks.

For your convenience, there will be an identical second copy of the doorway information in theexamination room. Please do not remove the doorway information from the examination room.

Doorway Information

1. Opening Scenario

Jolene Brown, a 48 year-old female, comes to the Emergency Departmentcomplaining of chest pain.

2. Vital Signs

BP: 160/80

Temp: 99.5° F (37.5° c)

RR: 16/minute

HR: 95/minute, regular.

3. Examinee Tasks

1. Obtain a focused history.2. Perform a relevant physical examination

(Do not perform rectal, pelvic, genitourinary, or female breast examinations).3. Discuss your initial diagnostic impression and your work-up plan with the patient.4. After leaving the room, complete your patient note on the given form.

Sample Case

History Taking and Physical Examination Checklists

Standardized patients will document your actions during the encounter, and they are trained to do

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so in a fair and consistent manner. Each patient fills out checklists that document the inquiries youmake and maneuvers you perform during the encounter. The history-taking checklist includes allof the key inquiries you are expected to make in the course of taking the patient’s history for aparticular case. Patients also use a physical examination checklist that includes all of the keymaneuvers you should perform during the course of doing a physical examination. Your techniquein doing these maneuvers is also taken into account by the patient. He or she goes through thechecklists and marks those items you asked or performed, for which you receive credit.

Since the cases are broad, your history taking should consider multiple possible diagnoses. Do notprematurely close your history taking on a single diagnosis, and do not attempt a complete history.During your physical examination of the patient, you should attempt to elicit important positive andnegative signs. The 15 minutes you have with the patient does not permit a complete history takingor physical examination, but only a gathering of relevant data. Make sure you discuss with thepatient your initial diagnostic impression and work-up plan. The patients are instructed to ask veryspecific questions concerning their complaints. These inquiries are intended to challenge you, soyou should address each patient’s concern as you would normally do in a clinical setting.

All physical examination maneuvers, including exposing and draping the patient, should be done as

you would normally do them in regular practice. Your score is based on what you look for in theencounter and the technique you employ while going about it.

The sample checklist items on the following page are examples of examinee questions and physicalexamination maneuvers that might be expected in a particular case. However, the listed questionsand maneuvers are not exact representations of complete history taking and physical examinationchecklists.

Standardized Patient History Taking Checklist (Sample Items)

KEY: Y, yes N, no

Y

Y

Y

Y

Y

N

N

N

N

N

5. Is there a history of smoking?

4. Nausea? OR Sweating? OR Dyspnea?

3. Are there any precipitating factors?

2. Does the pain radiate?

1. What is the character of the pain?





Y

Y

N

N

7. Past medical history?

6. Family history?

Standardized Patient Physical Examination Checklist (SampleItems)

KEY: Y, yes N, no

Y

Y

Y

N

N

N

3. Examinee palpates abdomen, at least epigastric or right upper quadrant.

2. Examinee auscultates precordium in at least 2 positions.

1. Examinee auscultates lungs.

Sample Case

Patient Note

After leaving the encounter, you will have ten minutes to complete the patient note. In an actualpractice setting, the patient note would be used to communicate with other health professionals.Keep in mind that once you leave the patient to complete your patient note, you cannot re-enter theexamination room. Blank paper will be provided for note taking in the examination room, but allsheets must be returned with your completed patient notes. For security reasons, the sheets of blank paper are numbered.

Refer to the example of a blank patient note, followed by two examples of completed notes. Thereare several styles of writing patient notes that are acceptable. The two examples are presented todemonstrate some of the variations in style. They are not meant to represent ideal or perfect patientnotes, nor should they be assumed to be complete or accurate with respect to content. Bothformats and styles, however, would be considered acceptable, despite their differences.

HISTORY

Make note of significant positives and negatives from the history taking. The following history


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categories may yield important information, although not all will necessarily be pertinent to everycase:

● Chief complaint (CC) ● History of present illness (HPI) ● Past medical history (PMH) ● Review of systems (ROS) ● Social history (SH) ● Family history (FH)

PHYSICAL EXAMINATION

List pertinent positive and negative findings from the physical examination.

DIFFERENTIAL DIAGNOSIS

Consider a range of possible diagnoses, and list up to five of them.

DIAGNOSTIC WORK UP

Write your immediate plans for further diagnostic work-up. If you think rectal, pelvic, genitourinary,or female breast examinations should be done as part of the evaluation for that specific patient, youmay include them in your diagnostic work-up plan on the patient note. Treatment (therapeutics)should not be included. Do not include hospitalization, consultations, or referrals.

You should order fundamental first line tests that will help point you in a diagnostic direction. Theserequested tests must also be specific. For example, if you suspect hypothyroidism, you might order

"T4 and TSH," but not "Thyroid studies" or "Thyroid panel." Do not order "SMA-20," "Chemistrypanel," or "Liver profile," but rather, the specific component tests you are interested in, e.g., BUN,glucose, electrolytes.

You may use abbreviations commonly used in the United States. If you are uncertain about theabbreviation, write out the full term. For the patient note to be scored, your handwriting must belegible. For your convenience in preparing for CSA, the glossary at the end of this manual lists

some commonly recognized abbreviations and definitions.


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[Click for full-size image]

Patient Note Example One

The patient note below is written primarily in a narrative style. The History is written in full or near full sentences and the Physical Examination also has fairly complete phrases. Note that there areonly four studies ordered under the Diagnostic Workup section; this is acceptable.

There are some abbreviations not included in the glossary of terms and common abbreviations, but

they are common enough to be recognizable by the practicing physicians rating the notes. The noteis written in cursive script but it is legible.


Patient Note Example Two

This patient note is written in more of a telegraphic or "bullet" style. There are no complete


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sentences, although there are some phrases where appropriate. However, in some parts of theHistory in particular, there are one or two words that stand alone. The writer of this note has chosento transcribe the patient’s blood pressure from the doorway information. You may wish to includevital signs if they are particularly relevant to the case.

In this note only four items are listed in both the Differential Diagnosis and in the Diagnostic Workupsections; again this is acceptable. This sample also has some abbreviations or symbols notincluded in the glossary of terms and common abbreviations but, as in Example One, they are

generally recognizable. This note is printed throughout, although a mixture of cursive script andprinting would also be acceptable provided both were legible.


Sample Case

Communication Skills

SPs undergo extensive and continuous training to rate your communication skills. This method of rating results in fair, valid, and reliable data. (See "References" at the back of this manual.) During

all eleven encounters, each patient will evaluate your communication skills based on the followingcriteria:

● Skills in interviewing and collecting information❍ the clarity of your questions;❍ the effectiveness of your questioning techniques;❍ appropriate use of medical language;❍ your verification and summarization of information with the patients;❍ the effectiveness of your transitions between different parts of the interview.

● Skills in counseling and delivering information❍ the clarity of the information you give;❍ the effectiveness and sincerity of your counseling;❍ the thoroughness of the encounter closure;


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❍ the clarity and appropriateness of your speech;❍ the effectiveness of your summarization of information and how you link various

information together.

● Rapport (connection between doctor and patient)❍ your attentiveness to the patients;❍ the appropriateness of your body language;❍ your confidence level and attitude;❍ the level of empathy and support you show the patients.

● Personal Manner ❍ your manner of introducing yourself to the patients;❍ the appropriateness of how you expose and drape the patients;❍ your manner while conducting physical examinations;❍ the appropriateness of your demeanor.

● Spoken English Proficiency❍ your ability to communicate understandably;❍ your pronunciation and grammar;❍ your ability to correct or clarify your language when needed;

❍ the amount of effort required by patients to understand you.

Communication Skills Rating Scale

The following scale is used by the SPs to rate your communication skills performance. A ratingscale is completed for each of the eleven stations.

Item 1. Skills in Interviewing and Collecting Information

(clarity of questions; open vs. closed questions, verification, summarization, transitions)

Unsatisfactory MarginallySatisfactory

Good Excellent

1 2 3 4

Item 2. Skills in Counseling and Delivering Information

(giving information, counseling, closure, language and speech, summarization and connection)


Good Excellent

1 2 3 4





Item 3. Rapport (connection between doctor and patient)

(attentiveness, body language, confidence, attitude, empathy and support)


Good Excellent

1 2 3 4

Item 4. Personal Manner

(hygiene, draping, physical examination, demeanor, introduction)

Unsatisfactory MarginallySatisfactory Good Excellent

1 2 3 4

Item 5. Spoken English Proficiency

(ability to communicate understandably, pronunciation and grammar, amount of effort required by patients tounderstand you)

1

ComprehensibilityLow

2

ComprehensibilityMedium

3

ComprehensibilityHigh Very High

4

Comprehensibility

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General Information on Scoring and Score Reporting

Overview

In order to pass CSA, you must pass pre-defined performance standards set by medical experts intwo separate components. The first component, called the Integrated Clinical Encounter (ICE), is acombination of the Data Gathering (DG) and Patient Note (PN) scores. The second component,Communication Skills (COM), is derived from the SP evaluations of interpersonal skills and spokenEnglish language proficiency. You will have eleven patient encounters, ten of which will be used to


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derive your scores.

Scoring Components

Data Gathering (DG)

Using the history taking and physical examination checklists, the SP documents your ability in each

station to gather data relevant to the clinical encounter. Your DG score for a particular encounter isthe percentage of checklist items that you were given credit for in the history taking and physicalexamination. The SP does not evaluate your medical performance, but simply documents whether or not you successfully obtained relevant information or correctly performed the case-specificphysical examination maneuvers. Your final DG score is the average of your DG scores over tenCSA encounters in the assessment form.

Patient Note (PN)

Following the encounter with the SP, you will be required to complete a patient note. Physicians aretrained to rate these notes based on predefined criteria that include:

● organization; ● quality of information; ● interpretation of data; ● egregious/dangerous actions; ● legibility.

Your final PN score is the average score you earned across the ten scored exercises.

Integrated Clinical Encounter (ICE) Score

The DG and PN scores are combined to form an ICE score. Your final DG and PN scores reflectyour average performance across ten scored encounters. Therefore, you may compensate for poor performance in one encounter with excellent performance in another.

Communication Skills (COM)

Following each encounter the SP will also evaluate your COM skills along five dimensions:

● interviewing; ● counseling and delivering information; ● rapport; ● personal manner; ● spoken English proficiency.

For each of these dimensions, the SP assigns a score. SPs make these evaluations according to ascoring system that is fair, consistent and objective. Your COM score for the encounter is the sum





of the five COM dimension scores.

Over the ten scored encounters, the average of these COM scores makes up your finalCommunication score. Your score must meet or exceed a performance standard predefined byphysician experts.

Score Reporting

An overall pass/fail designation will be reported to you six to eight weeks after your CSAadministration. ECFMG reserves the right to delay the reporting of CSA pass/fail designations if additional data and/or analyses are required to assure the validity of the assessment scores.Candidates who pass the standards on both the Communication and Integrated Clinical Encounter components will receive a "PASS" designation for the CSA. Substandard performance on either theCommunication or the Integrated Clinical Encounter component will result in a "FAIL" designation.

To avoid misinterpretation and to protect your privacy, CSA results will not be provided bytelephone, facsimile, or E-mail.

Score Rechecks

Standardized procedures ensure that your scores are an accurate reflection of your performance,so a change in your CSA pass/fail designation based on a recheck is an extremely remotepossibility. However, if you would like a recheck of your CSA designation, you must submit anExaminee Request for Score Recheck Form (Form 751) and payment for this service to ECFMG.

The recheck will consist of recalculating the component scores on which your CSA pass/faildesignation is based.

Please send your request to the following address:

ECFMGAttention: CSA Score Inquiry3624 Market StreetPhiladelphia, PA 19104-2685 USA

The Day of the Assessment

When you arrive at the CSA Center on the day of your assessment, please be prepared to presentvalid, government-issued photo identification and your admission permit. Arrive at the CSA Center no more than 30 minutes prior to your scheduled assessment. If you are traveling a long distance,consider arriving in Philadelphia at least a day before your CSA session.

Please do not bring anything other than necessary personal items with you to the Center. Coatracks are available, and each candidate will be assigned a small open storage cubicle in whichpersonal belongings must be stored during the assessment. However, these cubicles are notsecure, and ECFMG assumes no responsibility for your personal items. Luggage cannot be





accommodated, so other arrangements must be made for its storage during the assessment. Wealso have no waiting facilities for spouses, family, or friends, so please plan on meeting themelsewhere after the assessment. Wear comfortable professional clothing and a white laboratory or clinic coat. The only piece of medical equipment you need to bring is your stethoscope. All other necessary medical equipment is provided in the examination rooms.

Throughout the assessment day CSA staff, who will be wearing identifying nametags, will direct youthrough the examination. Please follow their instructions at all times.

Each assessment session will begin with an orientation. This on-site orientation is in addition to thismanual and the videotape that ECFMG will send you when you are registered for CSA. Theorientation will familiarize you with the equipment in each examination room and the nature of typical encounters. It is also intended to inform you about examination procedures and regulations.During the orientation, you will be asked to sign a confidentiality agreement. It stipulates that you,as a CSA examinee, will not reveal case information to anyone at any time. This agreement is away to ensure that each examinee has the same opportunity as all others. If you discloseinformation to prospective candidates, there is no guarantee that the information you supply will aidthem. In fact, it may confuse subsequent candidates because different sets of cases are used each

day. In addition to the confidentiality agreement, there will be a demographic questionnaire for youto fill out before the assessment and a feedback questionnaire afterwards.

The CSA Center is a secured facility. Once you enter the secured area of the Center for orientation,you may not leave that area until CSA has been completed. Since the assessment lastsapproximately eight hours, two breaks will be provided. The first break is thirty minutes long andtakes place after your fourth encounter; the second break is fifteen minutes long and occurs after the eighth encounter. At break time, you are free to relax, use the rest rooms, and haverefreshments. A light meal will be served, and there are vending machines available for drinks. Youmay also bring your own food provided that no refrigeration or preparation is required. Smoking isprohibited throughout the Center.

You cannot, during breaks or at any time, discuss the cases with your fellow candidates.Conversation among candidates in languages other than English about any subject is strictlyprohibited at all times during these breaks. Examination proctors will be with you to monitor activity.To maintain security and quality assurance, each examination room is equipped with video camerasand microphones to record every encounter. Please conduct yourself as you would during a normalday in a clinic.

Preparing for CSA

History taking, physical examination, spoken and written English, and interpersonal behavior are allskills that can be improved by training, practice, and critique. You can refer to the multiple texts andother media sources that address these skills. Practice with colleagues, teachers, or mentors whowould portray patients could be useful, provided such role-plays are realistic and represent commoncomplaints.

Perhaps the best preparation of all is to see actual patients in a real clinical setting, especially if thisis done under the supervision and/or review of a competent clinical teacher. CSA is designed tosimulate an actual clinical experience, so the more clinical experience you have, the more





comfortable you will feel during the examination.

You will find additional test-taking strategies in the videotape that accompanies this manual. Thevideotape gives more information on CSA and demonstrates a typical patient encounter.

Test of Spoken English

It is not required that you speak English comparable to that of a native speaker. However, if you areuncertain of your spoken English language proficiency, you are encouraged to take the Test of Spoken English (TSE®) as a screening test prior to registration for CSA. The TSE was developedby the Educational Testing Service (ETS) and is administered in a number of sites around theworld. Studies indicate that candidates who obtained a score of 35 and lower on the TSE are notlikely to pass CSA; however, a TSE score above 35 does not ensure passage of CSA. A TSEscore of 35 represents a speaker who generally does not communicate effectively and cannotcompensate for weaknesses in language.

For information about TSE administration dates and locations, contact:

TOEFL/TSE ServicesP.O. Box 6151Princeton, NJ 08541-6151 USATelephone: 609-771-7100E-mail: [email protected]

Internet: http://www.toefl.org/

General Comments

● Greet the patient and state your name. ● Elicit or confirm the patient’s name. ● Never attempt to communicate with the patient other than as a physician to a patient. ● Feel free to take notes during the encounter. (Blank paper will be provided.) ● Don’t make assumptions about what you will see in each encounter. ● There may be more than one case testing related or similar clinical entities. ● Concentrate on the case on which you are working. ● Notify proctors of any problems.

History Taking

● Begin with broad questions and then focus your inquiries. ● Don’t rush the patient’s answers. ● Don’t cut the patient’s answer off with another question. ● Repeat your questions in different terms if necessary.


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● Ask follow-up questions.

Physical Examination

● Do a focused examination based on the patient’s complaint, symptoms, and history.● Wash your hands between patients, preferably before touching the patient or beginning the

physical examination.

● Tell the patient when you are going to begin the physical exam.● Describe the maneuvers either before or as you do them.● Always use patient gowns and drapes appropriately to maintain patient modesty and

comfort, but never examine through the gown.● Use the examination table extension when the patient reclines.● If you ask a patient to get off the examination table, offer to assist him or her.● Look for physical findings.● Do not perform rectal, pelvic, genitourinary, or female breast examinations.● Tell the patient your initial impressions and your plan for the diagnostic work-up.● Ask for and answer any additional questions.● Note the time warning for 5 minutes remaining in the encounter.● Close the encounter when the "End of Encounter" signal is given.


● Make eye contact. ● Ask clear questions and speak understandably. ● If you use medical terms, explain yourself. ● Be direct and honest, but also be sensitive. ● If you don’t know the answer to an SP’s question, say so. ●

Don’t give false reassurance or a premature diagnosis.

● Acknowledge the patient’s concerns or worries. Patient Note

● Approach the note as if you are communicating with another health professional. ● Write legibly. ● If necessary, refer to the notes you took during the encounter. ● Group similar data together. ● Write out information in a logical sequence. ● Clearly portray the patient problem. ● Be accurate. ● Be specific. ● Identify critical elements. ● Include pertinent positives and negatives. ● Make sure your plans for further diagnostic work-up are reasonable. ● Do not include treatment in your plans for diagnostic work-up.

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Application Form

Registration for CSA requires submission of the CSA application (Form 706). Form 706 is included

in the ECFMG Information Booklet and may also be downloaded from the ECFMG web site athttp://www.ecfmg.org. To register for CSA, you must complete Form 706 and send it, with fullpayment of the assessment fee, to ECFMG by mail (or courier service), following the mailinginstructions on the application form. You cannot register by facsimile, letter, postcard or e-mailmessage. Detailed application instructions are included with the application form. Follow theinstructions carefully and answer all questions completely. You should review the instructionsbefore you begin working on the application. If your application is not complete or if the required feeis not submitted, it will be returned to you.

Scheduling CSA

To be registered for the CSA, you must first meet all eligibility requirements as listed in theappropriate edition of the ECFMG Information Booklet , submit a completed CSA application, and

pay the current CSA fee. After you are registered, ECFMG will mail you a Notification of Registration for CSA. Once you receive this notification, you may schedule an assessment date.

You should be aware of two windows of time relative to CSA registration. The first is the period of time in which you must schedule a date to take CSA. This period of time is four months from thedate of your Notification of Registration. You must schedule an assessment date within this four month period. The assessment date does not need to be within this four month period, but the

selection of a date must be completed within this time frame.

The second window of time is one year from the date of your Notification of Registration. Within thistwelve month period, you must come to the CSA Center in Philadelphia and take the CSA. Your Notification of Registration will clearly indicate the dates by which you must schedule and take theCSA.

To schedule an assessment date, contact the CSA Scheduling Program. This can be done in either of two ways. You may telephone 1-215-970-1982 (Monday through Friday, 0800-2400 EST) to havean operator assist you with scheduling. You should be prepared to give your name,

USMLE™/ECFMG identification number, and date of birth as it appears on your Notification of Registration. Remember that you will only be able to schedule if you have received officialNotification of Registration. Have several preferred dates in mind, all within one year from the dateof your Notification of Registration. The operator will indicate which dates are available. When anacceptable date is found, the operator will formally schedule you and give you a confirmationnumber. An admission permit will be mailed to you the next business day. Once an assessmentdate is scheduled, it cannot be canceled or rescheduled. You should also be aware that schedulingoperators only assist in scheduling, and cannot answer any other questions or provide additionalinformation regarding CSA or ECFMG. They will refer any such inquiries to the ECFMG ApplicantInformation Services at 1-215-386-5900.


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If you have access to the Internet, you may also schedule directly through the CSA SchedulingProgram on the ECFMG Web Site at . If you choose to access the web site,http://www.ecfmg.org/

you will receive step by step directions on how to schedule an assessment date. Again, beprepared to provide your name, USMLE/ECFMG identification number, and date of birth as itappears on your Notification of Registration. If you select an assessment date through the Internet,you will be given a confirmation number, and an admission permit will be mailed to you the nextbusiness day. You will be committed to that date.

Assessment dates and sessions will be opened depending on demand. If no acceptable dates areavailable when you first call or access the web site to schedule, you may decide not to schedule atthat time. You may check again later to find out if additional dates or sessions have opened.However, be aware that there is still a requirement to schedule an assessment date within four months from the date of your Notification of Registration.

Every effort will be made to accommodate your scheduling preferences. However, due to thevolume of candidates and limited Center capacity, ECFMG cannot guarantee the availability of specific dates you may request.

It is the sole responsibility of the candidate to complete CSA in time to meet deadlines imposed bythe National Resident Matching Program (NRMP) and/or GME programs. Since the number of

candidates seeking to complete CSA may exceed the spaces available in time to meet thosedeadlines, there is no guarantee that sufficient spaces will be available for all candidates to meetdeadlines imposed by NRMP and/or GME programs. ECFMG assumes no liability of any kind if acandidate does not complete CSA in time to meet NRMP and/or GME program deadlines.

CSA Cancellation and Rescheduling Policies

If a registered CSA candidate fails to schedule a CSA assessment date within four months of notification of registration, or fails to take the CSA within one year of that notification, theregistration will become invalid and the assessment fee will be forfeit.

Once scheduled, a CSA assessment date cannot be rescheduled or cancelled. Cancellation of ascheduled CSA will result in forfeit of the assessment fee, as will failure to appear on the date of ascheduled CSA. In either case a new application must be submitted with the full assessment fee.

In extraordinary circumstances, appeals for exceptions to these policies will be considered on acase by case basis. Candidates wishing to appeal should contact ECFMG and request the CSA

Scheduling Exceptions Appeal Form (Form 745) that contains instructions for completion,documentation and submission. Form 745 is also available on the ECFMG web site athttp://www.ecfmg.org/. However, no consideration for cancellation or rescheduling will be

considered within 30 days of the scheduled CSA date. Submit your appeal to the following address:

ECFMGAttention: CSA Scheduling Exceptions Appeals3624 Market StreetPhiladelphia, PA 19104-2685 USA





CSA Center Location

The CSA is administered only at the following location:

ECFMG3624 Market StreetCSA Center: 3rd Floor Philadelphia, PA 19104-2685 USA

Examinees with Disabilities

The CSA Center is wheelchair accessible, and reasonable accommodations will be made for theadministration of CSA to candidates with documented disabilities. For instructions on requestingtest accommodations, refer to the Guidelines and Questionnaire for ECFMG/CSA Applicants

Requesting Test Accommodations (Form 756). Such requests, including the completed

Questionnaire, should be made as soon as possible, and must be received by ECFMG no later thanthe application for the CSA itself. Scheduling CSA means accepting ECFMG’s conditions for theassessment; therefore no requests for test accommodations will be accepted after scheduling hasoccurred. When the CSA is administered with test accommodations, performance reports andtranscripts will not include any annotation that an accommodation was granted.

Requests should be sent to the following address:

ECFMGAttention: CSA Test

Accommodations Committee3624 Market StreetPhiladelphia, PA 19104-2685 USA

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TEST REGULATIONS

Irregular Behavior

Since CSA is a high stakes examination which must be passed to receive ECFMG certification,ECFMG reserves the right to enforce necessary security measures to protect test materials and toensure the integrity of the testing process. Irregular behavior includes any action, committed or solicited by a candidate, which subverts or could subvert the CSA examination process or the


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ECFMG certification process. Examples of such behavior include, but are not limited to:

1. Falsification of information on the application form;2. Failing to comply with any CSA policy, procedure, or rule while at the CSA Center;

❍ Interacting with any standardized patients in an unprofessional manner and/or outside of that standardized patient’s given case portrayal, before, during or after theexamination;

❍ Entering restricted areas; ❍ Leaving the test area unescorted by a designated CSA staff member; ❍ Possessing and/or using recording devices; ❍ Possessing and/or using study aids; ❍ Conversing with other CSA candidates in any language other than English at any

time while at the CSA Center;❍ Giving or receiving aid during the examination;❍ Disruptive behavior which affects other candidates, SPs, or ECFMG staff.

3. Seeking and/or obtaining access to examination materials prior to a test administration;4. Impersonation of an examinee or engaging a substitute to take the examination;5. Sharing information about any of the cases presented during the CSA;6. Possessing unauthorized materials during an examination;7. Making reference notes of any kind during the examination, except on the blank, numbered

sheets provided;8. Altering or misrepresenting examination scores;9. Theft of examination materials;

10. Unauthorized reproduction and/or dissemination of copyrighted materials.

Instances of irregular behavior relating to CSA, whether in connection with applying for theexamination or as reported by CSA staff or standardized patients, will be investigated and reviewedinitially by CSA staff. Those instances where staff concludes that there is reasonable evidence of irregular behavior will be presented to the CSA Committee on Irregular Behavior. Any Committee

finding of irregular behavior may be annotated on the CSA Performance Report and in thecandidate’s ECFMG record.

If, after due consideration, the Committee determines that the irregular behavior threatened theintegrity of CSA or the ECFMG certification process, or affected the validity of the performancemeasure, it may order that no result be released. The Committee may then order that the examineeeither retake CSA, with or without special conditions, be barred from CSA, or be barred fromECFMG certification.

Back to Contents

COMMON QUESTIONS

1. If an applicant’s CSA date on the Standard ECFMG Certificate has expired for the purposeof entering graduate medical education, will the applicant be required to pass a subsequentCSA before entry into GME?


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Yes. The Standard ECFMG Certificate may be used for entry into accredited programs of graduatemedical education as long as the program start date is not later than either of the valid throughdates (English test and CSA) indicated on the Standard ECFMG Certificate.

The CSA date indicated on the Standard ECFMG Certificate is valid for three years from the mostrecent date of passing performance on CSA. If the CSA date has expired, an applicant will berequired to pass a subsequent CSA before entering graduate medical education.

2. What are the eligibility requirements for taking CSA?

To be eligible to take CSA, an applicant must meet the following requirements at the time that theapplication is submitted and at the time CSA is taken:

● Be either a medical student officially enrolled in a foreign medical school listed in thecurrent edition of the World Directory of Medical Schools published by the World Health

Organization and be within 12 months of completion of the full didactic curriculum or a

graduate of a medical school which was listed in the World Directory of Medical Schools at

the time of graduation. A graduate of a foreign medical school must have had at least four credit years (academic years for which credit has been given toward completion of themedical curriculum) in attendance at a medical school that is listed in the World Directory of

Medical Schools at the time of graduation.

● Have passed USMLE Step 1 or its equivalent and the English language proficiency test.

Applicants who, as of June 30, 1998, had met all ECFMG certification requirements in effectthrough this date are not required, but are permitted, to take CSA.

3. Is USMLE Step 3 a certification requirement and, thus, a prerequisite to CSA?

No. Passing USMLE Step 3 is not a requirement for ECFMG certification. Individual state medicalboards, not ECFMG, administer USMLE Step 3 as part of their licensing examination requirements.Questions regarding Step 3 should be addressed to the Federation of State Medical Boards

(FSMB). Refer to the ECFMG Information Booklet for contact information.

4. What is the application procedure for CSA?

Registration for CSA requires submission of the CSA application (Form 706). Form 706 is includedin the ECFMG Information Booklet and may also be downloaded from the ECFMG web site athttp://www.ecfmg.org. To register for CSA, you must complete Form 706 and send it, with fullpayment of the assessment fee, to ECFMG by mail (or courier service), following the mailinginstructions on the application form. You cannot register by facsimile, letter, postcard or e-mailmessage. Detailed application instructions are included with the application form. Follow theinstructions carefully and answer all questions completely. You should review the instructionsbefore you begin working on the application. If your application is not complete or if the required feeis not submitted, it will be returned to you.


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Once the completed application form and payment are received at ECFMG, and the applicant isdetermined to be eligible to take CSA, the Notification of Registration, which includes information onscheduling CSA, will be sent to the applicant. Applicants must schedule CSA within four months of,and must take CSA within one year of, the date indicated on the Notification of Registration. Failureto schedule CSA within four months, or to actually take CSA within one year, will requiresubmission of a new application and fee.

An admission permit confirming the date, time and location of the assessment will be mailed to

applicants as soon as they schedule CSA. Applicants must present this admission permit at theClinical Skills Assessment Center.

5. What is the application deadline for CSA?

Since CSA is offered throughout the year, there is no deadline for submitting the application form toregister for CSA.

6. What is the fee for CSA?

The CSA fee is $1,200 (U.S. dollars) which must be included with the CSA application. Refer to theECFMG Information Booklet for payment information.

7. How often is CSA administered?

Daily, depending on demand, except for major U.S. holidays.

8. How long do CSA administrations last?

The duration of CSA, including orientation, testing, and breaks, is approximately eight hours.

9. Does CSA require candidates to diagnose and treat real patients?

No. CSA consists of encounters with standardized patients (SPs), lay persons trained to accuratelyand consistently portray patients. SPs will respond to questions from candidates with answersappropriate to the case and, upon physical examination, will demonstrate appropriate physicalfindings. Candidates will be expected to proceed through each encounter with an SP as they wouldwith a real patient, but treatment of any kind is not to be done.

10. Is a proctor present during the candidates’ encounters with SPs?

No. However, all encounters are videotaped for research and quality control purposes. In addition,all encounters can be observed in real time by both video and one-way mirror.

11. Following an encounter with an SP, are the candidates required to present the casehistory, diagnosis, management plan, or other material related to the encounter, in writing or orally?


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Candidates are required to compose a written record of each patient encounter.

12. How soon after the CSA are results available?

Reports of performance on CSA are normally mailed to candidates within six to eight weeks after the examination date.

13. Do scores consist of a PASS/FAIL designation or numeric value?

A report of performance on CSA consists of a pass/fail designation.

14. How does a failing applicant retake CSA?

For the purpose of ECFMG certification, there is no limit on the number of attempts to pass CSA.Once you pass CSA, you may only repeat it to revalidate your CSA date. If you fail the CSA andwish to retake it, you must submit a new application and assessment fee. You may not take CSAwithin three months of your last attempt on the CSA. Registration and scheduling procedures will be

the same as for all other examinees.

15. How does a holder of a Standard ECFMG Certificate which includes a CSA date that willexpire before entry into a GME program revalidate the Certificate?

A passing CSA performance is valid for three years for purposes of entry into graduate medicaleducation. If an applicant enters an ACGME-accredited program of graduate medical education inthe United States, permanent validation of the Standard ECFMG Certificate can be requested.Permanent validation means that the CSA valid-through date (and the English language proficiencyvalid-through date) is no longer subject to expiration. Holders of Standard ECFMG Certificates that

include CSA may revalidate their CSA date at any time by retaking CSA. Passing CSA willrevalidate the CSA date for a period of three years from the date on which CSA is taken.Registration and scheduling procedures will be the same as for all other examinees.

16. What are the qualifications of the SPs who document the clinical skills and evaluatecommunication skills of candidates?

The SPs are lay people who undergo extensive training and evaluation prior to participation in CSA.

17. How many SP encounters need to be passed in order to obtain a passing performanceon CSA?

Passing performance on CSA is not based on passing any specific number of encounters, butrather overall performance on the CSA components.

18. What is the difference between Standard ECFMG Certificates issued to applicants whomet all certification requirements on or before June 30, 1998 and those issued to applicantswho complete the certification requirements after this date?





Standard ECFMG Certificates issued to applicants who met the certification requirementssubsequent to June 30, 1998, will indicate the dates of a passing performance of CSA and theduration of its validity for entry into GME, as well as the date of passing performance and durationof the validity of the English test.

19. Will applicants who are certified but have not taken CSA be at a disadvantage inobtaining a residency compared to applicants who have passed CSA?

The criteria for selecting applicants for residency positions are determined by individual graduatemedical education programs. However, the number of applicants frequently exceeds the number of residency programs available. Historically, programs select from the pool of applicants thoseindividuals who have met the requirements that are current at the time of selection. This does notnecessarily mean that applicants who were certified under a previous set of requirements will not beselected for residency positions at such programs.

20. Is CSA required to participate in the NRMP Match?

In order to participate in the Match, students/graduates of foreign medical schools must have

passed the examinations necessary for ECFMG certification. Therefore, applicants who arerequired to pass CSA for ECFMG certification must pass CSA in order to participate in the Match.

21. Where is CSA administered?

CSA is given throughout the year only at the following location:

ECFMG3624 Market StreetCSA Center: 3

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Floor Philadelphia, PA 19104-2685 USA Back to Contents

REFERENCES

1. Educational Commission for Foreign Medical Graduates: Clinical Skills AssessmentPrototype

Gerald P. Whelan. Medical Teacher 1999;21: 156-160.

2. Lessons Learned from Six Years of International Administrations of the ECFMG’s SP-Based Clinical Skills Assessment

Amitai Ziv, Miriam Friedman Ben-David, Alton I. Sutnick and Nancy E. Gary. Academic

Medicine. 1998;73:S83-S90


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3. Use of Standardized Patients in Clinical Assessments: Recent Developments andMeasurement Findings

Nu Viet Vu and Howard S. Barrows. Educational Researcher. 1994;23;3:23-30

4. ECFMG Assessment of Clinical Competence of Graduates of Foreign MedicalSchools

Alton I. Sutnick, Paula L. Stillman, John J. Norcini, Miriam Friedman, Mary Beth Regan,Reed G. Williams, Elizabeth K. Kachur, Mary A. Haggerty and Marjorie P. Wilson. Journal of

the American Medical Association. 1993;270:1041-1045

5. An Overview of the Uses of Standardized Patients for Teaching and EvaluatingClinical Skills

Howard S. Barrows. Academic Medicine. 1993;68:443-451

6. Measurement Characteristics of Examinations Using Standardized Patients

Arthur I. Rothman, Robert Cohen, Beth Dawson-Saunders, Peeter P. Poldre and JohnRoss. Academic Medicine. 1992;67:S40-S41

7. The Use of Standardized Patients to Evaluate the Spoken-English Proficiency of Foreign Medical Graduates

Miriam Friedman, Alton I. Sutnick, Paula L. Stillman, John J. Norcini, Susan M. Anderson,Reed G. Williams, Grant Henning and Marcia J. Reeves. Academic Medicine. 1991;66:S61-S63.

8. Results of a Survey on the Use of Standardized Patients to Teach and EvaluateClinical Skills

Paula L. Stillman, Mary Beth Regan, Mary Philbin and Heather-Lyn Haley. Academic

Medicine. 1990;65:288-292

9. TSE ® Score User’s Manual: 1995 Edition

Educational Testing Service, Princeton, NJ

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GLOSSARY OF TERMS AND COMMONABBREVIATIONS


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TERMS USED IN THIS MANUAL

ACGME

CSA

ECFMG

FSMB

GME

LCME

NRMP

SP

TOEFL

TSE

USMLE

TERMS USED IN CSA

Accreditation Council for Graduate Medical Education Clinical Skills Assessment Educational Commission for Foreign Medical Graduates Federation of State Medical Boards Graduate Medical Education Liaison Committee on Medical Education National Resident Matching Program Standardized Patient Test of English as a Foreign Language Test of Spoken English United States Medical Licensing Examination

(the following lists will be available on-site for reference during CSA administrations) UNITS OF MEASURE kg Kilogram g Gram

mg Milligram

lbs Pounds

oz Ounces

m Meter

cm Centimeter

min Minute

hr Hour

C Centigrade





F VITAL SIGNS BP P

R

T

Fahrenheit

Blood pressure

Pulse

Respirations

Temperature

COMMON ABBREVIATIONS FOR THE PATIENT NOTE

(this is not intended to be a complete list of acceptable abbreviations, but rather isrepresentative of the types of common abbreviations that may be used on the patientnote)

yo Year-old

m or G Male

f or E Female

b Black

w White

L Left

R Right

hx History

h/o History of

c/o Complaining of

NL Normal limits

WNL Within normal limits

˘ Without or no

+ Positive

- Negative

Abd Abdomen





AIDS AP BUN CABG CBC CCU cig CHF COPD CPR CT CVA or TIA CVP CXR DM DTR ECG ED EMT ENT EOM

ETOH Ext FH GI

Acquired Immune Deficiency Syndrome Anteroposterior Blood urea nitrogen Coronary artery bypass grafting Complete blood count Cardiac care unit Cigarettes Congestive heart failure Chronic obstructive pulmonary disease Cardiopulmonary resuscitation Computerized tomography Cerebrovascular accident OR Transient ischemic attack Central venous pressure Chest x-ray Diabetes mellitus Deep tendon reflexes Electrocardiogram Emergency department Emergency medical technician Ears, nose, and throat Extraocular muscles

Alcohol Extremities Family history Gastrointestinal





GU HEENT HIV HTN IM IV JVD KUB LMP LP MI MRI MVA Neuro NIDDM NKA NKDA NSR PA PERLA po

PT PTT RBC SH

Genitourinary Head, eyes, ears, nose, and throat Human immunodeficiency virus Hypertension Intramuscularly Intravenously Jugular venous distention Kidney, ureter, and bladder Last menstrual period Lumbar puncture Myocardial infarction Magnetic resonance imaging Motor vehicle accident Neurologic Non insulin-dependent diabetes mellitus No known allergies No known drug allergy Normal sinus rhythm Posteroanterior Pupils equal, react to light and accommodation Orally Prothrombin time Partial prothrombin time Red blood cells Social history





U/A Urinalysis URI Upper respiratory tract infection WBC White blood cells Back to Contents

CSA Home Page Guide to Philadelphia

ECFMG Information Booklet ECFMG Home Page


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CLINICAL SKILLS ASSESSMENT (CSA ® )

CANDIDATE ORIENTATION MANUAL


CONTENTS

PREFACE

GENERAL INFORMATION

● Purpose of CSA

● Prerequisites to CSA ● Historical Perspective on CSA

● An Introduction to Taking CSA

● CSA Case Development

● CSA Case Content Selection


● CSA Prototype● Sample Opening Scenarios● Case Background Information

❍ Doorway Information❍ History Taking and Physical Examination Checklists❍ Patient Note❍ Communication Skills

● General Information on Scoring and Score Reporting● The Day of the Assessment ● Preparing for CSA

❍



● Application Form ● Scheduling CSA● CSA Cancellation and Rescheduling Policies ● CSA Center Location ● Examinees with Disabilities

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TEST REGULATIONS

● Irregular Behavior

COMMON QUESTIONS

REFERENCES

GLOSSARY OF TERMS AND COMMON ABBREVIATIONS

PREFACE

This Candidate Orientation Manual is intended as a guide for graduates of foreign medical schools

who plan to take the Clinical Skills Assessment (CSA®) as part of their ECFMG® certificationprocess. In the pages that follow, there is general information and a description of the CSA, itscomponents and the method by which scores are derived. Also included are registration andscheduling procedures as well as practical information on preparing to take CSA. In addition, themost commonly asked questions about CSA are discussed. This manual will be periodicallyupdated. Visit the ECFMG web site for the most current information.

GENERAL INFORMATIONPurpose of CSA

The purpose of CSA is to ensure that graduates of foreign medical schools can demonstrate theability to gather and interpret clinical patient data and communicate effectively in the Englishlanguage at a level comparable to students graduating from United States medical schoolsaccredited by the Liaison Committee on Medical Education (LCME). The CSA is still only one of thetest elements leading to ECFMG certification.

Prerequisites to CSA

The ECFMG Information Booklet describes the prerequisites to CSA.

Historical Perspective on CSA

There are approximately 1,600 medical schools worldwide, each with varying educational standards


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and curricula. No universal system currently exists to compare the quality and characteristics of these medical schools with those of U.S. medical schools accredited by the LCME. The LCMErequires that the assessment of clinical skills be a part of the overall evaluation of U.S. medicalstudents. However, in the absence of any single set of international accreditation standards for medical schools throughout the world, the only viable alternative was to assess students graduatingfrom those medical schools with a standardized assessment, the CSA.

As early as 1980 ECFMG introduced the concept of testing the clinical skills of graduates of foreign

medical schools as part of ECFMG certification requirements. ECFMG initiated an extensiveprogram of planning and research to develop a CSA prototype that would provide an objective andconsistent evaluation of the readiness of graduates of foreign medical schools to enter graduatemedical education (GME) programs in the U.S. Pilot projects were conducted around the world, andas a result of those studies the current CSA prototype was developed. It integrates clinicalencounters with standardized patients to assess history taking, physical examination, interviewingand interpersonal skills, as well as the ability to communicate effectively in written and spokenEnglish. The current CSA prototype was tested in the United States and abroad to compile data anddemonstrate its validity and reliability.

Effective July 1, 1998, applicants who had not met all requirements for ECFMG certification by June30, 1998 are required to pass CSA, as well as the basic medical and clinical science components of the medical science examination and the English language proficiency test. Applicants must alsodocument the completion of all requirements for, and receipt of, the final medical diploma.

The incorporation of CSA into the certification process helps to ensure that graduates of foreignmedical schools achieving ECFMG certification possess the necessary basic clinical skills for entryinto supervised GME training programs in the U.S.

An Introduction to Taking CSA

The CSA is designed to evaluate the basic clinical skills you will need to gain entry into asupervised GME training program in the U.S. The attributes of CSA, including the patients, medicalpresentations, and the CSA Center, simulate common medical practice in clinics, doctors’ officesand emergency departments in the U.S. The CSA is used to assess your ability to consider reasonable diagnostic possibilities by presenting a set of common clinical scenarios. In addition,you must demonstrate an acceptable level of professionalism and rapport, as well as written andspoken English language skills.

By gathering relevant medical history and performing a focused physical examination, you will be

demonstrating your ability to collect information unique to the presentation of each patient. Taking arelevant medical history means that it relates specifically to the chief complaint of the patient. Afocused physical examination consists of maneuvers that reveal information in direct relation to thesame patient’s chief complaint, age and gender, and medical history.

You will be required to write a legible patient note indicating the pertinent positive and negativehistorical and physical findings that relate to your potential diagnoses. Once you list the possibledifferential diagnoses that relate to the patient’s complaint, you will also list the diagnostic studiesthat you would use to pursue those diagnoses. A listing of treatment procedures or medications willnot be required.





When you take CSA, you will have the same opportunity as all other candidates to demonstrateyour clinical skills proficiency. The assessment is standardized so that upon asking the same or similar questions, all candidates receive the same information from each patient. An on-goingmechanism of quality control is employed to ensure that the assessment is fair to all. A videotapemonitoring system documents each encounter and ensures the safety of the patients andcandidates, and is an additional quality control procedure.

The patients you will see are lay people trained to portray a clinical problem. This method of assessment is referred to as a standardized patient (SP) based examination. Ninety-five percent of LCME accredited medical schools in the U.S. and Canada use SPs for instruction. About 74% of these same institutions use them for evaluation. SPs are also incorporated into the Medical Councilof Canada’s (MCC) medical licensure examination for Canadian and foreign medical graduates.The SP-based testing method was established more than 30 years ago, and its procedures weretested and validated in the United States and internationally.

The CSA is designed as a standards-based (criterion referenced) examination, meaning thatspecific scores are set for passing performance. Committees of physicians review the case

materials and determine the essential skills and behaviors that must be demonstrated bycandidates for each case. You are evaluated only with reference to this standard, so there is nopredetermined number or percentage of graduates of foreign medical schools who will pass. Passrates for CSA candidates are solely a function of performance. Consequently, anyone can pass,depending on his or her level of proficiency relative to the standard. For purposes of entry intograduate medical education, a passing performance on the CSA will be valid for three years fromthe date passed.

CSA is offered at a single site in Philadelphia, Pennsylvania, USA. The complex testing systeminvolves a specially designed facility and trained personnel. Therefore, specific strategies for quality

control were designed initially for only one site. In the future, consideration may be given toestablishing another site outside of the United States.

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CSA Case Development

Practicing physicians and medical educators write and review cases to ensure that they are fair andvalid. These cases represent the kinds of patients and problems you would normally encounter

while training in an accredited U.S. GME program. Cases are specially designed to elicit a processof history taking and physical examination in a clinical encounter that will demonstrate your ability tolist and pursue various possible diagnoses.

The eleven cases that make up each administration of CSA reflect a balance of presentingcomplaints as well as a diversity of patient age, sex, and ethnicity. There is also a mix of acute,subacute and chronic problems. On any assessment day, the set of cases will differ from thecombination presented the day before or the following day, but each set of eleven cases will havecomparable degrees of difficulty.


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CSA includes test cases representing the major clinical education programs encountered at medicalschools accredited by the LCME in the United States. These disciplines include:

● Internal Medicine● Surgery● Obstetrics and Gynecology● Pediatrics● Psychiatry● Family Medicine

CSA Case Content Selection

The CSA case content area is the universe of clinical symptoms (cases) that will be represented bystandardized patients. The selection of eleven clinical cases from the larger pool of CSA contentarea is guided by the CSA assessment form specification that defines five main content areas:

● Cardiovascular/Respiratory● Digestive/Genitourinary● Neurologic/Psychiatric● General symptoms● Other (ear, eyes, nose, throat, musculoskeletal)

The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.

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CSA Prototype

In your CSA administration you will have eleven patient encounters, ten of which will be scored.Non-scoreable patient-encounter stations are added to the CSA rotation for research and other purposes, but those encounters are not counted in determining your score.

Before you enter each examination room, you will have a few moments to review information thatwill be posted on the examination room door. This information gives you specific instructions, andtells you the patient’s name, age, gender, and reason for visiting the doctor. It will also indicate hisor her vital signs, including pulse rate, blood pressure, temperature (Centigrade and Fahrenheit),and respiratory rate. You can accept these as accurate and do not need to repeat unless youbelieve the case specifically requires it.

Upon entering each room, you will encounter an SP. By asking this patient the relevant questionsand performing a focused physical examination, you will be able to gather enough information todevelop preliminary differential diagnoses and a diagnostic work-up plan. You will also be expected


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to communicate in spoken English with the patients in a professional and empathetic manner. Youare to answer any questions they have, tell them what diagnoses you are considering, and advisethem on what tests and studies you will be ordering to clarify their diagnoses.

The kinds of medical problems that your patients will be portraying are those you would commonlyencounter in a clinic, doctor’s office or emergency department. There are no children presenting asSPs. However, there may be cases dealing with pediatric issues in which you may encounter a sickchild’s parent or caretaker. In such cases, physical examination is obviously not possible and will

not be expected.

The elements of medical history you need to obtain in each case will be determined by the nature of the patient’s problems. Not every part of the history needs to be taken for every patient. Somepatients may have acute problems, while others may have more chronic ones. You probably will nothave time to do a complete physical examination on every patient, nor will it be necessary to do so.Pursue the relevant parts of the examination, based on the patient’s problems and other informationyou obtain during the history taking.

The key to interacting with the SPs is to relate to them exactly as you would to any patients that you

may see with similar problems. The only exception is that certain parts of the physical examinationmust not be done: rectal, pelvic, genitourinary, or female breast examinations. If you believe theseare indicated, you may include them in your proposed diagnostic work-up.

You will have fifteen minutes to spend with each patient. An announcement will tell you when tobegin the encounter, when there are five minutes remaining, and when the encounter is over. Insome cases you may complete the encounter in less than fifteen minutes. If so, you may leave theexamination room early, but you are not permitted to re-enter. Be certain that you have obtainedall of the necessary information before leaving the examination room.

Immediately following each encounter you will have ten minutes to complete a patient note. You willbe asked to write a patient note similar to the medical record you would compose after seeing apatient in a clinic, office or emergency department. You should record pertinent medical history andphysical examination findings, as well as your initial differential diagnoses. Finally, you will list thediagnostic studies you would order next on that particular patient. If you think a rectal, pelvic,genitourinary, or female breast examination would have been indicated in the encounter, then list itas part of your diagnostic work-up. Treatment, consultations, or referrals should not beincluded in your work-up plan.

Most cases are designed to present more than one diagnostic possibility. Based on the patient’s

presenting complaint and the additional information you obtain as you begin taking the history, youshould consider all possible diagnoses and explore the relevant ones as time permits.

Perform physical examination maneuvers correctly and expect that there will be positive physicalfindings in some instances. Some may be simulated, but you should accept them as real and factor them into your evolving differential diagnosis. However, be considerate of the patients and alwayskeep them comfortable and properly draped as you perform the physical examination.

The testing area of the CSA Center consists of a series of examination rooms equipped withstandard examination tables, commonly-used diagnostic instruments (blood pressure cuffs,





otoscopes, and ophthalmoscopes), latex gloves, sinks, and paper towels. The orientation givenimmediately before you take CSA will include a brief demonstration of the instruments andequipment that you will be using in the actual patient encounters.

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Sample Opening Scenarios

So that you have a better understanding of the typical mixture of case scenarios presented in oneCSA administration, below are ten sample opening scenarios. This is the basic information that isposted on the doorway of each examination room prior to your seeing the patient. The scenarioslisted below are representative of, but are not the exact cases you will see in your assessmentsession.

1. 50 year-old female complaining of chest painBlood pressure = 138/92 Pulse = 80 Respirations = 18 Temperature = 98.6

2. 35 year-old female complaining of abdominal painBlood pressure =146/88 Pulse = 92 Respirations = 20 Temperature = 99.1

3. 75 year-old male brought to see you because of a fallBlood pressure =155/75 Pulse = 68 Respirations = 14 Temperature = 98.2

4. Mother of 1 year-old child with diarrhea(child not available for physical examination)

5. 46 year-old male complaining that he has no energy for the past three monthsBlood pressure = 122/70 Pulse = 70 Respirations = 12 Temperature = 98.7

6. 18 year-old female complaining of vaginal bleeding for two daysBlood pressure = 95/65 Pulse = 84 Respirations = 14 Temperature = 98.6

7. 63 year-old male with history of diabetes; new to your practice; here for medication refillBlood pressure = 140/75 Pulse = 76 Respirations = 18 Temperature = 99.0

8. 24 year-old female brought in by colleagues because of a seizure at workBlood pressure = 155/85 Pulse = 100 Respirations = 24 Temperature = 99.2

9. 59 year-old male complaining of blurry visionBlood pressure = 138/82 Pulse = 88 Respirations = 14 Temperature = 98.6

10. 79 year-old female complaining of shortness of breath since last nightBlood pressure = 158/90 Pulse = 92 Respirations = 20 Temperature = 98.6


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Sample Case

Case Background Information

The case excerpts you will see on the following pages were selected to familiarize you with thecontent and evaluative objectives that provide the basis for scoring. This information is used to trainSPs. When you come to take the CSA, you will not have access to the information below. The

background information presented here is simply an example of the materials on which a typicalcase is based.

Most CSA cases incorporate patient history, physical examination, examinee communication skills(including spoken English proficiency), and a post-encounter patient note. You should becomeacquainted with the following examples of the doorway information, the checklists SPs use todocument your actions during the encounter, the patient note format, and the evaluative tools usedto derive communication skills ratings.

● Chief Complaint

Jolene Brown is a 48 year-old female complaining of chest pain.

● History of Present Illness

The patient is a 48 year-old female complaining of burning chest pain thatbegan one and a half hours prior to presenting to the EmergencyDepartment. The pain began 30 minutes after a heavy lunch. Nausea, slightsweating and dyspnea accompanied the pain. The pain passed

spontaneously 20 minutes after its onset. She presently feels fine and wishesto be immediately discharged. She describes several similar episodes in theprevious two to three months, especially after heavy meals or physicalexertion, continuing for two to three minutes and passing spontaneously.Prior to this period Ms. Brown had no chest pain. She is not working harder nor experiencing any specific stress lately. She plays tennis once a week; noother physical activity. Lately, during matches, Ms. Brown complains of mildretrosternal burning sensation. Over the past two to three months, during theburning episodes, she used antacids, with partial relief of symptoms. For thepast three to four years, the patient has had occasional heartburn after heavymeals and antacids gave partial relief. But now the pain is different. Her painis not related to breathing or changes in body position. She has had nochange in bowel movements, no melena. She has no symptoms of congestive heart failure or arrhythmias (no orthopnea, paroxysmal nocturnaldyspnea or palpitations).

● Past Medical History

Hyperlipidemia: Ms. Brown had cholesterol checked on routine blood testsdone two years ago. She was told that her cholesterol was high, but does not





remember any specific values. A low cholesterol diet was suggested at thetime, but she did not follow this advice. Otherwise, the patient is completelyhealthy. She has not seen a physician in two years.

● Medication, Allergies, Diet, Immunization

Medications: The patient takes no prescribed medication. Occasional use of over the counter antacids.

Allergies: Penicillin caused her to break out in a rash.

Diet: Unremarkable.

Immunization: Unremarkable.

● Family History

Older brother : Diagnosed with some sort of ‘heart problem,’ but never treated (patient does not know exact details).

Father : Peptic ulcer disease.

Mother : Non insulin-dependent diabetes mellitus (NIDDM) treated by dietalone.

● Social History and Habits

Smoking: She stopped smoking three years ago, and until then she smokedtwo packs a day for 15 years.

Alcohol: Occasionally drinks socially, but takes in small amounts.

Occupation: Executive Vice President of a not-for-profit charitableorganization.

Marital Status: Single heterosexual female.

Sample Case

Doorway Information





Before entering the examination rooms, you will be given some basic information. This doorwayinformation is posted on the examination room door and is similar to a triage note that a nursenormally gives a physician. Please read it carefully before seeing the patient because it will tell youhis or her name, gender, age, presenting complaint, and the tasks you are to complete. You shouldaccept the doorway information as accurate, though in some cases reexamination of vital signs maybe appropriate. Most CSA stations will have the same types of tasks listed, but some may includespecific, unique tasks.

For your convenience, there will be an identical second copy of the doorway information in theexamination room. Please do not remove the doorway information from the examination room.

Doorway Information

1. Opening Scenario

Jolene Brown, a 48 year-old female, comes to the Emergency Departmentcomplaining of chest pain.

2. Vital Signs

BP: 160/80

Temp: 99.5° F (37.5° c)

RR: 16/minute

HR: 95/minute, regular.

3. Examinee Tasks

1. Obtain a focused history.2. Perform a relevant physical examination

(Do not perform rectal, pelvic, genitourinary, or female breast examinations).3. Discuss your initial diagnostic impression and your work-up plan with the patient.4. After leaving the room, complete your patient note on the given form.

Sample Case

History Taking and Physical Examination Checklists

Standardized patients will document your actions during the encounter, and they are trained to do





so in a fair and consistent manner. Each patient fills out checklists that document the inquiries youmake and maneuvers you perform during the encounter. The history-taking checklist includes allof the key inquiries you are expected to make in the course of taking the patient’s history for aparticular case. Patients also use a physical examination checklist that includes all of the keymaneuvers you should perform during the course of doing a physical examination. Your techniquein doing these maneuvers is also taken into account by the patient. He or she goes through thechecklists and marks those items you asked or performed, for which you receive credit.

Since the cases are broad, your history taking should consider multiple possible diagnoses. Do notprematurely close your history taking on a single diagnosis, and do not attempt a complete history.During your physical examination of the patient, you should attempt to elicit important positive andnegative signs. The 15 minutes you have with the patient does not permit a complete history takingor physical examination, but only a gathering of relevant data. Make sure you discuss with thepatient your initial diagnostic impression and work-up plan. The patients are instructed to ask veryspecific questions concerning their complaints. These inquiries are intended to challenge you, soyou should address each patient’s concern as you would normally do in a clinical setting.

All physical examination maneuvers, including exposing and draping the patient, should be done as

you would normally do them in regular practice. Your score is based on what you look for in theencounter and the technique you employ while going about it.

The sample checklist items on the following page are examples of examinee questions and physicalexamination maneuvers that might be expected in a particular case. However, the listed questionsand maneuvers are not exact representations of complete history taking and physical examinationchecklists.

Standardized Patient History Taking Checklist (Sample Items)

KEY: Y, yes N, no

Y

Y

Y

Y

Y

N

N

N

N

N

5. Is there a history of smoking?

4. Nausea? OR Sweating? OR Dyspnea?

3. Are there any precipitating factors?

2. Does the pain radiate?

1. What is the character of the pain?





Y

Y

N

N

7. Past medical history?

6. Family history?

Standardized Patient Physical Examination Checklist (SampleItems)

KEY: Y, yes N, no

Y

Y

Y

N

N

N

3. Examinee palpates abdomen, at least epigastric or right upper quadrant.

2. Examinee auscultates precordium in at least 2 positions.

1. Examinee auscultates lungs.

Sample Case

Patient Note

After leaving the encounter, you will have ten minutes to complete the patient note. In an actualpractice setting, the patient note would be used to communicate with other health professionals.Keep in mind that once you leave the patient to complete your patient note, you cannot re-enter theexamination room. Blank paper will be provided for note taking in the examination room, but allsheets must be returned with your completed patient notes. For security reasons, the sheets of blank paper are numbered.

Refer to the example of a blank patient note, followed by two examples of completed notes. Thereare several styles of writing patient notes that are acceptable. The two examples are presented todemonstrate some of the variations in style. They are not meant to represent ideal or perfect patientnotes, nor should they be assumed to be complete or accurate with respect to content. Bothformats and styles, however, would be considered acceptable, despite their differences.

HISTORY

Make note of significant positives and negatives from the history taking. The following history


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categories may yield important information, although not all will necessarily be pertinent to everycase:

● Chief complaint (CC)● History of present illness (HPI)● Past medical history (PMH)● Review of systems (ROS)● Social history (SH)● Family history (FH)

PHYSICAL EXAMINATION

List pertinent positive and negative findings from the physical examination.

DIFFERENTIAL DIAGNOSIS

Consider a range of possible diagnoses, and list up to five of them.

DIAGNOSTIC WORK UP

Write your immediate plans for further diagnostic work-up. If you think rectal, pelvic, genitourinary,or female breast examinations should be done as part of the evaluation for that specific patient, youmay include them in your diagnostic work-up plan on the patient note. Treatment (therapeutics)should not be included. Do not include hospitalization, consultations, or referrals.

You should order fundamental first line tests that will help point you in a diagnostic direction. Theserequested tests must also be specific. For example, if you suspect hypothyroidism, you might order

"T4 and TSH," but not "Thyroid studies" or "Thyroid panel." Do not order "SMA-20," "Chemistrypanel," or "Liver profile," but rather, the specific component tests you are interested in, e.g., BUN,glucose, electrolytes.

You may use abbreviations commonly used in the United States. If you are uncertain about theabbreviation, write out the full term. For the patient note to be scored, your handwriting must belegible. For your convenience in preparing for CSA, the glossary at the end of this manual lists

some commonly recognized abbreviations and definitions.


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Patient Note Example One

The patient note below is written primarily in a narrative style. The History is written in full or near full sentences and the Physical Examination also has fairly complete phrases. Note that there areonly four studies ordered under the Diagnostic Workup section; this is acceptable.

There are some abbreviations not included in the glossary of terms and common abbreviations, but

they are common enough to be recognizable by the practicing physicians rating the notes. The noteis written in cursive script but it is legible.


Patient Note Example Two

This patient note is written in more of a telegraphic or "bullet" style. There are no complete


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sentences, although there are some phrases where appropriate. However, in some parts of theHistory in particular, there are one or two words that stand alone. The writer of this note has chosento transcribe the patient’s blood pressure from the doorway information. You may wish to includevital signs if they are particularly relevant to the case.

In this note only four items are listed in both the Differential Diagnosis and in the Diagnostic Workupsections; again this is acceptable. This sample also has some abbreviations or symbols notincluded in the glossary of terms and common abbreviations but, as in Example One, they are

generally recognizable. This note is printed throughout, although a mixture of cursive script andprinting would also be acceptable provided both were legible.


Sample Case


SPs undergo extensive and continuous training to rate your communication skills. This method of rating results in fair, valid, and reliable data. (See "References" at the back of this manual.) During

all eleven encounters, each patient will evaluate your communication skills based on the followingcriteria:

● Skills in interviewing and collecting information❍ the clarity of your questions;❍ the effectiveness of your questioning techniques;❍ appropriate use of medical language;❍ your verification and summarization of information with the patients;❍ the effectiveness of your transitions between different parts of the interview.

● Skills in counseling and delivering information❍ the clarity of the information you give;❍ the effectiveness and sincerity of your counseling;❍ the thoroughness of the encounter closure;


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❍ the clarity and appropriateness of your speech;❍ the effectiveness of your summarization of information and how you link various

information together.

● Rapport (connection between doctor and patient)❍ your attentiveness to the patients;❍ the appropriateness of your body language;❍ your confidence level and attitude;❍ the level of empathy and support you show the patients.

● Personal Manner ❍ your manner of introducing yourself to the patients;❍ the appropriateness of how you expose and drape the patients;❍ your manner while conducting physical examinations;❍ the appropriateness of your demeanor.

● Spoken English Proficiency❍ your ability to communicate understandably;❍ your pronunciation and grammar;❍ your ability to correct or clarify your language when needed;❍ the amount of effort required by patients to understand you.

Communication Skills Rating Scale

The following scale is used by the SPs to rate your communication skills performance. A ratingscale is completed for each of the eleven stations.

Item 1. Skills in Interviewing and Collecting Information

(clarity of questions; open vs. closed questions, verification, summarization, transitions)


Good Excellent

1 2 3 4

Item 2. Skills in Counseling and Delivering Information

(giving information, counseling, closure, language and speech, summarization and connection)


Good Excellent

1 2 3 4





Item 3. Rapport (connection between doctor and patient)

(attentiveness, body language, confidence, attitude, empathy and support)


Good Excellent

1 2 3 4

Item 4. Personal Manner

(hygiene, draping, physical examination, demeanor, introduction)


Good Excellent

1 2 3 4

Item 5. Spoken English Proficiency

(ability to communicate understandably, pronunciation and grammar, amount of effort required by patients tounderstand you)

1

ComprehensibilityLow

2

ComprehensibilityMedium

3

ComprehensibilityHigh Very High

4

Comprehensibility

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General Information on Scoring and Score Reporting

Overview

In order to pass CSA, you must pass pre-defined performance standards set by medical experts intwo separate components. The first component, called the Integrated Clinical Encounter (ICE), is acombination of the Data Gathering (DG) and Patient Note (PN) scores. The second component,Communication Skills (COM), is derived from the SP evaluations of interpersonal skills and spokenEnglish language proficiency. You will have eleven patient encounters, ten of which will be used to


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derive your scores.

Scoring Components

Data Gathering (DG)

Using the history taking and physical examination checklists, the SP documents your ability in each

station to gather data relevant to the clinical encounter. Your DG score for a particular encounter isthe percentage of checklist items that you were given credit for in the history taking and physicalexamination. The SP does not evaluate your medical performance, but simply documents whether or not you successfully obtained relevant information or correctly performed the case-specificphysical examination maneuvers. Your final DG score is the average of your DG scores over tenCSA encounters in the assessment form.

Patient Note (PN)

Following the encounter with the SP, you will be required to complete a patient note. Physicians aretrained to rate these notes based on predefined criteria that include:

● organization; ● quality of information; ● interpretation of data; ● egregious/dangerous actions; ● legibility.

Your final PN score is the average score you earned across the ten scored exercises.

Integrated Clinical Encounter (ICE) Score

The DG and PN scores are combined to form an ICE score. Your final DG and PN scores reflectyour average performance across ten scored encounters. Therefore, you may compensate for poor performance in one encounter with excellent performance in another.

Communication Skills (COM)

Following each encounter the SP will also evaluate your COM skills along five dimensions:

● interviewing; ● counseling and delivering information; ● rapport; ● personal manner;● spoken English proficiency.

For each of these dimensions, the SP assigns a score. SPs make these evaluations according to ascoring system that is fair, consistent and objective. Your COM score for the encounter is the sum





of the five COM dimension scores.

Over the ten scored encounters, the average of these COM scores makes up your finalCommunication score. Your score must meet or exceed a performance standard predefined byphysician experts.

Score Reporting

An overall pass/fail designation will be reported to you six to eight weeks after your CSAadministration. ECFMG reserves the right to delay the reporting of CSA pass/fail designations if additional data and/or analyses are required to assure the validity of the assessment scores.Candidates who pass the standards on both the Communication and Integrated Clinical Encounter components will receive a "PASS" designation for the CSA. Substandard performance on either theCommunication or the Integrated Clinical Encounter component will result in a "FAIL" designation.

To avoid misinterpretation and to protect your privacy, CSA results will not be provided bytelephone, facsimile, or E-mail.

Score Rechecks

Standardized procedures ensure that your scores are an accurate reflection of your performance,so a change in your CSA pass/fail designation based on a recheck is an extremely remotepossibility. However, if you would like a recheck of your CSA designation, you must submit anExaminee Request for Score Recheck Form (Form 751) and payment for this service to ECFMG.

The recheck will consist of recalculating the component scores on which your CSA pass/faildesignation is based.

Please send your request to the following address:

ECFMGAttention: CSA Score Inquiry3624 Market StreetPhiladelphia, PA 19104-2685 USA

The Day of the Assessment

When you arrive at the CSA Center on the day of your assessment, please be prepared to presentvalid, government-issued photo identification and your admission permit. Arrive at the CSA Center no more than 30 minutes prior to your scheduled assessment. If you are traveling a long distance,consider arriving in Philadelphia at least a day before your CSA session.

Please do not bring anything other than necessary personal items with you to the Center. Coatracks are available, and each candidate will be assigned a small open storage cubicle in whichpersonal belongings must be stored during the assessment. However, these cubicles are notsecure, and ECFMG assumes no responsibility for your personal items. Luggage cannot be





accommodated, so other arrangements must be made for its storage during the assessment. Wealso have no waiting facilities for spouses, family, or friends, so please plan on meeting themelsewhere after the assessment. Wear comfortable professional clothing and a white laboratory or clinic coat. The only piece of medical equipment you need to bring is your stethoscope. All other necessary medical equipment is provided in the examination rooms.

Throughout the assessment day CSA staff, who will be wearing identifying nametags, will direct youthrough the examination. Please follow their instructions at all times.

Each assessment session will begin with an orientation. This on-site orientation is in addition to thismanual and the videotape that ECFMG will send you when you are registered for CSA. Theorientation will familiarize you with the equipment in each examination room and the nature of typical encounters. It is also intended to inform you about examination procedures and regulations.During the orientation, you will be asked to sign a confidentiality agreement. It stipulates that you,as a CSA examinee, will not reveal case information to anyone at any time. This agreement is away to ensure that each examinee has the same opportunity as all others. If you discloseinformation to prospective candidates, there is no guarantee that the information you supply will aidthem. In fact, it may confuse subsequent candidates because different sets of cases are used each

day. In addition to the confidentiality agreement, there will be a demographic questionnaire for youto fill out before the assessment and a feedback questionnaire afterwards.

The CSA Center is a secured facility. Once you enter the secured area of the Center for orientation,you may not leave that area until CSA has been completed. Since the assessment lastsapproximately eight hours, two breaks will be provided. The first break is thirty minutes long andtakes place after your fourth encounter; the second break is fifteen minutes long and occurs after the eighth encounter. At break time, you are free to relax, use the rest rooms, and haverefreshments. A light meal will be served, and there are vending machines available for drinks. Youmay also bring your own food provided that no refrigeration or preparation is required. Smoking isprohibited throughout the Center.

You cannot, during breaks or at any time, discuss the cases with your fellow candidates.Conversation among candidates in languages other than English about any subject is strictlyprohibited at all times during these breaks. Examination proctors will be with you to monitor activity.To maintain security and quality assurance, each examination room is equipped with video camerasand microphones to record every encounter. Please conduct yourself as you would during a normalday in a clinic.

Preparing for CSA

History taking, physical examination, spoken and written English, and interpersonal behavior are allskills that can be improved by training, practice, and critique. You can refer to the multiple texts andother media sources that address these skills. Practice with colleagues, teachers, or mentors whowould portray patients could be useful, provided such role-plays are realistic and represent commoncomplaints.

Perhaps the best preparation of all is to see actual patients in a real clinical setting, especially if thisis done under the supervision and/or review of a competent clinical teacher. CSA is designed tosimulate an actual clinical experience, so the more clinical experience you have, the more





comfortable you will feel during the examination.

You will find additional test-taking strategies in the videotape that accompanies this manual. Thevideotape gives more information on CSA and demonstrates a typical patient encounter.


It is not required that you speak English comparable to that of a native speaker. However, if you areuncertain of your spoken English language proficiency, you are encouraged to take the Test of Spoken English (TSE®) as a screening test prior to registration for CSA. The TSE was developedby the Educational Testing Service (ETS) and is administered in a number of sites around theworld. Studies indicate that candidates who obtained a score of 35 and lower on the TSE are notlikely to pass CSA; however, a TSE score above 35 does not ensure passage of CSA. A TSEscore of 35 represents a speaker who generally does not communicate effectively and cannotcompensate for weaknesses in language.

For information about TSE administration dates and locations, contact:

TOEFL/TSE ServicesP.O. Box 6151Princeton, NJ 08541-6151 USATelephone: 609-771-7100E-mail: [email protected]

Internet: http://www.toefl.org

General Comments

● Greet the patient and state your name.● Elicit or confirm the patient’s name.● Never attempt to communicate with the patient other than as a physician to a patient. ● Feel free to take notes during the encounter. (Blank paper will be provided.) ● Don’t make assumptions about what you will see in each encounter. ● There may be more than one case testing related or similar clinical entities. ● Concentrate on the case on which you are working.● Notify proctors of any problems.

History Taking

● Begin with broad questions and then focus your inquiries.● Don’t rush the patient’s answers.● Don’t cut the patient’s answer off with another question.● Repeat your questions in different terms if necessary.







● Ask follow-up questions.

Physical Examination

● Do a focused examination based on the patient’s complaint, symptoms, and history.● Wash your hands between patients, preferably before touching the patient or beginning the

physical examination.

● Tell the patient when you are going to begin the physical exam.● Describe the maneuvers either before or as you do them.● Always use patient gowns and drapes appropriately to maintain patient modesty and

comfort, but never examine through the gown.● Use the examination table extension when the patient reclines.● If you ask a patient to get off the examination table, offer to assist him or her.● Look for physical findings.● Do not perform rectal, pelvic, genitourinary, or female breast examinations.● Tell the patient your initial impressions and your plan for the diagnostic work-up.● Ask for and answer any additional questions.● Note the time warning for 5 minutes remaining in the encounter.● Close the encounter when the "End of Encounter" signal is given.


● Make eye contact.● Ask clear questions and speak understandably.● If you use medical terms, explain yourself.● Be direct and honest, but also be sensitive.● If you don’t know the answer to an SP’s question, say so. ●

Don’t give false reassurance or a premature diagnosis.

● Acknowledge the patient’s concerns or worries.Patient Note

● Approach the note as if you are communicating with another health professional.● Write legibly.● If necessary, refer to the notes you took during the encounter.● Group similar data together.● Write out information in a logical sequence.● Clearly portray the patient problem.● Be accurate.● Be specific.● Identify critical elements.● Include pertinent positives and negatives.● Make sure your plans for further diagnostic work-up are reasonable.● Do not include treatment in your plans for diagnostic work-up.

Back to Contents


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Application Form

Registration for CSA requires submission of the CSA application (Form 706). Form 706 is included

in the ECFMG Information Booklet and may also be downloaded from the ECFMG web site athttp://www.ecfmg.org. To register for CSA, you must complete Form 706 and send it, with fullpayment of the assessment fee, to ECFMG by mail (or courier service), following the mailinginstructions on the application form. You cannot register by facsimile, letter, postcard or e-mailmessage. Detailed application instructions are included with the application form. Follow theinstructions carefully and answer all questions completely. You should review the instructionsbefore you begin working on the application. If your application is not complete or if the required feeis not submitted, it will be returned to you.

Scheduling CSA

To be registered for the CSA, you must first meet all eligibility requirements as listed in theappropriate edition of the ECFMG Information Booklet , submit a completed CSA application, and

pay the current CSA fee. After you are registered, ECFMG will mail you a Notification of Registration for CSA. Once you receive this notification, you may schedule an assessment date.

You should be aware of two windows of time relative to CSA registration. The first is the period of time in which you must schedule a date to take CSA. This period of time is four months from thedate of your Notification of Registration. You must schedule an assessment date within this four month period. The assessment date does not need to be within this four month period, but the

selection of a date must be completed within this time frame.

The second window of time is one year from the date of your Notification of Registration. Within thistwelve month period, you must come to the CSA Center in Philadelphia and take the CSA. Your Notification of Registration will clearly indicate the dates by which you must schedule and take theCSA.

To schedule an assessment date, contact the CSA Scheduling Program. This can be done in either of two ways. You may telephone 1-215-970-1982 (Monday through Friday, 0800-2400 EST) to havean operator assist you with scheduling. You should be prepared to give your name,

USMLE™/ECFMG identification number, and date of birth as it appears on your Notification of Registration. Remember that you will only be able to schedule if you have received officialNotification of Registration. Have several preferred dates in mind, all within one year from the dateof your Notification of Registration. The operator will indicate which dates are available. When anacceptable date is found, the operator will formally schedule you and give you a confirmationnumber. An admission permit will be mailed to you the next business day. Once an assessmentdate is scheduled, it cannot be canceled or rescheduled. You should also be aware that schedulingoperators only assist in scheduling, and cannot answer any other questions or provide additionalinformation regarding CSA or ECFMG. They will refer any such inquiries to the ECFMG ApplicantInformation Services at 1-215-386-5900.


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If you have access to the Internet, you may also schedule directly through the CSA SchedulingProgram on the ECFMG Web Site at . If you choose to access the web site,http://www.ecfmg.org

you will receive step by step directions on how to schedule an assessment date. Again, beprepared to provide your name, USMLE/ECFMG identification number, and date of birth as itappears on your Notification of Registration. If you select an assessment date through the Internet,you will be given a confirmation number, and an admission permit will be mailed to you the nextbusiness day. You will be committed to that date.

Assessment dates and sessions will be opened depending on demand. If no acceptable dates areavailable when you first call or access the web site to schedule, you may decide not to schedule atthat time. You may check again later to find out if additional dates or sessions have opened.However, be aware that there is still a requirement to schedule an assessment date within four months from the date of your Notification of Registration.

Every effort will be made to accommodate your scheduling preferences. However, due to thevolume of candidates and limited Center capacity, ECFMG cannot guarantee the availability of specific dates you may request.

It is the sole responsibility of the candidate to complete CSA in time to meet deadlines imposed bythe National Resident Matching Program (NRMP) and/or GME programs. Since the number of

candidates seeking to complete CSA may exceed the spaces available in time to meet thosedeadlines, there is no guarantee that sufficient spaces will be available for all candidates to meetdeadlines imposed by NRMP and/or GME programs. ECFMG assumes no liability of any kind if acandidate does not complete CSA in time to meet NRMP and/or GME program deadlines.

CSA Cancellation and Rescheduling Policies

If a registered CSA candidate fails to schedule a CSA assessment date within four months of notification of registration, or fails to take the CSA within one year of that notification, theregistration will become invalid and the assessment fee will be forfeit.

Once scheduled, a CSA assessment date cannot be rescheduled or cancelled. Cancellation of ascheduled CSA will result in forfeit of the assessment fee, as will failure to appear on the date of ascheduled CSA. In either case a new application must be submitted with the full assessment fee.

In extraordinary circumstances, appeals for exceptions to these policies will be considered on acase by case basis. Candidates wishing to appeal should contact ECFMG and request the CSA

Scheduling Exceptions Appeal Form (Form 745) that contains instructions for completion,documentation and submission. Form 745 is also available on the ECFMG web site athttp://www.ecfmg.org. However, no consideration for cancellation or rescheduling will be considered

within 30 days of the scheduled CSA date. Submit your appeal to the following address:

ECFMGAttention: CSA Scheduling Exceptions Appeals3624 Market StreetPhiladelphia, PA 19104-2685 USA





CSA Center Location

The CSA is administered only at the following location:

ECFMG3624 Market StreetCSA Center: 3rd Floor Philadelphia, PA 19104-2685 USA

Examinees with Disabilities

The CSA Center is wheelchair accessible, and reasonable accommodations will be made for theadministration of CSA to candidates with documented disabilities. For instructions on requestingtest accommodations, refer to the Guidelines and Questionnaire for ECFMG/CSA Applicants

Requesting Test Accommodations (Form 756). Such requests, including the completed

Questionnaire, should be made as soon as possible, and must be received by ECFMG no later thanthe application for the CSA itself. Scheduling CSA means accepting ECFMG’s conditions for theassessment; therefore no requests for test accommodations will be accepted after scheduling hasoccurred. When the CSA is administered with test accommodations, performance reports andtranscripts will not include any annotation that an accommodation was granted.

Requests should be sent to the following address:

ECFMGAttention: CSA Test

Accommodations Committee3624 Market StreetPhiladelphia, PA 19104-2685 USA

Back to Contents

TEST REGULATIONS

Irregular Behavior

Since CSA is a high stakes examination which must be passed to receive ECFMG certification,ECFMG reserves the right to enforce necessary security measures to protect test materials and toensure the integrity of the testing process. Irregular behavior includes any action, committed or solicited by a candidate, which subverts or could subvert the CSA examination process or the


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ECFMG certification process. Examples of such behavior include, but are not limited to:

1. Falsification of information on the application form;2. Failing to comply with any CSA policy, procedure, or rule while at the CSA Center;

❍ Interacting with any standardized patients in an unprofessional manner and/or outside of that standardized patient’s given case portrayal, before, during or after theexamination;

❍ Entering restricted areas;❍ Leaving the test area unescorted by a designated CSA staff member; ❍ Possessing and/or using recording devices;❍ Possessing and/or using study aids;❍ Conversing with other CSA candidates in any language other than English at any

time while at the CSA Center;❍ Giving or receiving aid during the examination;❍ Disruptive behavior which affects other candidates, SPs, or ECFMG staff.

3. Seeking and/or obtaining access to examination materials prior to a test administration;4. Impersonation of an examinee or engaging a substitute to take the examination;5. Sharing information about any of the cases presented during the CSA;6. Possessing unauthorized materials during an examination;7. Making reference notes of any kind during the examination, except on the blank, numbered

sheets provided;8. Altering or misrepresenting examination scores;9. Theft of examination materials;

10. Unauthorized reproduction and/or dissemination of copyrighted materials.

Instances of irregular behavior relating to CSA, whether in connection with applying for theexamination or as reported by CSA staff or standardized patients, will be investigated and reviewedinitially by CSA staff. Those instances where staff concludes that there is reasonable evidence of irregular behavior will be presented to the CSA Committee on Irregular Behavior. Any Committee

finding of irregular behavior may be annotated on the CSA Performance Report and in thecandidate’s ECFMG record.

If, after due consideration, the Committee determines that the irregular behavior threatened theintegrity of CSA or the ECFMG certification process, or affected the validity of the performancemeasure, it may order that no result be released. The Committee may then order that the examineeeither retake CSA, with or without special conditions, be barred from CSA, or be barred fromECFMG certification.

Back to Contents

COMMON QUESTIONS

1. If an applicant’s CSA date on the Standard ECFMG Certificate has expired for the purposeof entering graduate medical education, will the applicant be required to pass a subsequentCSA before entry into GME?


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Yes. The Standard ECFMG Certificate may be used for entry into accredited programs of graduatemedical education as long as the program start date is not later than either of the valid throughdates (English test and CSA) indicated on the Standard ECFMG Certificate.

The CSA date indicated on the Standard ECFMG Certificate is valid for three years from the mostrecent date of passing performance on CSA. If the CSA date has expired, an applicant will berequired to pass a subsequent CSA before entering graduate medical education.

2. What are the eligibility requirements for taking CSA?

To be eligible to take CSA, an applicant must meet the following requirements at the time that theapplication is submitted and at the time CSA is taken:

● Be either a medical student officially enrolled in a foreign medical school listed in thecurrent edition of the World Directory of Medical Schools published by the World Health

Organization and be within 12 months of completion of the full didactic curriculum or a

graduate of a medical school which was listed in the World Directory of Medical Schools at

the time of graduation. A graduate of a foreign medical school must have had at least four credit years (academic years for which credit has been given toward completion of themedical curriculum) in attendance at a medical school that is listed in the World Directory of

Medical Schools at the time of graduation.

● Have passed USMLE Step 1 or its equivalent and the English language proficiency test.

Applicants who, as of June 30, 1998, had met all ECFMG certification requirements in effectthrough this date are not required, but are permitted, to take CSA.

3. Is USMLE Step 3 a certification requirement and, thus, a prerequisite to CSA?

No. Passing USMLE Step 3 is not a requirement for ECFMG certification. Individual state medicalboards, not ECFMG, administer USMLE Step 3 as part of their licensing examination requirements.Questions regarding Step 3 should be addressed to the Federation of State Medical Boards

(FSMB). Refer to the ECFMG Information Booklet for contact information.

4. What is the application procedure for CSA?

Registration for CSA requires submission of the CSA application (Form 706). Form 706 is includedin the ECFMG Information Booklet and may also be downloaded from the ECFMG web site athttp://www.ecfmg.org. To register for CSA, you must complete Form 706 and send it, with fullpayment of the assessment fee, to ECFMG by mail (or courier service), following the mailinginstructions on the application form. You cannot register by facsimile, letter, postcard or e-mailmessage. Detailed application instructions are included with the application form. Follow theinstructions carefully and answer all questions completely. You should review the instructionsbefore you begin working on the application. If your application is not complete or if the required feeis not submitted, it will be returned to you.


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Once the completed application form and payment are received at ECFMG, and the applicant isdetermined to be eligible to take CSA, the Notification of Registration, which includes information onscheduling CSA, will be sent to the applicant. Applicants must schedule CSA within four months of,and must take CSA within one year of, the date indicated on the Notification of Registration. Failureto schedule CSA within four months, or to actually take CSA within one year, will requiresubmission of a new application and fee.

An admission permit confirming the date, time and location of the assessment will be mailed to

applicants as soon as they schedule CSA. Applicants must present this admission permit at theClinical Skills Assessment Center.

5. What is the application deadline for CSA?

Since CSA is offered throughout the year, there is no deadline for submitting the application form toregister for CSA.

6. What is the fee for CSA?

The CSA fee is $1,200 (U.S. dollars) which must be included with the CSA application. Refer to theECFMG Information Booklet for payment information.

7. How often is CSA administered?

Daily, depending on demand, except for major U.S. holidays.

8. How long do CSA administrations last?

The duration of CSA, including orientation, testing, and breaks, is approximately eight hours.

9. Does CSA require candidates to diagnose and treat real patients?

No. CSA consists of encounters with standardized patients (SPs), lay persons trained to accuratelyand consistently portray patients. SPs will respond to questions from candidates with answersappropriate to the case and, upon physical examination, will demonstrate appropriate physicalfindings. Candidates will be expected to proceed through each encounter with an SP as they wouldwith a real patient, but treatment of any kind is not to be done.

10. Is a proctor present during the candidates’ encounters with SPs?

No. However, all encounters are videotaped for research and quality control purposes. In addition,all encounters can be observed in real time by both video and one-way mirror.

11. Following an encounter with an SP, are the candidates required to present the casehistory, diagnosis, management plan, or other material related to the encounter, in writing or orally?


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Candidates are required to compose a written record of each patient encounter.

12. How soon after the CSA are results available?

Reports of performance on CSA are normally mailed to candidates within six to eight weeks after the examination date.

13. Do scores consist of a PASS/FAIL designation or numeric value?

A report of performance on CSA consists of a pass/fail designation.

14. How does a failing applicant retake CSA?

For the purpose of ECFMG certification, there is no limit on the number of attempts to pass CSA.Once you pass CSA, you may only repeat it to revalidate your CSA date. If you fail the CSA andwish to retake it, you must submit a new application and assessment fee. You may not take CSAwithin three months of your last attempt on the CSA. Registration and scheduling procedures will be

the same as for all other examinees.

15. How does a holder of a Standard ECFMG Certificate which includes a CSA date that willexpire before entry into a GME program revalidate the Certificate?

A passing CSA performance is valid for three years for purposes of entry into graduate medicaleducation. If an applicant enters an ACGME-accredited program of graduate medical education inthe United States, permanent validation of the Standard ECFMG Certificate can be requested.Permanent validation means that the CSA valid-through date (and the English language proficiencyvalid-through date) is no longer subject to expiration. Holders of Standard ECFMG Certificates that

include CSA may revalidate their CSA date at any time by retaking CSA. Passing CSA willrevalidate the CSA date for a period of three years from the date on which CSA is taken.Registration and scheduling procedures will be the same as for all other examinees.

16. What are the qualifications of the SPs who document the clinical skills and evaluatecommunication skills of candidates?

The SPs are lay people who undergo extensive training and evaluation prior to participation in CSA.

17. How many SP encounters need to be passed in order to obtain a passing performanceon CSA?

Passing performance on CSA is not based on passing any specific number of encounters, butrather overall performance on the CSA components.

18. What is the difference between Standard ECFMG Certificates issued to applicants whomet all certification requirements on or before June 30, 1998 and those issued to applicantswho complete the certification requirements after this date?





Standard ECFMG Certificates issued to applicants who met the certification requirementssubsequent to June 30, 1998, will indicate the dates of a passing performance of CSA and theduration of its validity for entry into GME, as well as the date of passing performance and durationof the validity of the English test.

19. Will applicants who are certified but have not taken CSA be at a disadvantage inobtaining a residency compared to applicants who have passed CSA?

The criteria for selecting applicants for residency positions are determined by individual graduatemedical education programs. However, the number of applicants frequently exceeds the number of residency programs available. Historically, programs select from the pool of applicants thoseindividuals who have met the requirements that are current at the time of selection. This does notnecessarily mean that applicants who were certified under a previous set of requirements will not beselected for residency positions at such programs.

20. Is CSA required to participate in the NRMP Match?

In order to participate in the Match, students/graduates of foreign medical schools must have

passed the examinations necessary for ECFMG certification. Therefore, applicants who arerequired to pass CSA for ECFMG certification must pass CSA in order to participate in the Match.

21. Where is CSA administered?

CSA is given throughout the year only at the following location:

ECFMG3624 Market StreetCSA Center: 3

rd

Floor Philadelphia, PA 19104-2685 USA Back to Contents

REFERENCES

1. Educational Commission for Foreign Medical Graduates: Clinical Skills AssessmentPrototype

Gerald P. Whelan. Medical Teacher 1999;21: 156-160.

2. Lessons Learned from Six Years of International Administrations of the ECFMG’s SP-Based Clinical Skills Assessment

Amitai Ziv, Miriam Friedman Ben-David, Alton I. Sutnick and Nancy E. Gary. Academic

Medicine. 1998;73:S83-S90


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3. Use of Standardized Patients in Clinical Assessments: Recent Developments andMeasurement Findings

Nu Viet Vu and Howard S. Barrows. Educational Researcher. 1994;23;3:23-30

4. ECFMG Assessment of Clinical Competence of Graduates of Foreign MedicalSchools

Alton I. Sutnick, Paula L. Stillman, John J. Norcini, Miriam Friedman, Mary Beth Regan,Reed G. Williams, Elizabeth K. Kachur, Mary A. Haggerty and Marjorie P. Wilson. Journal of

the American Medical Association. 1993;270:1041-1045

5. An Overview of the Uses of Standardized Patients for Teaching and EvaluatingClinical Skills

Howard S. Barrows. Academic Medicine. 1993;68:443-451

6. Measurement Characteristics of Examinations Using Standardized Patients

Arthur I. Rothman, Robert Cohen, Beth Dawson-Saunders, Peeter P. Poldre and JohnRoss. Academic Medicine. 1992;67:S40-S41

7. The Use of Standardized Patients to Evaluate the Spoken-English Proficiency of Foreign Medical Graduates

Miriam Friedman, Alton I. Sutnick, Paula L. Stillman, John J. Norcini, Susan M. Anderson,Reed G. Williams, Grant Henning and Marcia J. Reeves. Academic Medicine. 1991;66:S61-

S63.

8. Results of a Survey on the Use of Standardized Patients to Teach and EvaluateClinical Skills

Paula L. Stillman, Mary Beth Regan, Mary Philbin and Heather-Lyn Haley. Academic

Medicine. 1990;65:288-292

9. TSE ® Score User’s Manual: 1995 Edition

Educational Testing Service, Princeton, NJ

Back to Contents

GLOSSARY OF TERMS AND COMMONABBREVIATIONS


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TERMS USED IN THIS MANUAL

ACGME

CSA

ECFMG

FSMB

GME

LCME

NRMP

SP

TOEFL

TSE

USMLE

TERMS USED IN CSA

Accreditation Council for Graduate Medical Education Clinical Skills Assessment Educational Commission for Foreign Medical Graduates Federation of State Medical Boards Graduate Medical Education Liaison Committee on Medical Education National Resident Matching Program Standardized Patient Test of English as a Foreign Language Test of Spoken English United States Medical Licensing Examination

(the following lists will be available on-site for reference during CSA administrations) UNITS OF MEASURE kg Kilogram g Gram

mg Milligram

lbs Pounds

oz Ounces

m Meter

cm Centimeter

min Minute

hr Hour

C Centigrade





F VITAL SIGNS BP P

R

T

Fahrenheit

Blood pressure

Pulse

Respirations

Temperature

COMMON ABBREVIATIONS FOR THE PATIENT NOTE

(this is not intended to be a complete list of acceptable abbreviations, but rather isrepresentative of the types of common abbreviations that may be used on the patientnote)

yo Year-old

m or G Male

f or E Female

b Black

w White

L Left

R Right

hx History

h/o History of

c/o Complaining of

NL Normal limits

WNL Within normal limits

˘ Without or no

+ Positive

- Negative

Abd Abdomen





AIDS AP BUN CABG CBC CCU cig CHF COPD CPR CT CVA or TIA CVP CXR DM DTR ECG ED EMT ENT EOM

ETOH Ext FH GI

Acquired Immune Deficiency Syndrome Anteroposterior Blood urea nitrogen Coronary artery bypass grafting Complete blood count Cardiac care unit Cigarettes Congestive heart failure Chronic obstructive pulmonary disease Cardiopulmonary resuscitation Computerized tomography Cerebrovascular accident OR Transient ischemic attack Central venous pressure Chest x-ray Diabetes mellitus Deep tendon reflexes Electrocardiogram Emergency department Emergency medical technician Ears, nose, and throat Extraocular muscles

Alcohol Extremities Family history Gastrointestinal





GU HEENT HIV HTN IM IV JVD KUB LMP LP MI MRI MVA Neuro NIDDM NKA NKDA NSR PA PERLA po

PT PTT RBC SH

Genitourinary Head, eyes, ears, nose, and throat Human immunodeficiency virus Hypertension Intramuscularly Intravenously Jugular venous distention Kidney, ureter, and bladder Last menstrual period Lumbar puncture Myocardial infarction Magnetic resonance imaging Motor vehicle accident Neurologic Non insulin-dependent diabetes mellitus No known allergies No known drug allergy Normal sinus rhythm Posteroanterior Pupils equal, react to light and accommodation Orally Prothrombin time Partial prothrombin time Red blood cells Social history





U/A Urinalysis URI Upper respiratory tract infection WBC White blood cells Back to Contents

CSA Home Page Guide to Philadelphia



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ECFMG Welcome Page

ublications & Forms

nnouncements

CFMG Certification

● USMLE™ Step

1/Step 2

● English Language

Proficiency Test

● Clinical Skills

Assessment (CSA ® ),

including

Scheduling

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Credentials

ertification Verification

ervice

RAS ® - the Electronic

esidency Application

ervice

-1 Visa Sponsorship

nternational Fellowships

n Medical Education

FME)

oundation for

dvancement of

nternational Medical

Through its program of certification, the EducationalCommission for Foreign Medical

Graduates (ECFMG®) assessesthe readiness of internationalmedical graduates to enter residency or fellowship programsin the United States that areaccredited by the AccreditationCouncil for Graduate MedicalEducation (ACGME).

ECFMG offers a variety of other programs and services tophysicians educated abroad andother members of the internationalmedical community. Detailedinformation on ECFMGcertification and ECFMG's other programs and services is availableon this site and in the ECFMGInformation Booklet .

If you are an international medicalstudent or graduate interested inECFMG certification, you must

refer to the ECFMG InformationBooklet for detailed informationand application procedures.

You can download the Information

Booklet and Application Materialsfrom the Publications Page of this

website.

Apply On-line for

USMLE™ Step 1 o

Step 2

On-line Applicant

Status and Informat

System (OASIS) Check the status of yourexam application, scorereport, TOEFL® scoreacceptance, medicaleducation credentials,ECFMG Certificate, USMtranscript request, ECFMfinancial account and mo

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requently-Asked

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ECFMG Publications & Forms

Publications & Forms

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Reader, you can get a free copy by clickingon the Acrobat Reader icon below andfollowing the instructions. If you would rather save a form on your computer and read itlater, right-click on the name of the documentin the list below and choose to save it.

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Free E-Newsletters:

The ECFMG Reporter for ECFMG Applicants

ECFMG ERAS News for IMGs using ERAS

The ECFMG Correspondent for ECFMG

certified physicians

ECFMG Information BookletThe ECFMG Information Booklet contains detailed information about ECFMG certification. Applicants for USMLE Step 1/Step 2 or the ECFMG Clinical Skills Assessment are required to read the Information Booklet .

Current Edition

2002 Information Booklet - HTML Format (for on-line viewing)

2002 Information Booklet - PDF Format (for

printing/downloading)

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2001 Information Booklet - HTML Format (for on-line viewing)

2001 Information Booklet - PDF Format (for

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USMLE Bulletin of InformationThe USMLE Bulletin of Information contains detailed information about USMLE, the three-step examination for medical licensure in the United States. Applicants for USMLE Step 1/Step 2 are required to read the Bulletin of Information.

Current Edition

2002 USMLE Bulletin of Information

Previous Edition (for reference only)

2001 USMLE Bulletin of Information

English Language Proficiency Test

TOEFL Application Materials

TOEFL Acceptance Request Form

Request for Permanent Validation of Standard ECFMG

Certificate (Form 246)

USMLE Step 1 / Step 2

Apply On-line for USMLE™ Step 1 or Step 2

2002 USMLE Step 1/Step 2 Application Materials

Request to Extend a USMLE™ Eligibility Period

Download Step 1 / Step 2 Sample Test Materials from theUSMLE web site

USMLE Transcript Request Forms


http://www.ecfmg.org/2002boi.pdf






http://www.ecfmg.org/toeflapp.htm

http://www.ecfmg.org/toeflacc.pdf

http://www.ecfmg.org/permvald.pdf



http://www.ecfmg.org/forms/02s12app.pdf

http://www.ecfmg.org/form176.pdf

http://www.usmle.org/

http://www.ecfmg.org/usmle/transcripts/index.html

http://www.ecfmg.org/usmle/transcripts/index.html

http://www.usmle.org/












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Computer-based USMLE TM : An Introductory Brochure for

Students and Graduates of Foreign Medical Schools

Score Recheck Request Form

Clinical Skills Assessment

Clinical Skills Assessment (CSA) Application Materials

Candidate Orientation Manual

Candidate's Guide to Philadelphia

Guidelines and Questionnaire: Requests for Test

Accommodations for Examinees with Disabilities Taking the Clinical Skills Assessment



CSA Examinee Request for Score Recheck Form (Form 751)

Scheduling Exceptions Appeals Form

Medical Education Credentials



Applicant Profile

Address / Name Change (Form 182)

Payment


http://www.ecfmg.org/cbt/index.html




http://www.ecfmg.org/steprchk.pdf



http://www.ecfmg.org/csaapeal.pdf



http://www.ecfmg.org/forms/form182.pdf






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Payment Form (Form 900)

E-Newsletters

The ECFMG Reporter

ECFMG ERAS NewsThe ECFMG Correspondent

Certification Verification Service (CVS)

Forms for State Medical BoardsForms for Residency Program DirectorsForms for Other Organizations

Exchange Visitor Sponsorship Program (EVSP)

Application Materials for Initial Sponsorship

Application Materials Continuation of Sponsorship

Supplementary Statement for Graduate Medical Trainees

(Form I-644)

Informational Memos

Electronic Residency Application Service (ERAS)

Request for an ERAS Token

ECFMG ERAS News






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Other Publications

Graduate Medical Education, Licensure and Specialty

Certification in the United States: An Overview for

International Medical Graduates

ECFMG Certification and J-1 Visa Sponsorship: An Overview


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Copyright ©®

). Form , JAN 1999All rights reserved.

This form is available on the ECFMG web site at http://www.ecfmg.org.

Educational Commission for Foreign Medical GraduatesClinical Skills Assessment (CSA ® )

Examinee Request for Score Recheck

Standardized procedures ensure that the CSA score reported for each examinee is an accurate reflection of his or her performance, and a change in score based on a recheck is an extremely remote possibility.

However, a request for a score recheck will be honored if this form and a service fee of $ 35.00 issubmitted to ECFMG®.

The service fee of $35.00 for one CSA score recheck, may be paid by credit card, check, bank draft or money order made payable to ECFMG. You must also attach a copy of your ECFMG CSA Score

Report to this form.

Please type or print.

1. __________________________________ _____________________________ Last (Surname/Family Name) First

2. USMLE�/ECFMG IDENTIFICATION NUMBER:

3. Date of CSA:Month Day

Submitted by.Signature Date

Address, Phone Number or Fax Number where you can be reached:

_____________________________________________________________________________ Street Address/Post Office Box

__________________________________________ ____________________________________ City State/Province

__________________________________________ ____________________________________ Zip/Postal Code Country

Telephone _____________________________ Fax_____________________________

Payment by Credit Card

Charge $______To my credit card, Visa ( ) MasterCard ( ) expiration date _______________

Credit Card Number ____________________________________________________________

Name of Card Holder ___________________________________________________________

Address of Card Holder

Card Holder’s signature

1999 Educational Commission for Foreign Medical Graduates (ECFMG 751Page 1 of 2

_______/_______/_______ Year

___________________________________________________________

________________________________________________________

________________________________________________________



Copyright ©®

). FormAll rights reserved. Page 2 of 2

This form is available on the ECFMG web site at http://www.ecfmg.org.

Mail this request to:

Score Recheck RequestEducational Commission for Foreign Medical Graduates

Clinical Skills Assessment Program3624 Market Street

Philadelphia, PAU.S.A.

Upon receipt of your request and fee, ECFMG will:

1. Recheck your Clinical Skills Assessment score.2. Respond to you in writing within eight weeks.

Do not write below this line.

Date Recheck Request and payment Received: _______/_______/_______ Month Day

Score Recheck Findings:

Score Recheck Investigator:Signature Date

1999 Educational Commission for Foreign Medical Graduates (ECFMG 751, JAN 1999

19104-2685

For Administrative Use Only.

Year

_______________________________________________



The Official Web Site for the Test of English as a Foreign Language

est of English as a Foreign Language

est of Spoken English

n-Site Testing ProgramsTOEFL ITP

SLEP

SPEAK

est Takers with

Disabilities

est Preparation

ducators

esearchers

tudent Resource Center

Bulletin Center

TOEFL CBT Bulletin

TOEFL Supplemental Paper

TSE Bulletin

Privacy Policy

The TOEFL® program provides English

proficiency testing services for international

students planning to study in the United States,

Canada, or other countries where English is the

language of instruction.

Educational Testing Service (ETS) develops the

test under the direction of the TOEFL Board, a

board comprised of professionals drawn from thehigher education community.

The TOEFL test is made available worldwide to

all persons, regardless of age, gender, race,

nationality, or religion.

TOEFL NewsNew Publication

The 2001-02 Edition of the

TOEFL Test and Score Dat

Summary is now available a

downloadable publication.

Test Center Changes inPakistan

The computer-based testingcenter in Karachi, Pakistan

been temporarily closed as

management of the center

changes. Paper-based test

temporarily replacing comp

based testing in Karachi. Pa

based administrations will b

held on January 19, 2002, a

May 11, 2002. Further

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Supplemental Paper Test CUpdates.

Paper Test Center Update

The list of supplemental pap

test centers has been chan

since the printing of the 200

Supplemental Bulletin. See

of the changes under

Supplemental Paper Test C

Updates.

Institutional Online WritinEvaluation

The TOEFL program annou

the Online Writing Evaluatio

Service for institutions.

TSE NewsTSE Test Center Updates

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Copyright © 2001 Educational Testing Service. All rights reserved. This entire site isprotected by copyright. All rights reserved. By accessing and using this site, you agreeto be subject to the "Terms and Conditions Governing Use and Access to

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NRMP - National Resident Matching Program

The National Resident Matching Program To participate in an NRMP match, click on (NRMP) is a private, not-for-profit corporation Match Site to reach the login/registration established in 1952 providing uniform date of page.appointment to positions in graduate medical education (GME) in the United States. Five NEWS from NRMP€

organizations sponsor the NRMP: December 1 is the deadline for applicants toregister for the Main Residency Match.

· American Board of Medical Specialties Registration and payments will be accepted

(ABMS), after December 1 with an additional late

· American Medical Association (AMA), registration fee of $50.

· Association of American Medical Colleges(AAMC), Pediatric Surgery and Pediatric

· American Hospital Association (AHA), Hematology/Oncology Fellowship Matches· Council of Medical Specialty Societies open on November 28, 2001.

(CMSS).For the timing of these matches, go to

Managed by the Association of American Fellowship Matches/Schedule of Dates.

Medical Colleges.

Updated 11/9/2001

© 2001 NRMP Copyright Notice

ttp://www.nrmp.org/ [12/8/2001 5:35:26 PM]

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CSA Guidelines and Questionnaire for Test Accommodations

Clinical Skills Assessment (CSA ® )

Guidelines and Questionnaire: Requests for Test Accommodations for Examinees withDisabilities Taking the Clinical Skills Assessment

Administered by the Educational Commission for Foreign Medical Graduates (ECFMG® )


How to Request Test Accommodations

1. Read the guidelines carefully.

2. Complete the Questionnaire for CSA® Applicants Requesting Test Accommodations.

3. Be sure to sign the questionnaire where indicated.4. If appropriate, have your medical school complete the Certification of Documentation for Test

Accommodations.

5. Attach documentation of the disability and your need for accommodation.6. Send only your questionnaire and documentation in the envelope provided to:

ECFMG / CSA Test Accommodations Committee3624 Market StreetPhiladelphia, PA 19104 USA

Requests for test accommodations and accompanying documentation must bereceived no later than the application for CSA.

Guidelines for ECFMG/CSA Examinees with Disabilities Requesting TestAccommodations

The Educational Commission for Foreign Medical Graduates provides reasonable and appropriateaccommodations for CSA examinees with documented disabilities. Examinees are informed of theavailability of test accommodations in the ECFMG Information Booklet .

Test Accommodations are adjustments to the testing activity for an individual with a disability in order to ease the effect of the disability on the testing process. Reasonable accommodations varyaccording to the type and extent of the disability, documentation provided, and the requirements of the examination. ECFMG will provide the qualified CSA examinees who have documenteddisabilities with appropriate auxiliary aids and services that do not fundamentally alter themeasurement of the skills or knowledge the examination is intended to test and that would not resultin an undue burden to ECFMG.

ttp://www.ecfmg.org/csa/csa756a.html (1 of 4) [12/8/2001 5:35:28 PM]

http://www.ecfmg.org/csa/csa756b.pdf



http://www.ecfmg.org/csa/csa756c.pdf








Documentation

Applicants requesting reasonable accommodations because of disabilities must provide appropriatedocumentation of the disability and specify the extent to which the standard testing procedures needto be modified.

The following documentation should be submitted to support a request for accommodations.

1. A completed Questionnaire for CSA® Applicants Requesting Test Accommodations.

2. A detailed report from a qualified professional appropriate for evaluating the disability,describing the applicant’s condition and its severity. Given that the manifestations of adisability may vary over time, the evaluation should be no more than three years old. Thereport should include:

❍ a specific diagnosis;❍ specific findings in support of the diagnosis (relevant history, tests administered, test

results in standard score format and interpretation of those test results);❍ a description of the individual’s functional limitations due to the stated disabilities;❍ specific recommendations for test accommodations, including a detailed explanation

of why the accommodations are needed;❍ name, address, telephone number and qualifications of each professional expert who

provides documentation.3. If no prior accommodations have been provided, the professional expert should include a

detailed explanation as to why no accommodations were given in the past, and whyaccommodations are needed now.

4. If the applicant has received prior test accommodations from a medical school, a Certification

of Documentation for Test Accommodations must be completed by an appropriate medical

school official.

ECFMG reserves the right to request further verification, if necessary, of the professional’scredentials and expertise relevant to the diagnosis being made. ECFMG also reserves the right torequire further evaluation of the applicant by a professional of its choice at its expense.

Learning Disabilities

For those applicants claiming a learning disability, documentation should be provided by adiagnostician with formal training in written and oral language and should consist of:

● relevant psychoeducational testing● an educational history● a demonstrated impact on academic functioning

Because learning disabilities are most commonly manifested during childhood, historical informationof learning difficulties in elementary, secondary and post-secondary education is usually available, aswell as records of previous classroom and/or test accommodations. Therefore, as much historicalinformation as possible, including any previous psychoeducational testing, should be included in therequest for accommodations.













The basic test battery should include individually administered measures of cognitive ability,academic achievement and information processing, such as the Wechsler Adult Intelligence Scale(WAIS-R), the Woodcock-Johnson Psychoeducational Battery-Revised, and the Detroit Tests of Learning Aptitude (DTLA-A). In addition, recognized tests of reading related processes includingcomprehension and word attack, as well as measures of language, memory, attention andconcentration and auditory and perceptual functioning should be included to determine if there areany deficits in the information processing systems undergirding the learning process.

Timeline for Submitting Documentation

An applicant must notify ECFMG in writing that he or she has a disability and is requesting testaccommodations. The notification and accompanying documentation must be received no later thanthe application for CSA itself. Scheduling CSA means accepting ECFMG’s conditions for the test;therefore no requests for test accommodations will be accepted after scheduling has occurred. Toaccelerate the review process, applicants are urged to submit their request and supportingdocumentation as early as possible.

If there is a need for further verification of the disability or the need for accommodation, it is possible

that the decision on granting the accommodation will be delayed. Applicants having any questionsare encouraged to contact the ECFMG / CSA Test Accommodations Committee staff at 215-823-2220.

Cancellation

If an applicant requesting test accommodations decides not to take the examination, the applicantmust notify the ECFMG/CSA Test Accommodations Committee two weeks before the testadministration to allow time to cancel the arrangements at the Center.

Score Reporting

ECFMG will not annotate score reports and transcripts for CSA administrations for which testaccommodations were granted.

Application for Subsequent Test Accommodations

The applicant must notify the ECFMG/CSA Test Accommodations Committee in writing of a requestfor accommodations for any subsequent test administration.

1. If requesting identical accommodations for the same disability, send a letter of requestindicating the previous test administration for which accommodations were provided. Theletter must be received no later than the application for CSA itself.

2. If there is a change in the nature or extent of the disability and/or additional or differentaccommodations are being requested, documentation for the new request must be submittedaccording to appropriate deadlines.

3. To facilitate arranging for test accommodations, applicants are urged to submit their requestsas early as possible.





Address all requests and inquiries to:

ECFMG/CSA Test Accommodations Committee3624 Market StreetPhiladelphia, PA 19104 USA(215) 823-2220

CSA materials, to the above address.

Always send disability information separately from other ECFMG /

TO PROTECT YOUR CONFIDENTIALITY

CSA Home Page CSA Candidate Orientation Manual Guide to Philadelphia





World Health Organization: World Health Organization

World Health Organizatio

World Health Organization English] · Español · Français

Home · Health topics A to Z · WHO as an Organization · Site Index · Search

irector-General's Office

ography of the Director-Generalnd text of all the Director-eneral's speeches.

More info

CURRENT WHO INFORMATION ON:

The

Weapons

Central

Asia

Crisis

Biological

and

Chemical

nformation resources

brary. Publications Catalogue.ultimedia resources. Individualublications such as the Bulletin,eekly Epidemiological Record,orld Health Report, ICD-10

More info

assification scheme.

ress Media Centre

ress releases, notes for the press,ct sheets, audio clips, & hotographs. Links to historicalrchives of press releases, fact

More info

heets, & multimedia.

overnance

xecutive Board, Policy and World

More info

ealth Assembly documentation.

Inside the camps inAfghanistan

6 December 2001 | Islamabad | WHOpersonnel are assessing thehealth situation in the internallydisplaced peoples’ camps in theHerat area of Afghanistan. Half the people seen by health staff are suffering from acuterespiratory infection, the numberone killer in Afghanistan. Withwinter fast approaching, thesituation in the camps is dire,with people exposed to theelements and without adequateshelter. In response, WHO is

continuing to supply essentialmedical supplies and drugs tohealth facilities in Herat andelsewhere in Afghanistan.

Full text

isease outbreaks

nformation on current outbreaks.ncludes historical archives by year

Outbreaks

1996 to 2000) and disease.

Upcoming Events

Macroeconomics and HealthReport of the Commission on

20 December 2001

The Commission onMacroeconomics anHealth will present landmark report,Macroeconomics an

Health: Investing in Health for Economic Development to WHODirector-General, Dr Gro HarlemBrundtland on 20 December. ThCommission was established byBrundtland two years ago toresearch the role of health in gleconomic development.

The Commis

Recent Events

Do you?"World AIDS Day 2001: "I car

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mergencies

nformation on current emergenciesy country as well as technicaluidance.

Action

Emergency and Humanitarian

raveller's health

nformation on vaccinationequirements and health advice foreople travelling between thearious countries of the world.

Full story

elated web sites

holera: basic facts for travellers ·

A Guide on Safe Food for

ravellers" ·

uidelines for Prevention & Control

street vended food ·

uberculosis & Air Travel:

mployment

urrent vacancies and recruitmentrocedures for professional staff,upport staff, associate professional

More info

fficers, interns and volunteers.

Africa recordsimpressive resultsin polio eradication

4 December 2001 | Harare | In 2001

the WHO African Region recordedimpressive results in the drive toeradicate polio, with the numberof countries reporting wildpoliovirus dropping from 11 in2000 to 6 this year. SuccessfulNational Immunization Days havebeen conducted in all countries inthe Region since the launch of thepolio eradication initiative.

Countries in the Region have alsotaken advantage of the polioimmunization process to addressother killer diseases ravaging theRegion, including measles andmicronutrient deficiencies.

Full text

WHO EuropeanRegion celebratesthree polio-free

years: Certification withinreach in 2002

30 November 2001 | Copenhagen,

Brussels | "The 51 countries of theWHO European Region have hadno reported cases of indigenouspolio for three years," declared DrMarc Danzon, WHO RegionalDirector for Europe, today."Europe is firmly on track towardsbecoming fully certified as a polio-free Region in 2002." The Region

1 December 2001

World AIDS Day 2001 focused othe role of men in determining tspread, control and mitigation oHIV/AIDS epidemics in all regioThe theme for the Day, "Men ma difference" recognizes that coof AIDS epidemics requiresreorientation of health services meet the needs of all men, as was those populations that are thmost at risk.

World AIDS Camp

Tobacco Control negotiationsThe Framework Convention o

22-28 November 2001 / Geneva

The Intergovernmental NegotiatBody held the third round of negotiations on the FrameworkConvention on Tobacco Control(FCTC) in Geneva on 22-28November. The FCTC will tackletobacco epidemic by addressingissues such as tobacco advertisand promotion, smuggling, taxe

and subsidies.

Official Documents for Negotiat

Tobacco Free Initia

Vulnerable"Appeals "Reaching theLaunch of the UN Consolidat


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of the Americas was certified polio-free in 1994, and the WesternPacific Region in 2000 and theworld is on track to be certifiedpolio-free in 2005.

Full text

World is now readyto turn back theAIDS epidemic

30 November 2001 | Geneva | "The

world is now ready to turn backthe HIV/AIDS epidemic, learningfrom those who have blazed atrail, scaling up best practices andconfronting AIDS systematically,"said Dr Gro Harlem Brundtland,WHO Director-General, today in aceremony for World AIDS Day.

Full text

Tuberculosis inAfghanistan

29 November 2001 | Islamabad |

Detection and control of tuberculosis (TB) is becomingincreasingly difficult inAfghanistan leading to thepossibility of further emergence of drug-resistant strains of thedisease. TB control drugs are notreaching people who need themand patients who were following atreatment course may not be able

27 November 2001 / Geneva

The annual UN appeals forAfghanistan and 17 other crisiscountries were launched in Genby Gro Harlem Brundtland, DireGeneral of the World HealthOrganization on 27 November. T

year's Global Consolidated AppeProcess called on the internationcommunity to strengthen effortreach vulnerable populations.

Global CAP La


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to finish it. WHO will providetraining and supplies and continueto work in close collaboration withNGOs and local health authoritiesin Afghanistan to limit the spreadof the disease.

Full text

AIDS epidemic ballooningin Eastern Europe

28 November 2001 | Moscow | The

number of HIV infections inEastern Europe is rising fasterthan anywhere else in the worldaccording to a joint UNAIDS/WHOreport. "HIV is spreading rapidlythroughout the entire EasternEuropean region with a quarter of a million new cases in this yearalone," said Dr Peter Piot,Executive Director of the Joint

United Nations Programme onHIV/AIDS.

Full text

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Welcome to FSMB

Welcome to FSMB Online

2002 Annual Meeting Agenda Now Available Online: The program agen

for the Federation's 2002 Annual Meeting, which will be held April 25 in S

Diego, is now available in the Educational Programs section. Online registr

is now available.

The Federation will provide links to information bulletins and weekly

reports issued by the Centers for Disease Control and Prevention (CDCThis effort is to assist the CDC in distributing critical information, specific

related to responses to the intentional release of biological agents, to physic

throughout the United States.

The Federation and its Board of Directors encourage member boards to

facilitate licensees' access to this important information via this Web site.

Additional information is available by visiting the CDC Web site; the

Association for Professionals in Infection Control and Epidemiology, Inc; t

U.S. Army Medical Research Institute of Infectious Diseases; and the John

Hopkins Center for Civilian Biodefense.

Eligibility Extensions for USMLE Step 3: In early to mid December, FSM

will begin accepting requests to extend the eligibility period for USMLE St

applicants. All requests will need to be submitted on the "Request Form to

Extend the USMLE Step 3 Eligibility Period" which will be placed on this

site at that time.

2002 USMLE Step 3 application materials now available online: The 20

Step 3 application cycle runs Nov. 1, 2001, through Dec. 31, 2002. Individu

who immediately submit a 2002 application will likely have an eligibility p

that begins Nov. 1, 2001, and extends through Jan. 2002. Otherwise, the us

two to four weeks required for processing an application will determine the

exact start of an examinee's eligibility period within the 2002 application cy

An additional 15 days is added to the 90-day eligibility period to allow for

mailing of the scheduling permit.

Institute for Physician Evaluation featured in The New York Times: Th

ttp://www.fsmb.org/ (1 of 2) [12/8/2001 5:36:37 PM]

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http://www.fsmb.org/Annual%20Meeting/Annual%20Meeting%20Reg%20form.htm

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http://www.bt.cdc.gov/

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Welcome to FSMB

Institute for Physician Evaluation, a collaborative initiative between the

Federation of State Medical Boards, the National Board of Medical Examin

and the Colorado Personalized Education Program, was recently featured in

New York Times. The Denver-based IPE provides an in-depth analysis of

physicians' clinical competency through a combination of standardized and

personalized assessment tools. For more information on the Institute for

Physician Evaluation, please call (817) 868-4041 or by e-mail at

[email protected]. Additional information about IPE is available by clicking t

"Post-Licensure Assessment" link on the left side of this page.

FSMB Releases Annual Summary of Board Actions: The Federation of

Medical Boards (FSMB) released its Annual Summary of Board Actions, a

report that compiles data on licensure and disciplinary activities from 69 sta

medical boards.

The Federation of State Medical Boards of the United States, Inc., is a national organization comprised o69 medical boards of the United States, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin

Islands. On behalf of its membership, the Federation's mission is to be a leader in improving the quality,

and integrity of health care in the United States by promoting high standards for physician licensure and

practice.

Federation of State Medical Boards of the United States Inc.Federation Place

400 Fuller Wiser Road, Suite 300Euless, Texas, 76039-3855

phone (817) 868-4000; fax (817) 868-4098www.fsmb.org

For e-mail listings by department, see the Contact FSMB page.

ttp://www.fsmb.org/ (2 of 2) [12/8/2001 5:36:37 PM]


http://www.fsmb.org/Home%20Page%20News%20Blurbs/FSMB%202001%20Stats%20Release.htm



http://www.fsmb.org/Home%20Page%20News%20Blurbs/FSMB%202001%20Stats%20Release.htm




®

ECFMG ® Clinica l Skills Assessme nt (CSA ® )

20 01 Applicat ion Instruct ions

EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATESP. O. BOX 820992, PHILADELPHIA, PENNSYLVANIA 19182-0992, USA

TELEPHONE: (215) 386-5900 INTERNET: http://www.ecfmg.org

APPLICATION MATERIALSYour CSA application packet includes: these application instructions (Form 716), anidentification form (Form 707) and the five-page application form (Form 706). You may use the following application

form to apply for CSA administrations in 2001.

IDENTIFICATION FORM An identification form is included with the CSA application form. You must complete andreturn this form with your application. Enter your name, USMLE/ECFMG Identification Number, date of birth andgender. Sign the form where indicated. You must attach a full-face photograph in the space provided on theidentification form. The photograph you provide must be current; it must have been taken within six months of the datethat you send your application. Cut out the form along the dotted lines before enclosing with your application.

GENERAL INSTRUCTIONS Refer to the following instructions when completing your application form. Follow theseinstructions exactly and answer all items completely and accurately, even if you have previously submitted thisinformation to ECFMG. If you are asked to provide additional documentation, be sure to include it. All information should

be provided in English; signatures and official titles should be provided in Latin characters with English translations, whereapplicable. If your application is not complete, it will be rejected and returned to you.

You must complete the application in ink. You should type or print neatly in uppercase letters. You must completethe following application and identification form and send them with all attachments and payment to ECFMG, following themailing instructions above Part A on the application form. All photographs, signatures and seals/stamps must be originalYou cannot register by faxing or sending photocopies of your completed application to ECFMG.

Before submitting the following application form, you are required to read the 2001 Information Booklet. The 2001

Information Booklet is available on the ECFMG web site at http://www.ecfmg.org and from ECFMG upon request.

PART A — BIOGRAPHICAL INFORMATIONUSMLE/ECFMG IDENTIFICATION NUMBER➀ Enter your USMLE/ECFMG Identification Number in the spaces provided

in item 1 and in the spaces provided on pages 2-5 of the application.

Enter your first and middle names (given names) and your last name (surname) in uppercase letters in itemNAME➁2 and in the spaces provided on pages 2-5 of the application. If you are a graduate and the name you enter initem 2 does not match exactly the name on your medical diploma, you must submit a copy of a legal documentverifying that both of these names belong to you (see Name of Applicant on page 24 of the 2001 InformationBooklet).

PREVIOUS/MAIDEN NAME.12 If the name you entered in item 2 above is different from the name on the lastapplication you submitted to ECFMG, enter your previous name here. You must include with the application a copy ofthe legal document that verifies this name change (either a passport, marriage certificate, birth certificate or court order) tochange your name in your ECFMG file. If you do not provide one of the documents listed above that verifies thisname change, your application will be rejected and returned to you.

MAILING ADDRESS➂ Enter the address at which you would like to receive ECFMG correspondence, including yourCSA admission permit, score report, statements of account and your Standard ECFMG Certificate. If your addresschanges, you must notify ECFMG promptly in writing.

TELEPHONE NUMBER, FAX NUMBER AND E-MAIL ADDRESS.13 Enter all that apply. If you provide an e-mail addresson your application, ECFMG will send you an e-mail message to confirm receipt of your application. If you do not providean e-mail address, ECFMG will send confirmation by mail.

➃ U.S. SOCIAL SECURITY AND/OR NATIONAL IDENTIFICATION NUMBERS Enter all that apply.

FORM 716-W, Rev. June 2001 Page 1 of 4 © ECFMG 2001 All Rights Reserve



BIRTHDATE/BIRTHPLACE➄ Enter the numbers that correspond to the day, month and year of your birth. Enter thisinformation in the order DAY-MONTH-YEAR. For example, if your date of birth were January 5, 1970, you would ente“05” for the day, “01” for the month and “1970” for the year. You must also enter your place of birth.

GENDER➅ Indicate whether you are male or female.

NATIVE LANGUAGE➆ Enter the name of your native language.

CITIZENSHIP➇ Enter your citizenship: (A) At Birth, (B) When you entered medical school, and (C) Now.

ETHNICITY➈ Check the box that best describes your ethnicity. Although you are encouraged to complete this itemproviding this information is voluntary. This information will be used for research purposes and will be kept confidentialChoosing a particular answer or choosing not to answer this question will not affect the outcome of your application.

PART B — REGISTRATION INFORMATION

CLINICAL SKILLS ASSESSMENT CENTER10 CSA is administered throughout the year at the ECFMG Clinical Skills Assessment Center in Philadelphia, Pennsylvania, USA. Refer to Taking the Exam on page 20 and Clinical Skills

Assessment Center on page 36 of the 2001 Information Booklet for additional information. Detailed information, including

a Philadelphia travel guide, is available in the CSA Candidate Orientation Manual . ECFMG sends this publication toapplicants when they are registered for CSA. The CSA Candidate Orientation Manual and Philadelphia travel guide arealso available on the ECFMG web site at http://www.ecfmg.org.

11 FEE The CSA Fee is $1,200. You must complete page 3 of the application to submit payment.

12 PAYMENT Refer to page 3 of the application. Check the box for the method of payment you are using. You muscomplete all requested information for that payment method to ensure that your payment is credited to your account. Ifyou pay by credit card, there will be an additional $20 credit card processing fee for each application to cover thecosts of processing your credit card payment. You must add this fee on page 3 when calculating the total amount tobe charged to your credit card. You must send full payment of all applicable fees with the application. If you do notinclude full payment, the application will be rejected and returned to you. See Payment on page 25 of the 2001

Information Booklet for a detailed explanation of ECFMG’s payment policies.

EXAMINEES WITH DOCUMENTED DISABILITIES13 Check “Yes” only if you have a documented disability coveredunder the Americans with Disabilities Act and are requesting test accommodations for CSA. Checking “Yes” does noconstitute an official request. If you are requesting test accommodations, you must obtain the packet entitledGuidelines and Questionnaire: Requests for Test Accommodations for Examinees with Disabilities Taking the Clinica

Skills Assessment (see page 21 of the 2001 Information Booklet ) and follow its instructions before you submit youCSA application. Your official request, including the completed questionnaire and all required documentation asdescribed in the Guidelines and Questionnaire, must be received at ECFMG no later than your application.

OTHER EXAM HISTORY and APPLICANT NUMBERS14 If you have previously submitted an application form to theNational Board of Medical Examiners (NBME) for a Part or Step examination or to a U.S. State Licensing Authority forthe Federation Licensing Examination (FLEX), you should check the appropriate box and enter the Identification Numberthat was assigned to you at that time. You should enter this information even if you did not actually take the exam. Ifyou took one of these exams, you should also enter the date of the most recent exam taken.

Page 2 of 4



PART C — MEDICAL EDUCATION, LICENSURE AND EMPLOYMENT INFORMATION

Enter the exact name and address of the medical school from which youMEDICAL SCHOOL NAME AND ADDRESS15

graduated or expect to graduate. If all information is not completed, your application will be rejected and returnedto you.

1 1 .5 MEDICAL SCHOOL INFORMATION Enter all the information requested. If all information is not completed, yourapplication will be rejected and returned to you.

STATUS OF MEDICAL SCHOOL STUDENT2 51 . This question refers to some of the minimum medical education

requirements for medical school students to take the CSA. If you are a medical school student, you must answer thisquestion. See Eligibility for CSA on page 19 of the 2001 Information Booklet for detailed information on CSA eligibilityrequirements. If you are a medical school student and do not answer this question, your application will berejected and returned to you. Medical school graduates are not required to complete this item.

STATUS OF MEDICAL SCHOOL DIPLOMA3 51 . Medical school graduates must complete this item and provide therequired documents, as described below. Medical school students are not required to complete this item.

If you have not previously submitted two photocopies of your medical diploma, you must send two photocopies of yourmedical diploma with the application. You must also send two full-face photographs with the copies of your medicadiploma. The photographs must be current; they must have been taken within six months of the date you send them. Aphotocopy of a photograph is not acceptable. (These photographs are in addition to the three photographs that alapplicants must send with the application form [see 19.1 below].) Write your full name and USMLE/ECFMG IdentificationNumber, if one has been assigned, on the back of the photographs and the copies of your diploma. Refer to theReference Guide for Medical Education Credentials on pages 45-48 of the 2001 Information Booklet for a list of themedical degrees required by ECFMG.

If you have previously submitted two photocopies of your medical diploma to ECFMG, you are not required to submitthem again.

If you graduated from medical school but your medical diploma has not been issued, you must submit with yourapplication a letter signed by your Medical School Dean, Vice Dean or Registrar that confirms you graduated frommedical school, have met all requirements to receive your medical diploma and states the date your medical diploma wilbe issued.

Any document that is not in English must be accompanied by an English translation. This translation must be preparedby and certified to be correct by a government official, medical school official or recognized translation service. Thetranslation must appear on official stationery, must identify the translator, and must bear the signature of the official or

representative of the translation service. A copy of the document from which the translation was made must accompanythe translation.

If you do not submit two photocopies of your medical diploma (with an official English translation, if applicable)or, if your diploma has not been issued and you do not submit a letter from a medical school official asdescribed above, your application will be rejected and returned to you.

OTHER MEDICAL SCHOOL(S) ATTENDED16 If you attended medical school(s) other than the medical school youentered in item 15, enter the exact name and address and dates of attendance at this other medical school. If youattended more than one other medical school, list the name, address and attendance dates for the other medicalschool(s) on a separate sheet and attach it to the application. Enter your full name and USMLE/ECFMG IdentificationNumber, if one has been assigned, on the attached sheet.

TRANSFER CREDITS1 61 .

Indicate whether you transferred academic credits from any school to the medical schoothat conferred or will confer your medical degree. If yes, attach to the application a separate sheet of paper that lists: thename of the school(s) from which the credits were transferred, the number of credits transferred and the course titles forall credits transferred. Enter your full name and USMLE/ECFMG Identification Number, if one has been assigned, on theattached sheet.

MEDICAL LICENSURE17 If you received an unrestricted license or certificate of full registration to practice medicineenter the date and the country or state of your licensure.

If you are currently employed, list the name and address of yourEMPLOYMENT — Present employment only18

employer, the position that you hold and the dates of your employment.

Page 3 of 4



Use this space to explain why your application could not be signed inthe presence of your Medical School Dean, Vice Dean or Registrar. This explanation must be acceptable to ECFMG andmust be provided each time you submit an application form.

Use this space to explain why your application could not be signed inthe presence of your Medical School Dean, Vice Dean or Registrar. This explanation must be acceptable to ECFMG andmust be provided each time you submit an application form.

CERTIFICATION BY APPLICANT19 Students and graduates must read the certification statement and sign and datethe application form in the presence of their Medical School Dean, Vice Dean or Registrar. The medical school officiamust then certify the application in 19.2.A below. The application form should be mailed to ECFMG from the office of thisofficial.

If a graduate cannot sign the application form in the presence of a medical school official, he/she must sign theapplication form in the presence of a Consular Official, First Class Magistrate or Notary Public and must explain in writingon the application (section 19.2.B.1) why the form could not be signed in the presence of a medical school official. Thisofficial must then certify the application in 19.2.B below. The application form should be mailed to ECFMG from the officeof this official.

PHOTOGRAPHS1 19. You must provide three full-face photographs with the application. Attach one photograph tothe application form in the space provided. Attach a second photograph to the Identification Form (see Identification Form

above). To attach the photos, use tape or glue. Do not use staples or paper clips. You must enclose the othephotograph with the application form. Write your full name and USMLE/ECFMG Identification Number, if one has beenassigned, on the back of all photographs. The photographs that you use must be current; they must have been takenwithin six months of the date that you send your application. A photocopy of a photograph is not acceptable. The seal orstamp of the official who certifies your application form (see 19.2 below) must cover a portion of the photographthat you attach to the application form. (The three photographs that you must provide with the application form are inaddition to the two photographs that graduates must provide with the copies of their medical diplomas [see 15.3 above]. )

19.2.A CERTIFICATION BY MEDICAL SCHOOL OFFICIAL The Medical School Dean, Vice Dean or Registrar that witnesses

your signature must sign and date the application and provide his/her name, official title and the institution name. Thesignature of the medical school official must be current; the official must have signed the application form within fourmonths of the date that it is received at ECFMG. All information, including the official signature, must be in Latincharacters with English translations, where appropriate. The medical school official must also affix the medical schooseal or stamp over a portion of the photograph in 19.1. Application forms from students which are not signedand dated by one of the medical school officials listed above or do not contain the medical school seal or stampover a portion of the applicant’s photograph will not be accepted.

19.2.B CERTIFICATION BY OFFICIAL IDENTIFICATION WITH EXPLANATION (Pertains to graduates only) For graduates whocannot sign the application form in the presence of a medical school official, the Consular Official, First Class Magistrateor Notary Public that witnesses their signature must sign and date the application form and provide his/her official titleThe signature of this official must be current; the official must have signed the application form within four months of thedate that it is received at ECFMG. All information, including the official signature, must be in Latin characters with English

translations, where appropriate. The official must affix his/her seal or stamp over a portion of the photograph in 19.1.

19.2.B.1 EXPLANATION (Pertains to graduates only) Use this space to explain why your application could not be signed inthe presence of your Medical School Dean, Vice Dean or Registrar. This explanation must be acceptable to ECFMG andmust be provided each time you submit an application form.

20 CLINICAL CLERKSHIPS The term clinical clerkships refers to that period of your medical education in the clinicaldisciplines during which, as a medical student, you gained practical experience in hospitals or clinics through rotations,pre-graduate internships, etc. List all of your clinical clerkships for each discipline. If necessary, continue on a separatesheet of paper and attach this sheet to the application. Include your full name and USMLE/ECFMG Identification Numberif one has been assigned, on all attachments.

Page 4 of 4



Form 707-W, Rev. July 2000

TYPE OR PRINT NAME CAREFULLY:

DAY MONTH

Last Name Middle Initial

Date of Birth

USMLE/ECFMG Identification Number

Signature of Applicant

YEAR

First Name

FemaleMaleGender

CLINICAL SKILLS ASSESSMENTIDENTIFICATION FORM

✄Educational Commission for Foreign Medical Graduates3624 Market Street, Philadelphia, PA 19104-2685, USA

Attach current, full-face photohere. Use tape or glue; nostaples or paper clips, please.

Include your name and USMLE/ECFMG Identification Number,if known, on back of photographbefore attaching.

✄

✄

✄Page 1 of 1

Instructions

• Complete all information. • Attach photograph.Type or print name carefullywhere indicated and signname where indicated.

Reminder — C ut along dotted lines

before enclosing this

form with your

application.



®

200 1 ECFMG ® Clinica l Skills Assessme nt (CSA ® )

EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATESTELEPHONE: (215) 386-5900 INTERNET: http:/ / www.ecfmg.org

MAILING INSTRUCTIONS:

OR

via regular mail to:Educational Commission for Foreign Medical GraduatesPO Box 820992Philadelphia, PA 19182-0992 USA

V E R Y

I M P O

R T A N T

via courier service to:ECFMG Box #82-0992PNC Bank LockboxRoute 38 & Eastgate DriveMoorestown, NJ 08057-0932 USA

NOTE: All items on all sides of the application must be filled out completely for initial and reexamination or application will be rejected.Use typewriter or print carefully in ink using uppercase letters.

PART A — BIOGRAPHICAL INFORMATION

➀ USMLE (/ ECFMG IDENTIFICATION NUMBER:

Enter your USMLE/ECFMG Identification Number in the following boxes:

➁ NAME:

First Name Middle Name

Last Name (Surname/Family Name)

21 PREVIOUS/MAIDEN NAME:. First Name Middle Name

Last Name (Surname/Family Name)

MAILING ADDRESS:➂

Street Address/Post Office Box

Address Continued

City (Include Postal Code as required for non-USA/non-Canadian address.) State/Province

Zip/Postal Code Country

31. TELEPHONE NUMBER, FAX NUMBER AND E-MAIL ADDRESS:

Country Code City/Area Code Telephone Number City/Area Code Fax Number

E-Mail Address:

U.S. SOCIAL SECURITY AND/OR NATIONAL IDENTIFICATION NUMBERS:➃

U.S. Social Security Number National Identification Number Country

BIRTHDATE/BIRTHPLACE:➄Location: City:

Day Month Year State/Province: Country:

B. Upon EnteringMedical School:

C. Now:

CITIZENSHIP:➇

Male

GENDER:➅

A. At Birth:

USA

USA

USA

or

or

or

Other (Specify)

Other (Specify)

Other (Specify)

Hispanic3

Asian/Pacific Islander 2

1 American Indian/ Alaskan Native

is voluntary. See Instructions for details.

➈ ETHNICITY: Provision of the following informatio

4

5

6 Other

White (not of Hispanic Orig

Black (not of Hispanic Orig

Female

NATIVE LANGUAGE:➆

APPLICATION FORM 706-W, Rev. June 2001

Page 1 of 5

© ECFMG 2001 All Rights Rese



Enter your USMLE/ECFMGName: Identification Number:

(Last, First, Middle)

PART B — REGISTRATION INFORMATION

CLINICAL SKILLS ASSESSMENT CENTER:10

CSA is administered throughout the year at: ECFMG Clinical Skills Assessment Center 3624 Market Street, Third Floor Philadelphia, PA 19104 USA

11 FEE: The Clinical Skills Assessment Fee is $1,200 (U.S. dollars/Fee subject to change.)

EXAMINEES WITH DOCUMENTED DISABILITIES:13

12

For Office Use OnlyPAYMENT — Refer to page 3 of this application.

To submit payment, complete page 3 of thisapplication.

You must send full payment of the total amountwith this application.

If you do not include full payment, this applicationwill be rejected.

I have a documented disability covered under the Americans with Disabilities Act and am requesting test accommodations for CSA. Yes No

FOR OFFICE USE ONLY

MR FP CRED REGLOG

Check below the organizations (other than ECFMG) to which you previously applied for examinations. Enter the date of the most recent examination thawas administered to you and the identification number that was assigned to you by that organization.

14 OTHER EXAM HISTORY and APPLICANT NUMBERS:

91

Month Year NBME Parts I/ II ApplicantIdentification Number:

USMLE Steps 1/2 Month Year ApplicantIdentification Number:

NATIONAL BOARDOF MEDICALEXAMINERS

Date of Most RecentExamination Taken:

Date of Most RecentExamination Taken:

STATE LICENSING FLEX Month Year AUTHORITY IN THE FIN – Federation Date of Most RecentUNITED STATES Identification Number: Examination Taken:

Page 2 of 5

91



2001 EXAM PAYMENT

USMLE™ / ECFMG® Identification Number: --===-===-=First Name: Middle Name:

Last Name (Surname or Family Name):

1Enter your IdentificationNumber.

Enter your name.

2.AChecks and Wire Transfers

2.BCredit Cards

2Refer toEITHER

2.AOR

2.B,depending onmethod of payment.

2001Clinical SkillsAssessmentRegistration Assessment Fee

$1,200.00

Assessment Fee

Credit Card Processing Fee(An additional processing fee of

$20.00 will be added to your examfee.)

Total Amount Due

$ 1 ,2 0 0 . 0 0

+ 2 0 . 0 0

$-,---.--(A) o Charge my credit card. (Complete 2.B above)

Credit CardNumber: ---- --- --- --- Exp. Date

(Month/Year): --/ ---Check One: o VISA o MASTERCARD o DISCOVER

Name of Card Holder:

Address of Card Holder:

City:

State:

Country:

Zip/Postal Code:

By signing below, I authorize ECFMG to charge my credit card in the amount listed in Item 2.B above.

Signature of Card Holder:

(B) o My check, bank draft, or money order made payable to ECFMG is enclosed. (Refer to 2.A above)

Payment must be made in U.S. funds through a U.S. bank.Include your USMLE/ECFMG Identification Number on your check.

(C) o I have sent a wire transfer to ECFMG. (Refer to 2.A above)

Funds may be wire transferred through most banks in the United States (Fedwire) to the ECFMG ACCOUNTNUMBER 8611080982 at PNC BANK, N.A., ROUTING / TRANSIT NUMBER 031000053. Your payment must be

identified with your full name and USMLE / ECFMG Identification Number. Additionally, you must provide the following information:

Date Sent:

Originating Bank:

Bank Reference Number:

Name of Sender:

3Select amethod of payment andcomplete allinformationrequested.

Do NOTsend cash.

You mustsend fullpayment of the totalamount duewith thisapplicationform. If youdo notinclude fullpayment,thisapplicationwill berejected.

ECFMG Payment Policy

If you owe money to ECFMG at the time that your application is processed, ECFMG will apply the payment included with your application to the amount that you owe. Any money that is left after this will bused to pay for the exam(s) that you request. If there is not enough money remaining to pay for the exam you request, your application will be rejected.

If you have money in your ECFMG account at the time that your application is processed, it will be used to pay for the next exam / service request processed by ECFMG. If you have money in your ECFMaccount and will not request additional exams / services, you may send a written request to ECFMG for a refund. If the money in your account was a payment for an exam application that was incompleteotherwise deficient, your refund will be subject to a $100 processing fee.

Refer to "Payment" on page 25 of the ECFMG Information Booklet for detailed information.

Page 3 of 5



(Last, First, Middle)Name:

Enter your USMLE/ECFMGIdentification Number:

PART C — MEDICAL EDUCATION, LICENSURE AND EMPLOYMENT INFORMATION

MEDICAL SCHOOL NAME AND ADDRESS:15

Page 4 of 5

List the exact name and address of the medical school from which you graduated or expect to graduate.

Official Name of Medical School

Street Address

City State/Province Postal Code

115 MEDICAL SCHOOL INFORMATION:

Country University Name (if applicable)

.

toYEARMONTH

Attendance Dates: FromYEARMONTH

Number of Years Attended:

Date you graduated (or expect to graduate):YEARMONTH

Date your medical diploma was issued (or expect to be issued):

STATUS OF MEDICAL SCHOOL STUDENT — Must be completed by all students:1

Title of Medical Degree you received or will receive

Are you now officially enrolled and will you be officially enrolled and be within 12 months of completion

of the formal didactic curriculum at your medical school by the date of the CSA? Check Yes or No:If you are a student and answered “No,” you are not eligible to take CSA. (See Eligibility for CSA on page 19 of the 2001 Information Booklet .)

Refer to the “Reference Guide for Medical Education Credentials” on pages 45-48 of the 2001 Information Booklet for the list of medical degrees required by ECFM

25.

Yes No

STATUS OF MEDICAL SCHOOL DIPLOMA — Must be completed by all graduates:1 35.

Graduates must check one:

I have graduated from medical school and am enclosing 2 photocopies of my medical diploma.

I have graduated from medical school and have previously submitted to ECFMG 2 photocopies of my medical diploma.

I have graduated from medical school, but my medical diploma has not yet been issued. I am enclosing a letter from my medical school thatconfirms I graduated, have met the requirements to receive my medical diploma and states the date my medical diploma will be issued.

Note: Your application will be rejected if you graduated from medical school and have not submitted photocopies of your med

diploma or a letter from your medical school that confirms your graduation (as described above).OTHER MEDICAL SCHOOL(S) ATTENDED — Continue on a separate sheet of paper, if necessary:16

List the names, addresses and dates of attendance of all other medical schools you attended.

PART C CONTINUES ON PAGE 5.

EMPLOYMENT — Present employment only:18 Position(s) Dates

Institution/Company

Street

Official Name of Medical School

Street Address

City State/Province Postal Code

Country University Name (if applicable)

Country or state in which you are licensed:

Attendance Dates: From to

TRANSFER CREDITS:

Did you transfer academic credits from any school(s) to the medical school that conferred or will confer your medical degree?If Yes, indicate on a separate sheet of paper the name of the school(s) from which the credits were transferred, the number of credits transferred and the course titles for all credits transferred.

MEDICAL LICENSURE:17

Yes N

Date you received an unrestricted license or certificate of full registration to practice medicine:MONTH YEAR

MONTH YEAR MONTH YEAR

161 .

City/State/Country

YEARMONTH

If you have graduated from medical school, you must include 2 photocopies of your medical diploma if you have not sent them previously. If ygraduated from medical school but your medical diploma has not yet been issued, you must submit with your application a letter signed by your MedicSchool Dean, Vice Dean or Registrar that confirms you graduated from medical school, have met all requirements to receive your medical diploma anstates the date your medical diploma will be issued. (See “Provision of Credentials and Translations” on page 22 of the 2001 Information Booklet.)



(Last, First, Middle)Name:

Enter your USMLE/ECFMGIdentification Number:

Page 5 of 5

PART C — MEDICAL EDUCATION, LICENSURE AND EMPLOYMENT INFORMATION (Continued)

CERTIFICATION BY APPLICANT :19 PHOTOGRAPHS:119.

Attach one current, full-face photo here. Attacha second photo to theIdentification Form. Usetape or glue; no staplesor paper clips, please.

Enclose the other photowith this application form.

I hereby certify that I currently meet CSA eligibility requirements and that the information in this application is true and accurate tothe best of my knowledge and that the photographs enclosed were taken within 6 months of the date of this application.

I also certify and acknowledge that I have reviewed the current edition (that which pertains to the administration for which I amregistering) of the ECFMG Information Booklet, am aware of its contents and meet the eligibility requirements set therein and agreeto abide by the policies and procedures therein.

I understand that (1) falsification of this application, or (2) the submission of any falsified documents to ECFMG, or (3) thesubmission of any falsified ECFMG documents to other agencies, or (4) the giving or receiving of aid in the examination asevidenced either by observation at the time of the examination or by statistical analysis of my answers and those of one or moreother participants in that examination, or engaging in other conduct that subverts or attempts to subvert the examination process,may be sufficient cause for ECFMG to bar me from the examination, to terminate my participation in the examination, to withholdand/or invalidate the results of my examination, to withhold a certificate, to revoke a certificate, or to take other appropriate action.(See page 21 of the 2001 Information Booklet for additional details concerning Validity of Scores and Irregular Behavior.)

I understand that the Standard ECFMG Certificate and any and all copies thereof remain the property of ECFMG and must bereturned to ECFMG if ECFMG determines that the holder of the Certificate was not eligible to receive it or that it was otherwiseissued in error.

I hereby authorize the Educational Commission for Foreign Medical Graduates to transmit any information contained in thisapplication, or information that may otherwise become available to ECFMG, to any federal, state or local governmental departmentor agency, to any hospital or to any other organization or individual who, in the judgment of ECFMG, has a legitimate interest in suchinformation.

Students and graduates must sign the application in the presence of their Medical School Dean, Vice Dean or Registrar. (See 19.2.A below.)

Application forms are to be mailed to ECFMG from the office of the official or notary who witnesses the applicant'ssignature. All information on the application form is subject to verification and acceptance by the Educational Commissionfor Foreign Medical Graduates.

If a graduate cannot sign the application form in the presence of a medical school official noted above, he/she must sign the applicationform in the presence of a Consular Official, First Class Magistrate or Notary Public (See 19.2.B below) and must explain in writing why theapplication form could not be signed in the presence of a medical school official. (See 19.2.B.1 below.)

I certify that on the date set forth below the individual named above did appear personally before me and that I did identify this applicant by: (a) comparing his/hphysical appearance with the photograph on the identifying document presented by the applicant and with the photograph affixed hereto, and (b) comparing applicant's signature made in my presence on this form with the signature on his /her identifying document. The statements in this document are subscribed a......

Day Month Year

Signature of Applicant (In Latin Characters)

(Signature must match full legal name as given in PART A-2.)

X

19.2.A CERTIFICATION BY MEDICAL SCHOOL OFFICIAL (Must be completed for Medical School students):I hereby certify that the photograph, signature, and information entered in all parts of Section 15 of this form, including medical school and attendance dateaccurately apply to the individual named above, and that this individual is: (must check one) officially enrolled in or a graduate of institution indicated below. I have affixed the medical school seal or stamp over a portion of the photograph above.

Signature of Medical School Official (In Latin Characters) XDay Month Year

(In Latin Characters with English translation, where applicable.)Print Name and Official Title Institution

19.2.B CERTIFICATION BY IDENTIFICATION WITH EXPLANATION (Pertains to graduates only):OR

sworn to before me by the applicant on this ., in the year day, of the month of

Clinical Discipline Supervising Physician Dates of Clerkship

20 CLINICAL CLERKSHIPS — Continue on a separate sheet of paper, if necessary:

Hospital/Clinic Location (exact address)

XSignature of Consular Official, First Class Magistrate, Notary Public (In Latin Characters with English translations, where applicable.) Official Title

19.2.B.1 EXPLANATION (Pertains to graduates only) – Explain in the space below why the application could not be signed in the presence of your Medical School Dean, Vice Dean or Registrar. Any explanation must be acceptable to ECFMG and must be provided each time you submit anapplication to ECFMG.

Seal or stampof official

must cover a portionof the attached

photograph.



CSA General Information

Clinical Skills Assessment (CSA ® ) - GeneralInformation

CSA Scheduling (For

Registered

Candidates Only)

The Clinical Skills Assessment evaluates your ability to gather aninterpret clinical patient data and communicate effectively in theEnglish language. CSA consists of eleven stations, ten of whichare scored; in each station you will encounter a StandardizedPatient (SP), a lay person trained to realistically and consistentlyportray a patient. The SPs will respond to your questions withanswers appropriate to the patient being portrayed and will reactappropriately to physical maneuvers. You will be expected toproceed through each encounter with an SP as you would with areal patient.

CSA assesses whether you can obtain a relevant medical historyperform a focused physical exam and compose a written record othe patient encounter. CSA requires that you demonstrateproficiency in spoken English, which will be evaluated by theStandardized Patients you encounter in the test stations. CSA isadministered only in English.

To be eligible to take CSA, you must have passed USMLE Step (or its equivalent) and the English Language Proficiency Test. Yo

must also meet certain medical education requirements (seeEligibility at left).

CSA is offered continuously at the ECFMG Clinical Skills Assessment Center in Philadelphia, Pennsylvania, USA. If youmeet the eligibility requirements, you may apply for CSA at anytime.

The date of your most recent passing performance on CSA will

appear on your Standard ECFMG Certificate. This CSA Date isvalid for three years from the date passed for the purpose of entering a program of graduate medical education in the UnitedStates. If your CSA Date expires before you enter a U.S. programof graduate medical education, you must revalidate your CSADate before you may enter such a program. You can revalidatethe CSA Date for an additional three-year period by passing asubsequent CSA. Once you enter a program of graduate medicaeducation in the United States, the CSA Date is no longer subjec

Description of CSA

Eligibility

Registration &

Scheduling

CSA Fee

Test Center

Application Materials

Examinees with

Documented Disabilities

How to Prepare

Scores

Reexamination

Revalidation of the

CSA Date on the

Standard ECFMG

Certificate

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http://www.ecfmg.org/2001ib/ibcsa.html#description_of_csa

http://www.ecfmg.org/2001ib/ibcsa.html#csaeligibility

http://www.ecfmg.org/2001ib/ibregcsa.html#app_process


http://www.ecfmg.org/2001ib/ibregcsa.html#csafee

http://www.ecfmg.org/2001ib/ibregcsa.html#csa_center

http://www.ecfmg.org/2001ib/ibcsa.html#doc_disabilities



http://www.ecfmg.org/2001ib/ibcsa.html#csa_prep

http://www.ecfmg.org/2001ib/ibcsa.html#scoring_components

http://www.ecfmg.org/2001ib/ibcsa.html#reexamination

http://www.ecfmg.org/2001ib/ibcert.html#revalidation








http://www.ecfmg.org/2001ib/ibcsa.html#reexamination

http://www.ecfmg.org/2001ib/ibcsa.html#scoring_components

http://www.ecfmg.org/2001ib/ibcsa.html#csa_prep




http://www.ecfmg.org/2001ib/ibregcsa.html#csa_center

http://www.ecfmg.org/2001ib/ibregcsa.html#csafee



http://www.ecfmg.org/2001ib/ibcsa.html#csaeligibility

http://www.ecfmg.org/2001ib/ibcsa.html#description_of_csa






CSA General Information

to expiration, and you may request permanent validation of youCSA Date.

Comprehensive information on CSA is available in the ECFMG

Information Booklet and the CSA Candidate Orientation Manual .

Permanent

Validation of the

CSA Date on the

Standard ECFMG

Certificate

Frequently-Asked

Questions

Publications & Forms

Back to ECFMG

Home Page

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http://www.ecfmg.org/2001ib/ibfaq.html#csa


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Guide to Philadelphia

Clinical Skills Assessment CSA®

CANDIDATE’S GUIDE TO PHILADELPHIA


TRAVEL AND TRANSPORTATION

Airport

Philadelphia International Airport, 8 miles from Center City, is served by all major domestic carriers, withflights to more than 100 cities in the United States. Terminal A is an East Coast gateway for flights fromEurope, Canada, and the Caribbean, and offers connections to Asia. In addition, the SEPTA Airport Rail

Line (the R1 train) connects each terminal of the airport with 30 th Street Station, which is about 6 blocksfrom the CSA Center. For information on the R1 Regional Rail Line, stop at one of the information booths

located in all of the terminals at the airport, or call the number below.

Philadelphia International Airport (215) 937-6937

or http://www.phl.org

For up-to-the-minute information regarding airline travel and departure times as well as gate assignments,call 800-PHL-GATE.

Airport Shuttle Services

Most shuttle services between the airport and hotels close to the CSA Center cost $8-14.

Lady Liberty (215) 724-8888

Rapid Rover (856) 428-1500

Super Shuttle(800) 689-0521 (within PA)(800) 258-3826 (out of state)

Buses

Inter-city bus service is excellent, with daily arrivals from all parts of the country. These includetranscontinental buses via Chicago and St. Louis, buses from New England, New York, the South,

Southwest, and Midwest. ECFMG® is only a 10-15 minute cab ride from the bus terminal on Filbert Street.Cabs are readily available at either of the below bus terminals, and the cab fare to the CSA Center is about$9. One may also easily access the Market-Frankford subway line from the bus stations. The closest stop to

the CSA Center is located at 34th and Market Streets.

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http://www.phl.org/

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Greyhound

10th and Filbert Streets(800) 231-2222

Peter Pan Trailways

11th and Filbert Streets(800) 343-9999

Car Rental

Alamo (800) 327-9633

Avis (800) 831-2847

Budget (800) 527-0700

Dollar (800) 800-4000

Enterprise (800) 736-8222

Hertz (800) 654-3131

National (800) 227-7368

Trains

Philadelphia’s 30th Street Station is served by AMTRAK, which operates rail service along the NortheastCorridor stretching from Boston, MA to Washington, DC and from New Haven, CT to Springfield, MA.Visitors have access to intercity trains operating over the corridor, including high-speed Metroliners betweenNew York and Washington. Intercity service is also provided to many points south and west. The CSA

Center is only a 5 minute cab ride from 30th Street Station, and the fare is about $5.

Amtrak 800-USA-RAILor http://www.amtrak.com

Public Transportation

The Southeast Pennsylvania Transportation Authority (SEPTA) offers commuter rail service between the

city and surrounding areas. 30th Street Station provides quick connections with Amtrak. Each of thesestations connects the entire rail system with the city’s Airport Rail Line (R1 Regional Rail Line).

SEPTA also operates a large fleet of buses and street cars through the city with highly concentrated lines inthe Center City area. Two subway lines—the Market Frankford (east-west) and Broad Street (north-south)—crisscross the city. Cash fare on most routes is $2.00 (exact change required). Discounted tokensand passes are available at SEPTA sales offices and at commercial sales outlets. The easiest way to travelto all of Philadelphia’s sights and attractions is with SEPTA’s Day Pass. The pass is good for one day of unlimited riding on all City Transit vehicles, plus a one-way trip on the Airport Line. A Day Pass costs $5 and

can be purchased at the Visitors Center at 16th Street and JFK Boulevard.

SEPTA (215) 580-7800


http://www.amtrak.com/

http://www.amtrak.com/




or http://www.septa.com

NJ Transit (215) 569-3752

Transportation for the Disabled

Most City Transit Division bus routes are lift-equipped. Market East Station is fully wheelchair accessible, asare all SEPTA railroad trains and the Airport Terminal stations.

SEPTA Paratransit (215) 580-7145

714 Market Street, 5th Floor

Taxis

Philadelphia’s taxi fleet has more than 1400 taxicabs. There is taxi service at many area hotels and atdesignated "taxi stations." One-way cab fare from the airport to Center City or hotels near the CSA Center isabout $20.

Olde City Taxi Coach Association (215) 338-0838

Quaker City Cab (215) 728-8000

City Cab Company (215) 492-6500

Liberty Cab Company (215) 389-8000

Yellow Cab (215) 333-3333

DRIVING DIRECTIONS TO THE CSA CENTER

From New York & New Jersey

● Take New Jersey Turnpike to Exit 4● Take Route 73 (N) to Route 295 (S)● Cross Walt Whitman Bridge to Route 76 (W)

● Follow 76 (W) to 30th Street Station Exit

● Proceed directly through 1st traffic light

● Turn left at 2nd traffic light onto Market Street● Proceed on Market Street for 6 blocks

● When you pass 36th Street, you will see 3624 Market Street on your left. Parking is available acrossthe street.

From Princeton, Trenton, & Points North

● Take 95 (S) to 676/Central Philadelphia Exit● Follow signs to 676 (W)● Take 676 (W) to 76 (E) exit

● Follow 76 (E) to 30th Street Station Exit (about 1/5 mile)● Follow ramp around station to Market Street● Turn right onto Market Street● Proceed on Market Street for 6 blocks


http://www.septa.com/

http://www.septa.com/





From Western Pennsylvania

● Take Pennsylvania Turnpike to Valley Forge Exit (Exit 24)

● Follow 76 (E) to 30th Street Station Exit● Follow ramp around station to Market Street

● Turn right onto Market Street● Proceed on Market Street for 6 blocks


From Philadelphia International Airport, Washington, DC & Points South

● Take 95 (N) to 76 (W)

● Follow 76 (W) to 30th Street Station Exit

● Proceed directly through 1st traffic light

●

Turn left at 2nd

traffic light onto Market Street● Proceed on Market Street for 6 blocks


LODGING NEAR THE CSA CENTER

Note: The following information is provided solely as a convenience for candidates, and is not arecommendation or endorsement. ECFMG has no relationship with these lodging establishments andassumes no responsibility or liability for reservations, your stay at such establishments, or any problemsencountered.

Cornerstone Bedand Breakfast

(215) 387-6065 or http://www.cornerstonebandb.com

3300 Baring Street (5 blocks from CSA Center)

Divine Tracy Hotel (215) 382-4310

20 South 36th Street (2 blocks from CSA Center)

International House (215) 387-5125or http://www.libertynet.org/~ihouse

3701 Chestnut Street (2 blocks from CSA Center)

(Ask for the "CSA Discount" of $50 per night.)Penn Tower Hotel (215) 387-8333

Civic Center Boulevard at 34th Street (6 blocks from CSACenter)

Sheraton UniversityCity Hotel

(215) 387-8000 or or http://www.sheraton.com/UniversityCity

36th and Chestnut Streets (2 blocks from CSA Center)


http://www.cornerstonebandb.com/

http://www.libertynet.org/~ihouse

http://www.sheraton.com/UniversityCity

http://www.sheraton.com/UniversityCity

http://www.libertynet.org/~ihouse

http://www.cornerstonebandb.com/




The Inn at Penn (215) 222-0200or http://www.theinnatpenn.com

3600 Sansom Street (3 blocks from CSA Center)

OTHER RESOURCES

Currency Exchange

Currency may be exchanged at the following locations. In some cases, there may be limitations. Please callfirst. Several hotels and restaurants also redeem currency. Look for laminated signs displayed inparticipating establishments.

Thomas Cook Currency Services (800) 287-7362

1800 John F. Kennedy Boulevard

There are also two other locations in the Philadelphia International Airport, at Terminals A and B, openfrom 6 AM to 8 PM daily.

Mellon PSFS (215) 561-01141234 Market Street

PNC Bank (215) 585-5178

Broad and Chestnut Streets

Reference Phone Numbers

Police, Fire & Medical Emergencies 911

Accidental Poisoning (215) 386-2100

Airport Medical Emergencies (215) 492-3111

American Red Cross (215) 299-4000

Doctor (215) 563-5343

(Philadelphia County Medical Society)

Mayor’s Commission on People withDisabilities

(215) 686-2798

Traveler’s Aid Society (215) 546-0571

Time (215) 846-1212

U.S. Customs (215) 596-1972

Weather (215) 936-1212

Consulates and Embassies

Austria (215) 772–7630


http://www.theinnatpenn.com/

http://www.theinnatpenn.com/




Belgium (215) 238–8729

Chile (215) 829–9520

Chinese Embassy (202) 328-2500

Czech Republic (215) 646–7777

Denmark (215) 772–7292

Dominican Republic (215) 923–3006

Ecuador (215) 925–9060El Salvador (610) 642–9391

Finland (215) 465–5565

France (215) 851–1474

Germany (215) 665–3200

Guatemala (215) 885–5551

Haiti (215) 751–2516

Iceland (717) 761-8435

Indian Embassy (202) 939-7000Israel (215) 546–5556

Italy (215) 592–7329

Kingdom of Lesotho (215) 563–7512

Madagascar (610) 640–7832

Mexico (215) 922–4262

Netherlands (610) 520–9591

Norway (215) 462–2502

Pakistani Embassy (202) 939–6200Panama (215) 574–2994

Spain (215) 848–6180

Sweden (215) 496-7200

Switzerland (215) 922-2215

United Kingdom (215) 557-7665

Tipping Customs

Waitresses, waiters, and related service personnel should be tipped a minimum of 15 percent.

PHILADELPHIA VISITORS CENTER

For more information on Philadelphia, contact the Visitors Center at (215) 636-1666, (800) 537-7676, or http://www.pcvb.org.


http://www.pcvb.org/

http://www.pcvb.org/




CSA Home Page CSA Candidate Orientation Manual


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