Conference: Dr. Kim Edward LeBlanc’s Plenary Address to ASPE: Do We Need Clinical Skills Assessment?
By: Michael Maury, UC-San Diego

Tuesday’s ASPE plenary address was delivered by Dr. Kim Edward LeBlanc. Dr. LeBlanc is the Executive Director of the Clinical Skills Evaluation Collaboration (CSEC). CSEC creates and administers the USMLE Step 2 Clinical Skills Examination. He is a family physician with a certification in Sports Medicine, previously served on the Louisiana State Board of Medical Examiners for nearly 14 years, and was Professor and Head of the Department of Family Medicine at the LSUHSC School of Medicine in New Orleans for 11 years.

While taking in the words and presentation of Dr. Kim Edward LeBlanc, I was reminded of some of the tenets of improvisational theatre. Improv rules and concepts such as “Yes, and…” and “It’s good to fail” resonated within my heart as Dr. LeBlanc’s speech unfolded. “Do we need clinical skills assessment?” the title of this talk asked. I answered in my mind, without thought, “yes! Okay, conversation over.” And yet, as he dug into the topic more and more, while sharing important research data and fun facts of his own life, I was drawn into the importance of what we do as Standardized Patient Educators. There is so much more that must be taken into consideration while administering Clinical Skills Assessments and Dr. LeBlanc focuses on some of those important details.

Using a quote by Yogi Berra, Dr. LeBlanc began his talk by saying, “I’d like to thank everyone that made this necessary.” The subtle humor of these words by the former Yankee’s catcher allowed for this presentation to unfold effortlessly. Dr. LeBlanc went on to share that while growing up on a chicken farm in South Louisiana, running around with no shoes on, he, along with his brother, learned to enjoy the simple things that life had to offer. Interestingly enough, they would both go on to become Medical Doctors; his brother, a surgeon and he, a family physician.

While training to be a physician in medical school, Dr. LeBlanc noted that he was never observed by any faculty member while taking a medical history or performing a physical exam. He also noted that he performed his first lumbar puncture with virtually no supervision and that he only witnessed a vaginal delivery once before performing one himself with a sutured episiotomy which he had never done before. Dr. LeBlanc shared his own experience to lay out the reality that we have come a long way since then in medical education. As he noted, and we know Standardized Patients are now regularly used in medical education giving the medical students an opportunity to become better doctors sooner with more human-to-human interaction and experience.

Dr. LeBlanc shared much history of Standardized Patient Education and the importance of what we do. As he put it, he knew he was “Preaching to the Choir,” but he wanted to take a moment to thank all of us SP Educators for what we do. He then explained with enthusiasm why we still need High-Stakes Clinical Skills Assessment in medical education.

Here are a few highlights and “home-run” points that Dr. LeBlanc made in his plenary speech.

• The #1 concern in 2018 for Healthcare Organizations were Diagnostic Errors according to the Emergency Care Research Institute.
  • As the Institute of Medicine said in 2015, “It is likely that most of us will experience at least one diagnostic error in our lifetime, sometime with devastating consequences.”
  • These Diagnostic Errors most likely came down to the Top 3 Problems in Healthcare which are as follows:

1. Communication
2. Communication
3. Communication

• Quoting the famous Irish Playwright, George Bernard Shaw, he said “The single biggest problem in communication is the illusion that it has taken place.”
• Diagnostic errors may be attributed to miscommunication in any of the following areas:
  • Listening Skills
  • Interpersonal skills with patients and colleagues
  • Empathy and Emotional Intelligence
  • In most malpractice suits, the patients have been forgotten and it comes down to an issue of miscommunication.
  • Defending this point and the importance of clearer communication skills Dr. LeBlanc shared:
    • Individuals who score poorly on Clinical Skills Exams usually deal with communication errors down the road.
    • Low scores can be markers for these individuals and a precursor that they may have poor communication with patients in the future.
    • Dr. LeBlanc then asked the pertinent questions:
      • Who is at fault? – Once they leave our institutions, they are on their own.
      • Are we just trying to graduate these students?
      • Are we trying to train doctors who are fit to practice?

Dr. LeBlanc made a great point that we need a reality check when it comes to training and assessment. He used the analogy of his own desires to be a Professional Football Player in the NFL. He had the desire of course, but lacked the skills, height and guts to play. He knew his talents were better suited elsewhere. Thankfully for us, he went into medicine.

He went on to ask the question, “Why do good students fail?” While there may be many reasons, such as overconfidence and lack of preparation (Fun fact: Of those taking the USMLE-CSE, only 20% actually watch the online orientation video provided), or lack of clinical reasoning and diagnostic skills, Dr. LeBlanc believes the main reason may be in our “Failure to Fail” those that must be failed.

Why don’t we fail those who must be failed? It could be fear of legal action, or faculty fear of receiving a bad evaluation, or simply concern for student self-esteem. Regardless of the reason, it is the duty and responsibility of all to calibrate faculty to be sure they are all on the same page to ensure patient safety, social accountability, and upholding the highest standards in the profession.

Dr. LeBlanc suggested we overcome mediocrity by using accrediting bodies, scrutinize our standardization and assessment methods, and perhaps assuring a minimum level of competency through a national standard.

This plenary speech asked “Do we need clinical skills assessment?” and my simple, original answer was, of course, confirmed “YES” by Dr. LeBlanc! This is obvious to all of us involved in Standardized Patient Education; however, the take away that Dr. LeBlanc mapped out for us is that it is not just about saying “YES” to this question. Like an improvised scene we must say “Yes, and…” by accepting and embracing that high-stakes, Clinical Skills Assessment is necessary “And” that national standardization of these assessments is vitally important as well. We have to be willing to embrace the mistake and call out failure when it occurs. In failing those that must be failed, we will succeed in building future doctors capable of handling the communicative flow that is needed to navigate the cumbersome and ever-evolving world of medicine.

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