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Background: High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods: Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Results: Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Discussion: Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later. Conclusions: Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations. Keywords: high stakes assessment; licensing examination; procedures; communication and interpersonal skills; residency program directors To access the supplementary material to this article: ' Supplemental Content ', please see Supplementary Files under Article Tools online. (Published: 23 July 2012) Citation: Med Educ Online 2012, 17 : 18812 - http://dx.doi.org/10.3402/meo.v17i0.18812

BACKGROUND The ability to communicate effectively with patients is an essential element of a physician's clinical expertise. METHOD As part of the USMLE Step 2 Clinical Skills exam, standardized patients (SPs) provided ratings of communication and interpersonal skills (CIS) along three dimensions. Assessment data from a one-year (2006) cohort of graduates of international medical schools (IMGs) were analyzed and psychometric characteristics of the CIS measures are described. RESULTS Female and native English-speaking physicians received slightly higher CIS ratings than did males and examinees of other language backgrounds across all dimensions. However, no significant examinee by SP gender interaction effect was detected. Correlations with other measures support the construct validity of the CIS scale. CONCLUSIONS Results of this preliminary study indicate that properly trained SPs can provide accurate and defensible ratings of IMGs' communication and interpersonal skills.