108 PREPARATION OF SCHOOL LEADERS
selected for the project because it is an assessment process whose sole focus is development
and because the skills assessed relate well to the skills needed to accomplish the performances
in the ISLLC Standards successfully.
Following several years of successful implementation and adaptation, faculty decided to
completely revise the process and design new assessment activities that mirrored the
situations and events candidates would experience as building-level principals in the ECU
service area. That effort was successful and has been implemented for all principal
preparation candidates for the past three years. The new activities included a leaderless
group, an in-basket, and a communication situation that were unique to eastern North
Carolina.
Once the new procedure was established, candidates had opportunities to demonstrate
their skill in a small-group setting and in responding to written documents. However, no
opportunities existed to demonstrate their skill in a one-on-one setting. This void was a
concern for program faculty members because principals often engage in one-on-one
meetings during a typical work day. Adding a role player simulation to the assessment center
process was an option, but would require development of an activity, role player training, and
additional resources. At this point faculty became aware of the clinical practice examanation
procedure through the dissertation of a doctoral student and discussions began with the
clinical practice faculty regarding a possible partnership.
CLINICAL PRACTICE EXAMINATION
Standardized patients used in medical education, evaluation, and research were first
introduced as a methodology by Howard Barrows (Barrows & Abrahamson, 1964; Stillman,
Sabars, & Redford, 1976). Standardized patients portray patients reflecting actual patient
encounters in scenarios developed to provide consistent and realistic simulations of specific
medical problems and communication challenges to meet specific goals and objectives
(Barrows, 1987). Standardized patients provide opportunities for learners to practice their
communication and physical examination skills in a safe and controlled environment without
possibility of harm to patients or threat to medical students. This method is reliable and valid
as a method for evaluation (Fraser, McKinley, & Mulholland, 1994; Sharp, Pearce, Konen, &
Knudson, 1996).
Standardized patients are used to assess medical students and other health professionals in
several formats. The Objective Structured Clinical Examination (OSCE) is generally an
assessment of techniques of a specific physical examination such as fundoscopic or
neurological, for example. The term is sometimes used interchangeably with a Clinical
Practice Examination (CPX) although the CPX is a set of patient encounters used to assess in
a structured and standardized setting clinical skills such as history taking, physical exam, and
communication skills. The use of a structured, summative assessment of clinical skills is used
extensively and increasingly since the late 1970s (Harden & Gleeson, 1979; Klass, 1994;
Langsley, 1991; Stillman & Swanson, 1987; Vu & Barrows, 1994). Since 2004, the United
States Medical Licensure Examination has added a Clinical Performance Examination
component (Step 2 CS) to the licensure examination for medical students. Thus, all physicians
in the United States, both US-trained and foreign medical graduates, must pass a clinical skills
examination to be licensed to practice medicine.
The CPX encounter is based on authenticity. Communication skills are learned in the
context of face-to-face patient interactions. CPX participants experience evaluation through
direct observation as all CPX encounters are videotaped and through feedback that is