January 29, 2021, 2:43 pm David Mitchell — U.S. allopathic medical students will no longer have to incur the cost or travel expenses associated with the United States Medical Licensing Examination Step 2 Clinical Skills exam.
“I’m thrilled to hear this news,” said Cynthia Ciccotelli, a fourth-year medical student at Geisinger Commonwealth School of Medicine in Scranton, Penn., and the student member of the AAFP Board of Directors. “Medical students feel like we’re already adequately tested in our own medical school curriculum.”
The Federation of State Medical Boards and the National Board of Medical Examiners — co-sponsors of the USMLE — suspended Step 2 CS examinations last May due to the COVID-19 pandemic. At the time, the organizations said they planned to take up to 18 months before launching a modified version of the exam. However, on Jan. 26 they instead announced plans to discontinue it.
The AAFP updated its policy regarding Clinical Skills Assessment Exam for Medical Students last year, encouraging individual medical schools to evaluate their “students’ clinical skills on a consistent basis to ensure competency.” The updated policy also said that if medical schools can’t consistently provide objective assessments of students, the sponsoring organizations should make the USMLE and the Comprehensive Osteopathic Medical Licensing Examination affordable and accessible for all students.
Ciccotelli noted that the USMLE Step 2 CS exam had cost more than $1,000 and was offered in a limited number of locations.
“The inconvenience of travel takes time away from clinical rotations,” she said. “In addition, most medical students take student loans to pursue their education, and that extra $1,000 makes an impact, especially for something that might not be necessary because schools are already administering a similar test.”
Ciccotelli said the Objective Structured Clinical Examinations that medical schools administer near the end of clinical rotations test students’ ability to interview patients, perform physical exams, consider differential diagnoses, explain potential tests and treatment plans to patients, and correctly document the encounter.
“These are all things that the USMLE Step 2 CS also aims to test,” she said, “which means it should not be necessary for U.S. medical students to take both.”
Karen Mitchell, M.D., the director of the AAFP’s Division of Medical Education, said discontinuing the USMLE Step 2 CS exam will eliminate redundancy with OSCEs. However, she said the quality of OSCEs were variable across medical schools, and the FSMB and the NBME likely will work with schools and other stakeholders to make OSCE-type exams more standardized.
Although the FSMB and the NBME have no plans to bring back the Step 2 CS exam, the organizations said they will “focus on working with our colleagues in medical education and at the state medical boards to determine innovative ways to assess clinical skills.” In the absence of the Step 2 clinical skills exam, they said, elements of clinical reasoning and communication will continue to be assessed in other exams, including simulations in Step 3 and content recently added to Step 1.
There is recent precedent for National Board of Osteopathic Medical Examiners to follow the USMLE’s lead. In December, the NBOME announced it would change score reporting for the COMLEX-USA Level 1 from a three-digit numeric score to a pass-fail format beginning in 2022. The USMLE had made a similar announcement 10 months earlier.
However, in an Jan. 26 email to osteopathic medical schools, President and CEO John Gimpel, D.O., M.Ed., said the NBOME was “committed to its mission of protecting the public via assessment,” including its Level 2-Performance Evaluation, which includes osteopathic manipulation medicine.
The elimination of the USMLE Step 2 CS exam affected the Educational Commission for Foreign Medical Graduates, which until last year had required the exam as part of its assessment of the readiness of international medical graduates seeking to enter residency or fellowship programs in the United States.
After the Step 2 CS exam was suspended due the pandemic last spring, the ECFMG established five pathways to allow IMGs who had not yet passed the Step 2 CS to meet its clinical and communication requirements and participate in the 2021 Match. In light of the USMLE announcement, the ECFMG has expanded those pathways for IMGs who plan to participate in the 2022 Match.