The Step 2 Clinical Skills (CS) test of the United States Medical Licensing Examination (USMLE) has been discontinued, the two organizations that sponsor the exam .
Following the postponement of Step 2 CS last May due to the COVID-19 pandemic, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) stated that part of the test will now be discontinued permanently.
Initially, the organizations planned to suspend Step 2 CS for 12 to 18 months, with the intent of bringing back a modified and improved version. But "after reviewing current and anticipated progress with the exam and in consideration of the rapidly evolving medical education, practice and technology landscapes," the organizations said that the exam step will be terminated.
"We have no plans to bring back Step 2 CS, but we intend to take this opportunity to focus on working with our colleagues in medical education and at the state medical boards to determine innovative ways to assess clinical skills," the USMLE statement said.
"I did not see this coming at all," said Bryan Carmody, MD, of Eastern Virginia Medical School, who advocates for improvements in medical licensing evaluation. Carmody told 鶹ý that while Step 2 CS has faced justified criticism of its ability to effectively evaluate clinical skills, he did not expect the NBME to retreat from it entirely.
In absence of Step 2 CS, he said, the responsibility to evaluate clinical skills should fall on medical schools. "Schools, I think, should seize the opportunity to rigorously evaluate their students' competency in a formative way, rather than a single, one-day, high-stakes way, and verify those competencies to their residency programs and the public," Carmody said.
The decision to cancel Step 2 CS follows a significant change to Step 1 scoring last year, which shifted reporting of scores from numeric to pass/fail. This change aimed to halt overemphasis on Step 1, while still allowing those who oversee medical licensing to continue to use the test to determine eligibility.
The USMLE consists of three "steps" that all medical students must pass to apply for a U.S. license. The first exam, or "Step 1," is usually taken midway through medical school. Step 2, a two-part test consisting of clinical knowledge and clinical skills, is administered prior to residency match. Step 3 is taken during residency.
Step 2 CS has been an all-day exam, and typically requires test-takers to gather clinical information, perform physical exams, and communicate with colleagues about a set of standardized patients. The test aims to evaluate interpersonal and communication skills in a clinical setting, as opposed to a multiple-choice exam. But critics of Step 2 CS say it's too expensive and time-consuming, often posing unnecessary barriers for medical students.
Some thought that Step 2 CS might return in a virtual format, after Chris Feddock, MD, of the NBME, that it could be the case. However, that apparently won't happen.
Despite the cancellation of Step 2 CS, clinical reasoning and communication will continue to be assessed in other steps, including computer simulations in Step 3 and bolstered content in Step 1, the organizations said.