The Step 2 Clinical Skills (CS) test for medical school students and graduates has been permanently canceled, cosponsors of the US Medical Licensing Examination (USMLE) announced in a press release this afternoon.
As Medscape Medical News previously reported, the USMLE cosponsors, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), had announced in May that they would take the following 12-18 months to revamp the required test.
COVID-19 had forced a suspension of the all-day test, which requires test takers to have physical contact with standardized patients. It’s designed to gauge how soon-to-be doctors gather information from patients, perform physical exams, and communicate their findings to patients and colleagues.
However, the cosponsors said today, “[W]e 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.”
David Johnson, FSMB’s chief assessment officer, told Medscape Medical News that after months of study, “It became clear that the relaunch of a modified Step 2 CS exam would not meet our expectations to be appreciably better than the prior exam.”
Only Weeks Ago, NBME Was Hiring for the Revamp
The news came as a huge surprise. Just weeks earlier, NBME was advertising for a position key to modifying the exam. The description for the position read: “This role will focus on operational planning and coordination both within the NBME and with ECFMG [Educational Commission for Foreign Medical Graduates] to effectively deliver a modified Step 2 Clinical Skills exam.”
Bryan Carmody, MD, MPH, an assistant professor at Eastern Virginia Medical School in Norfolk, Virginia, noted in a January 15 tweet that the position requires extensive information technology experience, “suggesting plans for a virtual test remain intact.”
Plans for the ‘revitalized’ USMLE Step 2 CS continue to move forward:
The NBME is now hiring a program director to ‘deliver a modified Step 2 CS exam.’
The position requires extensive IT experience… suggesting plans for a virtual test remain intact.https://t.co/sa3BCCfag2
— Bryan Carmody (@jbcarmody) January 15, 2021
Johnson said that although the opportunities for helping lead the revamp of the test were posted until the announcement, no one had been hired for the position.
Today’s announcement stated that the USMLE still believes independent standardized tests for medical knowledge and clinical skills are important; however, it now feels clinical reasoning and communication skills will be able to be assessed in other steps.
“Computer-based case simulations in Step 3 and communication content recently bolstered in Step 1 are examples of these efforts that will continue,” the press release stated. “While not a replacement for Step 2 CS, these formats continue to contribute positively, e.g., measuring critical knowledge of medical communication.”
Critics “Thrilled” by Test Termination
Lydia Flier, MD, from the department of internal medicine at Harvard Medical School, in Boston, Massachusetts — who wrote an editorial for Medscape in august advocating that Step 2 CS be changed completely or ended entirely — told Medscape Medical News today that she was “surprised and thrilled” by the announcement.
She said the cosponsors hadn’t initially appeared to agree with the growing sentiment that disruption from the pandemic had “proven the test was unnecessary and it looked like they really were going to try and keep it.”
“I’m thrilled for future generations,” she said today. “It is proof of what many people have known all along, which is that the test is a no-value-add proposition that did not actually help determine people’s clinical skills.”
The test “met a breaking point” during the pandemic, she said, “from which CS could not recover.”
She noted in her editorial that the test costs $1300 plus travel fees, as the test had been offered at only five sites. She agrees that the skills assessed by the Step 2 CS are already covered in medical school and through other Steps.
“It seems as though they could not justify it anymore. It’s the obvious right answer,” said Flier, who in 2016 cofounded #EndStep2CS, a nationwide movement demanding an end to the exam.
Another cofounder in that movement, Christopher Henderson, MD, a staff physician with Kaiser Permanente in Seattle, Washington, told Medscape Medical News, “This decision represents tremendous progress in the fight to reduce unnecessary costs in medical education, and is a win for future students. Credit goes to the many women and men who organized and voiced their desire for change.” He added that his views are his own and “do not reflect or imply the views of my organization.”
For the FSMB’s part, Johnson acknowledged that “the consideration of cost and value were two of many important factors for the Step 2 CS revitalization work.”
Johnson, Flier, and Henderson have declared no relevant financial relationships.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.