USMLE Step 2 Clinical Skills

Last updated

Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) was an exam administered to medical students/graduates who wish to become licensed physicians in the U.S. [1] It is similar to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates who seek licensure as physicians in the U.S. [2] For US medical students, the exam fee is $1,300 (as of 2020). [3] For medical students at non-US medical schools, the tests cost is higher—currently $1,535. [4] These fees do not include costs associated with travel and lodging to take the test. Historically, US students have taken Step 2 CS late in their senior year, prior to graduation. However, now that more residency programs require students to record a passing score, many US medical schools recommend students take Step 2 CS in the fall of their senior year.

Contents

On May 26, 2020, in response to the COVID-19 pandemic, the USMLE "suspended Step 2 CS test administrations for the next 12-18 months." [5]

On January 26, 2021, the USMLE announced that the work to relaunch a modified form USMLE Step 2 CS had been discontinued citing rapidly evolving medical education and changes in other standardized exams, like computer-based simulations in Step 3, that would supplement medical students' education in place of Step 2 CS. [6]

Structure

The USMLE Step 2CS exam consists of a series of patient encounters in which the examinee must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. Examinees are expected to investigate the simulated patient's chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.

Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. The patient note is slightly different from a standard SOAP note. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The examinees will then state up to 3 differential diagnoses relating to the simulated patient's symptoms, and tests or procedures to investigate the simulated patient's complaints. [7] The examinees should also list pertinent positive and negative findings to support each potential diagnosis. [7] The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters. Examinees are required to type patient notes on a computer. [8]

USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16, 2004. When the CSA first started it was strictly for Foreign Medical Graduates while US graduates were not required to do it. That was considered a double standard in the US medical licensing process. Later the CSA was replaced with the USMLE step 2 CS and became inclusive to all medical graduates.

Grading [9]

The test was graded on a pass/fail basis, without any numerical score associated with it (as opposed to the other parts of the USMLE series). Examinees were scored on three separate subcomponents: Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE). Each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS.

Exam centers

Before its retirement, the exam could be taken in the U.S. at five Clinical Skills Evaluation Centers (CSEC), located in:

Controversy

The Step 2 CS exam was added to the USMLE series in 2004 by the NBME and FSMB. However, the test garnered criticism for its high exam fee and need to travel to one of five testing sites. Even before the exam was rolled out, the American Medical Association raised serious concerns with the exam, both because it failed to provide students feedback and room for remediation and because there was no proof the exam actually accomplished its mission of protecting the public. [10]

Beginning in 2004, the USMLE program undertook a comprehensive review of the USMLE, referred to as the Comprehensive Review of USMLE (CRU). The review was overseen by the committee to Evaluate the USMLE Program (CEUP), which was composed of students, residents, clinicians, and members of the licensing, graduate, and undergraduate education communities. The goal of the committee was to determine if the mission and purpose of USMLE were effectively and efficiently supported by the current design, structure, and format of the USMLE. This process was to be guided, in part, by an analysis of information gathered from stakeholders, and was to result in recommendations to USMLE governance. The CEUP worked from 2006 to early 2008. The CEUP's final report states that "none of the feedback (received from other stakeholders) seemed to indicate that USMLE is broken, but there was considerable interest in enhancing and improving the program." Additionally, the report states that "there appeared to be very strong reactions to Step 2 CS, and CEUP felt that survey and stakeholder meeting data on this component needed to be interpreted in a special way by attempting to separate (but still be attentive to) issues related to the mechanics and costs of Step 2 CS versus the value of what the exam is intended to measure. On the issue of mechanics and costs, CEUP recognized that USMLE must be very attentive to the burden put on examinees by this testing format and that the impact on examinees must be considered when proposing future directions. Concerning the skills measured by Step 2 CS, there seemed to be legitimate concerns about content. Many people wanted to see the exam begin to assess whether the examinee can detect and interpret abnormal findings and handle challenging communication issues. There was a frequently expressed sentiment that this exam was ripe for enhancement and that many of the more advanced communication skills and other competencies could be assessed through this vehicle." In response to the feedback gathered, the CEUP recommended that "the assessment of clinical skills remain a component of USMLE, but that USMLE consider ways to further enhance the testing methods currently used, in order to address additional skills im-portant to medical practice. It is also recommended that the administrative challenges and costs to examinees associated with related testing formats be given substantial weight in the consideration of future changes." [11]

In 2013, an article published in the New England Journal of Medicine raised concerns about the value of the exam. The authors calculated that the test fee alone cost students $36 million annually, and that the cost of detecting a single student who failed the exam on back-to-back attempts was $1.1 million. [12] A letter to the editor from the leadership of the NBME and the FSMB in response to the article highlighted the need to view the value of the Step 2 CS in terms other than just cost; specifically, they state that:

Although (the authors') interest in cost is consistent with the current climate in health care, the 'value' referenced in their title is a function of quality as well as cost. They fail to fully consider the long-term effect of this assessment program on patient safety and satisfaction, societal expectations, and effective medical education.

They also note that inclusion of Step 2 CS in the USMLE "brought the USMLE closer to meeting the expectations of the public that physicians exhibit competence in communicating with and examining patients." [12] [13]

In February 2016, a group of students at Harvard Medical School launched a national petition calling for an end to Step 2 CS. Since the petition opened, it has collected over 20,000 signatures from medical students and physicians from all over the country. [14]

In May 2016, the Massachusetts Medical Society and the Michigan State Medical Society have passed resolutions calling for the elimination of Step 2 CS.

In June 2016, the Arizona Medical Association and the AMA - Medical Student Section passed resolutions also calling for the elimination of Step 2 CS. All four resolutions were introduced to the American Medical Association's 2016 Annual House of Delegates meeting, and were combined and adopted as a substitute, single resolution by a unanimous voice vote on 6/15/2016. The adopted language calls for the AMA to work with the FSMB, NBME, state medical societies, and state medical boards to pursue the transition from the Step 2 CS exam to a school-administered clinical skills exam as a licensure requirement. [15]

March 16, 2020, USMLE cancelled all appointments for the USMLE STEP 2 CS exam due to the COVID-19 pandemic. Scheduling functionality for the exam was also cancelled.

On May 26, 2020, USMLE has "decided to suspend Step 2 CS test administrations for the next 12-18 months." [16]

The USMLE announced on January 26, 2021, that "[they] have decided to discontinue Step 2 CS." [17]

See also

Related Research Articles

The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Physicians with a Doctor of Medicine (MD) degree are required to pass the USMLE for medical licensure. However, those with a Doctor of Osteopathic Medicine degree (DO) are required to take the COMLEX-USA (COMLEX) exams but may also sit for the USMLE as well.

According to the US Department of Education, the Educational Commission for Foreign Medical Graduates (ECFMG) is "the authorized credential evaluation and guidance agency for non-U.S. physicians and graduates of non-U.S. medical schools who seek to practice in the United States or apply for a U.S. medical residency program. It provides comprehensive information and resources on licensure, the U.S. Medical Licensure Examination (USMLE), residencies, and recognition."

The United States Medical Licensing Examination (USMLE) Step 1 is a standardized test that assesses a medical student's knowledge of basic science concepts and their application to clinical medicine. The exam is one of three components required for medical licensure in the United States and is typically taken by students after their second year of medical school.

USMLE Step 2 CK is a nine-hour-long exam that represents the second part of the United States Medical Licensure Examination. It assesses clinical knowledge through a traditional, multiple-choice examination divided into eight 60-minute blocks, each containing up to 40 questions, as well as an hour of break time. In contrast to USMLE Step 1, which prioritizes knowledge of basic sciences, the focus of Step 2 is on clinical application of medical knowledge, and requires the examinee to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. The USMLE Step 2 is generally taken during the third or fourth year of medical school by U.S. medical students. Step 2 results are reported numerically on a scale between 1 and 300; this is in contrast to Step 1, which is pass/fail only.

An objective structured clinical examination(OSCE) is an approach to the assessment of clinical competence in which the components are assessed in a planned or structured way with attention being paid to the objectivity of the examination which is basically an organization framework consisting of multiple stations around which students rotate and at which students perform and are assessed on specific tasks. OSCE is a modern type of examination often used for assessment in health care disciplines.

The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a series of three osteopathic medical licensing examinations administered by the National Board of Osteopathic Medical Examiners (NBOME) similar to the United States Medical Licensing Examination (USMLE). COMLEX-USA is the most common pathway by which osteopathic physicians (D.Os) apply for medical licensure, and is accepted in all 50 states. The 3-digit standard scores of COMLEX-USA Level 1, Level 2- Cognitive Evaluation (CE), and Level 3 have a range of 9-999 and a mean of 500. Most candidates score between 250 and 800. 400 is the minimum passing score for COMLEX-USA Levels 1 and 2; 350 for COMLEX-USA Level 3. It was announced on January 24, 2022, that the COMLEX-USA Level 1 examination will be moving from a 3-digit numeric score to solely pass/fail beginning on May 10, 2022.

In health care, a simulated patient (SP), also known as a standardized patient, sample patient, or patient instructor, is an individual trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated patients have been successfully utilized for education, evaluation of health care professionals, as well as basic, applied, and translational medical research.

An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. The term non-local medical graduate may be similarly used in countries with distinct licensing regions within them. Generally, the medical school of graduation is one listed in the World Directory of Medical Schools (WDOM) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.

<span class="mw-page-title-main">Naturopathic Physicians Licensing Examinations</span>

The Naturopathic Physicians Licensing Examinations (NPLEX) are professional licensing exams administered by the North American Board of Naturopathic Examiners (NABNE). Graduates of naturopathic programs accredited by the Council on Naturopathic Medical Education (CNME) are required to pass the exams before being permitted to practice naturopathic medicine in a U.S. state or Canadian province that licenses naturopaths.

The American University of Integrative Sciences (AUIS), is a private for-profit offshore medical school with a single campus located in Barbados. Founded in 1999, it was formerly known as the University of Sint Eustatius School of Medicine (USESOM). For a period, the school was based in Sint Maarten, where it was taken over by IEMR LLC, a US-based company. Since October 2017, AUIS has operated in Barbados, and it is currently a candidate for accreditation by the Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP).

Step 3 is the final exam in the USMLE series of examinations. It is part of the licensing requirements for Doctors of Medicine (M.D.), including international medical graduates aiming to practice medicine in the United States. Generally, it is a pre-requisite of the majority of the state licensing boards.

The Federation of State Medical Boards (FSMB) of the United States is a national non-profit organization that represents the 71 state medical and osteopathic boards of the United States and its territories and co-sponsors the United States Medical Licensing Examination. Medical boards license physicians, investigate complaints, discipline those who violate the law, conduct physician evaluations, and facilitate the rehabilitation of physicians where appropriate. The FSMB's mission calls for "continual improvement in the quality, safety and integrity of health care through the development and promotion of high standards for physician licensure and practice."

<span class="mw-page-title-main">Aureus University School of Medicine</span> Medical school in Aruba

Aureus University School of Medicine is a private university located in Oranjestad, Aruba. Aureus confers upon its graduates the Doctor of Medicine (MD) degree.

The United States Medical Licensing Examination score (USMLE score) is given to test takers as a 3-digit score. This score is commonly used by hospitals to determine eligibility for residency and fellowship. The three-digit score is based on a theoretical maximum of 300, but this has not been documented by the NBME / FSMB. Previously, a 2 digit score was also provided, but has since been eliminated. The two-digit score was normalized to the three-digit score such that a 75 was equal to the minimum passing score (currently 194) for the USMLE Step 1. Contrary to popular opinion, the two-digit score does not represent a percentile.

<span class="mw-page-title-main">Humayun Chaudhry</span> American physician and medical educator

Humayun Javaid Chaudhry, D.O., DSc (Hon.), MACP, FRCP (Lon.), FRCP (Edin.) is an American physician and medical educator who is president and chief executive officer of the Federation of State Medical Boards (FSMB) of the United States, a national non-profit organization founded in 1912 that represents the 70 state medical boards of the United States and its territories and which co-sponsors the United States Medical Licensing Examination (USMLE). From 2007 to 2009, he served as Commissioner of Health Services for Suffolk County, New York, the state's most populous county outside New York City. In 2016, he was listed by Modern Healthcare magazine as one of the 50 Most Influential Physician Executives and Leaders.

<span class="mw-page-title-main">National Board of Medical Examiners</span> Medical accreditation board

The National Board of Medical Examiners (NBME), founded in 1915, is a United States non-profit which develops and manages assessments student physicians. Known for its role in developing the United States Medical Licensing Examination (USMLE) in partnership with the Federation of State Medical Boards (FSMB), USMLE examinations for medical students and residents are used by medical licensing authorities in the U.S. to help determine qualifications to grant and recognize medical licenses. NBME also creates assessments and materials that are used by medical students, medical educators, practicing physicians, and for state testing of physicians already holding licenses.

<span class="mw-page-title-main">Howard Barrows</span> American physician and medical educator

Howard S. Barrows was an American physician and medical educator who was Professor Emeritus at the Southern Illinois University School of Medicine where he had previously served as Associate Dean for Educational Affairs and Chair of Medical Education. Trained as a neurologist, Barrows is best known today for his many innovations in medical education, particularly teaching using Problem-Based Learning (PBL), developed while he was a professor at McMaster University Medical School, assessing clinical skills using simulated patients, and studying clinical reasoning using stimulated recall techniques.

<span class="mw-page-title-main">Medical College Admission Test</span> Standardized examination for prospective medical students in the United States and Canada

The Medical College Admission Test is a computer-based standardized examination for prospective medical students in the United States, Australia, Canada, and the Caribbean Islands. It is designed to assess problem solving, critical thinking, written analysis and knowledge of scientific concepts and principles. Before 2007, the exam was a paper-and-pencil test; since 2007, all administrations of the exam have been computer-based.

St. George's University School of Medicine is the medical school of St. George's University located in St. George's, Grenada. The school was founded by Charles R. Modica on July 23, 1976. Because of its size, the school placed more doctors into first-year US residency positions than any other medical school in the world between 2011 and 2012. It was rated by The Princeton Review as one of the "Best 168 Medical Schools" in 2012. There are 158 accredited MD-granting institutions in the United States.

Edithe J. Levit was an American medical educator who served as president of the National Board of Medical Examiners from 1977 to 1986. She reformed the process of assessing doctors' clinical competence using standardized tests rather than subjective bedside observation.

References

  1. ↑ "United States Medical Licensing Examination ®". www.usmle.org. Retrieved 2018-06-22.
  2. ↑ "NBOME". www.nbome.org. Retrieved 2018-06-22.
  3. ↑ NBME. "USMLE Exam Fees | NBME". www.nbme.org. Retrieved 2018-06-22.
  4. ↑ "ECFMG | Fees Overview". ECFMG. Retrieved 2018-06-22.
  5. ↑ "Recent Announcements | USMLE".
  6. ↑ "Recent Announcements | USMLE".
  7. 1 2 Step 2. Clinical Skills (CS). Content Description and General Information 2013
  8. ↑ "United States Medical Licensing Examination | Announcements". www.usmle.org. Retrieved 2018-06-22.
  9. ↑ "United States Medical Licensing Examination | Step 2 CS (Clinical Skills)". www.usmle.org. Retrieved 2016-08-18.
  10. ↑ Johnson, H. (2003-12-01). "A Critical Review of Standardized Patient Examinations as Part of the USMLE". Virtual Mentor. 5 (12). Johnson, Hillary. doi:10.1001/virtualmentor.2003.5.12.pfor1-0312. ISSN   1937-7010. PMID   23267573.
  11. ↑ "United States Medical Licensing Examination | CRU (Comprehensive Review)". www.usmle.org. Retrieved 2016-08-18.
  12. 1 2 Lehman, Elmer Philip IV; Guercio, Jason Ross (2013-03-07). "The Step 2 Clinical Skills Exam — A Poor Value Proposition". New England Journal of Medicine. 368 (10): 889–891. doi:10.1056/NEJMp1213760. ISSN   0028-4793. PMID   23465102.
  13. ↑ First, Lewis R.; Chaudhry, Humayun J.; Melnick, Donald E. (2013-03-07), "Quality, Cost, and Value of Clinical Skills Assessment", New England Journal of Medicine (letter), 963 (10): 963–964, doi: 10.1056/nejmc1301008 , PMID   23465108
  14. ↑ "Home". End Step 2 CS. Retrieved 2016-03-13.
  15. ↑ Tsichlis, Jason T.; Re, Andrew M. Del; Carmody, J. Bryan (2021-08-13). "The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination". Cureus. 13 (8): e17157. doi: 10.7759/cureus.17157 . ISSN   2168-8184. PMC   8437080 . PMID   34548971.
  16. ↑ "Recent Announcements | USMLE".
  17. ↑ "United States Medical Licensing Examination | Announcements". www.usmle.org. Retrieved 2021-01-26.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.