Time to Eliminate the Step 2 Clinical Skills Examination for US Medical Graduates

Flier, Lydia; Henderson, Christopher R.; Treasure, Carolyn L.

doi:10.1001/jamainternmed.2016.3753

Cited by 10 publications

(12 citation statements)

References 4 publications

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“…Though licensing authorities and medical educators have generally embraced the examination, many medical students and some faculty continued to express concerns about the value of Step 2 CS [4][5][6][7][8][9][10][11][12][13][14].…”

Section: The Birth Of Step 2 Clinical Skills Examination and Its Oppositionmentioning

confidence: 99%

“…Because the percentage of USMGs who pass the Step 2 CS examination on their first attempt is high (and the vast majority of those who do not initially pass do so on their next attempt without any additional preparation), it has been estimated that it costs over $1.1 million to identify a single U.S. student who fails the examination more than once [ 11 ]. In 2016, a medical student-led petition to “End Step 2 CS” gathered over 16,000 signatures along with support from the Massachusetts Medical Society and the Michigan State Medical Society [ 12 , 45 ]. The AMA also drafted a policy to work with other stakeholders to transition clinical skills assessment to accredited medical schools [ 46 ].…”

Section: Reviewmentioning

confidence: 99%

“…This decision was necessitated by the novel coronavirus pandemic, which made the administration of a national examination involving standardized patients impractical. Although some medical educators expressed concern about the loss of a standardized measure of bedside skills [2,3], the announcement was widely celebrated by many medical students in the United States, who had long regarded the USMLE Step 2 CS examination as expensive, burdensome, and unnecessary [4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination

Tsichlis

Carmody

2021

Cureus

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In January 2021, the United States Medical Licensing Examination (USMLE) announced the permanent suspension of their Step 2 Clinical Skills (CS) examination. Launched in 2004, the Step 2 CS examination was intended to ensure that physicians entering graduate medical education possess the necessary information gathering, clinical reasoning, and communication skills necessary to provide patient care. Although the requirement that doctors pass a clinical skills examination as a condition of licensure likely improved some elements of medical education and physician practice, the Step 2 CS examination was deeply unpopular among many medical students since its inception. The demise of USMLE Step 2 CS provides an opportunity to re-examine the test's value and incorporate improvements in future iterations. However, doing so requires a clear understanding of why the test was so vigorously challenged. Here, we review the history of clinical skills examinations used for medical licensure in the United States and highlight the persistent concerns regarding Step 2 CS's cost, value, validity, and lack of examinee feedback before proposing future improvements to address each concern.

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Section: The Birth Of Step 2 Clinical Skills Examination and Its Oppositionmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination

Tsichlis

Carmody

2021

Cureus

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“…Consider the proposed analogy to the USMLE Step 2 Clinical Skills examination (Horner et al 2020). Critics have pointed out, however, that this examination lacks an evidence-base and is not cost-effective (Flier et al 2016;Lehman and Guercio 2013). Objective Structured Clinical Examinations (OSCE), a method used to evaluate a range of skills, are also not optimal, as the psychometric properties of OSCE rating scales have been found to be of intermediate quality (Comert et al 2016).…”

Section: Examination Formatmentioning

confidence: 99%

The Healthcare Ethics Consultant-Certified Program: Fair, Feasible, and Defensible, But Neither Definitive Nor Finished

Antommaria

Feudtner

Benner

et al. 2020

The American Journal of Bioethics

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In June 2018, the Healthcare Ethics Consultant (HCEC) Certification Commission (the Commission) began accepting applications, and since then three candidate cohorts have received the Healthcare Ethics Consultant-Certified (HEC-C) designation. While these individuals have reported favorable experiences, concerns about the HEC-C program-both the certification process and what the designation represents-exist.As members of the Commission, we welcome dialogue about these concerns and wish to enhance understanding of the Commission's reasoning behind key aspects of the HEC-C program. This program is part of an evolving system of professional structures, for which much work remains. In developing the HEC-C program, we were guided by well-established standards. The HEC-C program is not set in stone, but instead will evolve over time. We hope that transparency will encourage productive dialogue, improving the practice of, and access to, healthcare ethics consultation.

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“…In the US, the National Board of Medical Examiners (NBME), in 2004, introduced the Step 2 Clinical Skills examination into the United States Medical Licensing Examination (USMLE). That examination is controversial, a high-profile paper, supported by a petition with 16,000 signatories, argued for its abolition, for multiple reasons, including excessive cost and the absence of evidence of improvements in patient safety or public trust in physicians [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study

Wakeford

Ludka²,

Woolf

et al. 2018

BMC Med

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BackgroundThe predictive validity of postgraduate examinations, such as MRCGP and MRCP(UK) in the UK, is hard to assess, particularly for clinically relevant outcomes. The sanctions imposed on doctors by the UK’s General Medical Council (GMC), including erasure from the Medical Register, are indicators of serious problems with fitness to practise (FtP) that threaten patient safety or wellbeing. This data linkage study combined data on GMC sanctions with data on postgraduate examination performance.MethodsExamination results were obtained for UK registered doctors taking the MRCGP Applied Knowledge Test (AKT; n = 27,561) or Clinical Skills Assessment (CSA; n = 17,365) at first attempt between 2010 and 2016 or taking MRCP(UK) Part 1 (MCQ; n = 37,358), Part 2 (MCQ; n = 28,285) or Practical Assessment of Clinical Examination Skills (PACES; n = 27,040) at first attempt between 2001 and 2016. Exam data were linked with GMC actions on a doctor’s registration from September 2008 to January 2017, sanctions including Erasure, Suspension, Conditions on Practice, Undertakings or Warnings (ESCUW). Examination results were only considered at first attempts. Multiple logistic regression assessed the odds ratio for ESCUW in relation to examination results. Multiple imputation was used for structurally missing values.ResultsDoctors sanctioned by the GMC performed substantially less well on MRCGP and MRCP(UK), with a mean Cohen’s d across the five exams of − 0.68. Doctors on the 2.5th percentile of exam performance were about 12 times more likely to have FtP problems than those on the 97.5th percentile. Knowledge assessments and clinical assessments were independent predictors of future sanctions, with clinical assessments predicting ESCUW significantly better. The log odds of an FtP sanction were linearly related to examination marks over the entire range of performance, additional performance increments lowering the risk of FtP sanctions at all performance levels.ConclusionsMRCGP and MRCP(UK) performance are valid predictors of professionally important outcomes that transcend simple knowledge or skills and the GMC puts under the headings of conduct and trust. Postgraduate examinations may predict FtP sanctions because the psychological processes involved in successfully studying, understanding and practising medicine at a high level share similar mechanisms to those underlying conduct and trust.

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Time to Eliminate the Step 2 Clinical Skills Examination for US Medical Graduates

Cited by 10 publications

References 4 publications

The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination

The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination

The Healthcare Ethics Consultant-Certified Program: Fair, Feasible, and Defensible, But Neither Definitive Nor Finished

Fitness to practise sanctions in UK doctors are predicted by poor performance at MRCGP and MRCP(UK) assessments: data linkage study

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