413:, 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."
278:. 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. The examinees should also list pertinent positive and negative findings to support each potential diagnosis. 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.
325:- includes assessments of both data gathering and data interpretation skills. Scoring for this subcomponent consists of a checklist completed by the standardized patients for the physical examination portion of the encounter, and global ratings provided by trained physician raters. The patient note raters provide ratings on the documented summary of the findings of the patient encounter (history and physical examination), diagnostic impressions, justification of the potential diagnoses, and initial patient diagnostic studies.
319:- includes assessment of clarity of spoken English communication within the context of the doctor-patient encounter (for example, pronunciation, word choice, and minimizing the need to repeat questions or statements). SEP performance is assessed by the standardized patients using a global rating scale, where the rating is based upon the frequency of pronunciation or word choice errors that affect comprehension and the amount of listener effort required to understand the examinee's questions and responses.
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452:'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.
313:- includes assessment of the patient-centered communication skills of fostering the relationship, gathering information, providing information, helping the patient make decisions, and supporting emotions. CIS performance is assessed by the standardized patients, who record these skills using a checklist based on observable behaviors.
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who seek licensure as physicians in the U.S. For US medical students, the exam fee is $ 1,300 (as of 2020). For medical students at non-US medical schools, the tests cost is higher—currently $ 1,535. These fees do not include costs associated with travel and lodging to take the test. Historically, US
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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. A letter to the editor from the leadership of the NBME and
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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
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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
253:
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
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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
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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,
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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.
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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.
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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.
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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."
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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
266:(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
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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
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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.
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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.
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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:
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In May 2016, the
Massachusetts Medical Society and the Michigan State Medical Society have passed resolutions calling for the elimination of Step 2 CS.
401:. 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
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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.
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USMLE Step 2 CS replaced the former ECFMG Clinical Skills
Assessment (CSA) effective June 14, 2004. The last administration of the
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First, Lewis R.; Chaudhry, Humayun J.; Melnick, Donald E. (2013-03-07), "Quality, Cost, and Value of
Clinical Skills Assessment",
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Before its retirement, the exam could be taken in the U.S. at five
Clinical Skills Evaluation Centers (CSEC), located in:
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Lehman, Elmer Philip IV; Guercio, Jason Ross (2013-03-07). "The Step 2 Clinical Skills Exam — A Poor Value
Proposition".
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873:"The Past, Present, and Future of the United States Medical Licensing Examination Step 2 Clinical Skills Examination"
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On May 26, 2020, USMLE has "decided to suspend Step 2 CS test administrations for the next 12-18 months."
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The USMLE Step 2CS exam consists of a series of patient encounters in which the examinee must see
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The USMLE announced on
January 26, 2021, that " have decided to discontinue Step 2 CS."
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Please help update this article to reflect recent events or newly available information.
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was an exam administered to medical students/graduates who wish to become licensed
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Beginning in 2004, the USMLE program undertook a comprehensive review of the
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Step 2. Clinical Skills (CS). Content Description and General Information
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Tsichlis, Jason T.; Re, Andrew M. Del; Carmody, J. Bryan (2021-08-13).
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in the U.S. It is similar to the COMLEX-USA Level 2-PE exam, taken by
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step 2 CS and became inclusive to all medical graduates.
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101:. Unsourced material may be challenged and removed.
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311:Communication and Interpersonal Skills (CIS)
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27:Exam to become a physician in United States
1358:Issues in higher education inside the U.S.
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228:Step 2 Clinical Skills (Step 2 CS) of the
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161:Learn how and when to remove this message
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416:In 2013, an article published in the
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99:adding citations to reliable sources
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931:"Recent Announcements | USMLE"
618:"Recent Announcements | USMLE"
604:"Recent Announcements | USMLE"
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385:Controversy
366:Los Angeles
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290:Grading
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848:"Home"
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486:COMLEX
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128:books
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913:PMID
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636:2013
399:FSMB
397:and
395:NBME
296:edit
114:news
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