Next Steps...

Over the past few months, we have been hard at work behind the scenes gathering additional signatures on our petition as well as gathering data from MedEd leaders about their views on Step 2 CS.  They all have unequivocally shared serious concerns about Step 2 CS.  Earlier today, we sent the letter below to the NBME in an effort to move our project ahead.  

Regardless of their reply, we need your help. We need you to share your thoughts and concerns about Step 2 CS with your state’s legislators and state medical board.  We need you to reach out to members of the FSMB or NBME, especially if they are connected to your medical school or hospital.  Share widely with your friends and colleagues! The more pressure we are able to build at the local, state, and national level, the more likely we are to succeed. From our end, we will not stop our work until we put an end to Step 2 CS!

Percent of Medical School Deans Concerned about Step 2 CS

Source: Unpublished data from a survey of 269 medical school deans representing 125 different medical schools.

Dear members of the NBME and FSMB,

As you know, last year we began collecting signatures on our petition to end the USMLE Step 2 Clinical Skills examination.  Since that time, over 17,500 students and physicians have signed.  Through our ongoing efforts, we have been fortunate to interact with students, physicians, and medical school deans and faculty regarding their views on Step 2 CS and, more generally, how to effectively teach and test clinical skills in the medical school curriculum.  

In our ongoing discussions, we have heard concerns about the cost, inconvenience, redundancy, and lack of feedback available to those who take Step 2 CS.  Our survey of over 250 medical school deans from 125 medical schools supported these concerns.  Of those surveyed who did not have an NBME affiliation, 88% were concerned about the cost of the exam, 83% were concerned about the inconvenience of the exam, and 68% were concerned about the lack of feedback provided to test takers.    

Our survey data also supported the notion that those faculty affiliated with the NBME have a far more positive view of the examination.  We understand and deeply respect the tireless efforts members of the NBME and FSMB have dedicated over the past several decades to improving the quality of medical evaluation and working to incorporate clinical skills as part of that evaluation.  

However, our survey and petition support the notion that Step 2 CS is not the best way to accomplish this goal.  We concur that clinical skills must be effectively taught and tested during medical training.  However, we do not think that the current examination format of Step 2 CS can accurately assess the skills of students taking the exam.  While a multiple choice exam has clear right and wrong answers that can be tallied to a final score, this subjective examination does not.

To be clear, the consequences of even small amounts of subjectivity are grave.  Failing any USMLE exam, including Step 2 CS, can derail a medical student's career plans even if that student has succeeded on every prior examination and has performed well on the wards.  In fact, the vast majority of students who fail Step 2 CS pass on their second attempt without any additional preparation.  

Our goal is to continue to engage with all of the stakeholders involved in order to discuss how to end step 2 CS while working to develop more effective clinical skills education and evaluation at individual medical schools.  We have and will continue working with state legislators, state medical board members, national organizations, medical school administrators, and students.  We welcome any ongoing discussions and would again appreciate the opportunity to express the views of over 17,500 students and physicians who agree with our proposal to eliminate Step 2 CS.

The End Step 2 CS Committee