USMLE Step 2 Clinical Skills

Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) is an exam that is currently administered to medical students/graduates who wish to become licensed physicians in the U.S.. It is comparable to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates who seek licensure as physicians in the U.S.[1] For US medical students, the exam fee is $1,275 (as of January 2016).[2] For medical students at foreign medical schools, the tests cost is higher—currently $1,535.[3] These fees do not include costs associated with travel and lodging to take the test of one of only five centers. 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.

Structure

The USMLE Step 2CS exam consists of a series of patient encounters in which the examinees 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.[4] The examinees should also list pertinent positive and negative findings to support each potential diagnosis.[4] 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. Step 2 CS examinees will be required to type patient notes on a computer beginning July 17, 2011.[5]

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 double standards 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

The test is graded on a pass/fail basis, without any numerical score associated with it (as opposed to the other parts of the USMLE series). In order to pass, one must achieve a grade of "pass" in each of the three sub-components of the exam.[6] A score report is provided in the event of failure.

Exam centers

This exam can be taken only 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.[7] In a comprehensive review of the USMLE series that began in 2004, many stakeholders had "strong reactions" to Step 2 CS, questioning the "value added by its inclusion in the USMLE sequence, and noting the redundancy with what some US schools are already measuring, as well as the difficult burden it places on students."[8]

In 2013, an article published in the New England Journal of Medicine raised additional 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.[9]

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 14,300 signatures from medical students and physicians from all over the country.[10]

See also

References

  1. ↑
  2. ↑ http://www.nbme.org/students/examfees.html
  3. ↑ http://www.ecfmg.org/fees/index.html
  4. 1 2 Step 2. Clinical Skills (CS). Content Description and General Information 2013
  5. ↑ http://www.usmle.org/General_Information/announcements.aspx
  6. ↑ USMLE: Test Content & Practice Materials
  7. ↑ "A Critical Review of Standardized Patient Examinations as Part of the USMLE". Virtual Mentor 5 (12). 2003-12-01. doi:10.1001/virtualmentor.2003.5.12.pfor1-0312.
  8. ↑ "United States Medical Licensing Examination | CRU (Comprehensive Review)". www.usmle.org. Retrieved 2016-03-18.
  9. ↑ 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.
  10. ↑ "Home". End Step 2 CS. Retrieved 2016-03-13.

External links

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