Is it Time to Let USMLE Step 2 CS Go?

  • /Reviewed by: Amy Rontal, MD
  • Is it time to end Step 2 CS? According to a group of students at Harvard medical school, whose petition to dissolve the exam has amassed almost 14,500 signatures in just 3 weeks, the answer is a resounding “yes.”They argue that Step 2 CS, meant to assess bedside manner and patient care skills, is far too expensive and inconclusive to justify itself.

    The price tag certainly is hefty: as of January 2016, the cost to take Step 2 CS is $1,275 for US medical students and $1,535 for international students. The exam is administered at only 5 test centers throughout the country, meaning many students are forced to accrue additional expenses from transportation and lodging.

    Its detractors also contend that as a pass/fail exam (96% of the 20,252 US and Canadian students who took it in 2015 passed), students themselves learn little from the experience, as well as that the staged patient interactions simply don’t reflect the reality of being in a hospital or clinic.

    Most crucially of all, the petition—which you can read herepoints out the lack of empirical evidence to suggest the exam’s usefulness in its past 12 years of existence. It reiterates in bold that “There are no data to support a causal link between Step 2 CS and improved patient outcomes.”

    The petition proposes that instead of having to take a standardized exam, students should instead be tested on their clinical skills by their individual medical schools, noting that the vast majority of programs already do so. The AMA used this argument when they initially opposed Step 2 CS during its creation.

    Step 2 CS has existed since 2004, when the NBME decided it was unfair that international students were required to take a standardized clinical skills exam but not US MDs. The eight-hour test consists of twelve 15-minute encounters with actors posing as patients, followed by a 10-minute period to complete a patient note. Examinees are evaluated on “Communication and Interpersonal Skills,” “Spoken English Proficiency,” and the “Integrated Clinical Encounter.”

    Supporters of Step 2 CS look to the lower pass rate among international students: 78% in 2015. They also remark that 94% of US/Canadian students and 78% of international students passed Step 1 last year, similar figures that do not cast doubt on that exam’s necessity. Dr. Paul Katsufrakis, senior vice president of the NBME, warns that while only a small percentage of students fail the exam, “they could potentially affect the thousands of patients they would treat in practice.” About 810 US/Canadian and 3,199 international students failed Step 2 CS in 2015.

    What do you think of Step 2 CS? Please vote in our poll or sound off in the comments below!