Some medical students are breathing a sigh of relief that they have one less exam to study for: the United States Medical Licensing Examination® (USMLE®) Step 2 Clinical Skills (CS) exam. The USMLE Step 2 CS canceled news comes about eight months after the exam was initially suspended amidst the COVID-19 pandemic. Shortly after, COMLEX-USA® Level 2-PE was also canceled. So, why were these exams discontinued, what does it mean for US medical students and international medical graduates (IMGs), and how should institutions and educators proceed?
USMLE Step 2 Cancelation: The initial announcement
In May 2020, the National Board of Medical Examiners® (NBME®) announced that Step 2 CS would be postponed for 12–18 months. During that time, NBME was to be working on a better version of the exam that would be safer due to the circumstances of the COVID-19 pandemic.
Step 2 CS was an in-person test with standardized patients and observed interactions that became difficult to administer, and travel restrictions meant many students couldn’t get to the exam safely. The five testing centers were located in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia. This meant some students (particularly those living abroad) had to travel thousands of miles to get to a testing location.
Some theorized that the exam would move to a telehealth format, which would have reduced the financial travel burden for students while also increasing COVID-19 safety. Of course, this supposition never came to fruition.
USMLE Step 2 Cancelation: Why it’s now permanent
On January 26, 2021, The Federation of State Medical Boards (FSMB) and NBME, who co-sponsor USMLE announced that the exam will be discontinued, rather than re-worked as previously announced. The main reasons for discontinuation include:
- The ongoing COVID-19 pandemic
- Concerns about the usefulness of the exam due to pass rates being above 90%
- Expense to students
The exam was designed to measure clinical skills in a realistic setting with live patient actors, but even before the COVID-19 pandemic, the exam had its critics. Because the exam already had flaws—such as its high pass rate that suggested it wasn’t an ideal way to test students’ skills and the difficulty many students faced getting to a testing site—it was likely already on its way out.
In the announcement, USMLE said, “We have no plans to bring back Step 2 CS, but we intend to take this opportunity to focus on working with our colleagues in medical education and at the state medical boards to determine innovative ways to assess clinical skills.”
It’s clear that Step 2 CS will cease to exist in its previous form, but US medical students and IMGs should understand that they will still be expected to have strong clinical skills.
Get tips for acing USMLE® Step 2 CK and SHELF exams from Dr. Justin Ling.
What USMLE Step 2 CS Cancelation Means for US Medical Students
Understandably, many US medical students are pleased about the news of having one less exam to stress about. For many students, this one was particularly stressful, expensive, and time-consuming due to the necessary travel to one of the five testing centers in the US.
With the USMLE Step 2 CS cancelation, US medical students will still need to pass the following exams:
- USMLE Step 1, which students typically take at the end of their second year of medical school
- USMLE Step 2 CK, which students typically take during their fourth year of medical school
- USMLE Step 3, which students can only take after they graduate medical school; many choose to take it toward the beginning of their residency
This news might take some of the pressure off, especially during the fourth year of medical school when many students took Step 2 CS, but it doesn’t mean students will cease to be assessed on their clinical skills. Clinical skills will continue to be assessed in Step 3, and communication content has been bolstered in Step 1.
Additionally, medical school educators may increase their assessments of clinical skills to ensure they are properly preparing their students to practice medicine in a clinical setting. Because students won’t have to spend as much time preparing for, traveling to, and taking the exam, they will also be able to devote more time to relevant and practical training.
“I believe this was a positive change in making medicine more accessible to a wider variety of people. This exam was very expensive and required students to fly out to a testing site which many people may not have the means to do,” says Gillian Cooper, a medical student at the University of Maryland. “While it is supposed to be a standardized exam, this is often not the case in CS and can be more subjective. I believe this change was needed and will help lower the costs of medical education.”
Get tips for acing USMLE® Step 1 from Dr. Rishi Desai.
COMLEX-USA® Level 2-PE Canceled: What it means for Doctor of Osteopathy (DO) students
Shortly after the USMLE Step 2 CS cancelation was announced, the National Board of Osteopathic Medicine Educators (NBOME®) announced that the Comprehensive Osteopathic Medical Licensing Examination of the United States® (COMLEX-USA®) Level 2 Performance Evaluation (PE) is canceled as well.
This exam, which is similar to USMLE Step 2 CS, is postponed indefinitely. Doctor of Osteopathy students, who often take both exams, are likely breathing an extra sigh of relief at this news.
What USMLE Step 2 CS Cancelation Means for International Medical Graduates (IMG)
While many US medical students are rejoicing at the cancelation of Step 2 CS, some international medical graduates might not be so excited. IMGs may now feel more pressure to perform exceptionally well on Step 2 CK (especially after the decision to make Step 1 pass/fail) so they can prove their knowledge and skills are acceptable.
In other ways, this news is exciting for IMGs as well. Like US medical students, they had to travel to one of the five testing centers for Step 2 CS, and that trip was often even more costly and time-consuming. Another bright spot for IMGs is that some communication elements in Step 2 were challenging for those who didn’t speak English as a first language. These students will, however, still need to take the OET exam. The Educational Commission for Foreign Medical Graduates (ECFMG) will continue to work on alternative ways to evaluate IMGs on clinical skills.
In some ways, the change can be seen as a double-edged sword: “I actually think it’s good for us IMGs because it’s one less exam we have to pay for—and boy, are they expensive!” says Mónica Contreras Leal, a medical student at Universidad Anáhuac Querétaro. “But I really feel that clinical skills is a fundamental thing we as future doctors need to know.”
There is a small subset of students who unfortunately failed Step 2 CS before the cancelation, meaning they never had the ability to retake the exam. For these students, the ECFMG recently announced a new pathway for certification; according to the ECFMG website, “the applicant’s clinical skills must be evaluated by licensed physicians using ECFMG’s Mini-Clinical Evaluation Exercise (Mini-CEX). Additional details and instructions for meeting the requirements for Pathway 6 will be provided as soon as they are available.”
What USMLE Step 2 and COMLEX-USA Level 2-PE Cancelations Mean for Institutions and Educators
USMLE Step 2 CS and COMLEX-USA Level 2-PE may be discontinued, but that does not mean that educators need to focus less on teaching clinical skills. Now more than ever, educators should take this time to ensure their students’ communication and diagnostic skills are top-notch. During this time, medical exam boards are working on alternative ways to assess clinical skills, the burden of assessment might lie more heavily on institutions and educators.
Rather than assessing clinical skills one time in a summative assessment, medical schools can now help students develop their skills through both formal and informal formative assessments. Assessing students this way will likely prove to reduce their stress while simultaneously increasing their retention.
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The United States Medical Licensing Examination (USMLE®) is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). Osmosis is not affiliated with NBME nor FSMB. COMLEX-USA® is a registered trademark of the National Board of Osteopathic Medical Examiners, Inc. (NBOME). Osmosis is not affiliated with NBOME.
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