Improving Passage Rate on USMLE Step 2 Clinical Skills: Results from a Pilot Program

Area of Science:

• Medical Education
• Clinical Skills Assessment

Background:

• The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) is essential for residency entry.
• Increased USMLE Step 2 CS performance standards in 2017 were expected to lower passage rates for US and international medical students.
• The impact of institutional clinical skills examinations on USMLE Step 2 CS passage rates remained unstudied.

Purpose of the Study:

• To assess the effect of a novel, standardized patient (SP)-based practice examination on subsequent USMLE Step 2 CS passage rates.
• To evaluate the utility of a simulated clinical skills assessment in preparing students for the official examination.

Main Methods:

• A six-case, standardized patient (SP)-based examination was developed to simulate the USMLE Step 2 CS.
• Students received structured quantitative and qualitative feedback following the practice examination.
• 173 out of 184 students (94.5%) participated; the intervention incurred direct costs of $26,000 and required 20 SPs.

Main Results:

• The local failure rate for USMLE Step 2 CS decreased from 4.5% pre-intervention to 2.1% post-intervention.
• During the same period, the national US failure rate increased from 3.8% to 5.1%.
• The difference between local and national failure rates was not statistically significant (P = .07).

Conclusions:

• The developed SP-based practice examination demonstrated initial success in improving local USMLE Step 2 CS passage rates.
• Medical institutions may consider implementing similar practice examinations to enhance student performance on high-stakes clinical skills assessments.
• This intervention offers a potential strategy to mitigate the anticipated decline in passage rates due to updated examination standards.