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Demise of the USMLE Step-2 CS exam: Rationalizing a way forward.

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  • 1Texas A&M University College of Medicine, Health Professions Education Building, 8447 Riverside Pkwy, Bryan, TX 77807, USA.

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Summary

The USMLE Step-2 Clinical Skills (CS) exam was canceled due to COVID-19, prompting a reevaluation of clinical skills assessment. A new framework proposes remote and local assessment methods to ensure valid, reliable, and fair evaluation of physician competencies.

Keywords:
Clinical skills assessmentStep-2 CSUSMLE

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Area of Science:

  • Medical Education
  • Clinical Skills Assessment
  • Physician Licensure Examinations

Background:

  • The COVID-19 pandemic led to the permanent cancellation of the USMLE Step-2 Clinical Skills (CS) exam.
  • This cancellation sparked debate regarding the future of clinical skills assessment in medical education.
  • The USMLE sought to innovate the assessment process, addressing concerns about validity, cost, and feasibility.

Purpose of the Study:

  • To redefine Clinical Skills (CS) and its assessment modalities.
  • To develop a theoretical framework for valid, reliable, feasible, fair, and verifiable CS assessment.
  • To propose a new model for CS assessment in light of pandemic-related challenges.

Main Methods:

  • Defined Clinical Skills (CS) as the art of medicine in the physician-patient encounter, encompassing history taking and physical examination.
  • Classified CS components into knowledge and psychomotor domains to inform assessment strategies.
  • Explored historical evolution of CS assessment and proposed remote and local assessment models.

Main Results:

  • Established a theoretical framework for CS assessment, emphasizing communication skills and cultural competence.
  • Demonstrated that CS can be largely assessed remotely, with remaining components assessed locally under USMLE supervision.
  • Proposed a national/regional faculty development program and an External Peer Review Initiative (EPRI).

Conclusions:

  • Clinical skills assessment requires innovation to ensure validity, reliability, and feasibility.
  • A hybrid model of remote and local assessment, regulated by USMLE, can effectively evaluate physician competencies.
  • Advocated for the evolution of Clinical Skills into a distinct academic discipline.