Step 2 CS Canceled Forever (Hopefully)

The NBME announced yesterday that they’re scrapping plans to relaunch the USMLE Step 2 CS as a virtual telehealth evaluation that pretends to assess clinical skills:

Following the May 2020 suspension of Step 2 CS due to the COVID-19 pandemic, we announced our intention to take 12-18 months to bring back a modified Step 2 CS exam that was appreciably better than the prior assessment. After reviewing current and anticipated progress with the exam and in consideration of the rapidly evolving medical education, practice and technology landscapes, we have decided to discontinue Step 2 CS.

If you want to read somebody pillorying the initial plan, here was my take.

Clinical skills evaluation isn’t dead, it’s just unclear how it will be incorporated in the future. The obvious solution is to offload a formal standardized clinical experience to schools in the form of a universal OSCE, but who knows. If there’s a way for the NBME to profit here without completely looking awful, they’ll find it.

A long time coming

In 2016, there was a grassroots movement to #EndStep2CS, codifying the gripes of generations of medical students angry about an expensive and inconvenient test (read: tax) with a near 100% pass rate. In response, the NBME increased the failure rate. While they couldn’t argue about the expense or the inconvenience, they could pretend that the exam was now really good at catching “deficient” students (even though they had no data that Step 2 CS performance meant anything in the real world).

One of The only benefit of Step 2 CS for US students was that it really forced schools to invest more in (LCME-required) Objective Structured Clinical Examinations (OSCE) and provide more structured instruction in clinical skills. OSCEs aren’t perfect, but there is an undeniable role for simulated medical exams and standardized patients in the medical education toolkit. But the idea that pandemic-affected residents seeing real patients would need to travel around the country to see fake ones in order to do what they’re already doing was silly. And the idea that the NBME could move CS online and somehow have that be more meaningful than what the schools are already required to do in-person was untenable.

And so here we are.

It took a pandemic, but Step 2 CS is canceled.

I’ll admit that wasn’t on my 2021 bingo card, but perhaps in the background, the NBME was looking for a way to save face and cancel the increasingly unpopular CS without admitting the test was garbage.

Now what?

It’s still early days here. Advocate-in-chief Dr. Carmody rapidly turned around a good summary, which I always recommend, including how the news will impact international students (for now, back to taking an English test) and DO students (the NBOME sunk enough money into their version that they really don’t want to cancel it).

The NBOME, the NBME’s osteopathic counterpart, deserves some serious scorn here for continuing to double down on their products (and, really, continuing to exist at all). The preservation of separate parallel licensing exams is a bad look in a world where most states don’t actually require DOs to take DO-specific exams, most residencies prefer the USMLE, and where ACGME has since taken over the accreditation of all residencies. It’s an extra cost for DO students that provides no value.

The continued existence of osteopathic schools as a distinct entity from allopathic schools itself is mostly an anachronism, and the faster the NBME and the copy-cat NBOME can merge the better off students will be. If not, I hope osteopathic schools will increasingly remove any COMLEX-specific board exam graduation requirements and enable the students to vote with their feet (and student loan dollars). Let the market decide.



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