Recent medical school graduates are familiar with the Step 2 Clinical Skills examination, a day-long charade of simulated clinical encounters intended to screen out medical students who are incapable of functioning in a clinical setting. This test was adapted from the ECFMG Clinical Skills Assessment, intended essentially to screen out foreign medical graduates with inadequate communication skills to safely practice medicine in the United States.
However, U.S. and Canadian medical school graduates pass this test 98% of the time on the first attempt, and 91% of the time on a re-attempt. This means each year $20.4 million are expended in test fees – and probably half again that amount in travel expenses – to identify 30-odd medical school graduates who are truly non-functional. The authors of this brief letter in the NEJM suggest, with interest compounding secondary to medical school debt repayments, it costs over a million dollars per failed student.
Clearly, some medical students are not capable of functioning as physicians. However, clinical skills teaching, evaluation, and remediation ought to be part of the purview of the medical school training program that has multi-year longitudinal experience with the student, not a one-day simulation. I’m sure some of the few who fail Step 2 CS twice are capable of safely practicing medicine, and certainly many who pass Step 2 CS still require additional teaching. I agree with these authors that this test is an expensive and ineffective farce.
Then again, as this NYTimes vignette points out, medical schools are having a tough time failing folks for poor clinical skills. However, the solution is not to pass the buck along to the NBME.
“The Step 2 Clinical Skills Exam — A Poor Value Proposition”
www.nejm.org/doi/full/10.1056/NEJMp1213760
3 thoughts on “The Boondoggle of Step 2 CS”
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Other than being a money maker for hotels and airlines and taxi's, I never did see the point in the clinical skills test. If the med schools are teaching clinical skills correctly, then why not let the med schools themselves test the students in clinical skills? Besides, you really don't learn clinical skills well until you are actually IN the hospital setting performing clinical skills on ACTUAL very sick patients which does not happen until your 3rd and 4th year of med school.
In this day and age of more testing based merit, there will likely be more tests instead of fewer. Look at the creep into recertification. What used to be a test every 10 years is now 8 LLSA tests, 25 AMA PRA credits (8 being self assessment) per year, two practice improvement activities, and 2 communication/professionalism activities. Each of these costs money.
While not having any certification is certainly worse, I don't think the answer is to have yearly merit badges.
I had to take the test twice because on the first exam, I did not cover enough daily questions and lifestyle instruction. I got every diagnosis correct and my note was complete (with plan), but the SP's said I did not cover enough outside of the pertinent complaint (smoking/etoh cessation, etc.). I work at a L1 trauma center and am one of the chief residents in my EM residency. I'm sorry you are in a lot of pain from your possibly ruptured appendicitis, but could I ask you your favorite color, any pets at home, and do you use a seatbelt when you are in a motor vehicle?