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The Fight To End the Step 2 CS Exam

Medical students, residents, attending physicians, and Harvard Medical School faculty are fighting to put an end to the Step 2 CS, an exam required of U.S. medical students to become licensed physicians.

In just one month, the petition, End Step 2 CS has garnered massive support and 14,000 signatures.

Step 2 CS is a clinical skills exam that was first administered in 2004 as a means by which to test a medical student’s ability to communicate with their patients. The movement argues that the exam is redundant, unnecessarily costly, and that there is little evidence to prove that it benefits patients.

Samia Osman/ Photo courtesy of LinkedIn

Samia Osman/ Photo courtesy of LinkedIn

The main point of the movement, said Samia Osman, one of the movement organizers and a student in her fourth year at Harvard Medical School, is that “after a decade of implementing this test, there is no significant outcome saying that this test actually improves patient care.”

The Step 2 CS has long been controversial among students for being both inconvenient and expensive. The exam is only offered once per year in five locations around the country: Atlanta, Chicago, Houston, Los Angeles, and Philadelphia. This means that in addition to the $1275 registration fee, most students have to pay for transportation to one of those cities and for the cost of a hotel.

Cost aside, the test is considered redundant. Step 2 CS is administered as part of the United States Medical Licensing Examination; however, at many schools students must pass another exam that tests the same skills in order to graduate.“Ninety one percent of all U.S. medical schools require this clinical skills exam, if not a more rigorous version of this exam,” said Osman. “Our point is that if the schools are already doing this it is time for us to transfer this jurisdiction over required clinical skills exams back to medical schools.”

Osman also argues that students would benefit more from the exam if it was administered by medical schools. At most schools, Osman explained, students receive immediate feedback on their performance. Step 2 CS doesn’t offer any feedback, and, while most students pass the exam on the first try, those who don’t aren’t given the opportunity to learn from it.

“We are not asking to eliminate the entire clinical skills exam. All we’re asking is for schools to do it with guidelines from a national body, for example, the [Liaison Committee on Medical Education], which is the liaison of medical schools,” she added. “We actually care about patient outcome.”

Throughout the exam’s 10 year history, questions of its value and efforts to eliminate it have been raised several times. Osman attributes End Step 2 CS’s success to its use of social media.

“I think the 14,000 signatures is a testament to that and also we are making it something that everyone can relate to,” she said. “It is a people’s movement.”

End Step 2 CS has submitted resolutions to the Massachusetts Medical Society and American Medical Association. The resolution to the MMS specifically asks them to advocate to the state medical licensing body to eliminate the Step 2 CS requirement for all U.S. medical schools that already offer the exam. End Step 2 CS will meet with MMS in May. The House of Delegates will vote on the resolution at that time.

“Even though it’s a movement started at HMS, this movement has become a movement from the medical community,” Osman said of the progress they’ve made.

While they’ve made significant strides, they’ve also received some pushback. In an article published by STAT on March 11, Dr. Peter Katsufrakis, the senior vice president of the National Board of Medical Examiners, is quoted in the story saying that the exam is an issue of public trust, adding that medical schools don’t have the time to administer the test.

Osman countered that most medical schools already do administer a clinical skills exam.

“For public trust, I would say clinical skills exams are making sure we can communicate with our patients. I do see that as an important point and that’s why we’re not looking for removing the clinical skills exam,” she said.

Alexandra David

Alexandra David

    Alexandra David is a senior at Boston University studying journalism. She was the City Editor of the Daily Free Press and has worked for the IDG News Service and LeadingAge. Her passions include social justice, Boston, and, of course, journalism. Her hobbies include reading (like a good writer) and watching documentaries.

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    1 Comment

    1. We respect how much this group of petitioners cares about their education and their emphasis on patient-oriented impact. That is exactly why it is so important to have clinical skills of all prospective licensees assessed using the same national standard. Medical school programs vary by design. They have differing standards for admission, offer different curricula, and use different assessment systems. For example, the American Association of Medical Colleges (AAMC) reports that in 2014 – 15, only 74% of U.S. medical schools required their students to pass a clinical skills exam of some sort for graduation.

      We do understand students’ desire for more individual feedback on their Step 2 CS exam (which is offered year-round at five locations) and are currently exploring ways to provide meaningful feedback while preserving the fairness of the exam for all test-takers.

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