About the Discussion

NEJM CareerCenter Conversations: The Future of the Step 2 Clinical Skills Exam

The USMLE Step 2 Clinical Skills exam was created to address concerns that all licensed physicians should have basic clinical competencies and communication skills to interact with patients. The exam consists of interactions with standardized patients, and examinees are graded on clinical reasoning and English proficiency. The exam is jointly controlled by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB). These two boards were responsible for the additional of a national clinical skills examination to the medical licensure process in 2004.

However, Step 2 Clinical Skills has been fought by many medical school administrators and the American Medical Association since its inception. The test fee alone is exensive, and that fee does not include the travel costs to one of the four cities where the exam is offered. Many feel that the task of identifying medical student deficiencies in clinical skills should be the job of medical school curricula, not a national exam. And there is no current data linking a national standardized exam to improved patient safety. A petition to end step 2 clinical skills started in 2016 has gathered over 15,000 signatures nationwide and has the support of deans of many medical schools.

This discussion will feature members of the NBME as well as the authors of the petition to end step 2 CS. We will also have experts in the field of medical education and standardized medical testing to provide a broad perspective. 


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