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Demise of the USMLE Step-2 CS exam: Rationalizing a way forward
The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
National Medical Association. Published by Elsevier Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10214039/ https://www.ncbi.nlm.nih.gov/pubmed/37246081 http://dx.doi.org/10.1016/j.jnma.2023.05.003 |
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author | Achike, Francis I. Christner, Jennifer G. Gibson, Jeremy L. Milman, Robert M. Obadia, Sharon Waer, Amy L. Watson, Patricia K. |
author_facet | Achike, Francis I. Christner, Jennifer G. Gibson, Jeremy L. Milman, Robert M. Obadia, Sharon Waer, Amy L. Watson, Patricia K. |
author_sort | Achike, Francis I. |
collection | PubMed |
description | The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE's fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship. |
format | Online Article Text |
id | pubmed-10214039 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | National Medical Association. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102140392023-05-26 Demise of the USMLE Step-2 CS exam: Rationalizing a way forward Achike, Francis I. Christner, Jennifer G. Gibson, Jeremy L. Milman, Robert M. Obadia, Sharon Waer, Amy L. Watson, Patricia K. J Natl Med Assoc Article The COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE's fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship. National Medical Association. Published by Elsevier Inc. 2023-05-26 /pmc/articles/PMC10214039/ /pubmed/37246081 http://dx.doi.org/10.1016/j.jnma.2023.05.003 Text en © 2023 National Medical Association. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Achike, Francis I. Christner, Jennifer G. Gibson, Jeremy L. Milman, Robert M. Obadia, Sharon Waer, Amy L. Watson, Patricia K. Demise of the USMLE Step-2 CS exam: Rationalizing a way forward |
title | Demise of the USMLE Step-2 CS exam: Rationalizing a way forward |
title_full | Demise of the USMLE Step-2 CS exam: Rationalizing a way forward |
title_fullStr | Demise of the USMLE Step-2 CS exam: Rationalizing a way forward |
title_full_unstemmed | Demise of the USMLE Step-2 CS exam: Rationalizing a way forward |
title_short | Demise of the USMLE Step-2 CS exam: Rationalizing a way forward |
title_sort | demise of the usmle step-2 cs exam: rationalizing a way forward |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10214039/ https://www.ncbi.nlm.nih.gov/pubmed/37246081 http://dx.doi.org/10.1016/j.jnma.2023.05.003 |
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