After the Discontinuation of Step 2 CS: A Collaborative Statement from the Directors of Clinical Skills Education (DOCS)

Abstract

Issue: The United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills Examination (Step 2 CS), the only clinical skills competency testing required for licensure in the United States, has been discontinued. Evidence: This exam, though controversial, propelled a movement emphasizing the value of clinical skills instruction and assessment in undergraduate medical education. While disappointed by the loss of this national driver that facilitated standardization of clinical skills education, the Directors of Clinical Skills Education (DOCS) see prospects for educational innovation and growth. DOCS is a national organization and inclusive community of clinical skills education leaders. This statement from DOCS regarding the discontinuation of USMLE Step 2 CS has been informed by DOCS meetings, listserv discussions, an internal survey, and a review of recent literature. Implications: Rigorous clinical skills assessment remains central to effective and patient-centered healthcare. DOCS shares specific concerns as well as potential solutions. Now free from the external pressure to prepare students for success on Step 2 CS, clinical skills educators can reprioritize content and restructure clinical skills programs to best meet the needs of learners and the ever-evolving healthcare landscape. DOCS, as an organization of clinical skills leaders, makes the following recommendations: 1) Collaboration amongst institutions must be prioritized; clinical skills assessment consortia should be expanded. 2) Governing, accrediting, and licensing organizations should leverage their influence to support and require high quality clinical skills assessments. 3) UME clinical skills leaders should develop ways to identify students who perform with exceptional, borderline, and poor clinical skills at their local institutions. 4) UME leadership should fully commit resources and curricular time to graduate students with excellent clinical skills.

Keywords:

• Clinical skills
• clinical skills competency
• USMLE Step 2 CS
• licensure
• assessment

Acknowledgments

Dr. Toshiko Uchida, MD, from Northwestern University Feinberg School of Medicine and Immediate Past President of DOCS whose leadership has been key in creating a platform for timely discussions with multiple stakeholders which influenced and informed this piece.

Saori Wendy Herman, MLIS, AHIP from Zucker School of Medicine who assisted with literature review and citations.

Cynthia D Smith, MS Ed from CUNY School of Medicine who assisted with the data management of the DOCS internal survey.

The DOCS membership and listserv community for championing clinical skills education with such collaboration and passion and for driving clinical skills education in the US and beyond.

The DOCS Executive Council for their leadership and perspectives in informing and framing this paper. We are honored to be part of this team.

Dr. Toshiko Uchida- Northwestern University Feinberg School of Medicine

Dr. Lisa Bernstein- Emory University School of Medicine

Dr. Laurie Caines- University of Connecticut School of Medicine

Dr. Gregory Harlan- Keck School of Medicine of the University of Southern California

Dr. Jennifer Jackson- Wake Forest School of Medicine

Dr. Sharon Obadia- A.T. Still University-School of Osteopathic Medicine in Arizona

Dr. Robin Ovitsh- SUNY Downstate Health Science Center (Current DOCS President)

Dr. Danielle Roussel- University of Utah School of Medicine

Dr. Adam Weinstein- Frank Netter School of Medicine Quinnipiac University

Ms. Katharine Yamulla- New York Medical College

Dr. Sarah Yonder- Central Michigan University College of Medicine

Other disclosures

Deepthiman Gowda, MD, MPH, MS served as a member of the USMLE Step 2 CS Test Material Development Committee from 2014-2021 and as Co-Chair of the Committee from 1/2018 to 1/2021.

Funding

The author(s) reported there is no funding associated with the work featured in this article.