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John JT, Gowda D, Schlair S, Hojsak J, Milan F, Auerbach L. After the Discontinuation of Step 2 CS: A Collaborative Statement from the Directors of Clinical Skills Education (DOCS). TEACHING AND LEARNING IN MEDICINE 2023; 35:218-223. [PMID: 35287502 DOI: 10.1080/10401334.2022.2039154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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.
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Affiliation(s)
- Janice Thomas John
- Science Education and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Deepthiman Gowda
- Medical Education and Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Sheira Schlair
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joanne Hojsak
- Pediatrics and Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Felise Milan
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Katsufrakis PJ, Chaudhry HJ. Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1236-1238. [PMID: 34166234 DOI: 10.1097/acm.0000000000004214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program's sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program's continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.
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Affiliation(s)
- Peter J Katsufrakis
- P.J. Katsufrakis is president and CEO, NBME, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-9077-9190
| | - Humayun J Chaudhry
- H.J. Chaudhry is president and CEO, Federation of State Medical Boards, Euless, Texas; ORCID: https://orcid.org/0000-0003-3356-1106
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Talwalkar JS, Fortin AH, Morrison LJ, Kliger A, Rosenthal DI, Murtha T, Ellman MS. An Advanced Communication Skills Workshop Using Standardized Patients for Senior Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11163. [PMID: 34124349 PMCID: PMC8155077 DOI: 10.15766/mep_2374-8265.11163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Medical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students. The workshop emphasized communication skills for four scenarios-strong emotion, goals of care, medical error, and palliative care assessment-and utilized formative peer assessment and feedback. METHODS We created the four ACSW cases with case-specific communication behavior checklists and a common modified Master Interview Rating Scale in a Capstone Course for senior medical students. In groups of three, students rotated through three of four stations. Each student conducted one of the interviews while the other two completed the checklists and provided verbal feedback. We performed one-way analyses of variance on Likert responses and content analysis on open responses on a post-ACSW survey. RESULTS Ninety-one students completed the ACSW and survey. Students assigned high value to all four ACSW student roles: interviewer, observer, feedback recipient, and feedback provider. Students rated the experience above average to excellent on nearly all survey items. Open-response themes included "liked the opportunity to give or receive peer feedback" (46%) and "found the checklists helpful" (45%). DISCUSSION Feasible and well received by senior medical students, our ACSW offers an opportunity to practice and observe advanced communication skills and peer feedback. A peer-assisted, formative learning model, the ACSW efficiently addresses a key aspect of residency preparation.
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Affiliation(s)
- Jaideep S. Talwalkar
- Associate Professor, Departments of Medicine and Pediatrics, and Director of Clinical Skills, Yale School of Medicine
| | - Auguste H. Fortin
- Professor, Department of Medicine, and Director of Communication Skills Education, Yale School of Medicine
| | - Laura J. Morrison
- Associate Professor, Department of Medicine, and Director of Hospice and Palliative Medicine Fellowship, Yale School of Medicine
| | - Alan Kliger
- Clinical Professor, Department of Medicine, Yale School of Medicine
| | - David I. Rosenthal
- Assistant Professor, Department of Medicine, and Director of Capstone Course, Yale School of Medicine
| | - Tanya Murtha
- Assistant Professor, Department of Pediatrics (Critical Care Medicine), Columbia University
| | - Matthew S. Ellman
- Professor, Department of Medicine, and Director of Medical Student Palliative and End-of-Life Care Education, Yale School of Medicine
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Fatima R, Assaly AR, Aziz M, Moussa M, Assaly R. The United States Medical Licensing Exam Step 2 Clinical Skills Examination: Potential Alternatives During and After the COVID-19 Pandemic. JMIR MEDICAL EDUCATION 2021; 7:e25903. [PMID: 33878014 PMCID: PMC8092027 DOI: 10.2196/25903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 05/18/2023]
Abstract
We feel that the current COVID-19 crisis has created great uncertainty and anxiety among medical students. With medical school classes initially being conducted on the web and the approaching season of "the Match" (a uniform system by which residency candidates and residency programs in the United States simultaneously "match" with the aid of a computer algorithm to fill first-year and second-year postgraduate training positions accredited by the Accreditation Council for Graduate Medical Education), the situation did not seem to be improving. The National Resident Matching Program made an official announcement on May 26, 2020, that candidates would not be required to take or pass the United States Medical Licensing Examination Step 2 Clinical Skills (CS) examination to participate in the Match. On January 26, 2021, formal discontinuation of Step 2 CS was announced; for this reason, we have provided our perspective of possible alternative solutions to the Step 2 CS examination. A successful alternative model can be implemented in future residency match seasons as well.
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Affiliation(s)
- Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Ahmad R Assaly
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, United States
| | - Mohamad Moussa
- Department of Emergency Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Ragheb Assaly
- Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, OH, United States
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Ecker DJ, Milan FB, Cassese T, Farnan JM, Madigosky WS, Massie FS, Mendez P, Obadia S, Ovitsh RK, Silvestri R, Uchida T, Daniel M. Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:693-698. [PMID: 28834843 DOI: 10.1097/acm.0000000000001874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue.
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Affiliation(s)
- David J Ecker
- D.J. Ecker is assistant professor of medicine, assistant director of education, Hospital Medicine Group, and director, Integrated Clinicians Course, University of Colorado School of Medicine, Aurora, Colorado, and chair, Advocacy and Advancement Subcommittee, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0002-1530-0079. F.B. Milan is professor of medicine and director, Ruth L. Gottesman Clinical Skills Center and Introduction to Clinical Medicine Program, Albert Einstein College of Medicine, Bronx, New York, and president, Directors of Clinical Skills Courses (DOCS). T. Cassese is associate professor of medical science and director, Clinical Arts and Sciences Course, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, and president-elect, Directors of Clinical Skills Courses (DOCS). J.M. Farnan is assistant dean, Curricular Innovation and Evaluation, associate professor of medicine, and director, Clinical Skills Education, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and secretary, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0002-1138-9416. W.S. Madigosky is associate professor of family medicine and director, Foundations of Doctoring Curriculum, University of Colorado School of Medicine, Aurora, Colorado, and chair, Nominations Subcommittee, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0003-0714-4114. F.S. Massie Jr is professor of medicine, director, Introduction to Clinical Medicine Curriculum, and director, Clinical Skills Scholars Program, University of Alabama School of Medicine, Birmingham, Alabama, and past president (2014-2015), Directors of Clinical Skills Courses (DOCS). P. Mendez is associate dean, Clinical Curriculum, associate professor of medicine, and director, Clinical Skills Program, University of Miami Miller School of Medicine, Miami, Florida, and representative, Southern Group on Educational Affairs, Directors of Clinical Skills Courses (DOCS). S. Obadia is associate dean, Clinical Education and Services, associate professor of internal medicine, and codirector, Medical Skills Courses, A.T. Still University, School of Osteopathic Medicine, Mesa, Arizona, and chair, Program Planning Subcommittee, Directors of Clinical Skills Courses (DOCS). R.K. Ovitsh is assistant dean, Clinical Competencies, and assistant professor of pediatrics, State University of New York Downstate School of Medicine, Brooklyn, New York, and representative, Northeast Group on Educational Affairs, Directors of Clinical Skills Courses (DOCS). R. Silvestri is assistant professor of medicine and site director, Practice of Medicine Clinical Skills Course, Harvard Medical School, Boston, Massachusetts, and chair, Research Subcommittee, Directors of Clinical Skills Courses (DOCS). T. Uchida is associate professor of medicine and medical education and director, Clinical Skills Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and treasurer, Directors of Clinical Skills Courses (DOCS). M. Daniel is assistant dean, Curriculum, and assistant professor of emergency medicine and learning and health sciences, University of Michigan Medical School, Ann Arbor, Michigan, and past president (2015-2016), Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0001-8961-7119
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