Eliminate Step 2 CS!

[Furuncle]

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I realize this is not the USMLE forum, but I figure the most folks check this forum out. I just took Step 2 CS. I had heard from dozens of folks that it was a huge waste of time and money, but I was reserving judgment. Now, I have to agree. I'm writing to encourage everyone to contact USMLE and encourage them to GET RID OF THIS RIDICULOUS MESS! It's too late for us, but here's your chance to do something slightly altruistic and help those in classes below us.
It's expensive, you get no feedback, and most schools already require a similar exercise. If you agree, let 'em know. (If you are all for Step 2 CS, that's fine - you can tell them that, too.)
You can send them an e-mail at: [email protected]

 

[GeneGoddess]

Here is a link to the survey that 4th years at my school received. Remember, use CONSTRUCTIVE criticism.

http://www.ama-assn.org/ama/pub/category/12770.html

 

[pikachu]

The thing that kills me is that if the US seniors as a group had refused to take this test the NBME would have had to address this issue. Since we all knuckled under now we are stuck.

 

[PassinGas]

pikachu,

Not exactly stuck...next year's seniors could refuse after seeing what the reality has been for seniors this year. Although, I doubt they will unless AMSA gets involved and cries out, which wouldn't be such a bad idea as long as it is done in a noninflamatory-matter-of-fact sort of way.

 

[MD'05]

Thanks! I posted my constructive criticism. I didn't use the word f*ck once.

 

[doc05]

The thing that kills me is that if the US seniors as a group had refused to take this test the NBME would have had to address this issue. Since we all knuckled under now we are stuck.

what an unrealistic idea. How would you go about organizing the efforts of 16,000 people??

 

[funkless]

The thing about Step 2 CS is that it was designed with the expectation of a 95-97% pass rate, just screening out the bad communicators*. WTF?

So, we're expected to shell out mucho deniero, flying around the country like Waldo Pepper, so that we can catch the 5% among us who don't converse in English well?

*There's no way we'll see a 95% pass rate, but we're still talking about a ridiculous waste of money. And that's what it's all about, IMO. As long as we're willing to shell out the loot, they'll make a profit, and they get a GREAT feather for their public relations cap while they're at it.

--Funkless

 

[b&ierstiefel]

what an unrealistic idea. How would you go about organizing the efforts of 16,000 people??

agreed. what makes it harder is when your own med school requires taking and/or passing this exam to graduate medical school. here at university of michigan, we are required to pass step 2 BS to get our degree. if your school is making you take the exam, then how are people supposed to effect some kind of overhaul at the national level?

that being said, step 2 BS was a total waste of time and money and a total crock of ****.

 

[Gut Shot]

Thank God I passed that wretched piece of crap. I was seriously gonna consider blowing my brains out if I had to retake it.

While I've generally had a good experience at MCV, I must say that we have the tightest, stingiest financial aid office ever. Just try to wring some extra loan money out of those bastards. Car blew up? Sorry, try buying 10 lb. sacks of Grade D ground beef at CostCo. and partitioning them into 1 lb. increments in the freezer. That'll save ya some dough! The day after match we had a couple seminars on home buying, etc., and someone from the financial aid office told us how proud they were of our class because they gave us the same amount of loans as the class of 2004 and we had survived. This with a significant tuition hike and the $975 +travel of Step 2 BS. They were like "you guys have really learned how to budget" and we were like "WTF? The only thing I learned was how to put $975 on my credit card and beg my parents for money."

 

[DJPJ69Camaro]

Thank God I passed that wretched piece of crap. I was seriously gonna consider blowing my brains out if I had to retake it.

While I've generally had a good experience at MCV, I must say that we have the tightest, stingiest financial aid office ever. Just try to wring some extra loan money out of those bastards. Car blew up? Sorry, try buying 10 lb. sacks of Grade D ground beef at CostCo. and partitioning them into 1 lb. increments in the freezer. That'll save ya some dough! The day after match we had a couple seminars on home buying, etc., and someone from the financial aid office told us how proud they were of our class because they gave us the same amount of loans as the class of 2004 and we had survived. This with a significant tuition hike and the $975 +travel of Step 2 BS. They were like "you guys have really learned how to budget" and we were like "WTF? The only thing I learned was how to put $975 on my credit card and beg my parents for money."

I don't know if it's that big a waste of time. Many people still fail it. I heard that some US grads failed it already. And after taking it, I felt a little scared. I didn't study at all, but I made the mistake of picking up a book after the exam. And the book made it seem like they grade pretty hard; checklists, standards and all.

 

[alhkim]

I don't know if it's that big a waste of time.

I have to disagree with this--almost all schools have their own "CS" exam which you must pass in addition to the Step II BS exam. This redundency is a large waste of resources (especially $$$) and time.

 

[b&ierstiefel]

I have to disagree with this--almost all schools have their own "CS" exam which you must pass in addition to the Step II BS exam. This redundency is a large waste of resources (especially $$$) and time.

Totally. My school has a CCA (comprehensive clinical assessment) exam that all the students take at the end of M3 year. Not only do we have to do the same **** as on Step 2 BS, we have additional stations that involve reading X-rays, EKGs, and doing evidenced-based medicine exercises.

I smell money making scheme. An easier, more convenient way of doing things is for the NBME to set minimum standards on what should be tested on these in-school clinical exams and schools could have their comprehensive clinical exams CERTIFIED by the NBME. Schools could, of course, test additional skills and make their exams harder. But of course, doing it this way deprives NBME of millions of dollars.

 

[DJPJ69Camaro]

Totally. My school has a CCA (comprehensive clinical assessment) exam that all the students take at the end of M3 year. Not only do we have to do the same **** as on Step 2 BS, we have additional stations that involve reading X-rays, EKGs, and doing evidenced-based medicine exercises.

I smell money making scheme. An easier, more convenient way of doing things is for the NBME to set minimum standards on what should be tested on these in-school clinical exams and schools could have their comprehensive clinical exams CERTIFIED by the NBME. Schools could, of course, test additional skills and make their exams harder. But of course, doing it this way deprives NBME of millions of dollars.

I agree with both of you. But if so many schools have this at their own school, why are there still so many students and doctors that fail the real one?

 

[GeneGoddess]

That's the problem. We don't KNOW! I took this exam and passed (and I passed my school's exam as well), but I have NO idea how I did on the CS. Did I pass with flying colors? Did I barely squeak by? Am I middle of the road? There have been cases of US students failing, but not knowing why (feedback is "category" only, and not specific). Those who fail my school's exam are given detailed feedback (as are students who pass - if they need to improve something). But the CS exam gives no feedback at all...

 

[alhkim]

I agree with both of you. But if so many schools have this at their own school, why are there still so many students and doctors that fail the real one?

And at our school, we have our fair share that fail the in-house CSA also. I don't know if I can be convinced that the NBME provides any more of a screen for clinical skills than what most med schools test.

 

[b&ierstiefel]

Yeah, 1/3 of my classmates had failed at least one section of our CCA last year.

 

[neilc]

the CSA, while expensive and a PITA, is just like step 1 or step 2 CK. the powers that be have decided that your school's evaluation is not enough. they want to have a standardized verification of clinical skills...so, claiming that it is not neccessary because your school tested these skills is like saying you don't need to take step 1 because you passed the basic science tests that your school gave you...

it is too expensive, too subjective and there is not enough feedback....but, if they test your basic science on a national level, there is no reason that the clinical skills should not also be tested.

sorry, but this test is not going anywhere anytime soon....the best we can hope for is a reduction in cost and a better system of evaluation and feedback...but, since it is a new exam, the first batch of us guniea pigs will have to go through before it is improved. sucks to be first in line, eh?

 

[Gut Shot]

I agree with both of you. But if so many schools have this at their own school, why are there still so many students and doctors that fail the real one?

There are two main things at play here. First is that a certain percentage of exam-takers are going to fail. The NBME will fiddle with numbers to determine how many (my guess is 4-6% of domestic med students). That's what they do with the other Steps, so why not this one?

Second, CS is just a game with poorly defined rules. You yourself were surprised at the standards and checklists set forth in the book, which suggests you didn't realize beforehand just how much of a game it is. I suspect a lot of those who fail didn't realize this, either, and approached the encounters as they would in real life, with real patients. Alas, it's not about how good you really are, it's about how many check boxes you can get filled.

So yes, Step 2 CS must be destroyed. Hell, the AMA is even opposed.

 

[Gut Shot]

it is too expensive, too subjective and there is not enough feedback....but, if they test your basic science on a national level, there is no reason that the clinical skills should not also be tested.

Yes there is. It is too expensive and too subjective (see above). Good post.

Edit: and yes, it does suck to be first in line!

 

[yaah]

It's not only a money making scheme- it is also kowtowing to lawyers and the so-called "patient advocacy groups" who just want window dressing type of regulations and qualifications so they can say they are trying to respond to patient complaints. In reality, this test doesn't do **** to make people better doctors or better communicators. This should be up to med schools.

So now the AMA and other agencies can say that they are "taking steps to address the growing complaints of patients" blah blah blah.

They also published the results of a survey they took of patients asking "would you support graduating doctors being required to take a test assessing their ability to talk with patients and perform adequate physical exams?" Duh, what would you say?

 

[fantasty]

AMSA, AAMC organization of Student Reps, and AMA-student section were all quite opposed and expressed this for quite some time before the test roll out. But, NBME grants our licenses and can pretty much do whatever they want. As for schools requiring it, it's questionable whether they should require you to pass it in order to graduate. But, if your school does not require you to at least sit for the exam, you can't get financial aid for this. So, that's why most schools will at least require that.

Just came back from a meeting of the AAMC and I believe they said the current fail rate is about 5% for seniors (higher than the 3% anticipated, but they think it'll go down to 3% by the end of the year). The biggest complaints from the students thus far (as you all mentioned) is the lack of feedback and timeliness of the responses. (And, of course, cost and availability of the test times).

 

[retroviridae]

First, yes the CS is a complete waste of time and MONEY.

But ... does anyone actually believe step I or II CK actually tests anything of practical value? I am still highly unclear about how the questions asked in step I or II CK actually predicts my ability to be a good doctor. So having an equally worthless step II CS is no different than the rest of the steps.

 

[Gut Shot]

So having an equally worthless step II CS is no different than the rest of the steps.

At least the CK exams have some measure of objectivity in their format of multiple choice questions. Also, while I was as miserable as the next person while studying for them, they did force me to go back and push some of the foundational medical knowledge through my head again. The glass is half full, the glass is half full...

CS is essentially an objective veneer over an inherently subjective process, and one which cannot possibly do what it is purported to: accurately assess a student's ability to gather information, perform a basic physical exam, and communicate the "findings" appropriately (all with feeling). Not only that, passing doesn't mean you're good and failing doesn't mean your bad. So here we have a lousy assay that spits our meaningless results in the quest for a goal it cannot reach.

 

[GeneGoddess]

FYI, this was posted in the USMLE Forum, but I thought that I would reproduce the text here as well:

Problem Identified in Step 2 CS Reports Dated January 12 - March 30
Posted April 19, 2005


--------------------------------------------------------------------------------

During a review of data for the USMLE Step 2 Clinical Skills (CS) examination, the USMLE quality control team detected a software problem that resulted in an incorrect pass/fail classification for a small number of examinees. The problem affected only examinees with Step 2 CS reports dated January 12 to March 30, 2005.

Candidates whose Step 2 CS reports are dated before January 12 or after March 30 are not affected.

Thirty-eight examinees were notified of a change in classification from fail to pass by express mail scheduled for delivery on April 20. We have also contacted the deans of the US medical schools in which any of these students is enrolled. In addition, we are sending a corrected score report to any organization that received the previous, incorrect results as part of the transcript services or other reporting mechanisms.

We have also sent letters and new performance profiles to candidates whose failing classification on Step 2 CS was confirmed by our review of data. We are now completing a review of the data for the few remaining candidates whose failing classification could be affected by the problem and will advise them promptly whether their outcome changes or not.

The problem occurred in the computer program that assigns ratings for patient notes. After each clinical encounter, examinees complete notes, which are submitted to a group of physicians who are specially trained to rate them. This rating is one subcomponent of an examinee's score on the Integrated Clinical Encounter (ICE), which is itself only one part of an examinee's overall score on the examination.

We are also reviewing data on examinees who received a passing classification during the relevant period. At this point, it appears that few, if any, passing scores will be affected. While we are extremely sensitive to examinees' concerns, these considerations must be weighed in context of the overall purpose of the exam: to provide a common national minimum standard that all physicians must meet to be licensed to practice medicine in the US. If the governing board determines that the status of any examinee must on that basis change from pass to fail, we will notify that person as soon as we can confirm the change.

The USMLE recognizes the gravity of a change in pass/fail classification for any person. We deeply regret any disruption this problem may have caused. Concerned examinees can call our toll-free number at 866-504-8564 (if calling from within the US or Canada ). If you are calling from outside the US and Canada , please call 215-590-9260. Or e-mail us at [email protected].

 

[retroviridae]

I thought we paid the big bucks and waited as long as we did for results so that they could ensure the validity of the scores??? inexcusable.

 

[b&ierstiefel]

step 2 BS should be destroyed.

inexcusable.

 

[yaah]

I thought we paid the big bucks and waited as long as we did for results so that they could ensure the validity of the scores??? inexcusable.

They'll just have to charge more then. 🙄

 

[ptolemy]

They'll just have to charge more then. 🙄

And take even longer to get the scores back... what a crock.

 

[MD'05]

Oh no. I can't believe this. They are using a computer program to determine our fate.

Sounds like those AOA that failed and complained the loudest initiated some changes in the final scoring.

 

[Psych_hopeful]

And now 10 years later: endstep2cs.com/petition

 

[fantasty]

I'm not as involved in academic medicine as much any more, so I can't speak with certainty on this subject. But, I'm wondering how responsive NBME is to the needs / concerns of the students / test takers these days. (At they time, they clearly were not). Honestly, I would still check with AAMC's Organization of Student Representatives to gauge the likelihood of success. I'm not suggesting that the petition is a bad idea - It seems like a reasonable approach, so I hope everyone runs with it (who believe in it, of course, which is probably the majority). I'm such worried about it falling on deaf ears.

Rather than proving the individual burden (even cumulatively across all candidates), I've always thought it would be more effective to prove that US schools achieve an equivalent standard through their own required testing. I assume, by now, standardized patient testing is universal (or nearly universal), and should be part of accreditation of the school rather than the individual.

 

[Psych_hopeful]

Almost 8900 signatures. Wow.

 

[ThoracicGuy]

I'm not as involved in academic medicine as much any more, so I can't speak with certainty on this subject. But, I'm wondering how responsive NBME is to the needs / concerns of the students / test takers these days. (At they time, they clearly were not). Honestly, I would still check with AAMC's Organization of Student Representatives to gauge the likelihood of success. I'm not suggesting that the petition is a bad idea - It seems like a reasonable approach, so I hope everyone runs with it (who believe in it, of course, which is probably the majority). I'm such worried about it falling on deaf ears.

Rather than proving the individual burden (even cumulatively across all candidates), I've always thought it would be more effective to prove that US schools achieve an equivalent standard through their own required testing. I assume, by now, standardized patient testing is universal (or nearly universal), and should be part of accreditation of the school rather than the individual.

Stopping this will never happen. It's a cash cow for the NBME.

 

[fantasty]

Is it weird that NBME has an "Urban Legends" page?

http://www.nbme.org/students/Urban-Legends/index.html

The USMLE Clinical Skills exam (Step 2 CS) is 'going away'.

Reality Check: Fiction

Explanation:
The NBME, along with its collaborators in USMLE (the Federation of State Medical Boards and the Educational Commission for Foreign Medical Graduates), is committed to the assessment of clinical skills as part of the licensing examination sequence. In fact, a major recommendation from the Committee to Evaluate the USMLE program (CEUP) states: "CEUP recommends that the assessment of clinical skills remain a component of USMLE, but that USMLE consider ways to further enhance the testing methods currently used, in order to address additional skills important to medical practice. It is also recommended that the administrative challenges and costs to examinees associated with related testing formats be given substantial weight in the consideration of future changes."

This recommendation, among others, was approved by all three organizations that govern the USMLE program. The clinical skills examination is here to stay!

 

[pedstar09]

Do we really think this is going to happen? Let's be honest. Even if we have more than 20,000 signs for this petition, it is not going to be effective...unless AMA or AMSA student leaders step in and try to influence this decision.

 

[fantasty]

Do we really think this is going to happen? Let's be honest. Even if we have more than 20,000 signs for this petition, it is not going to be effective...unless AMA or AMSA student leaders step in and try to influence this decision.

That was kinda my point... Been there, done that. Before it happened. As it happened. 10 years after it happened.

But dare to dream!

 

[ThoracicGuy]

Do we really think this is going to happen? Let's be honest. Even if we have more than 20,000 signs for this petition, it is not going to be effective...unless AMA or AMSA student leaders step in and try to influence this decision.

Do you think AMA, much less AMSA really has ANY influence here?

They'll never get them to remove this requirement. I'm just glad I never had to take it.

 

[Psych_hopeful]

One question. If this is such a bad test and the NBME are a non-profit organization, why not remove it? Does that mean that NBME was "for-profit" all the time and they were actually lying about being "not-for-profit"?

 

[Xorthos]

One question. If this is such a bad test and the NBME are a non-profit organization, why not remove it? Does that mean that NBME was "for-profit" all the time and they were actually lying about being "not-for-profit"?

All non-profit means is that they can pay their board of directors a lot more money and write it off as a "business expense". As long as the money made goes back into the organization, they can earn as much as they want. It's in higher ups best interest to make as much money as possible, even in a non-profit organization.

 

[Psych_hopeful]

But shouldn't the focus be being effective at what you do rather than doing things because it makes you money? Because if physicians ordered expensive tests for no reason, that would be grounds for a lawsuit. Why then are test makers held to a lesser standard?

 

[akwho]

Step 2 CS has strong shades of the ABIM scandal (500k+ salaries for administrators, and a 2.5M luxury condo bought with MOC fees from working doctors). We are at the natural end point of regulatory capture. An independent body with unlimited power over the medical education certification process is now requiring a worthless $2,000 test with no oversight -- it just goes to feed their bloated salaries and lifestyles. They could give a damn less about the students struggling under mountains of debt, just turn on the federal loan spigot and they are bathing in gold doubloons.

 

[Psych_hopeful]

Ironic that in a profession where you have to justify everything you do that the test makers are free from this rule.

 

[Psych_hopeful]

Lol this petition now has 14000 signatures. And medical schools in the U.S. graduate around 18000 every year.

Could this actually work?

 

[akwho]

Here is a new LA Times article about the endstep2cs movement: http://www.latimes.com/opinion/op-ed/la-oe-0329-henderson-morris-step2cs-exam-20160329-story.html

 

[Psych_hopeful]

Lol. The Vice President of NBME said there that it was "vital" to patient safety in the comments. And he was voted down 3 times.

To think that the NBME would comment on this.

 

[Psai]

Do we really think this is going to happen? Let's be honest. Even if we have more than 20,000 signs for this petition, it is not going to be effective...unless AMA or AMSA student leaders step in and try to influence this decision.

Do nothing and nothing will change or do something and maybe something will change
I'll go with the second one. At the very least, it brings attention to the issue and puts pressure on the people making bank off of the test

 

[AStark]

Here is a new LA Times article about the endstep2cs movement: http://www.latimes.com/opinion/op-ed/la-oe-0329-henderson-morris-step2cs-exam-20160329-story.html

Why does the article keep mentioning US and Canadian students? Hardly anyone writes any of the USMLEs let alone Step 2CS. Otherwise we don't have any national standardized exams prior to the end of the med school when everyone takes the MCCQE1. The OSCE-style MCCQE2 is done a year or two into residency. I don't quite understand why Step 2CS is done in such limited locations. The MCCQE2 - similarly logistically challenging to organize - is held throughout the country.

 

[rokshana]

Why does the article keep mentioning US and Canadian students? Hardly anyone writes any of the USMLEs let alone Step 2CS. Otherwise we don't have any national standardized exams prior to the end of the med school when everyone takes the MCCQE1. The OSCE-style MCCQE2 is done a year or two into residency. I don't quite understand why Step 2CS is done in such limited locations. The MCCQE2 - similarly logistically challenging to organize - is held throughout the country.

probably because the LCME governs both US and Canadian schools and the writer used that terminology to make it easier for the reader to understand.

the same could be said of ANY of the exams...esp board certification and RE certification exams...they definitely add to the paperwork of a practicing physician, with no benefit to patients...med students can take the time out but all this MOC and recert stuff is bogging down practicing physicians...

 

[itscomplicated]

Have you had a chance to sign our petition? No need for giving personal info or donations and it does not matter where you are located. Help us fight the shortage of doctors in underserved areas! https://www.change.org/p/texas-legislature-and-governor-help-end-the-doctor-shortage

Although I personally think it's a great idea for a petition, I noticed that links from the poster of the End CS petition were closed by the mods (possibly because of multiple posts or in the wrong spot). I'm only saying this because I hope they'd move your post if there is a better place for it (rather than deleting or locking the post).

 

[AngryAsian]

I agree, Step 2CS is a terrible exam and it should be eliminated. When I started my mdphd program, there was no CS. And then it became a thing during the middle of my phd years. Still angry about that. 😡

That being said, I'm surprised the powers that be haven't converted Step 2CS from pass/fail to a numerical score like the other Steps. What better way to add unnecessary stress to the lives of medical students and continue the misuse of exams primary meant for medical licensure as residency/fellowship weed-out tools.