Step 2 CS has been discontinued.

[QuizzicalApe]

My theory is that some bigwig finally got around to watching Marie Kondo on Netflix, and realized there was not a single person for whom CS sparked joy

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[bananafish94]

This is amazing news and every sane person (including, I'm sure, the NBME administrators) recognize that it was one of the greatest scams ever perpetrated on the American education system. My question though is...what do they know that we don't? This test made the NBME a LOT of money. And people have hated it as long as it's existed, and it's consistently been universally recognized as a scam. Knowing them, they wouldn't just give up this cash cow without a fight.

 

[Redpancreas]

This is amazing news and every sane person (including, I'm sure, the NBME administrators) recognize that it was one of the greatest scams ever perpetrated on the American education system. My question though is...what do they know that we don't? This test made the NBME a LOT of money. And people have hated it as long as it's existed, and it's consistently been universally recognized as a scam. Knowing them, they wouldn't just give up this cash cow without a fight.

I suspect they were working on blue prints for the replacement to CS and with the pandemic saw no reason to force CS on students and took this opportunity to part ways. I think the NBOME was looking to renovate the "PE" test itself and got burnt when NBME cancelled their version. The two should really coordinate more. Regardless, if my suspicion's true, I hope whatever the new thing is uses the medical school's own resources. I could see a system where they give medical schools the onus of administering/grading their own exam which would essentially be an OSCE provided it meets NBME standards. The relative and/or absolute performance can be reported in Dean's letters. This would:

1) Reduce the financial burden on students (or pessimistically schools may just hide it in their 50K tuition).
2) Give school's flexibility to incorporate elements that align with their mission statement (health equity, etc.).
3) Allow more transparency in the grading of the exam so students don't fail for an idiosyncrasy they were unaware of.
4) Give residencies a metric potentially more translatable to patient care.
5) Once #4 happens, schools will be incentivized to help those struggling (i.e. improve history, exam, and clinical reasoning skills).
6) Allow the exam to be updated yearly to incorporate new developments (i.e. COVID).

 

[Pier]

Checking at the ECFMG certification websitre they say Step 2 CS is "suspended", so perhaps it will come back (?).

 

[Med Ed]

Checking at the ECFMG certification websitre they say Step 2 CS is "suspended", so perhaps it will come back (?).

Probably. There is an actual justification for giving a CS-style exam as part of ECFMG certification.

 

[ChordaEpiphany]

I believe some USMLE Step II CS review course people are pretty devastated...

While I have absolutely no sympathy for these people, it's sort of crazy how quickly the NBME makes these choices, and you wonder how people adjust. For step 1, it was a little hint that maybe they'd talk about it, and then suddenly it was off the table. This left a lot of MD/PhD students (rightfully) miffed that they'd basically spent 2 years of their life on something that is now an afterthought. Especially since now we're going to be going through step 1 hell all over again (but this time with kids and stuff ).

As an MD/PhD student, the quickness with which they make these decisions does scare me a bit. If they keep on this direction (i.e. make step 2 P/F), I'll have literally nothing to distinguish myself from other students. It makes the MD/PhD sort of useless if you can't distinguish yourself and wind up at a top place for fellowship to secure a K-grant, and I bet that would happen to tons of MD/PhDs who would get passed over by the virtually indistinguishable top 10 grads.

Certainly happy for this change, but the NBME's volatility definitely leaves me a bit uneasy.

 

[Med Ed]

While I have absolutely no sympathy for these people, it's sort of crazy how quickly the NBME makes these choices, and you wonder how people adjust. For step 1, it was a little hint that maybe they'd talk about it, and then suddenly it was off the table. This left a lot of MD/PhD students (rightfully) miffed that they'd basically spent 2 years of their life on something that is now an afterthought. Especially since now we're going to be going through step 1 hell all over again (but this time with kids and stuff ).

As an MD/PhD student, the quickness with which they make these decisions does scare me a bit. If they keep on this direction (i.e. make step 2 P/F), I'll have literally nothing to distinguish myself from other students. It makes the MD/PhD sort of useless if you can't distinguish yourself and wind up at a top place for fellowship to secure a K-grant, and I bet that would happen to tons of MD/PhDs who would get passed over by the virtually indistinguishable top 10 grads.

Certainly happy for this change, but the NBME's volatility definitely leaves me a bit uneasy.

The road to InCUS was years in the making. CS got killed because of the pandemic, but it has been the subject of increasing criticism for a long time. There is currently no movement whatsoever to convert Step 2 CK to P/F, and the program director contingent will fight to the death to keep a scored national exam. Unless there is a massive overhaul of the ERAS/NRMP system I don't think it's remotely feasible to switch Step 2 CK to P/F.

 

[mvenus929]

Re Step 1:

If the argument is med school grades vs a numerical Step 1, it's not even a question that an objective test all students take provides much more value. Otherwise, why don't we just do away with the numerical MCAT and SATs. Let's just use high school grades and a P/F SAT.

It's not the opinions of professors that matter; it's what the licensing exam assesses that does. Ideally, medical school professors would stay educated by going through all of the NBME material themselves, distill down exactly what the licensing exam wants, and then teach that content to students, demonstrating and explaining that what they're teaching is straight from the exams. Instead, students essentially get two distinct curricula: one from their med school, and the other from USMLE resources. Students are left in a tug of war between the two, where they interfere with each other. The truth is, the internet / USMLE resources are arbitraging out the need for medical schools, which are becoming increasingly obsolete. One could learn more sitting in an apartment in Iceland doing three Qbanks compared to someone attending daily classes at a US med school and not studying USMLE material.

We are discussing two different aspects to Step 1. Its original intention was a test that would screen for basic competence in training physicians. It was never intended to be used as a scored test, and the scores don't predict any meaningful outcomes. Sure, it's a way to distinguish students from each other, but what measure does that provide? Those who are innately more book smart? Those who are good at memorization? Does that translate to being a better physician (which is what residencies should care about)? Those who did worse on Step 1 likely worked just as hard, if not harder, to get their score than those who scored well. And your point is salient--if students are focusing only on what is tested on Step 1 and not the other knowledge and skills that might *actually* make them better physicians, than de-incentivizing the goal of doing extremely well should shift that focus.

For residency selection, there needs to be a shift in focus to what residencies actually care about. Each one has different goals in their learners and wants to attract a certain type of person, but it's hard to filter applications based on 'soft' variables, and programs receive *so* many applications. That's why those advocating for Step 1 to go P/F are simultaneously advocating for a fundamental change in residency applications.

Re 2CS:

I'm still yet to read any cogent arguments as far as why elimination of 2CS strengthens the medical licensing exam sequence. That the exam might seem like a nuisance to deal with in and of itself is not a sufficient line of reasoning. If Covid hadn't hit, 2CS wouldn't be going anywhere. This was a purely financial decision, not one related to strengthening of the licensing exam sequence.

It's the notion that it's superfluous in the first place is what I don't agree with. The exam wasn't removed because it had nominal/ostensible value. It was removed because Covid made it financially infeasible. It was just a business decision.

I also challenge this assertion. If the test provided something of true *value*, then they would have found a way to keep it around. Problem is--no one really found any use for it in the first place, so COVID just accelerated the decision to stop administering it. Yes, it was a financial decision on the part of NBME, but that was in the background of no one finding any significant use for the exam in the first place. Heck, it wasn't even part of the required series until 2004. You wanna tell me that physicians who graduated before 2004 have worse clinical skills than those who graduated later?

Residencies 'cared' about the exam because you needed a pass to get a license. If a potential resident couldn't get a license, that was an annoyance, as they wouldn't be able to start on time. It raised some eyebrows if you failed because so many people passed it, but it didn't actually provide any meaningful information about people's clinical skills because it was P/F and didn't provide any comments or feedback about deficiencies (except to the examinee). OSCEs administered by schools can provide information to the school, which can then be incorporated into an overall evaluation of the student and their strengths and weaknesses.

 

[Lawpy]

The road to InCUS was years in the making. CS got killed because of the pandemic, but it has been the subject of increasing criticism for a long time. There is currently no movement whatsoever to convert Step 2 CK to P/F, and the program director contingent will fight to the death to keep a scored national exam. Unless there is a massive overhaul of the ERAS/NRMP system I don't think it's remotely feasible to switch Step 2 CK to P/F.

I'd like to hope Step 2 CK remains scored but once the mania hits and people start ditching the wards for CK prep, things will look bad

Unless optimistically, attendings start failing or low passing students for ditching the wards.

 

[ChordaEpiphany]

The road to InCUS was years in the making. CS got killed because of the pandemic, but it has been the subject of increasing criticism for a long time. There is currently no movement whatsoever to convert Step 2 CK to P/F, and the program director contingent will fight to the death to keep a scored national exam. Unless there is a massive overhaul of the ERAS/NRMP system I don't think it's remotely feasible to switch Step 2 CK to P/F.

That's reassuring. Thank you.

 

[Gern Blansten]

Has the COMLEX made any decision on whether they will keep their version of this exam?

 

[DrStephenStrange]

Has the COMLEX made any decision on whether they will keep their version of this exam?

That was suspended as well.

 

[mvenus929]

That was suspended as well.

It was suspended for COVID. I haven't heard any updates about them canceling it permanently. The latest I can find just allows a pathway to certification for those in the classes of 2020 and 2021.

 

[DrStephenStrange]

It was suspended for COVID. I haven't heard any updates about them canceling it permanently. The latest I can find just allows a pathway to certification for those in the classes of 2020 and 2021.

And 2022

 

[mvenus929]

And 2022

Okay... still says temporary all over that page. USMLE has permanently canceled it, and so far, COMLEX has only temporarily canceled it. Looks like they're just trying to get validation to find a replacement that will also cost money, but aren't making 2022 pay the fees yet.

 

[Redpancreas]

Okay... still says temporary all over that page. USMLE has permanently canceled it, and so far, COMLEX has only temporarily canceled it. Looks like they're just trying to get validation to find a replacement that will also cost money, but aren't making 2022 pay the fees yet.

Maybe this has already been mentioned, but the vibe I got about this was that NBMEs opinion of CS was waning and COVID ended the relationship like ya’ll said. NBOME, on the other hand, had actually just pumped a lot of money into it even during the pandemic because they had some grand idea. When the NBME cancelled their version, it screwed over the NBOME which was eventually and reluctantly strong armed by their constituents to cancel their grand plan. I wouldn’t put it past them to come up with something analogous to the COMLEX PE that will further emphasize components proprietary to osteopathic medicine while including whatever they were planning pre-cancellation announcement.