With the recent nixing of CS, I am wondering if anyone is aware of any sort of talks of doing away with Step 3 as well? I would imagine the NBME would very extremely averse to eliminating another huge source or revenue, but I know that many think step 3 is just as useless. I am asking because I am 4th year med student who will be graduating shortly and was planning on taking it before even starting my intern year (I will be going into a highly specialized field and will never need to know the material on step 3 again for the most part and would like to get it out of the way). However, I am a little hesitant on spending the $$$ on this now, just to find out it will also be nixed by the time I need to have it done in residency. Already pissed that I was one of the last people who had to spend all that money on CS :/
Any rumors or whisperings would me much appreciated!
From a policy standpoint, I disagree. At the end of the day, your license to practice medicine needs to stand for something. The passage of Step 3 (after which you can apply for state licensure) indicates you've learnt the fundamentals of medicine so in the event of a random medical event, you can at least come up with a viable differential and first steps. Practically, a lot of residents/fellows leave medicine and there are some positions which require licensure but not board certification so having a broad exam to strengthen licensure requirements is a good thing for that. Also, the same argument (aversity to hoop jumping) can be applied to everything we have been doing since undergrad. Was organic chemistry necessary to be admitted to medical school? Is anatomy with emphasis on dissection required for all fields? Subspecialties have also already accounted for USMLE Step 3 by simply requiring completion of the exam and ignoring the score and by emphasizing their own training exams, etc. if they still care about exam scores.
Additionally, let's be real here. The USMLE/NBME did not cancel Step 2 CS because they suddenly agreed with students and realized it had little value. They had something else already in the works and COVID just accelerated the decision to permanently scrap Step 2 CS as it was. Further proof of evident by looking at what happened to the DO equivalent. They unfortunately still have to take their CS equivalent. I was reading an article the other day and it seems the main reason the DO board is still enforcing their exam is because they recently invested a few million dollars in renovation of it. The NBME (per my speculation) probably had their own plans for renovation too but hadn't put their $$$ down yet which makes it easier to cut ties with the exam. It's unfortunate the NBME did coordinate with their DO equivalent before making a decision given we're all effectively the same now.
All this said, there is one way I could see Step 3 discontinued and that's if NBME/USMLE creates a new set of exams with different names and creates a timeline for these to be administered without missing a beat. Nothing in the near future (this year or next) IMO. I've been saying this for years but will briefly outline the steps.
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1.) Cut the minutiae (detailed biochemistry, anatomy minutiae, and a few more things schools teach) out of the curriculum and make Step 1 more clinical. Things having been already moving in this direction but time to just scrap Step 1 and create something else. That exam should be taken before clerkships and it should essentially be what Step 2 is. That will effectively drive schools to be more clinically oriented from day 1. I'm tired of the argument that what differentiates us from midlevels is XYZ. If it is getting in the way. What should differentiate us is our admissions standard and the extent to which we have mastered medical knowledge during medical school.
2.) Create some form of a practical exam but it should not be taken at a random center and graded like it is. It should be administered at each medical school. Schools can then have the freedom to design certain parameters to fit their mission. Schools that are ahead of the curve on healthcare equity can dock points for insensitive interviewing techniques. There should still be specific standards for the practical detailed in an outline published on the NBME website for schools to base their exam off of. When the LCME visits schools, they should ensure this practical exam's content and execution is appropriate.
3.) There should be a third exam taken near the end of medical school training. It should be standardized and cover what is essentially Step 3. That way, Rad-Onc doesn't need to be worry about it after medical school. This will push schools to create better didactics/assessments during the last two years of medical school. I feel like during the first two years the didactics are great but clinical skills are lacking and vice versa in years 3 and 4. Some schools step up to the plate and teach these clinical schools students but many schools just allow students to run through the motions for clerkships and don't bat an eye at their medical knowledge so long as they pass the shelf exams designed to test esoteric diseases. Then come residency time, there is a glaring lack in basic medical knowledge (EKGs, CXRs, Indications for Oxygen Support/Lines, Sepsis management)
