The Step 2 Clinical Skills Exam — A Poor Value Proposition

Lehman, Elmer Philip; Guercio, Jason R.

doi:10.1056/nejmp1213760

Cited by 20 publications

(11 citation statements)

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“…There is also an argument that additional layers of intrastate and interstate regulation involving certification, credentialing, and accreditation, interwoven with regulatory politics, makes it very complicated for practitioners and public alike (Rehm & DeMers 2006). Advocates of NLEs infer that the standards associated with the testing process are improved as a result of the logistics of staging large-scale examinations, which necessarily require the pooling of resources and expertise (Neumann & Macneil 2007;Lehman & Guercio 2013). Furthermore, it may also be financially advantageous by economies of scale (Lehman & Guercio 2013).…”

Section: Resultsmentioning

confidence: 99%

The medical licensing examination debate

Archer

Lynn

Coombes

et al. 2016

Regulation & Governance

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National licensing examinations are typically large-scale examinations taken early in a career or near the point of graduation, and, importantly, success is required to subsequently be able to practice. They are becoming increasingly popular as a method of quality assurance in the medical workforce, but debate about their contribution to patient safety and the improvement of healthcare outcomes continues. A systematic review of the national licensing examination literature demonstrates that there is disagreement between assessment experts about the strengths and challenges of licensing examinations. This is characterized by a trans-Atlantic divide between the dominance of psychometric reliability assurance in North America and the wider interpretations of validity, to include consequences, in Europe. We conclude that the debate might benefit from refocusing to what a national licensing examination should assess: to achieve a balance between assessing a breadth of skills and the capacity for such skills in practice, and focusing less on reproducibility.

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Section: Resultsmentioning

confidence: 99%

The medical licensing examination debate

Archer

Lynn

Coombes

et al. 2016

Regulation & Governance

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“…Already, Step 2 CS has significantly influenced the curricula of many medical schools. Despite early concerns about its justification and cost-effectiveness, 12,13 there has been growing recognition of the substantial positive influence of Step 2 CS on the clinical education of young physicians. 14,15 The markedly higher passing standards introduced in 2017 further underscore its value, but also increase concerns for students who fail the exam.…”

Section: Discussionmentioning

confidence: 99%

Identifying Students at Risk of Failing the USMLE Step 2 Clinical Skills Examination

Rosenthal

Russo

Berg

et al. 2019

Fam Med

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Background and Objectives: New standards announced in 2017 could increase the failure rate for Step 2 Clinical Skills (CS). The purpose of this study was to identify student performance metrics associated with risk of failing. Methods: Data for 1,041 graduates of one medical school from 2014 through 2017 were analyzed, including 30 (2.9%) failures. Metrics included Medical College Admission Test, United States Medical Licensing Examination Step 1, and clerkship National Board of Medical Examiners (NBME) Subject Examination scores; faculty ratings in six clerkships; and scores on an objective structured clinical examination (OSCE). Bivariate statistics and regression were used to estimate risk of failing. Results: Those failing had lower Step 1 scores, NBME scores, faculty ratings, and OSCE scores (P<.02). Students with four or more low ratings were more likely to fail compared to those with fewer low ratings (relative risk [RR], 12.76, P<.0001). Logistic regression revealed other risks: low surgery NBME scores (RR 3.75, P=.02), low pediatrics NBME scores (RR 3.67, P=.02), low ratings in internal medicine (RR 3.42, P=.004), and low OSCE Communication/Interpersonal Skills (RR 2.55, P=.02). Conclusions: Certain medical student performance metrics are associated with risk of failing Step 2 CS. It is important to clarify these and advise students accordingly.

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“…Consider the proposed analogy to the USMLE Step 2 Clinical Skills examination (Horner et al 2020). Critics have pointed out, however, that this examination lacks an evidence-base and is not cost-effective (Flier et al 2016;Lehman and Guercio 2013). Objective Structured Clinical Examinations (OSCE), a method used to evaluate a range of skills, are also not optimal, as the psychometric properties of OSCE rating scales have been found to be of intermediate quality (Comert et al 2016).…”

Section: Examination Formatmentioning

confidence: 99%

The Healthcare Ethics Consultant-Certified Program: Fair, Feasible, and Defensible, But Neither Definitive Nor Finished

Antommaria

Feudtner

Benner

et al. 2020

The American Journal of Bioethics

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In June 2018, the Healthcare Ethics Consultant (HCEC) Certification Commission (the Commission) began accepting applications, and since then three candidate cohorts have received the Healthcare Ethics Consultant-Certified (HEC-C) designation. While these individuals have reported favorable experiences, concerns about the HEC-C program-both the certification process and what the designation represents-exist.As members of the Commission, we welcome dialogue about these concerns and wish to enhance understanding of the Commission's reasoning behind key aspects of the HEC-C program. This program is part of an evolving system of professional structures, for which much work remains. In developing the HEC-C program, we were guided by well-established standards. The HEC-C program is not set in stone, but instead will evolve over time. We hope that transparency will encourage productive dialogue, improving the practice of, and access to, healthcare ethics consultation.

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The Step 2 Clinical Skills Exam — A Poor Value Proposition

Cited by 20 publications

References 1 publication

The medical licensing examination debate

The medical licensing examination debate

Identifying Students at Risk of Failing the USMLE Step 2 Clinical Skills Examination

The Healthcare Ethics Consultant-Certified Program: Fair, Feasible, and Defensible, But Neither Definitive Nor Finished

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