Level 2 Performance Evaluations Postponed Indefinitely

The move came a little more than two weeks after the Federation of State Medical Boards and the National Board of Medical Examiners — co-sponsors of the United States Medical Licensing Examination — announced plans to discontinue the USMLE Step 2 Clinical Skills exam.  

The NBOME said in a statement that it is developing a temporary alternative pathway for graduates from the class of 2021 (and earlier) to meet the eligibility requirements for the COMLEX-USA Level 3 exam. Additionally, the organization said it will convene a special commission that will review the future of Level 2-PE and determine potential alternative pathways for 2022 graduates.

Karen Mitchell, M.D., director of the AAFP’s Medical Education Division, said the Academy recognizes “the importance of demonstrating clinical competency,” but she also noted that the AAFP updated its Clinical Skills Assessment Exam for Medical Students policy last year to address issues with both Step 2 CS and Level 2-PE.

“Our AAFP policy asks these boards to consider options for clinical skills assessment that are affordable and accessible for all medical students, including use of standardized exams within the medical school environment,” Mitchell said.

Rebecca Stoll, M.S., a third-year student at the Alabama College of Osteopathic Medicine, said Level 2-PE was “a burden on students” because the exam itself cost more than $1,000. It also required travel expense and time away from rotations for most students because the exam was offered only at two sites — Chicago and Philadelphia. The USMLE Step 2 CS exam had received similar criticism.

NBOME said in its statement that it was deferring work on a temporary clinical skills testing site that had been scheduled to open in May in California.

“From the interactions I’ve had with other osteopathic students, the majority of students want the exam to go away altogether,” said Stoll, a student delegate to the AAFP’s Congress of Delegates. “We’re hoping the special commission will at least come up with something that’s local. I’ve heard from students who believe schools are best equipped to assess our ability to take care of patients because they’ve worked with us for four years.”

Stoll pointed out that the pass rate of Level 2-PE is higher than 90% and added that schools should take responsibility for identifying students who cannot pass an assessment and address their shortcomings.

“We’re constantly being clinically evaluated,” Stoll said. “We take a dozen standardized OSCEs (Objective Structured Clinical Examinations) in our preclinical years. We’re evaluated during every clerkship rotation by preceptors, via standardized evaluations, in our third and fourth years.”

OSCEs are used in both allopathic and osteopathic medical schools to assess students’ clinical skills. Unlike USMLE Step 2 CS, the Level 2-PE includes osteopathic manipulation medicine. But, again, Stoll said, “students would rather be evaluated by our schools than travel for an expensive exam.”

Stoll said more students from underrepresented groups are needed in the physician workforce, especially in primary care. Lowering the cost of education could help, she said.

“The more we can do to reduce the cost of medical education, the more diverse our workforce will become and the better our health outcomes will be,” she said. “Patients like to see themselves reflected in those taking care of them.”