With the launch of the 2022 Match season a few months away, USMLE has decided it will cancel the Step 2 Clinical Skills (CS) exam that has been a required part of US
residency program applications since 2004. The test had been suspended last May with the advent of Covid-19 when USMLE said it would take 12-18 months to consider ways
to modify the exam in light of the global health crisis. The January 26 announcement makes the suspension permanent. The USMLE statement went on to add, “We have no
plans to bring back Step 2 CS, but we intend to take this opportunity to focus on working with our colleagues in medical education and at the state medical boards to determine
innovative ways to assess clinical skills.”
Meanwhile, ECFMG has announced that it will be expanding and clarifying its Pathways that has been serving as alternative ways for International Medical School Graduates
(IMGs) to meet Match requirements in lieu of taking Step 2 CS. ECFMG is the organization responsible for certifying the eligibility of IMGs for participation in US-based
medical education programs.
This article explores the two announcements relative to the cancellation of Step 2 CS and provides insights for IMGs.
What is USMLE and what is Step 2 CS?
The United States Medical Licensing Examination® (USMLE®) is an organization that administers exams for graduates of US and International Medical Schools as part of the
requirements to become a licensed physician in the United States. These exams are referred to as Steps 1, 2, and 3, with Step 2 divided into two parts: Clinical Knowledge
and Clinical Skills. Until May 2020, medical school graduates had been expected to pass all of these exams prior to starting a US-based residency program. Step 2 CS is an
experience-based test that includes a series of 12 fifteen-minute interactions with patients. Due to concerns about Covid-19 exposure during the testing for graduates,
patients, and medical staff, USMLE announced what was then thought to be a temporary suspension of Step 2 CS. Those graduates who had not yet taken the exam
for their 2021 match requirements were subsequently provided with alternate measures.
Why did USMLE decide to retire the Step 2 CS?
While there may be other reasons for taking the final decision, the board members were reacting to a student-initiated petition calling for the end of Step 2 CS. The petition was started several years ago by US medical graduates and had garnered several thousand signatures from both US and IMGs by the time board members began consideration of the proposed resolution in November 2020. As reasons for drafting the petition, the authors cited what was described as excessive costs for administering and taking the test, and they also questioned the basis for the test given that almost all test-takers (both USMGs and IMGs) passed the test on the first or second attempt. Having already suspended the test in order to consider modifications to it and recognize the rapidly changing nature of both medical education and technology, the organization decided to retire the test as a requirement for the 2022 Match season and beyond.
What, if anything, will replace the Step 2 CS requirement?
The responsible organizations continue to review their options. Meanwhile, at least for the 2022 Match season, IMGs can expect to continue to access the temporary
alternative set of options originally known as The Five Pathways. ECFMG had developed these to help 2021 Match applicants meet their requirements. In its recent
announcement, ECFMG said it has identified a sixth pathway designed to evaluate clinical skills. “As a result of the addition of this sixth pathway and changes to certain
eligibility requirements,” the statement says, “We expect more IMGs to be eligible to pursue a pathway for the 2022 Match.”
ECFMG also will continue to require IMGs to pass the Occupational English Test (OET) that is specifically designed for physicians.
IMGs who applied to a pathway for the 2021 Match and whose 2021 application was rejected can reapply to a pathway for the 2022 Match.
Where can I go to get more information about these new developments?
Anyone with questions about the Step 2 CS discontinuation and any other USMLE- related inquiries are encouraged to please contact the USMLE support team:
ECFMG will be making further announcements regarding its six pathways and encourages IMGs to monitor its website for updates.
IMGprep is not associated with the NRMP® or the MATCH®