Transition to USMLE™ Step 2 Clinical Skills (Step 2 CS)

[Anonymous]

Overview

A clinical skills examination will become part of the United States Medical Licensing Examination™ (USMLE™) in mid-2004. When this exam is implemented, USMLE Step 2 will consist of two separate components. The new clinical skills examination will be referred to as Step 2 Clinical Skills, or Step 2 CS. The current Step 2 will be referred to as Step 2 Clinical Knowledge, or Step 2 CK. Students and graduates of both U.S./Canadian and international medical schools will take Step 2 CS.

Currently, international medical students and graduates (IMGs) must pass the ECFMG® Clinical Skills Assessment (CSA®) to fulfill the clinical skills requirement for ECFMG Certification. When Step 2 CS is implemented, it will replace the ECFMG CSA as the exam that satisfies the clinical skills requirement for ECFMG Certification. Although the ECFMG CSA will not be administered after implementation of Step 2 CS, passing performance on the CSA will continue to be accepted by ECFMG for the purpose of ECFMG Certification. Passing Step 2 CS will be required in order to apply for Step 3 of the USMLE. IMGs should closely monitor this web page and the USMLE website at www.usmle.org for the effective date of this requirement. Passing performance on the ECFMG CSA will also satisfy this requirement.

The target date for beginning administration of Step 2 CS is June 1, 2004. IMGs will apply to ECFMG to take Step 2 CS, and registration is expected to begin in early 2004. Step 2 CS will be administered throughout the year at several locations in the United States. Applicants registered for Step 2 CS will be able to select test dates and locations, subject to availability.

The ECFMG CSA will be administered until spring 2004. There may be a brief period immediately prior to the implementation of Step 2 CS when the ECFMG CSA will not be administered. It is possible that all available CSA testing slots will be filled before all applicants registered for the CSA have scheduled their CSA test dates. Applicants who have not passed the ECFMG CSA prior to implementation of Step 2 CS can satisfy the clinical skills requirement for ECFMG Certification by passing Step 2 CS, provided that they meet the Step 2 CS eligibility requirements.

The transition from the ECFMG CSA to USMLE Step 2 CS will result in significant changes to some policies and procedures related to ECFMG Certification. IMGs who are certified by ECFMG or pursuing ECFMG Certification should be familiar with these changes. The table below compares selected policies, as they relate to the ECFMG CSA and USMLE Step 2 CS, with which IMGs should be familiar. As additional information regarding Step 2 CS becomes available, details will be provided on this web page and on the USMLE website.

It is essential that IMGs interested in ECFMG Certification, including those who have already passed or plan to take the ECFMG CSA, have an accurate understanding of the policies and procedures related to the transition to Step 2 CS. If you are interested in ECFMG Certification, refer to Resources on Step 2 CS below for important resources that you should monitor closely as the transition to Step 2 CS approaches.

[Anonymous]

Description of Step 2 CS

Step 2 CS will assess the clinical and communication skills that are essential to diagnosing and treating patients and communicating with other health care professionals. The new exam will complement the current USMLE Steps, which measure medical knowledge and analytical skills.

Step 2 CS will be a one-day exam that mirrors a physician's typical workday in a clinic. Examinees will examine "standardized patients," people trained to portray real patients. Examinees are expected to establish rapport with the standardized patients, elicit pertinent historical information from them, perform focused physical examinations, answer questions, and provide counseling where appropriate. After each exam, examinees will record pertinent history and physical examination findings, list diagnostic impressions, and outline plans for further evaluation if necessary. The cases will cover common and important situations that a physician is likely to encounter in a general ambulatory clinic. Standardized patients are selected to represent a broad range of age, racial, and ethnic backgrounds.

[Anonymous]

Comparison of Selected Policies Relating to the ECFMG CSA & USMLE Step 2 CS: Important Information for IMGs

(First paragraph in each segment is the ECFMG CSA and second is USMLE Step 2 CS)

Exam Availability

• The CSA is offered regularly, throughout the year.
  The ECFMG CSA will be administered until spring of 2004. There may be a brief period immediately prior to the implementation of Step 2 CS when the ECFMG CSA will not be administered. The CSA will not be administered after implementation of Step 2 CS.
  
  Step 2 CS will be offered regularly, throughout the year.
  The target date for beginning administration of Step 2 CS is June 1, 2004.

Accepted for ECFMG Certification?

• Yes. Although the ECFMG CSA will not be administered after implementation of Step 2 CS, passing performance on the CSA will continue to be accepted for ECFMG Certification. Applicants who have satisfied the clinical skills requirement for ECFMG Certification by passing the ECFMG CSA will not be required to take Step 2 CS for ECFMG Certification.
  
  Yes. Applicants who have not satisfied the clinical skills requirement for ECFMG Certification by passing the ECFMG CSA can satisfy this requirement by passing Step 2 CS (provided that they meet the Step 2 CS examination and education eligibility requirements).

Eligibility:

• Examination Prerequisites

• Must have:
  Passed USMLE Step 1 (or its equivalent), and
  Satisfied the English language proficiency requirement for ECFMG Certification.
  
  Must have:
  Passed USMLE Step 1 (Passing performance on former basic medical science exams will not satisfy the eligibility requirements for Step 2 CS.)

Eligibility:

Education

• Students:
  At the time of application and on the exam date:
  Must be officially enrolled in a medical school located outside the United States and Canada that is listed in the International Medical Education Directory (IMED).
  The "Graduation Years" in the school's IMED listing must be listed as "Current."
  By the exam date:
  Must be within 12 months of completing the full didactic curriculum.
  
  Graduates:
  Must be a graduate of a medical school located outside the United States and Canada that is listed in IMED.
  Graduation year must be included in the medical school's IMED listing.
  Applicant must have had at least 4 credit years (academic years for which credit hours have been given toward completion of the medical curriculum) in attendance.
  
  SAME for Step 2 CS

Test Centers

• Atlanta, Georgia
  Philadelphia, Pennsylvania
  
  Atlanta, Georgia
  Chicago, Illinois
  Houston, Texas
  Los Angeles, California
  Philadelphia, Pennsylvania

Application

• IMGs register for the CSA with ECFMG. Applicants can visit the ECFMG website to apply on-line or to obtain paper application materials.
  
  IMGs will continue to apply to ECFMG for Step 2 CS. On-line and paper application materials will continue to be available via the ECFMG website. See Applying for Step 2 CS.

Fee

• $1,200
  
  SAME

Scheduling

• Applicants must schedule a CSA date within 4 months of their registration date, and must take their CSA within 12 months of this date. Applicants are assigned to either the Philadelphia or Atlanta test center during the scheduling process.
  
  Applicants must take Step 2 CS within 12 months of their registration date. Applicants can select a testing location, subject to availability, at the time of scheduling.

Scoring

• PASS/FAIL designation
  
  SAME
  A delay in the release of initial scores for Step 2 CS is anticipated. This delay will affect Step 2 CS examinees registered by both ECFMG and NBME. Monitor the ECFMG and USMLE websites for additional information.

Exam Components

• 1. Integrated Clinical Encounter, made up of
  Data Gathering
  Patient Note
  2. Doctor-Patient Communication, made up of
  Interpersonal Skills
  Spoken English Proficiency
  
  To pass the CSA, examinees must pass both components.
  
  
  1. Integrated Clinical Encounter, made up of
  Data Gathering
  Patient Note
  2. Communication/Interpersonal Skills
  3. Spoken English Proficiency
  
  To pass Step 2 CS, examinees must pass all 3 components

Reexamination

• There is no limit on the number of attempts to pass the CSA for ECFMG Certification.
  However, the following restrictions apply:
  After 1 failed attempt, the applicant must wait at least 3 months before retaking the CSA.
  After 2 failed attempts, the applicant must wait at least 6 months before retaking the CSA.
  After 3 or more failed attempts, the applicant must wait at least 1 year before retaking the CSA.
  
  There is no limit on the number of attempts to pass Step 2 CS for ECFMG Certification.
  However, applicants may not retake Step 2 CS within 60 days of their last attempt on Step 2 CS. Additionally, they may not take Step 2 CS more than 3 times in any 12-month period.

Time Limit to Pass for ECFMG Certification

• ECFMG requires that IMGs pass those USMLE examinations required for ECFMG Certification (currently, Step 1 and Step 2 CK) within a 7-year period. This policy does not apply to CSA, since it is not a USMLE exam.
  
  ECFMG will continue to require that IMGs pass those USMLE examinations required for ECFMG Certification within a 7-year period. Since Step 2 CS will be a USMLE exam, applicants for ECFMG Certification must pass Step 1, Step 2 CK, and Step 2 CS within a 7-year period; this requirement will apply to applicants whose earliest USMLE passing performance that is valid for ECFMG Certification is on or after the date that Step 2 CS is implemented.

Validity for Entry into Graduate Medical Education

• Currently, passing performance on the CSA is valid for 3 years for the purpose of entering a program of graduate medical education (GME). This means that individuals whose most recent CSA pass is older than 3 years who have not entered GME must revalidate their passing performance by passing another CSA before starting a program.
  According to ECFMG policy, Step 2 CS, once passed, will not expire for the purpose of entering GME. Additionally, with the implementation of Step 2 CS, passing performance on CSA administrations taking place in the 3-year period before the implementation of Step 2 CS will not be subject to expiration. As a result, examinees who pass the ECFMG CSA during the 3-year period before the implementation of Step 2 CS will not be required to revalidate expired CSA dates before entering GME. These individuals may enter GME regardless of the length of time that has passed between their passing performance on the CSA and their program start date.
  
  
  According to ECFMG policy, Step 2 CS, once passed, will not expire for the purpose of entering GME

Required for NRMP Participation?

• The National Resident Matching Program (NRMP) requires that IMGs who wish to participate in the Match pass all examinations required for ECFMG Certification. Since passing the CSA is currently required for ECFMG Certification, IMGs must pass the CSA to participate in the Match.
  
  Once implemented, Step 2 CS will be required for ECFMG Certification. As a result, IMGs who wish to participate in the Match will be required to pass Step 2 CS. To participate in the 2005 Match, IMGs who are required to satisfy the clinical skills requirement for ECFMG Certification and who have not satisfied this requirement by passing the ECFMG CSA must pass Step 2 CS.

Meeting Eligibility Requirements for Step 3

• Although the ECFMG CSA will not be administered after implementation of Step 2 CS, passing performance on the CSA will satisfy the clinical skills requirement for taking Step 3.
  
  Passing Step 2 CS will be required in order to apply for Step 3 of the USMLE. IMGs should closely monitor this web page and the USMLE website at www.usmle.org for the effective date of this requirement.

[Anonymous]

Applying for Step 2 CS

IMGs will apply to ECFMG to take Step 2 CS, either by completing an on-line application using ECFMG's Interactive Web Application (IWA) or by downloading paper application materials from the ECFMG website and submitting them to ECFMG.

Registration for Step 2 CS is expected to begin in early 2004. IMGs interested in applying for Step 2 CS should monitor this website closely for application policies and procedures.