Step 2 CS, administered by NBME, is an exam for medical students meant as a proxy to demonstrate their competencies in a variety of skills related to communication and patient interactions. However, the exam is largely considered unnecessary, unhelpful, and costly. Now that NBME has announced its decision to transition the exam to a virtual format due to COVID-19, under the guise of practicing and evaluating telehealth skills, we believe that the need to end Step 2 CS is stronger than ever. A virtual Step 2 CS rolled out too quickly will very likely be unvalidated, unable to be compared to prior Step 2CS scores, unhelpful to residency programs, and unknown to students and residency programs. 

The medical community at large has recognized the incredible importance of strong communication skills for medical students, and Step 2 CS was meant to evaluate these skills and ensure that schools upheld this value. Today, most medical schools have a strong, and growing, focus on communication skills. Schools emphasize the need for students to be able to actively listen, express empathy, and use appropriate jargon-free language with patients and families. Many schools have a CS-style evaluation with standardized patients at some point (or multiple) during training. Thus, the school should already be able to speak to the student's communication skills, which can also be surmised from letters of recommendation, clerkship evaluations, and residency interviews. Given a residency program's ability to review an applicant's communication skills in other ways, Step 2CS adds minimal value to the overall application. While the exam may have served a clear purpose in prior years, Step 2CS no longer provides significant meaning for students, schools or residency programs. 

When Step 2 CS is transitioned to a "telehealth" or virtual platform, it will lose any of its remaining credibility. Residency program directors will likely be unable to utilize the data from a new Step 2CS exam that they feel has not been thoughtfully designed or rigorously tested. At this time, it seems that NBME plans to roll out a virtual version of this exam within only a few months of the suspension of in-person exams. Residency programs won't have an understanding of the exam or how it was designed, and will be aware that students were provided little time or preparation for this brand new exam. Thus, they won't be able to interpret the scores in a meaningful way. Now that NBME plans to quickly roll out a virtual version of an exam that already held little value, residency programs will very likely ignore an applicant's test result. 

Students will have little time to prepare for a brand new exam modality, with a clear lack of information about how to prepare, what types of patient interactions to expect, or how the grading works. Additionally, students and standardized patients alike will almost inevitably encounter technical issues along the way.

Previously, students were expected to conduct appropriate physical exams for standardized patients based on the patient's concerns and history. With a virtual version of the exam, there is clearly no way to evaluate a student's physical exam techniques. Additionally, a virtual exam will give no indication of a student's skills or style with regards to face-to-face interactions with patients. This will essentially be testing an entirely separate set of communication skills particular to telehealth encounters. While this skill set is arguably vital for future physicians to learn given the growth of telehealth, most students have not had any training whatsoever in this area. Yet NBME is willing to administer a brand new exam, required of all students, testing a skill set that none of us have learned or practiced. Ultimately this means students' performances will either be A) below par, thus providing a falsely low pass rate, or B) underwhelming but excused due to the newness of the exam and technical issues, thus providing a meaningless pass.

We highlight this, not to indicate a preference for an in-person exam, as we strongly believe Step 2 CS provides minimal value in either format, but rather to highlight that the change prevents NBME/USMLE from accomplishing their own goals when they created the exam. From the USMLE website: "Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues." 

If many students, schools, and residency programs already felt the exam added little value to an application, then moving to a virtual format will only reduce any of that value by completely eliminating the physical exam and preventing genuine in-person interactions. Thus, realizing the exam's limited added value in its prior format, and given the extreme circumstances preventing in-person exams to be conducted, we believe this provides the opportune moment for NBME to, at least temporarily, end the administration of Step 2 CS. 

To continue to force medical students to take an exam for which they'll be unprepared, to receive a score that will hold very little value for residency programs, proves that NBME is not upholding its responsibility to provide students and residency programs with helpful data and information. 

For all the hoops that medical students have to jump through during their training and application process, Step 2 CS was already a particularly challenging barrier for students. At $1300 to sign up for the exam, in addition to airfare to one of only a handful of cities where it's available, the exam adds to the cost-prohibitive nature of medical school that ultimately supports an extremely privileged system. Taking Step 2 CS has been widely considered unnecessary for years, and is now even less useful in the time of a pandemic if it were to be moved to an unvalidated virtual platform. 

As medical students, we are highly discouraged from ordering any test that won't change patient management. Yet this is exactly what Step 2CS will be: an unvalidated test that provides little contribution to the application process. Join us in our call to eliminate Step 2 CS altogether. Stand up for students, not for a corporation that makes over $100 million per year.