Report D: Resolution 1-2011 Withdraw Support for the USMLE Step 2 CS Examination: CLINICAL SKILLS PORTION of PART II EXAMINATION

PRESENTED BY:   Robert W. Monteiro, MD, President

REFERRED TO:     Reference Committee No. 1 –  Timothy M. Beittel, MD, Chair

Resolution 1-2011, Withdraw Support for the USMLE Step 2 CS Examination: CLINICAL SKILLS PORTION of PART II EXAMINATION was introduced at the 2011 Annual Meeting of the House of Delegates, by Dawn Brezina, MD, delegate of the Durham-Orange County Medical Society.  The Resolution called for the NCMS to adopt the following:

 RESOLVED, That the North Carolina Medical Society make public to its members information about the expensive clinical skills test that is now incorporated in Part 2 of the USMLE board examination (action); and be it further

RESOLVED, That the North Carolina Medical Society delegation to the AMA present a resolution to withdraw AMA support for the Clinical Skills II Examination and propose a standardized format for documenting clinical skills that 1) tests clinical skills and 2) keeps the testing process local and inexpensive (action).

Reference Committee I recommended that Resolution 1-2011 be referred to the Board of Directors for study and report back. The House of Delegates supported this recommendation.

Resolution 1-2011 was then referred by the NCMS Board of Directors to the Ethical and Judicial Affairs Committee for further consideration. 

At the June 2, 2012 meeting of the Ethical and Judicial Affairs Committee, committee members discussed the history of the clinical skills examination and noted several points.

Arguments made in support of the resolution: 

  • While not all medical schools require clinical skill testing, a majority if not all teach clinical skills using a standard method known as “Objective Structured Clinical Exam” or OSCE.
  • The exam comes at great personal cost to students at $1355, not including travel to one of only five test sites: Philadelphia, Atlanta, Houston, Chicago or Los Angeles.
  • The resolution’s whereas statements argue that the exams lacks evidence-based data to support its system of evaluation.
  • The exam boasts an extremely high pass rate which may indicate a lack of necessity.

Arguments made in opposition to the resolution: 

  • Although North Carolina’s medical schools have always made clinical skill testing a part of their curriculum, this is not true of all medical schools.  Support for this exam shows support for national standards in education and testing. Requiring this exam will also require medical schools across the country to “teach to the exam” which is valuable in this case.
  • In previous years this exam was required only for international medical graduates and was shown to be effective as that community grew to represent over 25% of the graduate community. Support for this exam shows support for parity.
  • The clinical skills examination not only provides necessary review of a student’s ability to perform a physical examination, but also provides much needed evaluation of communication skills – an area often overlooked by medical school curriculum.
  • The expense of this examination is due to the high quality facilities and professionals involved in testing and is comparable to the expense of other tests required during medical education.   It was reported that Wake Forest recognizes the value of this examination to the extent that the University pays the cost for its students.
  • A member of the committee representing Duke University noted that this test serves an important function in that a national body certifies that all graduating medical students can show up on time, wash their hands, examine patients and communicate effectively – all to the same standard. This is important for the public to see.
  • It was noted that the AMA has discussed this test several times in Reference Committee C over the past 5 years, and that the AMA really has no say in how this test is run. It was argued that this issue is not an appropriate task for the AMA delegation as suggested by the resolution.

Following a lengthy discussion, the Ethical and Judicial Affairs Committee found that the benefit of the Clinical Skills Examination in identifying inadequately trained professionals outweighs the expense and inconvenience of the test and urge continued support by the NCMS.

The NCMS Board of Directors at its meeting on September 8, 2012, approved the following recommendation from the Ethical and Judicial Affairs Committee which is hereby submitted to the House of Delegates for action. 


That the following be adopted and the remainder of the report be filed:

That Resolution 1-2011 be filed.  

Fiscal Note:  No additional funding above current resources estimated.  Current resources will be allocated based on the priorities of the Society and the NCMS budget.

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1 Comment

  • Robert Monteiro, MD

    I support the filing of Resolution 1-2011. I was present at the Ethical and Judicial Affairs Committee discussion and the arguments made are well represented in the report.