Many are celebrating the news that USMLE Step 2 CS is no more.

It was a burdensome and costly exam, and no doubt there were good reasons for this decision.

My first reaction was yay... then it mellowed. I'm gonna "think out-loud" to explore why.

Thread 1/ https://twitter.com/TheUSMLE/status/1354138565886828546

As stated in the letter, the purpose of the FSMB, NBME, and these licensing exams is to protect the public.

That is an important and challenging charge.

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Even when we go to a restaurant, a barber shop, a car mechanic - there are certification bodies that try to reduce the risk of us getting food poisoning, losing an ear, or losing control of the car as we drive off the lot.

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So let's just imagine not being a physician and hearing that there will no longer be a certification exam for doctors' clinical skills.

I bet it sounds something like "Pilots no longer have to pass a landing exam."

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It's now only up to each of the ~200 schools to rubber stamp competency...

...and by the way, schools are in the business of graduating their students, not failing them.

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Steps 1, 2 CK, 3 remain.

But fundamentally, computer-based exams assess our ability to interpret information that is given to us.

It is an entirely different skill to gather that information. @AndreMansoor

No to mention communicating and connecting with people.

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Certification aside, there's a clear understanding in education that "assessment drives learning."

I remember prepping for my first MS1 standardized patient exam and thinking critically about exam sequence, technique, and narration to optimize efficiency and patient comfort.

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Then practicing it until it felt natural.

I wish I could say that I subsequently reflected on and refined these habits before/after each real patient I saw...

But it was mostly before other SP exams, including Step 2-CS.

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Evidence also shows that assessment not only drives learning, but each episode of assessment *is* learning.

I remember finishing CS and thinking dang, that was the best clinic ever. Just me and the patients. So much good (and safe) practice/experience.

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I remember coming home after residency in-training exams, head buzzing with all the questions I wasn't sure about, and spending hours looking them up and either saying YESSSS or DOHHH ok I won't forget that again.

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All this to say...

Tests are hard. And imperfect. And important.

There were many things wrong with CS, and on the balance, it may well be a good thing that it's gone.

But to act like it had 0 value is to lose an opportunity to retain or regain that value...

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I think #MedEd folks realize this. But I think it's important for all students, residents, practicing docs, and everyone else to appreciate this too. Because popular opinion matters and shapes big decisions.

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The statement says that some assessment of communication and data gathering could be done through the other Steps, including with improving computer-based simulations. I hope so. It'll be something.. but not enough imo.

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The statement also says that FSMB & NBME "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"

Good. Easy to say, hard to do... and critical.

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For example, med schools can't cut back on their (difficult and costly) clinical skills assessments (e.g. SP exams) because their students no longer have to pass Step 2CS.

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In fact, more rigorous clinical assessments at the school level are necessary now that the national-level assessment (and thus learning) no longer exists.

But the costs, challenges of standardization, disincentives for stringency, and other challenges are huge.

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These are just musings and my knowledge of the relevant literature is incomplete.

I just know for sure there's a lot work to be done, and hope our community is up for the challenge.

@jbcarmody @boedudley @CincyIM @StephVSherman

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