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Comment & Response
February 2017

Value in the Step 2 Clinical Skills Examination—Reply

Author Affiliations
  • 1Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2017;177(2):293. doi:10.1001/jamainternmed.2016.8233

In Reply My coauthors and I agree with Gupta and Gruntmanis that there should be a broader discussion involving US and international medical schools about curricular standardization to assure all graduates are meeting standards. Even in its current form, the Step 2 Clinical Skills (CS) examination highlights discrepancies between licensure requirements for international and US medical students. First, international graduates must pay $250 more for the examination, in addition to the cost of travel from another country to 1 of 5 US cities. Moreover, international graduates fail the Step 2 CS exam at a rate 5 times higher than US or Canadian students,1 yet the United States Medical Licensing Examination (USMLE) does not provide sufficient data to clarify whether factors such as English proficiency, variations in accent, or racial bias have substantial effects on this discrepancy. Thus, it is important for the medical community to clarify the goal of a clinical skills examination. If one of the primary purposes is to assure English fluency for international graduates, there could be more efficient, cost-effective assessments than Step 2 CS.

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