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Issue Eight - May 27, 2003

Information on the USMLE CSE

A Clinical Skills Examination (CSE) will become part of the United States Medical Licensing Examination™ (USMLE) in mid-2004. The USMLE CSE 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. Students and graduates of both U.S./Canadian and international medical schools will take the CSE.

The CSE 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.

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 the USMLE CSE 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 the USMLE CSE, passing performance on the CSA will continue to be accepted by ECFMG for the purpose of ECFMG Certification. Once implemented, passing the CSE will be required in order to apply for Step 3 of the USMLE. However, a prior passing performance on the ECFMG CSA will also satisfy this requirement.

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

The ECFMG CSA will be administered until spring 2004. There may be a brief period immediately prior to the implementation of the USMLE CSE when the ECFMG CSA will not be administered. Applicants who have not passed the ECFMG CSA prior to the implementation of the USMLE CSE must pass the CSE to satisfy the clinical skills requirement for ECFMG Certification. It is possible that CSA testing slots through spring 2004 will be filled before all applicants registered for the CSA have scheduled their CSA test dates. These applicants will take the CSE instead of the CSA.

The transition from the ECFMG CSA to the USMLE CSE 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 the information contained in this announcement. The table included in this issue outlines some of the similarities and differences between the ECFMG CSA and the USMLE CSE. Additional, important information regarding the CSE will be published as it becomes available.

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 policies and procedures related to the transition to the CSE. If you are interested in ECFMG Certification, refer to Resources on CSE below for the sources of information that you should review and monitor closely as the transition to CSE approaches.

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Resources on CSE

For more information on the USMLE CSE and the transition to CSE, IMGs interested in ECFMG Certification should:

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Comparison of Selected Policies associated with the ECFMG CSA and USMLE CSE



Exam Availability | Accepted for ECFMG Certification? | Examination Prerequisites | Educational Eligibility | Test Centers | Registration | Time Limit to Pass for ECFMG Certification | Validity for Entry into Graduate Medical Education | Required for NRMP Participation? | Meeting Eligibility Requirements for Step 3

 

ECFMG CSA

USMLE CSE
Exam Availability The ECFMG CSA will be administered until spring of 2004. There may be a brief period immediately prior to the implementation of the USMLE CSE when the ECFMG CSA will not be administered. The CSA will not be administered after implementation of the USMLE CSE. The target date for beginning administration of the USMLE CSE is June 1, 2004.
Accepted for ECFMG Certification? Yes. Although the ECFMG CSA will not be administered after implementation of the USMLE CSE, 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 the USMLE CSE 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 the USMLE CSE.
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 the CSE.), and
  • Satisfied the English language proficiency requirement for ECFMG Certification.
Educational Eligibility 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
Test Centers Atlanta, Georgia
Philadelphia, Pennsylvania		 Atlanta, Georgia
Chicago, Illinois
Los Angeles, California
Philadelphia, Pennsylvania
and one additional location, to be determined
Registration Applicants 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 the USMLE CSE. On-line and paper application materials will continue to be available via the ECFMG website.
Time Limit to Pass for ECFMG Certification ECFMG requires that IMGs pass those USMLE examinations required for ECFMG Certification (currently, Steps 1 and 2) within a 7-year period. This 7-year rule 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 the CSE will be a USMLE exam, applicants for ECFMG Certification must pass Step 1, Step 2, and the CSE within a 7-year period.
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.

The USMLE CSE will not expire for the purpose of entering GME. Additionally, with the implementation of the CSE, passing performance on CSA administrations taking place in the 3-year period before the implementation of the USMLE CSE will not be subject to expiration. As a result, examinees who pass the ECFMG CSA during the 3-year period before the implementation of the USMLE CSE 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.

 Once passed, the CSE 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, the CSE will be required for ECFMG Certification. As a result, IMGs who wish to participate in the Match must pass the CSE. IMGs who wish to participate in the 2005 Match must pass the CSE if they have not satisfied the clinical skills requirement for ECFMG Certification by passing the ECFMG CSA.
Meeting Eligibility Requirements for Step 3 Although the ECFMG CSA will not be administered after implementation of the USMLE CSE, passing performance on the CSA will satisfy the clinical skills requirement for taking Step 3. Applicants who have passed the ECFMG CSA will not be required to take the USMLE CSE in order to be eligible to apply for Step 3. Applicants for Step 3 must have passed Step 1 and Step 2. Since the CSE will be a component of Step 2, CSE must be passed before applying to take Step 3.
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Frequently-Asked Questions

  1. How will the CSE fit into the USMLE sequence?
  2. Who must take the USMLE CSE?
  3. I have already passed the CSA and am certified by ECFMG. Will I have to take the CSE to be eligible to take USMLE Step 3?
  4. How do I register for the CSE?
  5. When can I register for the CSE?
  6. How do I find out when and where I will take the CSE?
  7. Will there be a time limit for passing the CSE for ECFMG Certification?
  8. If an applicant passes one component of Step 2 but fails the other component, will he/she have to reapply, pay for, and retake both components?
  9. The ECFMG CSA is valid for 3 years for the purpose of entering GME. Will the USMLE CSE also expire for this purpose?
  10. I have not yet passed the CSA. Should I wait and take the CSE?
  11. How will the CSE differ from the CSA?

1. How will the CSE fit into the USMLE sequence?

The CSE will be a separate exam component of USMLE Step 2. The multiple-choice Step 2 exam that is currently administered will be referred to as the Step 2 – Clinical Knowledge component. The CSE will be the Step 2 – Clinical Skills component. For ECFMG Certification, IMGs must pass Step 1 (and the English language proficiency test) before applying for the CSE. All applicants for Step 3 must have passed Step 1 and both exam components of Step 2.

2. Who must take the USMLE CSE?

IMGs pursuing ECFMG Certification who have not passed the ECFMG CSA by the time administration of the CSA stops in spring 2004 will be required to pass the USMLE CSE to satisfy the clinical skills requirement for ECFMG Certification. Applicants who have passed the ECFMG CSA will not be required to pass the USMLE CSE for ECFMG Certification.

Students and graduates of U.S./Canadian schools (USMGs) will also be required to take the CSE. The CSE will become a requirement for USMGs, beginning with the graduating class of 2005.

3. I have already passed the CSA and am certified by ECFMG. Will I have to take the CSE to be eligible to take USMLE Step 3?

No. IMGs who have passed the ECFMG CSA will not be required to pass the USMLE CSE in order to be eligible to take USMLE Step 3.

4. How do I register for the CSE?

IMGs will register for the CSE with ECFMG. On-line and paper application materials will be available on the ECFMG website.

5. When can I register for the CSE?

Registration materials for the USMLE CSE are expected to be available in early 2004. Once registration materials are available, you can apply for the CSE as soon as you meet the eligibility requirements. Refer to the table included in this issue and to the ECFMG and USMLE websites for information on eligibility.

6. How do I find out when and where I will take the CSE?

Applicants registered for the CSE must take the exam within 12 months of their registration date. Registered applicants will be able to select a test date and location, subject to availability, via the Web. The CSE will be administered in several locations in the United States, including Atlanta, Georgia; Chicago, Illinois; Los Angeles, California; Philadelphia, Pennsylvania; and one additional location, which has yet to be determined.

7. Will there be a time limit for passing the CSE for ECFMG Certification?

Yes. Applicants must pass all USMLE exams required for ECFMG Certification within a 7-year period. When the CSE becomes part of the USMLE sequence in mid-2004, applicants will be required to pass Step 1 and both components of Step 2 within a 7-year period to be eligible for ECFMG Certification.

8. If an applicant passes one component of Step 2 but fails the other component, will he/she have to reapply, pay for, and retake both components?

No. The Step 2 – Clinical Knowledge component (the exam currently administered) and the CSE (the Step 2 – Clinical Skills component) will be separate exams. Applicants will register and pay for these exams independently, and will receive a score report for each exam. Applicants who fail one exam component of Step 2 are only required to retake the failed component.

9. The ECFMG CSA is valid for 3 years for the purpose of entering GME. Will the USMLE CSE also expire for this purpose?

No. Once passed, the CSE will not expire for the purpose of entry into GME.

Additionally, passing performances for CSA administrations in the 3-year period before the implementation of the CSE will no longer be subject to expiration, once the CSE is implemented. As a result, applicants who passed the ECFMG CSA during the 3-year period before the implementation of the USMLE CSE will not be required to revalidate expired CSA dates before entering GME and can enter GME regardless of the length of time that has passed between their passing performance on the CSA and their program start date.

10. I have not yet passed the CSA. Should I wait and take the CSE?

Administration of the CSE will not begin until mid-2004. Applicants who must satisfy the clinical skills requirement for ECFMG Certification before the implementation of the CSE should apply for and take the ECFMG CSA. This includes applicants who plan to participate in the 2004 Match, since the NRMP requires that IMGs pass all exams required for ECFMG Certification by the Rank Order List deadline in February 2004. The number of applicants seeking to take the CSA may exceed the number of testing spaces available in the months preceding the Match. If you plan to participate in the 2004 Match, you are strongly encouraged to apply for the CSA as soon as you become eligible and to schedule your CSA exam date as soon as possible.

ECFMG will continue to register applicants for the CSA until testing slots available through the last CSA administration date in spring 2004 have been filled. Registration for the CSE is expected to begin in early 2004. Some applicants may be able to choose which exam to take. Applicants considering whether to apply for the CSA or the CSE should carefully review the information available for both exams in the table included in this issue. Additional important information on the CSE, including information on exam format and score reporting, will be published as it becomes available. Applicants interested in applying for the CSE should closely monitor the ECFMG and USMLE websites to ensure an accurate understanding of CSE policies and procedures.

ECFMG expects to administer the CSA until spring 2004. There may be a period of time before the implementation of the CSE when the CSA will not be administered. CSA applicants who are unable to take the CSA before administration ends in spring 2004 will be required to take the CSE.

11. How will the CSE differ from the CSA?

The CSE, like the CSA, will be a one-day exam using encounters with standardized patients to assess the clinical and communication skills essential to treating and diagnosing patients and communicating with other health care professionals. Although the content and format of the exams will be similar, there will be some differences. Information on the content and format of the CSE will be published on the USMLE website, as it becomes available. For detailed information on the content and format of the CSA, refer to the CSA Candidate Orientation Manual, available on the ECFMG website.

Questions?

Send your questions regarding the transition to the CSE to: info@ecfmg.org.

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[last update: May 27, 2003]