Change in the Performance Standard of the Step 2 CS Examination that Will Affect Examinees Testing on or after January 1, 2013

As stated in the USMLE Bulletin of Information and as explained in a previous posting to the USMLE website, the level of proficiency required to meet the recommended minimum passing level for each USMLE Step examination is reviewed periodically and may be adjusted at any time. Notice of such review and any adjustments are posted on the USMLE website.

At its December 2012 meeting, the Step 2 Committee conducted such a review for USMLE Step 2 Clinical Skills (CS). During the meeting, the Step 2 Committee considered information from multiple sources, including:

  1. Recommendations from independent groups of physicians who participated in content-based standard-setting activities in 2012;
  2. Results of surveys of various groups (e.g., state licensing representatives, medical school faculty, examinees) concerning the appropriateness of current pass/fail standards for the Step 2 CS examinations;
  3. Data on trends in examinee performance;
  4. Data on precision of pass/fail classifications.

The results of the review are described below. Because numerical scores are not reported for Step 2 CS, the decisions of the Step 2 Committee are reflected in terms of potential impact on examinees using data from recent administrations.

The Step 2 Committee decided to increase the performance levels required to receive a passing outcome on two of the three Step 2 CS subcomponents: Communication and Interpersonal Skills (CIS) and Integrated Clinical Encounter (ICE). There will be no change to minimum passing requirements for the Spoken English Proficiency (SEP) subcomponent of Step 2 CS at this time.

These changes will be applied to Step 2 CS examinees testing on or after January 1, 2013.

Because of the changes that were made to the design and content of the ICE and CIS subcomponents earlier this year, as announced, the ability to use historical trends to predict the impact of the changes in minimum passing requirements is limited. If the new minimum passing requirements were applied to the group of first-time examinees who recently tested under the new examination structure, the overall passing rate for examinees from U.S. medical schools would be approximately three percent lower and the overall passing rate for examinees from international medical schools would be approximately eighteen percent lower.

The impact of these changes on future examinees will depend on the examinees’ performance. The overall impact will be reviewed by the Step 2 Committee when more examinees have tested under these new requirements.