Clinical Skills in the Age of Google: A Call for Reform and Expansion of the USMLE Step 2 CS

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The past year has seen the rise of a movement devoted to ending the United States Medical Licensing Examination Step 2 Clinical Skills (CS) exam. Cited reasons have focused on the expense, limited accessibility, and questionable psychometric properties of the exam. Indeed, the $1,275 exam is offered in only five cities and has a 96% first-time pass rate.1 Nonetheless, calls for its termination are shortsighted and misdirected.
Current trends point to medicine’s ongoing and inevitable transformation into a bona fide service profession. Remuneration models and evaluation metrics that heavily weigh patient satisfaction increasingly tie physicians and hospitals to a domain largely driven by patient–clinician rapport.2 In addition, the epidemiological shift toward chronic disease means that medicine will increasingly center on long-term therapeutic alliances. This paradigm will render the patient–physician interaction important for clinical outcomes, as well as for processes of care. Moreover, my generation’s virulent individualism promises to magnify the import of patient voice and expression. Above all, the technological revolution spurred by search algorithms will increasingly make rote medical knowledge obsolete.3 During my short career as a medical student, my relationship with search engines has been marked by an odd mix of appreciation and despair. The search engine’s ability to take signs and symptoms and return disease labels with shocking accuracy has forced me to reconsider my priorities for the preclinical years.
Despite its growing importance, critical assessment of approaches to patient–physician interaction has lagged. While clinical science is subjected to empirical evidence, patient interaction is still largely taught at the bedside.
Admittedly, there is little evidence to suggest that Step 2 CS, in its current form, advances the goal of fostering better patient–physician communication. However, at the very least, it forces medical schools to adhere to a minimal set of universal criteria in teaching communication. Step 2 CS needs reform and medical education needs a test like the Step 2 CS more than ever. It is dangerous to weaken medical licensure at a time of rapid change and upheaval.
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