Over the last few weeks, I’ve been keeping busy traveling across the US. After a pit stop in Puerto Rico for Purvi’s Bachelorette Party, a weekend in Boston with Ronak, and adventures in the North End with Nina, I made my way to Los Angeles, California for the Step 2 CS exam.
For those that are still wondering what I was doing in LA, the CS exam is one part of the USMLE Step 2 Exam. It’s comprised of 12 encounters with patient actors, each 15 minutes long with an additional 10 minutes to write a progress note. With the patients, we take a focused history, physical exam and patient counseling. In real life, new patients with an acute problem generally need more than 15 minutes to be seen but this has to be standardized. This exam in only offered in 5 cities: Philly, Chicago, Atlanta, Houston and LA.
In my particular exam, I would say that somewhere between 25 and 50% of the examinees were foreign medical graduates. For them, the $1000 registration fee was topped of by an equally expensive plane ride to one of the 5 aforementioned sites.
Being in LA, I had high expectations for the patient actors that I would encounter. As I was told by Amit, 40,000 aspiring actors move into LA yearly…you figure some of them must try to make a quick buck acting as patients. Man, were the actors awful. Every patient encounter involves some sort of diffiicult questions…something like “Do you think I am dying?” or “Do you think I have cancer?” All I can say is I have never seen people less concerned about dying or having cancer
I am over-exaggerating a bit, I did have 1 or 2 patients who did a stand up job acting. Despite how great they were, the contrived nature of the encounter could not be avoided. In a regular day at the office, you rarely have to spend 15 minutes with 12 different patients and have to get a full past medical history, family history, social history, ect. In terms of the encounter itself, you walk into the room – you know that there is something going on, which is not always the case with real people. You also know that they have memorized pages of information related to their case…and they aren’t up-front with any of it which is unlike real people. You also know that you are being graded…which is unlike the real world. Like my friend Jim says, it’s hard not to feel like you are fighting these people for information that you know they have.
While I understand the ultimate idea behind the exam. It seems a little silly to me that the thousands of medical students graduating from accredited American Medical Schools regulated by the LCME should each spend over $1000 to take an exam which proves that they are competent during a patient encounter. It seems like it should be the responsibility of the medical school to evaluate the competency of their own students. It’s hard to believe that an individual with poor clinical skills could make it through 3rd or 4th year without one or two red flags. BU employs its own version of this exam with 6 encounters with standardized patients trained at U Mass called the End of Third Year Assesment (EOTYA). Its is run the same way as the CS exam. In this assessment, there is a minimum needed to pass. To be honest, I found no difference between the EOTYA and the CS exam. Since the CS exam is Pass/Fail – there really seems to be no benefit to taking this standardized exam as part of the USMLE series vs getting the ok from one’s medical school.
With so much national concern over the number of people going into specialties, it’s a little funny that medical students are asked to add another $1000+ in loans to take an exam that barely requires half a day to study for. At least, that is my opinion on the matter.