USMLE™ Step 2 Clinical Skills (Step 2 CS) |
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USMLE™ Step 2 CS Update for ECFMG® RegistrantsThis publication, USMLE™ Step 2 CS Update for ECFMG® Registrants (Form 101S), provides the latest information on selected Step 2 CS policies and procedures. However, this update does not provide complete information. Applicants for Step 2 CS are governed by the policies and procedures described in the ECFMG 2004 Information Booklet, USMLE 2004 Bulletin of Information, and at the USMLE website. Updated information on Step 2 CS policies and procedures may be published on the ECFMG and USMLE websites at any time. Applicants for Step 2 CS should continue to monitor these websites. Before applying for Step 2 CS, you are required to read the:
You are also required to read the updated information on Step 2 CS available on the USMLE website. You can access all of these materials from the Step 2 CS application materials page. Overview of Transition from ECFMG CSA® to USMLE Step 2 CSA clinical skills examination will become part of the USMLE in June 2004. When this exam is implemented, USMLE Step 2 will consist of two separate components. The new clinical skills examination will be referred to as Step 2 Clinical Skills (Step 2 CS). The existing Step 2 exam will be referred to as Step 2 Clinical Knowledge (Step 2 CK). The Step 2 CS and CK components will be administered and scored separately from each other, and results will be reported separately. Step 2 CS will test examinees' ability to gather information from patients, perform a physical examination, and communicate their findings to patients and colleagues. Step 2 CS will supplement the existing USMLE exams, which measure medical knowledge and analytical skills through multiple-choice questions and computer-based case simulations. Step 2 CS will replace the ECFMG Clinical Skills Assessment (CSA) as the exam that satisfies the clinical skills requirement for ECFMG Certification. Although the ECFMG CSA will not be administered after implementation of Step 2 CS, passing performance on the CSA will continue to be accepted by ECFMG for the purpose of ECFMG Certification. Passing USMLE Step 2 CS will become a requirement to apply for USMLE Step 3. Currently, IMGs who apply for Step 3 must, among other requirements, have passed USMLE Step 1 and Step 2 and must either be certified by ECFMG or have successfully completed a Fifth Pathway program. (Fifth Pathway programs are described on page 4 of the USMLE 2004 Bulletin of Information.) Effective July 1, 2005, IMGs registered for Step 3 must also have passed either Step 2 CS or the ECFMG CSA. Prior to July 1, 2005, IMGs can register for Step 3 regardless of whether they have passed Step 2 CS or the ECFMG CSA. This policy applies to IMGs who are certified by ECFMG and those who complete a Fifth Pathway program. Description of Step 2 CSStep 2 CS is a one-day test that mirrors a physician's typical workday in a clinic and other settings. Examinees will examine eleven or twelve "standardized patients"--- people trained to portray real patients. These include a very small number of nonscored patient encounters, which are added for piloting new cases and other research purposes. Such cases are not counted in determining an examinee’s score. Examinees will typically be given 15 minutes for these encounters, and during the encounters they are expected to establish rapport with the standardized patients, elicit pertinent historical information, perform focused physical examinations, communicate effectively, and document findings and diagnostic impressions. After each encounter, examinees will record a patient note, including pertinent history and physical examination findings, diagnostic impressions, and plans for further evaluation if necessary. The cases will cover common and important situations that a physician is likely to encounter in common medical practice in clinics, doctors' offices, emergency departments, and hospital settings in the United States. As part of the case development process, practicing physicians and medical educators write and review cases to ensure that they are fair and valid. These cases represent the kinds of patients and problems that one might encounter as part of medical practice in the United States. Most cases are specially designed to elicit a process of history taking and physical examination that demonstrates examinees' abilities to list and pursue various possible diagnoses. Some cases, however, focus only on history taking or on physical examination. The cases that make up each administration of the Step 2 CS examination are based upon an examination blueprint. An examination blueprint defines the requirements for each examination, regardless of where and when it is administered. The sample of cases selected for each examination reflects a balance of cases that is fair and equitable across all examinees. On any examination day, the set of cases will differ from the combination presented the day before or the following day, but each set of cases has a comparable degree of difficulty. The intent is to ensure that examinees encounter a broad spectrum of cases reflecting common and important symptoms and diagnoses. The criteria that are used to define the blueprint and create individual examinations focus primarily on presenting complaints and conditions. Presentation categories include, but are not limited to, cardiovascular, constitutional, gastrointestinal, genitourinary, musculoskeletal, neurological, psychiatric, respiratory, and women's health. Examinees will see cases from some, but not all, of these categories. The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case. EligibilityRequired ReadingApplicants for Step 2 CS are required to read the appropriate applicant informational materials. Refer to Application Materials for a list of the required publications. Prerequisite ExaminationsBoth medical school students and graduates must have passed USMLE Step 1, and this passing performance must be valid for the purpose of ECFMG Certification. If ECFMG does not have your passing Step 1 score at the time your complete application is received, the application will be rejected. Passing performance on the Test of English as a Foreign Language™ (TOEFL®), which was a prerequisite for the ECFMG CSA, is not required to apply for Step 2 CS. IMPORTANT NOTE: Applicants who are registered for the ECFMG CSA are not eligible to apply for USMLE Step 2 CS. Applicants who have passed the ECFMG CSA are not eligible to take USMLE Step 2 CS, except under certain, well-defined circumstances. (See Retaking a Previously Passed Examination.) EducationThe education requirements for medical school students and graduates to take Step 2 CS are the same as those for taking the ECFMG CSA. For complete information, refer to Eligibility in the ECFMG 2004 Information Booklet. RegistrationTimingRegistration will begin in January 2004. Step 2 CS will be offered regularly throughout the year. There is no deadline for submitting your application to register for Step 2 CS. However, in planning the timing of your application, refer to Eligibility Period for information on how Step 2 CS eligibility periods are assigned. You should also consider deadlines imposed by the National Resident Matching Program (NRMP) and graduate medical education (GME) programs. (See Applying to Graduate Medical Education Programs in the ECFMG 2004 Information Booklet.) Finally, you should be aware that demand for test dates / centers at certain times during the year may exceed the number of testing spaces available. IMPORTANT NOTE: It is solely the responsibility of the applicant to complete the required exams in time to meet deadlines imposed by the NRMP and / or GME programs. Since the number of applicants seeking to complete Step 2 CS may exceed the spaces available in time to meet those deadlines, there is no guarantee that sufficient spaces will be available for all applicants to meet deadlines imposed by the NRMP and / or GME programs. Additionally, a delay in the release of initial Step 2 CS scores is anticipated. (See Scoring and Score Reporting.) ECFMG assumes no liability of any kind if an applicant does not complete Step 2 CS in time to meet NRMP and / or GME program deadlines. Application ProcessTo apply for Step 2 CS:
You can access the on-line and paper application materials on this website. Updated application materials may be published on the ECFMG website at any time. To apply for Step 2 CS, you must use the most recently published application materials. If you submit a paper application, you should confirm that you have the most current application materials by comparing the edition date in the lower left-hand corner of the materials that you have with the edition date of the Step 2 CS application materials available on this website. If the application you submit is not the most recently published edition, your application will be rejected, and you will be required to reapply using the most recently published application materials. Detailed application instructions are included with the application. Follow these application instructions carefully and answer all questions completely. You should review these instructions before you begin working on the application. Some of the necessary items require advance planning. These items include photographs, official signatures, and additional documentation, such as copies of your medical diploma if you are a medical school graduate. If your application is not complete, it will be rejected. Once ECFMG receives your complete application and payment and determines that you are eligible, ECFMG will send your scheduling permit, which is your authorization to schedule your testing appointment. You can check the status of your application on-line by accessing OASIS on the ECFMG website. FeeThe Step 2 CS fee is $1,200 (U.S. dollars / fee subject to change). Full payment is required at the time of application. If you do not include full payment, your application will be rejected. For complete information, see Payment in the ECFMG 2004 Information Booklet. Examinees with Documented DisabilitiesReasonable accommodations will be made for USMLE examinees with disabilities who are covered under the Americans with Disabilities Act (ADA). If you wish to apply for test accommodations, you must send your official request / documentation at the same time that you apply for the exam. The policies and procedures for requesting test accommodations for Step 2 CS are the same as those for requesting test accommodations for Step 1 / Step 2 CK. For complete information, refer to: Examinees with Documented Disabilities in the ECFMG 2004 Information Booklet, Examinees with Disabilities on page 11 of the USMLE 2004 Bulletin of Information, and to the Test Accommodations information on the USMLE website. Eligibility PeriodApplicants registered for Step 2 CS are assigned a twelve-month eligibility period that begins on the date that their registration information is entered into the Step 2 CS scheduling system. Typically, this is the same date that the registration process is completed. EXAMPLE: A complete application is received at ECFMG on July 15, 2004, and processing of the application is completed on July 28, 2004. The applicant will be assigned an eligibility period of July 28, 2004 - July 27, 2005. Applicants who are registered before the exam starts in June 2004 will be assigned a twelve-month eligibility period that begins on the first day the exam is available. Your eligibility period will be listed on your Step 2 CS scheduling permit. You must take the exam during your eligibility period. You can schedule a testing appointment for any available date in your eligibility period. Once your eligibility period is assigned, it cannot be changed. If you do not take the exam within your eligibility period, you must reapply, including payment of the examination fee, to take the exam. Although you cannot change your assigned eligibility period, you can reschedule a scheduled testing appointment within your eligibility period. See Rescheduling. Scheduling PermitOnce you are registered, ECFMG will send your Step 2 CS scheduling permit to the e-mail address in your ECFMG record. The scheduling permit contains your eligibility period, instructions on how to schedule your testing appointment, a description of the kind of identification that you must present at the test center, and other important information. You will also be sent by mail the 2004 Step 2 CS CD, which contains an orientation video and the Step 2 CS Content Description and General Information booklet. If you lose the scheduling permit, you can reprint it by accessing IWA on the ECFMG website. Clinical Skills Evaluation CentersStep 2 CS will be administered at regional Clinical Skills Evaluation Centers (CSECs) in the United States. The locations and expected dates of availability for the CSECs are:
These dates are subject to change. You should monitor the ECFMG website for updates. Registered applicants select their test center, subject to availability, when they schedule their testing appointment. An examinee travel guide for each CSEC is available on the ECFMG website; the travel guides provide information on travel to and lodging near the test centers. The CSECs are secured facilities. Once you enter the secured area of the test center for orientation, you may not leave that area until Step 2 CS has been completed. SchedulingScheduling for Step 2 CS will be available to registered applicants in January 2004. Once you receive your scheduling permit, you can schedule your testing appointment on-line by accessing Step 2 CS Scheduling on the ECFMG website. If you are unable to schedule on-line, you can call 215-966-3574 (9:00 AM - 5:00 PM, Eastern Time in the United States, Monday through Friday) to speak to a representative, who will access the on-line scheduling system for you. If you have been granted test accommodations, you should follow the scheduling instructions on your scheduling permit. You can use Step 2 CS Scheduling to browse available test dates in your eligibility period at each of the five test centers. You can access the scheduling system to check availability at any time without scheduling a testing appointment. Before accessing Step 2 CS Scheduling, you should review the important information in How Test Dates Become Available. To schedule a testing appointment, you must select a test date and a test center. The test date you select must fall within your eligibility period. Step 2 CS is administered in both morning (AM) and afternoon (PM) sessions. You will not be able to choose your test session. When you confirm a testing appointment, you will be assigned to either an AM or PM session. A PM session is assigned if, for that test date and center, AM sessions have been filled and PM sessions have been opened. The scheduling system will indicate for each date whether AM or PM sessions are currently being assigned, and you can continue to check available dates for one offering your preferred session. Before you confirm a testing appointment, you will be informed once again whether an AM or PM session will be assigned. After you confirm your testing appointment, you will be able to print a confirmation notice from the scheduling system. The confirmation notice includes your scheduled test date, session (AM or PM), test center, and other important information. You should bring the confirmation notice to the test center on your test date. If you lose the confirmation notice, you can reprint it by accessing Step 2 CS Scheduling on the ECFMG website. ReschedulingIf you have a scheduled testing appointment and are unable to take the exam on your scheduled test date or at your scheduled test center, you can cancel your scheduled testing appointment and reschedule for a different date and / or center, subject to availability. A fee is charged for this service. To cancel or reschedule, access Step 2 CS Scheduling on the ECFMG website. Before canceling and / or rescheduling a scheduled testing appointment, you will have the opportunity to view available test dates at all testing locations. Your rescheduled test date must fall within your assigned eligibility period. There is no limit on the number of times you can cancel and reschedule your testing appointment. However, a rescheduling fee is charged for each rescheduled testing appointment. Any change to a scheduled testing appointment constitutes rescheduling. You can cancel and reschedule at the same time, or you can cancel and reschedule later. You can cancel and / or reschedule at any time through the end of day before your scheduled test date. However, no canceling or rescheduling is allowed beginning at 12:00 AM, Eastern Time in the United States, on the scheduled test date until it is confirmed that you did not take the exam (typically one to two days). If you do not cancel and you miss your scheduled testing appointment, you can reschedule after this confirmation period. IMPORTANT NOTE: If you cancel without rescheduling or miss your scheduled testing appointment, there is no guarantee that testing appointments during your eligibility period will be available at a given test center, or at any test center, when you attempt to reschedule. If you do not reschedule within your eligibility period, you must reapply, including payment of the exam fee, to take the exam. There is no fee to cancel a scheduled testing appointment; fees are due at the time of rescheduling. However, Step 2 CS rescheduling fees are based on the date that you cancel your appointment, using Eastern Time in the United States. These fees increase as your scheduled test date approaches, as described below:
If you are unable to keep your scheduled testing appointment, you should cancel your appointment as soon as possible to minimize rescheduling fees, regardless of whether you are ready to reschedule. How Test Dates Become Available
Travel StatusYou are responsible for making the necessary travel and accommodation arrangements. If you are neither a U.S. citizen nor U.S. lawful permanent resident, you are responsible for obtaining required travel documents. These documents may include a visa to enter the United States. The requirements of the U.S. Department of Homeland Security (DHS) and U.S. embassies and consulates regarding issuance of visas and travel to and from the United States are subject to change. You should review current requirements before applying for a visa. For additional information, visit the DHS website and the embassies and consulates page of the U.S. Department of State, Bureau of Consular Affairs website. Upon request, ECFMG provides Step 2 CS applicants with a letter that may assist during the process of applying for a visa. The letter indicates that the applicant is registered for Step 2 CS, one of the exams required for ECFMG Certification. The letter also indicates that the applicant is required to travel to the United States to take the exam and provides the date by which the applicant must complete the exam. You can request this letter when you apply for Step 2 CS. ECFMG will send the letter to you via postal mail after completion of the registration process. If you are traveling from a distant location, you should consider arriving a day or two prior to taking Step 2 CS in order to be rested for the assessment. PreparationWhen the registration process is complete, ECFMG will mail a CD that contains orientation materials. These materials include the 2004 USMLE Step 2 Clinical Skills Content Description and General Information booklet and a video of sample patient encounters. The Step 2 CS orientation materials are also available on the ECFMG and USMLE websites. Acceptable IdentificationWhen you arrive at the test center on your test date, you must present acceptable identification to be admitted. The identification requirements for Step 2 CS are the same as those for Step 1 / Step 2 CK. Refer to Acceptable Identification in the ECFMG 2004 Information Booklet. Your name as it appears on the form(s) of identification you present must match exactly the name in your ECFMG record. The name in your ECFMG record will appear on your scheduling permit. You can also check your name of record by accessing OASIS on the ECFMG website. If the names on your identification and in your ECFMG record do not match exactly, you will not be allowed to take the exam. Refer to Name of Applicant in the ECFMG 2004 Information Booklet. Scoring and Score ReportingPerformance on Step 2 CS will be reported as pass or fail. Examinees who fail will receive performance profiles, which will reflect the relative strengths and weaknesses of the examinee's performance across the components of Step 2 CS. Three primary components of a Step 2 CS exam are assessed:
Passing performances on all three components in a single administration are required to obtain the overall designation of passing on Step 2 CS. IMPORTANT NOTE: A delay in the release of initial scores for Step 2 CS is anticipated. This delay will affect Step 2 CS examinees registered by both ECFMG and the National Board of Medical Examiners® (NBME®) and will affect Step 2 CS administrations at all test centers. Although specific information on the score reporting schedule for Step 2 CS is not available, it is unlikely that initial scores will be reported before the fall of 2004. Applicants for Step 2 CS should monitor the ECFMG and USMLE websites for additional information. Time Limit for Passing Step 2 CS for ECFMG CertificationECFMG policy requires that applicants pass those USMLE exam components required for ECFMG Certification within a seven-year period. Once you pass a USMLE exam component, you will have seven years to pass the other USMLE exam component(s) required for ECFMG Certification. If you do not pass all required USMLE exam components within a maximum of seven years, your earliest USMLE passing performance will no longer be valid for ECFMG Certification. IMPORTANT NOTE: These policies apply only to ECFMG Certification. The USMLE program has made specific recommendations to state medical licensing authorities regarding the time to complete all Steps. If you are taking the Steps for the purpose of licensure, refer to Time Limit and Number of Attempts Allowed to Complete All Steps on page 5 of the USMLE 2004 Bulletin of Information for more information. You should also contact the medical licensing authority of the jurisdiction where you plan to apply for licensure or the Federation of State Medical Boards, since licensure requirements vary among jurisdictions. Before implementation of Step 2 CS, applicants are required to pass Step 1 and Step 2 CK within a seven-year period for ECFMG Certification. After implementation of Step 2 CS, applicants must pass Step 1, Step 2 CK, and Step 2 CS within a seven-year period for ECFMG Certification; this new seven-year requirement will apply to applicants whose earliest USMLE passing performance that is valid for ECFMG Certification is on or after the date that Step 2 CS is implemented, as described below.
Reapplication and ReexaminationFor the purpose of ECFMG Certification, there is no limit on the number of times you can take Step 2 CS until you have passed it. IMPORTANT NOTE: This policy applies only to ECFMG Certification. The USMLE program has made specific recommendations to state medical licensing authorities regarding the number of attempts allowed to pass each Step. If you are taking the Steps for the purpose of licensure, refer to Time Limit and Number of Attempts Allowed to Complete All Steps on page 5 of the USMLE 2004 Bulletin of Information for more information. You should also contact the medical licensing authority of the jurisdiction where you plan to apply for licensure or the Federation of State Medical Boards, since licensure requirements vary among jurisdictions. Once you pass Step 2 CS, you may not repeat it, except as described in Retaking a Previously Passed Examination. Retaking a Previously Passed ExaminationRetaking a previously passed USMLE exam is allowed under certain, well-defined circumstances. These exceptions to the USMLE policy on reexamination are explained in Time Limit and Number of Attempts Allowed to Complete All Steps on page 5 of the USMLE 2004 Bulletin of Information. The same exceptions to the USMLE policy on reexamination that apply to the existing USMLE exams will also apply to Step 2 CS and the ECFMG CSA. Once Step 2 CS is implemented, applicants who retake a previously passed Step 2 exam will be required to take both Step 2 CK and Step 2 CS. Retaking an Examination That Was Failed or IncompleteIf you fail or do not complete Step 2 CS, you may retake it, but you must reapply, including payment of the appropriate fee(s). You may not retake Step 2 CS within sixty days of your last attempt on Step 2 CS. Additionally, you cannot take Step 2 CS more than three times in any twelve-month period. Attempts on the ECFMG CSA will be counted as attempts on Step 2 CS for these purposes. If you do not take the exam during your eligibility period, you must reapply, including payment of the appropriate fee(s), if you wish to take the exam. Validity for Entry into Graduate Medical EducationAccording to ECFMG policy, a passing performance on Step 2 CS will not expire for the purpose of entering graduate medical education. Additional InformationThe implementation of Step 2 CS will result in significant changes to some policies and procedures related to ECFMG Certification. It is essential that physicians who are certified by ECFMG or pursuing ECFMG Certification be familiar with these changes. Additional information will be published as it becomes available. To ensure an accurate understanding of current policies and procedures, you should monitor the following resources closely as the implementation of Step 2 CS approaches.
If you have questions about the transition to Step 2 CS that are not answered by these resources, forward your questions to ECFMG by e-mail at info@ecfmg.org. |
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