USMLE Announces Development of Modified Clinical Skills Examination

Posted November 22nd, 2020 by .


The cancellation of the Step 2 CS Examination by the USMLE Program has had a profound impact on the medical licensure landscape, not only in the United States, but across the globe.   For many years, a large number of international (non-U.S.) medical schools have conditioned graduation upon a student’s passage of the USMLE Step 2 CS examination.  International Medical Graduates (IMGs) are required to pass Step 2 to obtain a ECFMG Certificate, the absence of which altogether precludes an IMG from obtaining a training (residency) position anywhere in the United States.

Response to Lack of Clinical Skills Assessment Examination 

Because of the cancellation of the Step 2 CS exam, many medical colleges have temporarily waived passage of Step 2 CS as a requirement for graduation, often substituting the CS exam with an OSCE (Objective Structured Clinical Examination) regimen.   In response to the cancellation of the Step 2 CS exam, ECFMG developed the “Alternative Pathways to Temporary ECFMG Certification”, which pathways have been the subject of several prior blog posts. While the Alternative Pathways continue to evolve, many IMGs have found themselves “locked out” of temporary certification via the pathways for reasons that seem unclear.  On several occasions since the institution of the Alternative Pathways, ECFMG has permitted “exceptions” to the new rules, while simultaneously identifying to which new rules no exceptions will be considered.

Just as the impact to the COVID-19 pandemic cannot be known for many years, so can the impact upon the medical field and, specifically, residency training programs, not readily be ascertained.  But certain is the fact that thousands if not tens of thousands of individuals seeking to train in the United States have had their career trajectory stalled because of the cancellation of the Step 2 CS exam and an inability to otherwise qualify.

Development of Modified CS Exam

On November 19, 2020, the USMLE Program released a brief podcast regarding the development of a new, modified clinical assessment examination.  Per the release:

We recognize that there will be many questions regarding when exam administrations will begin, the content that will be tested, how the exam will be scored, further specifics about exam format and delivery, and performance feedback, among others. These are being investigated and defined as part of the next phase – the design phase – of this work.  We are also cognizant of the important implications that relaunching the modified Step 2 CS exam will have on residency match timelines, curriculum calendars, and temporary eligibility policy changes that are in effect for both USMLE Step 3 and Educational Commission for Foreign Medical Graduates (ECFMG®) certification. Ultimately, we strive to relaunch the exam at a time that balances these many factors. We anticipate that we will be able to provide information regarding a projected implementation date in early 2021.

projected implementation date

USMLE and ECFMG frequently post updates, which can be found at USMLE and ECFMG




For more than 10 years, Dennis L. Abramson has dedicated a significant portion of his practice to counseling and representing medical students, IMGs, residents, fellows, and practicing physicians in compliance and disciplinary matters related to ECFMG, USMLE, NBME, and NRMP, including responding to and defending allegations of irregular behavior and violations of the Match® agreement. Should you need advice or counsel with a related issue, please contact Mr. Abramson at 610-664-5700 or

Mr. Abramson regularly updates this page with the latest developments related to ECFMG, USMLE, NRMP, ABIM, irregular behavior, and physician licensing and credentialing issues, so check back soon.

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