Michigan State Medical Society held their annual House of Delegates meeting this past weekend, with some exciting developments on the state level, the most groundbreaking being the first state policy in opposition to USMLE Step2CS. For most doctors in attendance, this was the first they’d heard of the new Step exam, now required of all medical students. The test, initially created for international graduates, has been required for all medical school graduates since 2004 but recently gained national attention through the hard of work of Harvard medical students in the EndStep2CS petition campaign. The unnecessary costs and outrageous executive salaries are researched extensively at the Step2CS website, it is stunning to see what these examination boards are getting away with. It’s not just AMBS and MOC, this is industry-wide rot and corruption. The EndStep2CS video sums it up:
There are many ways to fight back against these testing corporations, but it is definitely an uphill battle and hard to know where to start. The MSMS resolution, written by University of Michigan 3rd year student Andrew Zureick, and introduced with Michigan State University 4th year Nicholas Harrison and Wayne State University 3rd year Tamara Roumayah has a very innovative solution to the problem. Rather than simply ask for elimination of the test, they put the onus back on the medical schools. They ask that passage of a school-based clinical skills equivalent count as Step2CS. This is a smart solution, because it returns responsibility back to the medical schools and takes power away from the testing corporations, while still holding clinical skills education and competency to the highest standards. I encourage all medical student delegates to use this model language in your own House of Delegates, and for physician delegates to present and defend these resolutions on behalf of the students.
However, this resolution did not pass easily, and there are lessons learned in Michigan for other student and physician delegates pursing similar resolutions in their state medical societies. The resolution was initially rejected by the committee, who felt a better solution would be to advocate for lower costs and increased testing sites. I cannot blame the committee entirely, this resolution was submitted as a late resolution, so they were not able to review the extensive research before testimony and deliberations. This was the first time anyone on the committee had heard of Step2CS, so it was a lot to wade through quickly.
The resolution was extracted and taken to a vote of the full house of delegates, eventually passing after vigorous debate, with amendments to remove the first two resolveds dealing with state level action (final action summary below). Testimony on the floor was very revealing. The majority of doctors, recognizing the parallels with MOC, supported the students. However, those in medical school administration strongly supported Step2CS. I found this interesting, I would’ve thought medical schools would resent having their curriculum hijacked and having to “teach to the test”. Seeing how most medical school Clinical Skills exams are far more rigorous, I would’ve thought passing a school exam would be a welcome option to alleviate one more burden on their students and being able to advertise a qualified Clinical Skills exam that trumps Step2CS would be a major marketing point to potential students and donors.
Instead, I was shocked to hear administrators wanted this test as an “outside measure” of their students. They felt they had a “conflict of interest”, not to fail their students who were paying so much to attend. This is frightening. No one is entitled to become a doctor, just because they pay tuition. Our medical schools have a moral responsibility to fail unqualified students, residency programs should not graduate incompetent doctors. It is unconscionable to fall for political correctness and not want to offend anyone, hoping some national test will do the job we should be doing in educating the next generation of physicians. Discriminating against incompetent students is essential, not something to be feared. Discrimination in this sense is otherwise known as discernment, to distinguish and select what is true, appropriate, and excellent.
Secondly, I was shocked to see some medical students defend the test, claiming the need for accountability and a desire to be tested. When students stop questioning, and instead accept and crave bureaucracy, we’re in a dangerous place in American medicine. I’m used to hearing administrative doctors justify certification schemes and “quality” reporting measures, I was just dismayed to see this start so young. I couldn’t help but think of Dr. Hendricks from Atlas Shrugged:
“Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t.”
This strain of conformist behavior is another reason why we need organizations like Benjamin Rush Institute to encourage independent thinking among medical students. I am very proud of the student and physician delegates of the Michigan State Medical Society for coming together to pass the first state resolution dealing with Step2CS. I hope other state societies can move this forward, improving upon what we’ve started. Andrew Zureick, Tamara Roumayah, and Nicholas Harrison have done the heavy lifting for everyone, now go forth and multiply their efforts.
Final Action Summary-May 1, 2016
Transfer of Jurisdiction over Required Clinical Skills Examinations to LCME-Accredited and COCA-Accredited Medical Schools in Michigan – Full text here
The Committee recommended disapproval. They believed that a better solution would be to advocate for more testing sites and mitigating costs. Additionally, the Committee was concerned that other states may not accept students for residency programs or licensing if Step 2 CS was eliminated in Michigan. Committee testimony suggested a better option would be to expand testing sites, lowering costs, and offering better scheduling.
The Resolution was extracted on the Floor. The House of Delegates amended the resolved portion(s) to read:
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask the AMA to work with the Federation of State Medical Boards and state medical licensing boards to advocate for the elimination of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam and the COMLEX Level 2-PE (Performance Evaluation) as a requirement for Liaison Committee on Medical Education-accredited and Commission on Osteopathic College Accreditation-accredited medical school graduates who have passed a school-administered, clinical skills examination; and be it further
RESOLVED: That the Michigan Delegation to the American Medical Association (AMA) ask the AMA to amend D-295.998 by insertion (bold) and deletion 588 (strikethrough) as follows:
Required Clinical Skills Assessment During Medical School D-295.988
Our AMA will advocate that
encourage its representatives to the Liaison 592 Committee on Medical Education (LCME) and the American Osteopathic Association Commission on Osteopathic College Accreditation (COCA) to ask the LCME, to 1) determine and disseminate to medical schools a description of what constitutes appropriate compliance with the accreditation standard that schools should “develop a system of assessment” to assure that students have acquired and can demonstrate core clinical skills, and 2) require that medical students attending LCME-accredited or COCA-accredited institutions pass a school-administered clinical skills examination to graduate from medical school.