With Clinical Skills Tests Suspended, IMGs Need English Exam


With the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) test suspended as a result of the COVID-19 pandemic, the Educational Commission for Foreign Medical Graduates (ECFMG) will now require an English proficiency test for international medical graduates (IMGs) to become certified for the match.

On Wednesday, the ECFMG outlined its plan to assess the competency of IMGs looking to enter the 2021 match.

Before COVID-19, one tool the ECFMG relied on to certify IMGs for the match — and to assure residency program directors that an IMG’s training was comparable with that of US-trained medical students — was USMLE Step 2 CS test.

The USMLE announced in late May that it would suspend Step 2 CS entirely for at least another year, due to concerns related to the pandemic.

On June 5, the American Association of Colleges of Osteopathic Medicine (AACOM) and three other doctor of osteopathic medicine (DO) organizations followed suit regarding the clinical skills test that DOs are normally required to take.

The organizations said DO students scheduled to graduate in 2021 could, at the discretion of their deans, “receive the DO degree without having passed the COMLEX-USA Level 2-PE clinical skills examination, provided they have met all other graduation requirements and have been endorsed by the faculty.”

An AACOM spokesperson told Medscape Medical News that DO students will eventually have to take the test, just as their MD counterparts will eventually have to take their clinical skills test.

According to the statement, “COMLEX-USA Level 2-PE will still need to be completed for full licensure and is considered a necessary and ongoing requirement for the licensure of osteopathic physicians in all 50 states.”

ECFMG Adds Language Test

In the absence of the USMLE Step 2 CS, the ECFMG laid out the pathways by which IMGs can become certified for the match, adding a requirement that all IMGs must receive an acceptable score on an English language communication test.

William W. Pinsky, MD, president and CEO of the ECFMG, told Medscape Medical News that details on the test are forthcoming and that an outside vendor will be used to develop it.

Pinsky said the changes for IMGs described on the website are only for match year 2021.

“Sometime during the next several months, we’ll know if the clinical skills exam has been retooled and is coming back. And, if it is, then the clinical skills exam will be part of the ECFMG certification,” he said. If it doesn’t come back, ECFMG will present a more permanent replacement, he added.

As for the temporary plan, Pinsky stands behind its ability to ensure competency.

“They [IMGs] still have to take Step 1 and pass and still have to take Step 2 CK [clinical knowledge] and pass,” Pinsky said. “We believe the people who qualify through these pathways will be as qualified as anybody who’s come through in the past.”

Bryan Carmody, MD, a pediatric nephrologist at the Children’s Hospital of the King’s Daughters, in Norfolk, Virginia, who has written extensively about medical licensing exams, told Medscape Medical News he agrees that the way ECFMG has structured the new strategy will help ensure the same competency level as the Step 2 CS requirement did.

Among the pathways, for instance, is one that allows an IMG who was already licensed to practice medicine in another country to proceed. An alternative path is provided for applicants who have successfully completed a secure, standardized clinical skills examination in English as a requirement for medical licensure or registration in another country.

The pathways are a way of “crafting a more carefully vetted group of international medical graduates,” he said.

“I think for most test-takers, passing Step 2 CS tells you very little,” he said. The test is most useful in highlighting people at the extremes of qualified and not qualified, Carmody said.

However, the test has “face validity,” he said. “To be frank, medical boards like that. It makes you seem like you’re doing your due diligence to insist on this requirement.”

Carmody, an associate program director who evaluates students that include IMGs, said that it would be helpful for the ECFMG to share data it has detailing how these pathways and the language communication test requirement will ensure competency at the same level that the Step 2 test did.

He also said, if the assurance is the same under this new plan, it makes the argument more difficult that the Step 2 CS test is necessary in the first place.

Pinsky and Carmody have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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