New CS Performance Standards to Further Increase IMG Failures

January 14, 2013 by
Filed under: USMLE Step 2 CS 

As of January 1, 2013 the USMLE has raised the level of performance standards required for passing the USMLE Step 2 CS examination. According to the latest information posted at their website(, these higher passing requirements apply to the CIS(Communication & Interpersonal Skills) and the ICE(Integrated Clinical Encounter) components of the CS exam; the passing level for the SEP(Spoken English Proficiency) has not changed. This increase in performance requirements comes on the heels of changes to the structure of the Step 2 CS instituted this past June of 2012 which already broadened the criteria standards for passing CIS, and revised the format for patient note writing.

Since the USMLE has not yet released performance data for 2012, there is no way to quantify how the structural changes to the exam enacted last June have already affected passing rates for the second half of the year. We do know that passing rates among foreign and international graduates has steadily risen over recent years from 70% in 2008 to 77% in 2011. Based on the historic difficulty that IMGs have had with passing the CIS component, as well as added challenges now incorporated into the exam itself, it’s safe to assume that passing rates have undoubtedly already fallen. And now USMLE predicts that failures for first time foreign and international graduated will increase 18% beyond those estimated for the second half of 2012. Failures among those trained in American medical schools are expected to increase by 3%.

Needless to say, these latest changes are expected to have sweeping consequences for foreign and international graduates who are now planning to take the CS exam. Even assuming that passing rates for IMGs held at 77% for 2012(which is unlikely), the latest USMLE predictions maintain that approximately 4 in 10 will now fail under current performance standards.

Whether the new performance requirements(as well as the expansion of CIS criteria) represent an attempt to regulate the numbers of IMGs who will acquire residencies in the U.S. is anybody’s guess. Past increases in standards for passing the CS have generally had significant adverse effects on the passing rates for foreign graduates while having minimal impact on those from American schools. The bottom line is that those who study medicine outside of the U.S. will need to prepare longer and harder than ever before to clear the CS. Not only will they need to put in more preparation time, but they will also need to be more selective with choosing study sources and live instruction programs with which to prepare. Since instituting my Step 2 CS Review workshops in 2005, I have been amazed(and dismayed) at the proliferation of CS programs and those professing to be “experts” at preparing medical graduates for the exam. All too often students are attracted by the promise of abundant case practice, but are provided with little instruction which is often misguided, and assessed by inexperienced instructors and standardized patients. Furthermore, the more popular preparation books continue to offer the same faulty instruction with little or no consideration for the expanded CIS requirements.

It is more important than ever to get sound advice and quality expert feedback regarding your test taking performance before going forward, but be sure to ask questions about any program that you are considering, and find out about the experience of the instructors as well as that of the SPs before putting your money down.



Tell me what you're thinking...
and oh, if you want a pic to show with your comment, go get a gravatar!