By Sara Mangiardi and Oveys Mansuri Chicago

American medical students will now have one additional examination to pass before being licensed to practise medicine in the United States. The National Board of Medical Examiners (NBME) will begin offering the USMLE (United States Medical Licensure Examination) Step 2 CS (Clinical Skills) examination this summer. A similar exam already exists for foreign medical graduates wishing to practise in the United States.

The NBME believes the Step 2 CS exam will allow students to show fundamental clinical skills that are not covered by the current examinations. The test will consist of medical students examining 12 "standardised patients" for 15 minutes each. After each encounter the student will be expected to write notes, complete with relevant history and physical examination findings, diagnostic impressions, and an initial plan. The cases will be representative of common or important situations that doctors would find themselves in.

The new exam is controversial. It costs $975 (£539; €812) and is offered in only five cities, adding travel and hotel costs for some students. Andy Bozdech, a third year medical student at Chicago Medical School, said, "Testing foreign and domestic medical school grads equally for hands-on skills isn't a bad idea in theory, but when implementing such a test more than triples the already pricey cost of Step 2, students have to question the necessity of such costs. Is the CS portion going to make that big a difference to licensed doctors or to their future patients to warrant such a huge increase?"

Debra Klamen, associate dean for education and curriculum and chair of the department of medical education at Southern Illinois University School of Medicine, says the Step 2 CS exam serves an important role: "The utility of the new step 2 exam is that all medical students in the country will be tested on the same basic set of competencies. We have known for a long while that just because students can do well on a multiple choice exam... that doesn't necessarily mean they can perform...This exam will test some of those competencies that are unreachable on a multiple choice exam, ensuring that all our graduates have a minimum level of competency that we feel is essential for practising physicians."

The implementation of Step 2 CS is long overdue. For many years now, IMGs have had to take this exam as an evaluation of their ability to communicate with patients. It is time that the American medical student do the same.

It is unforetunate as to the logistics of the testing centers however. With only 5 locations (Philadelphia, Atlanta, Los Angeles, Houston, and Chicago), it does put a burden on the all-ready cash-strapped medical student. Hopefully, more testing centers will be added in the future to allow better access to this necessary evaluation.

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