The Step 2 Clinical Skills Examination—Reply

Since June 2004, the failure rate for the Step 2 CSE is 4% for US-educated students and 17% for internationally educated students.6 A candidate who fails to demonstrate these skills repeatedly through the 12 standardized patient encounters has not adequately mastered fundamentals of information-gathering and communication skills necessary for effective clinical practice. More realistic assessment of physical examination skills, including detection of abnormal findings, is needed, and a broader range of communication challenges is possible.