The Step 2 Clinical Skills exam.

To the Editor: We agree with the Perspective article by Lehman and Guercio (March 7 issue)1 that national clinical exams are expensive. We also agree with First et al.2 that such exams positively shape the educational and assessment programs of medical schools, promote standardization of accreditation criteria, and provide an essential service to the public by filtering out candidates in need of remediation of deficient skills. We feel, however, that a crucial aspect has been ignored so far: the effect of the exam on all students taking it. The role of summative assessment in shaping student learning is being defined in a growing body of literature.3-5 We may ignore to our peril the implied warning that without a mandatory high-stakes clinical skills exam, too many new graduates may lack the clinical skills deemed critical to effective health care. Considering its positive effects, a national clinical skills exam seems an excellent value proposition indeed.