When the United States Medical Licensing Examination (USMLE) suspended and then permanently cancelled the Step 2 Clinical Skills (CS) test, the decision was celebrated widely by medical students across the country.
But for international medical graduates (IMGs), the change has left many scrambling to meet new requirements -- some of which present challenges that could ruin their chances of matching with a U.S. residency program, they say.
When the Step 2 CS was temporarily suspended last May for safety reasons related to the pandemic, the Educational Commission for Foreign Medical Graduates (ECFMG) -- which certifies international students for residency in the U.S. -- subsequently announced in August that students would be required to take a new exam to assess their English proficiency, called the Occupational English Test (OET). They would also have to perform a clinical skills assessment via one of five pathways, ECFMG said.
IMG students in the 2021 match cycle feel they have been disadvantaged by these quick and major changes to the certification process. Many believe that the OET was not properly evaluated by the ECFMG before it became a part of the replacement for Step 2 CS.
More than 1,700 students demanding the ECFMG get rid of the OET as a match requirement for international students this year, claiming that it "is an unfair and unsafe, for-profit exam taking advantage of an already vulnerable portion of medical school applicants."
According to the petition, many students also couldn't schedule the exam in time for the deadline (because of a lack of open test dates). They also complained that the OET's writing component "is scored very subjectively," causing them to fail and therefore miss out on ECFMG certification.
Unexpected Barriers
Brandon Towey, a fourth-year medical student at St. George's University in Grenada, was ecstatic when Step 2 CS was temporarily suspended last May.
"CS is always a more onerous process for international students," Towey told 番茄社区. "When they temporarily cancelled it, we were all overjoyed."
But then, Towey found out that he had to take the OET.
Understanding that he had to turn in all residency application materials by the end of January, Towey scheduled his OET in November. He prepared to take the exam online, but faced unexpected technical difficulties on test day that even the proctor couldn't fix. Towey tried to reschedule, but there were no tests available until mid-December.
When Towey finally received his OET score in the middle of January, he was shocked to see that he had failed the writing section, and would not be eligible for ECFMG certification.
He couldn't take the test again; by the time he could schedule a retake, it would be far past the deadline. He already completed all other sections of his application, and interviewed with seven U.S. residency programs. Towey asked the ECFMG for an extension, but received little feedback on whether the deadline was flexible.
Towey became nervous about what would happen if he didn't match this cycle. He worried about finding a job next year, and how he would even begin to pay off hundreds of thousands of dollars in school loans.
"All of a sudden, I can't start residency because of an English exam," Towey said. "Right before the finish line, just to be tripped up by the most insignificant barrier is insulting."
William Pinsky, MD, president and CEO of ECFMG, told 番茄社区 in a statement that his organization "carefully considered options for evaluating communication skills before deciding on the Occupational English Test (OET) Medicine."
Pinsky stated that the OET administered exams to more than 7,500 international students in more than 90 countries in a span of six months, and that it is a robust and widely available option. The organization was unable to provide 番茄社区 with pass/fail rates for the OET as the match process is still ongoing, but Pinsky said that rates "fall in the same range as Step 2 CS."
Asked about deadline extensions, the ECFMG said it will accept passing scores received by Feb. 16.
Some Students in Limbo
After failing the OET, Towey submitted a request for a re-mark. Without having to retake the exam, he received a new grade and passed. Now, he has to wait to see if the ECFMG will receive and accept his new score in time for the deadline.
Others, too, are left waiting for a new score that could take weeks to come through, hoping that it will be accepted by the ECFMG if they pass. A student from St. George's University who spoke to 番茄社区 on condition of anonymity is now awaiting a re-mark after barely failing the writing section, leaving eligibility to apply for residency uncertain. The student interviewed with nearly 30 residency programs.
"I am devastated," the student said in an interview. "The only thing that is holding me back is an exam in my native tongue."
A different student from St. George's University, who asked not to be named, failed the reading section of the OET by one point. The student applied for a re-score, and is hoping to receive a passing grade in time for the new deadline.
Another student who wanted to remain anonymous said that, because there were few openings for the online OET, they had to fly to Florida and stay in a hotel to take the test in person -- which the Step 2 CS cancellation was meant to prevent.
St. George's University is the second largest supplier of doctors to the U.S. workforce, according to its website. Students from the school who spoke to 番茄社区, all of whom received an education in English and performed clinical rotations in the U.S., said such complications were especially frequent due to the sheer number applying for U.S. placement.
Caroline McCann, a spokesperson for the university, told 番茄社区 via email that "St. George's University is working closely with a very small number of students who have encountered difficulties on the Occupational English Test (OET)." McCann added that the school is working with the ECFMG to address any outstanding issues.
As the medical school continues to work with the ECFMG to make accommodations for these students, many are left still waiting to see whether or not years of preparation will allow them to match this spring.
"I haven't been this stressed in a long time," said one of those who failed the OET. "And I'm a medical student."