Our hope is that this petition will reach those in and outside of medicine alike, so to bring those in the latter group up to speed, let's start with a quick history (feel free to skip the following paragraph if you know about Step 2 CS/Level 2 PE).

For more than 15 years, medical students across the US, and international students hoping to practice in the US, have been required to take and pass an additional board exam, usually in their third year. Unlike the written board exams, this test is only offered in five cities across the nation and requires students to travel to one of these locations where they spend the day seeing twelve "standardized patients." These patients have been assigned a diagnosis and a script. Students are then graded based on their communication skills, history taking, physical exam skills, and the note they write after each encounter which includes workup and plan. Registration for the test costs more than $1,500 per student before the cost of travel and lodging. The test for students of allopathic Colleges of Medicine is called Step 2 Clinical Skills (CS) and is administered by National Board of Medical Examiners (NBME). For students of Colleges of Osteopathic Medicine, the test is called Level 2 Performance Evaluation (PE) and is conducted by National Board of Osteopathic Medical Examiners (NBOME). These two tests are practically identical in both purpose and administration. 

These organizations' response to the COVID-19 pandemic has three major flaws. As future medical professionals and leaders to the nation's healthcare teams this response is disappointing. 

First, these changes put responsibility on students to choose between minimizing exposure and continuing their education. Students may not be healthy, they may live with people who are not healthy, and they may live with people at increased risk. With the potential for asymptomatic (or relatively asymptomatic) carriers, even those who are healthy may worsen the national situation by traveling. Not to mention the regional variances of the virus. Rock meet hard place; we students have invested far too much to just not go to our exams. Ask a medical student if a dry cough will keep them from attending their board exams, many of them will uncomfortably admit that they would still take the test. Imagine a simple dry cough costing you $2,000 and delaying your graduation. Even if a student who is symptomatic practices effective social distancing all along the way they are still going to see the 12 patients and will be interacting with many other people throughout the day. 

Second, exams before May 31st have been cancelled, requiring students to reschedule their exams so much later that the value of the test results is practically eliminated. The scores are needed for residency applications, rotation applications, and graduation requirements. With how late many students had to reschedule this exam, the scores would not be available for any applications. All the risks and exposures associated with taking this exam would have almost no purpose.  

Third, for students whose exams were not cancelled or rescheduled, we have to acknowledge that airfare between international airports and national travel should not be a required part of medical education in the next several months. Desperate medical students should not be the reason COVID-19 is brought back to or reignited in a city. As the CDC travel guidelines have stated for the US, travel should be limited to those who are traveling to provide medical care or those whose essential job requires travel. Those who are sick should not travel. For health organizations to think everything will be back to normal by then or that national travel of medical students for a mandatory exam will be worth the risks makes many of us feel like profits are being valued over students' health and public health.

These organizations (NBME and NBOME) have a monopoly on our steps forward and they are funded primarily by student loans, so there needs to be some form of accountability. Considering NBME, for example, with revenues over $150 million (in 2017) and a "well compensated management team," we students must be allowed a voice in this. There must be accountability in administration of this exam, if to no one else, than to students themselves.

Medical schools across the nation have their own standardized patient training and testing to build student's competence in history taking, physical exam, and communication. Step 2 CS/Level 2 PE is a way to nationally standardize evaluation of these skills; it offers no new educational objectives that medical schools aren't already teaching and evaluating before students begin their third year. 

All other computer-based exams will not have a problem reopening and complying with CDC recommendations, so a majority of the medical student education process can continue. We feel that this particular step in our education is simply not responsible practice in light of a national pandemic. There are many potential solutions, but delay after delay after delay of this exam is not a responsible choice. As part of the NBME's mission to "Protect the Health of the Public through State of the Art Assessment," the administration of these exams needs to be rethought. These exams should be cancelled and an alternative solution offered by medical schools, NBME, and NBOME. 

Citation for picture: https://www.mdlinx.com/physiciansense/is-medicine-making-u-s-doctors-sick/

Citation for CDC Travel Guideline: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html

Citation for NBME Revenues: https://www.ncbi.nlm.nih.gov/pubmed/31850949

Citation for NBME Mission Statement: https://www.nbme.org/about-nbme