The unexpected discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills (CS) exam in January 2021 carries both risks and opportunities for medical education in the United States. Step 2 CS had far-reaching effects on medical school curricula and school-based clinical skills assessments. Absent the need to prepare students for this high-stakes exam, will the rigor of foundational clinical skills instruction and assessment remain a priority at medical schools? In this article, the authors consider the potential losses and gains from the elimination of Step 2 CS and explore opportunities to expand local summative assessments beyond the narrow bounds of Step 2 CS. The responsibility for implementing a rigorous and credible summative assessment of clinical skills that are critical for patient safety as medical students transition to residency now lies squarely with medical schools. Robust human simulation (standardized patient) programs, including regional and virtual simulation consortia, can provide infrastructure and expertise for innovative and creative local assessments to meet this need. Novel applications of human simulation and traditional formative assessment methods, such as workplace-based assessments and virtual patients, can contribute to defensible summative decisions about medical students' clinical skills. The need to establish validity evidence for decisions based on these novel assessment methods comprises a timely and relevant focus for medical education research.
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