Background: Medical schools face a new responsibility to prepare students for the United States Medical Licensing Exam Step 2 Clinical Skills (CS) exam.
Method: We conducted semistructured interviews with 25 leaders of medical school clinical skills assessments to explore purposes of in-house assessment and the impact of the Step 2 CS exam. Interviews were coded to identify major themes.
Results: Competency assessment, student and curricular feedback, and preparation for the licensing exam emerged as major purposes of in-house exams. Participants asserted that in-house exams assessed faculty-identified competencies, although not all schools had defined competencies. Limited resources made balancing formative and summative assessment goals problematic for some schools. Curricular feedback was general but valued. All schools, even those that disagreed with aspects of the licensing exam, acknowledged their roles in preparing students for the Step 2 CS.
Conclusion: An external licensing requirement engenders debate and motivates changes in clinical skills assessment and, in some cases, curricula.