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Step 2 CS of the USMLE assesses the examiners' ability to apply medical knowledge, skills, and understanding of clinical science, which is essential for the provision of patient care under supervision.

Step 2 CS uses Standardized Patients to test candidates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues. These are carried out in a mock hospital setting, with trained actors portraying certain symptoms and are selected from a broad range of age, race and ethnic backgrounds.

Candidates have fifteen minutes for each patient encounter and a further 10 minutes to complete a typed patient note. 

Examinees are expected to communicate with the Standardized Patients (SPs) in a sympathetic and professional manner, while gaining crucial historic information, perform a physical exam, answer questions from the SPs, tell them of the diagnoses being considered, also to inform them of any necessary tests to clarify their diagnoses. Each encounter will be recorded. 

This practical exam is administered on a year-round basis, in order to book your place for USMLE Step 2 CS, visit www.ecfmg.org and see the schedules for the different test centers. 

*NEW Exam Feature* Beginning May 22, 2016, students taking the USMLE Step 2 Clinical Skills test may see a case in which they will be provided with a digital image, such as a photograph, x-ray, MRI or CT scan on a tablet computer by the standardized patient. Test takers will be able to enlarge the image. During the pre-session orientation, test takers will be able to view a sample image and practice enlarging it on a tablet. Not all examinations will include a case with an image. Test takers will see a maximum of one case with an image per examination.

USMLE Step 2 CS Scoring

This is the only USMLE exam that does not generate a score, it is simply Pass or Fail. 

Examinees are, however, assessed on 3 separate subcomponents: 

  • Integrated Clinical Encounter (ICE): this looks into data gathering (patient history and physical examination), also the patient note submitted. 
  • Communication and Interpersonal Skills (CIS): looking at questioning skills, information sharing skills (such as overuse of medical jargon), Professional manner and rapport.
  • Spoken English Proficiency (SEP): clarity of spoken English communication within the context of the doctor- patient encounter (such as pronunciation, choice of words, etc). 

Each of these sub-components must be passed in a single administration in order to achieve a pass for the total exam. 

2012 Scoring Changes: 

These changes mainly concern the (CIS) Communication and Interpersonal Skills section of the scoring, as students will now be tested on the following areas within this: 

  • Fostering the Relationship
  • Gathering Information
  • Information Provision
  • Making Decisions
  • Supporting Emotions
  • Enabling Patient Behaviors

The other key changes to exam include the patient note, that delegates are required to produce at the end of each clinical encounter. In the new note, delegates will continue to be asked to document physical examination and relevant history findings, in addition to listing initial diagnostic studies. Student's will now be asked to create a reasoned and focused alternative (maximum of 3 possible diagnoses) listed in order of likelihood; indicating the supporting evidence obtained from the patient encounter. This new patient note allows examinees to show their analysis and thought process in coming to the possible conclusions.