All about USMLE Step 2 CS

USMLE Step 2 assesses the ability of examinees to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention.
USMLE Step 2 ensures that due attention is devoted to the principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and effective practice of medicine.
USMLE Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.

USMLE Step 2 CS Exam format

1. On-Site Orientation

- Each examination session begins with an on-site orientation. If you arrive during the on-site orientation, you may be allowed to test; however, you will be required to sign a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test.
- You will have to reschedule your testing appointment and will be required to pay the rescheduling fee.
- The clinical skills evaluation centers are secured facilities: Once you enter the secured area of the center for orientation, you may not leave that area until the examination is complete.

2. The Patient Encounter

- Your Step 2 CS administration will include twelve patient encounters.
  - These include a very small number of nonscored patient encounters, which are added for pilot testing new cases and other research purposes.
  - Such cases are not counted in determining your score. You will have 15 minutes for each.
- Announcements will tell you when to begin the patient encounter, when there are 5 minutes remaining, and when the patient encounter is over.
  - In some cases you may complete the patient encounter in fewer than 15 minutes. If so, you may leave the examination room early, but you are not permitted to re-enter.
  - Be certain that you have obtained all necessary information before leaving the examination room. Re-entering an examination room after leaving will be considered misconduct.
  - Continuing to engage the patient after the announcement to stop has been made may be considered irregular behavior, will be reported to the USMLE, and could jeopardize your continued participation in the USMLE program.
- If you are unsuccessful at Step 2 CS and must, therefore, repeat the examination.
  - It is possible that during your repeat examination you will see similarities to cases or patients that you encountered on your prior attempt.
  - Do not assume that the underlying problems are the same or that the encounter will unfold in exactly the same way. It is best if you approach each encounter, whether it seems familiar or not, with an open mind, responding appropriately to the information provided, the history gathered, and the results of the physical examination.

3. The Patient Note

- Immediately after each patient encounter, you will have 10 minutes to complete a patient note.
  - If you leave the patient encounter early, you may use the additional time for the note.
  - You will be asked to type (on a computer) a patient note similar to the medical record you would compose after seeing a patient in a clinic, office, or emergency department.
  - Examinees will not be permitted to handwrite the note, unless technical difficulties on the test day make the patient note typing program unavailable.
- The ratings for the patient note are overseen by practicing physicians.
- You should record pertinent medical history and physical examination findings obtained during the encounter, as well as your initial differential diagnoses (maximum of three).
  - The diagnoses should be listed in order of likelihood. You should also indicate the pertinent positive and negative findings obtained from the history and physical examination to support each potential diagnosis.
- While it is important that a physician be able to recognize findings that rule out certain serious or life-threatening diagnoses, the task for Step 2 CS examinees is to record only the most likely diagnoses, along with findings (positive and negative) that support them.
- Finally, you will list the diagnostic studies you would order next for that particular patient. If you think a rectal, pelvic, inguinal hernia, genitourinary, female breast, or corneal reflex examination, or a throat swab, would have been indicated in the encounter, list it as part of the diagnostic studies.
  - Treatment, consultations, or referrals should not be included.