Step 2 CS Case Development

Standardized Patient-Based Examinations

The patients you will see are lay people trained to portray a clinical problem. This method of assessment is referred to as a standardized patient examination. Most medical school programs in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME) use standardized patients for instruction; many of these institutions use standardized patients for evaluation as well.

Standardized patients have been used since 1998 in the ECFMG Certification process, and have also been incorporated into the Medical Council of Canada's medical licensure examination for Canadian and international medical graduates. The standardized patient-based testing method was established more than 35 years ago, and its procedures have been tested and validated in the United States and internationally.

Examination Blueprint

As part of the test development process, practicing physicians and medical educators develop and review cases to ensure that they are accurate and appropriate. These cases represent the kinds of patients and problems normally encountered during medical practice in the United States. Most cases are specifically designed to elicit a process of history taking and physical examination that demonstrates the examinee's ability to list and pursue various plausible diagnoses.

The cases that make up each administration of the Step 2 CS examination are based upon an examination blueprint. An examination blueprint defines the requirements for each examination, regardless of where and when it is administered. The sample of cases selected for each examination reflects a balance of cases that is fair and equitable across all examinees. On any examination day, the set of cases will differ from the combination presented the day before or the following day, but each set of cases has a comparable degree of difficulty.

The intent is to ensure that examinees encounter a broad spectrum of cases reflecting common and important symptoms and diagnoses. The criteria used to define the blueprint and create individual examinations focus primarily on presenting complaints and conditions.

Presentation categories include, but are not limited to, cardiovascular, constitutional, gastrointestinal, genitourinary, musculoskeletal, neurological, psychiatric, respiratory, and women's health. Examinees will see cases from some, but not all, of these categories. The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.

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.

When you take the Step 2 CS examination, you will have the same opportunity as all other examinees to demonstrate your clinical skills proficiency. The examination is standardized, so that all examinees receive the same information when they ask standardized patients the same or similar questions. An ongoing mechanism of quality control is employed to ensure that the examination is fair to all. The quality control approach focuses on consistency in portrayal and scoring of the individual cases, and utilizes both observation of live encounters and review of digital recordings.