Scoring the Step 2 CS Examination

Step 2 CS is designed to evaluate your ability to gather information that is important for a given patient presentation. During your physical examination of the standardized patient, you should attempt to elicit important positive and negative signs. Make sure you discuss with the patient your initial diagnostic impression and work-up plan. The patients may ask questions concerning their complaints. You should address each patient's concern as you would in a normal clinical setting.

The ability to communicate effectively with patients, demonstrating appropriate interpersonal skills, is essential to safe and effective patient care. Step 2 CS is intended to ensure that all physicians practicing in the United States, regardless of country of origin, can communicate effectively with patients. Carefully developed rating scales, as well as intensive training in their use, are used by the standardized patients to assess communication, interpersonal skills, and English-speaking skills.

Your ability to document in the patient note the findings from the patient encounter, diagnostic impression, and initial patient work-up will be rated by physician raters. You will be rated based upon the quality of documentation of important positive and negative findings from the history and physical examination, as well as your listed differential diagnoses and diagnostic assessment plans. As is the case with other aspects of Step 2 CS scoring, physician raters receive intensive training and monitoring to ensure consistency and fairness in rating.

Scoring of the Step 2 Clinical Skills Subcomponents

USMLE Step 2 CS is a pass/fail examination. Examinees are scored in three separate subcomponents: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). Each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS.

The ICE subcomponent includes assessment of:

• Data gathering - patient information collected by history taking and physical examination
• Documentation - completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up

Data gathering is scored by checklists completed by the standardized patients. The checklists are developed by committees of clinicians and medical school clinical faculty and comprise the essential history and physical examination elements for specific clinical encounters. The patient note is scored by trained physician raters. Copies of the patient note template, sample patient note styles, and software to practice typing the note are available on the USMLE website. (See also Appendices A - C.)

The CIS subcomponent includes assessment of:

CIS performance is assessed by the standardized patients, who provide a global rating of these skills using a series of generic rating scales. The domains included in these scales are, in part, based upon the scales used in the former Clinical Skills Assessment (CSA) of the Educational Commission for Foreign Medical Graduates, with enhancements based upon national consensus statements on essential communication skills and upon review of other commonly used rating forms.

The SEP subcomponent includes assessment of:

• Clarity of spoken English communication within the context of the doctor-patient encounter (eg, pronunciation, word choice, and minimizing the need to repeat questions or statements)

SEP performance is assessed by the standardized patients using rating scales and is based upon the frequency of pronunciation or word choice errors that affect comprehension, and the amount of listener effort required to understand the examinee's questions and responses.