The reporting schedule for examinees testing from June 17, 2012 through November 3, 2012 will be 2-3 weeks longer than for examinees testing during other periods.
More information about the Step 2 CS score reporting dates for examinations delivered in 2012 is provided in the Step 2 CS Score Reporting Schedule.

Changes to the assessment of Communication and Interpersonal Skills (CIS)

The CIS subcomponent of Step 2 CS has been redesigned to assess a fuller range of competencies.  Background information about these changes is provided on pages 5-6 of the Fall 2010/Winter 2011 NBME Examiner. The new approach divides communication skills into a series of functions. These functions have been further divided into sub-functions. Beginning June 17, 2012, the Communication and Interpersonal Skills (CIS) scale will focus on five functions:
1. Fostering the relationship
2. Gathering information
3. Providing information
4. Making decisions: basic
5. Supporting emotions: basic

Several additional functions are still under development; these include making decisions: advanced; supporting emotions: advanced; and helping patients with behavior change. A list of the functions and sub-functions is available.
 
Changes to the patient note
Also beginning June17, 2012, a new patient note will be introduced. The patient note is completed by the Step 2 CS examinee after the encounter with the standardized patient. In the new note, examinees will continue to be asked to document relevant history and physical examination findings and to list initial diagnostic studies to be ordered. Examinees will also be asked to create a reasoned, focused differential (maximum of three diagnoses) listed in order of likelihood and to indicate the evidence obtained from the history and physical examination that supports (or refutes) each potential diagnosis. The new patient note provides examinees with an opportunity to document their analysis of a patient's possible diagnoses. A sample of the new patient note is available for review.

Practice Materials
Updated practice materials for Step 2 CS will be posted to the USMLE website in March 2012. These include the Step 2 CS Content Description and General Information Booklet, onsite orientation video, sample patient notes, and a simulation of the program for typing patient notes.

Changes to Step 3 MCQs
Items with an associated drug ad or abstract will be introduced into the MCQ section of the USMLE Step 3 examination beginning in mid-February 2012. Each drug ad or abstract will appear as a 2- or 3- item set*; examinees will see no more than 5 of these item sets in their examination. A description of the purpose of these new item formats is provided in the November 2011 Comprehensive Review of USMLE update.

Introduction of these formats has resulted in the following changes to the structure of the MCQ portion of the Step 3 examination:

• Because item sets with an associated drug ad or abstract may require more time to answer than other multiple-choice items, exam blocks that include an abstract or drug ad item set will contain fewer items. A screen will appear at the beginning of a block alerting examinees if a block includes a drug ad or abstract item set so that examinees can monitor their time accordingly.
• The tutorial provided in Prometric centers on exam day at the beginning of the Step 3 exam has fewer screens and less detailed information than the tutorial available as part of the Step 3 practice materials on the USMLE website. In the exam-day tutorial, the screens describing some of the navigation features of the test delivery software have been consolidated into fewer screens. In advance of testing, examinees should review the longer tutorial available in the Step 3 practice materials.

* An “item set” is a drug ad or abstract and the two or three questions that accompany it.

Updated Step 3 practice materials have been posted to the USMLE website. Instructions for practicing with these new item formats are provided in the tutorial.

Changes to Step 3 CCS
The following changes to the structure of the CCS portion of the Step 3 examination will be introduced beginning in mid-February 2012:

• The CCS portion of the Step 3 exam, administered on the second day of testing, currently includes nine 25-minute cases. Examinees who test using the updated materials will see twelve cases: a combination of 20-minute cases and 10-minute cases; 25-minute cases will be eliminated.
• To help examinees manage their time, the Start Case screen has been updated to clearly indicate the allotted time for each case. In addition, the maximum allotted case time is displayed at the top of the screen during each case.
• In the current version of the software, when ordering a physical examination (PE) for a patient in a case, examinees can order a “Complete PE” or they can select individual physical examination components. The “complete PE” option will no longer be available in the updated version. For a physical examination, examinees will select the desired individual components; multiple components can be selected at one time.

Updated Step 3 practice materials have been posted. The updated materials contain both 20-minute and 10-minute cases. Examinees who will test during the transition period should practice with both sets of CCS practice materials.

• The number of MCQs will decrease from 480 items to 474 items.
• The number of CCS cases will increase from 9 cases to 12 cases.

Although the transition will occur quickly at many test centers, there may be some locations where the transition takes slightly longer. The transition period will likely last approximately 4 weeks. Please note that:

• Scores on both sets of forms will be comparable.
• The length of the examination day will remain unchanged.

For additional information about these changes, see Changes to Step 3 examinations.

Because of the changes, as well as routine modifications to the test item pool, there will be a delay in score reporting for most Step 3 examinations administered from mid-February 2012 through early May 2012. The target date for reporting Step 3 scores for most examinees testing during that interval will be Wednesday, June 6, 2012.