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Clarification on completing the Step 2 Clinical Skills (CS) patient note

Posted: January 02, 2013

Changes were introduced to the Step 2 CS examination program in mid-June 2012. These included changes to the patient note that examinees must complete after each standardized patient encounter.

As described in the Step 2 CS Content Description and General Information booklet, examinees should record pertinent medical history and physical examination findings obtained during the encounter, as well as initial differential diagnoses (maximum of three). The diagnoses should be listed in order of likelihood, most likely to least likely. Examinees should also indicate the pertinent positive and negative findings obtained from the history and physical examination to support each potential diagnosis. 

To clarify previous language about USMLE expectations for examinees completing the patient note: while it is acknowledged that it is important for a physician to be able to recognize the findings that rule out certain diagnoses, the task for Step 2 CS examinees at this time is to record only the most likely diagnoses along with findings (positive and negative), that support them.

Additional information about the Step 2 CS examination, and about all USMLE examinations, is available in the USMLE Bulletin of Information.

Instructions for completing the patient note, as well as a simulation program for practicing the note, and sample patient notes, are available in the Practice Materials section of the USMLE website.


Step 2 CS Rescheduling Fees

Posted: August 04, 2014

Beginning September 1, 2014, the rescheduling fees for the Step 2 Clinical Skills (CS) examination will change. If you have a scheduled testing appointment and are unable to take the exam on your scheduled test date or at your scheduled center, you may cancel your scheduled testing appointment and reschedule for a different date and/or center, subject to availability. You may cancel and/or reschedule at any time through the end of the day before your scheduled test date. However, no canceling is allowed beginning at 12:00 AM, Eastern Time in the United States, on your scheduled test date. The date that you cancel your testing appointment will determine the amount of your rescheduling fee, as described in the list and table below. All dates and notice periods are calculated using Eastern Time in the United States.

  • If you cancel more than 14 calendar days before your scheduled test date, you will not be charged a fee when you reschedule.
  • If you cancel between 3 and 14 calendar days before your scheduled test date, you will be charged a $400 fee when you reschedule.
  • If you cancel 2 calendar days before your scheduled test date, you will be charged a $615 fee when you reschedule.
  • If you cancel 1 day before your scheduled test date you will be charged a $1,230 fee when you reschedule.
  • If you miss your scheduled testing appointment without canceling, you will be charged a $1,230 fee when you reschedule.

Example: Step 2 CS Rescheduling Fees
Scheduled
Test Date
Cancel Date(s)
Fee
July 15
On or before June 30
No fee
July 1 – July 12
$400
July 13
$615
July 14
$1230


If you cancel without rescheduling or miss your scheduled testing appointment, there is no guarantee that testing appointments during your eligibility period will be available when you attempt to reschedule. If you do not reschedule within your eligibility period, you must submit a new application and exam registration fee in order to take the exam.

If you are unable to keep your scheduled testing appointment, we encourage you to cancel your appointment as soon as possible, regardless of whether you are ready to reschedule. When examinees cancel more than 14 calendar days before their appointment, it is more likely that another examinee will be able to fill that testing slot. Avoiding large numbers of unfilled testing slots helps the USMLE Program manage capacity and minimize increases in the cost of the exam.


Updated information materials for the Step 2 CK examination are now available

Posted: July 25, 2014
Updated: July 29, 2014

Updated information materials for the Step 2 Clinical Knowledge (CK) examination have been posted to the USMLE website. They include:


• USMLE Step 2 CK Sample Test Questions booklet (PDF)
 USMLE Step 2 CK Content Description and General Information booklet (PDF)
• Tutorial and practice test questions for multiple-choice items

Updates to the information materials include information regarding test specifications for the Step 2 CK examination that correspond to the organization of content areas in the USMLE Content Outline for all USMLE examinations, as well as test specifications that correspond to the organization of content areas in the USMLE Physician Task/Competencies outline. All USMLE examinations published in 2014 are being constructed using the classification systems in these two documents. Each Step exam will continue to have test specifications specific to that Step. Each Step exam will emphasize certain parts of both the content and task/competencies outline, and no single examination will include questions on all topics in the content outline.

Please note that changes to the Step 2 CK exam in 2014 resulting from use of the new outlines are minor, and the examination content will be similar to content on previous examinations. One change to note, however, is that the downloadable Step 2 CK practice test questions now include a multi-media item assessing recognition of breath sounds, similar in format to items assessing heart sounds.

The previous Step 2 CK content outline will remain available on the USMLE website for reference.


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