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.
USMLE takes action against individuals found to have engaged in irregular behavior
Posted: February 27, 2014
The USMLE Committee for Individualized Review (CIR) meets periodically throughout each year to review cases involving allegations of irregular behavior by applicants and/or examinees.
At its recent meetings, the CIR heard multiple cases involving the following:
- falsified information, including the creation of falsified score reports
- soliciting and/or seeking to obtain unauthorized access to examination materials
- communicating about specific test items, cases, and/or answers with another examinee
- applying and/or attempting to take an examination when ineligible
- making notes of any kind on anything other than materials provided
- failure to follow test center instructions, including writing past the ‘end patient note’ announcement
Actions taken by the CIR at its recent meetings included annotating the individual’s USMLE record with a finding of irregular behavior, barring access to USMLE for periods ranging from 0-3 years, and reporting the finding of irregular behavior to the disciplinary data bank of the Federation of State Medical Boards. State medical boards routinely query this data bank as part of their licensing processes.
As evidenced by the sanctions listed above, a finding of irregular behavior carries significant potential impact. USMLE applicants and examinees are reminded to read the USMLE Bulletin of Information carefully, follow the rules of conduct during testing, and refrain from any pre- or post-examination conduct that might constitute irregular behavior. Specific examples of conduct deemed to be irregular behavior can be found in the Bulletin.
The USMLE is committed to maintaining the integrity of its examination so that state medical boards may continue to rely upon it as an integral part of their decision-making process for licensure. Applicants and examinees are advised to observe all USMLE policies and procedures to avoid the potentially significant implications arising from a finding of irregular behavior.
USMLE encourages you to provide information about cheating and other activity of which you are aware that may compromise the security and integrity of USMLE. Please use our contact form to report such information.
Updated Step 2 Clinical Skills information available
Posted: January 24, 2014
An updated Step 2 Clinical Skills (CS) Content Description and General Information booklet is available.
The Description of the Examination and Scoring the Step 2 CS Examination sections include expanded language on expectations for interacting with standardized patients, as well as additional information on scoring. Appendix B includes new sample patient notes, which have additional information to help examinees understand how the notes are scored.