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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.


UPDATE - USMLE Step 1 and Step 2 CK Practice Sessions

Posted: March 23, 2015

Three new user-adjustable display features were piloted in USMLE Step 1 and Step 2 Clinical Knowledge (CK) Practice Sessions delivered at Prometric Test Centers beginning November 3, 2014:

  • Reverse color (color inversion)
  • Text magnification
  • Image magnification

The first 500 examinees who scheduled an appointment for a Practice Session with the new display features were offered a $40 discount applied to their fee.

The pilot has ended, and the discount is no longer in effect.

Examinees who take a Step 1 or Step 2 CK Practice Session may see the new display features, but should be aware that the display features are NOT currently available on live USMLE administrations or in practice materials available on the USMLE website.

When the new user-adjustable display features become available for use in USMLE Step examinations and the online practice materials, examinees will be notified.


Step 1 – Delay in score reporting and change in number of test items

Posted: March 18, 2015

Most score reporting of Step 1 results occurs within four weeks of testing.  However, because of necessary modifications to the test item pool, there will be a delay in reporting for some examinees who test beginning the week of May 11th.

The target date for reporting Step 1 scores for most examinees testing the week of May 11th through late June will be Wednesday, July 8, 2015.  For examinees whose circumstances require that they receive Step 1 scores before July 8, it is recommended that they take Step 1 no later than Friday, May 8, 2015.

During this time period (starting the week of May 11th), a transition will occur in the number of items in current forms of the Step 1 examination.  The change will be from a total of 322 items to 308 items. Although the transition will occur quickly at many test centers, there may be some locations where the changes take slightly longer to complete. The overall transition period will likely last approximately 6 weeks. Please note the following:

• Scores on new and old forms will be comparable; the decrease in the number of items per form will be accounted for in scoring the examination results.
• The length of the examination day will remain unchanged. The test day will continue to be divided into seven 60-minute blocks, administered in one seven-hour testing session.
• The number of items per block will decrease from 46 to 44. There will be a total of 308 items on each examination.


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