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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.


Updated abbreviation list for Step 2 CS patient notes

Posted: November 03, 2014

Examinees complete a patient note after each patient encounter in the Step 2 Clinical Skills (CS) examination. A list of common abbreviations that may be used in the notes is included in the Step 2 Clinical Skills Content Description and General Information booklet, and is posted at each computer station at all Clinical Skills Evaluation Collaboration (CSEC) test centers.

The Step 2 Clinical Skills Content Description and General Information booklet now includes an updated version of the abbreviation list; this version will be posted at test centers beginning November 3, 2014.

Changes to the list are minor. Examinees should be aware that this is not a complete list of all acceptable abbreviations, but rather represents the types of common abbreviations that may be used on the patient note. Patient notes are rated by licensed, board-certified physicians with experience in medical education, who will understand common medical abbreviations. However, an examinee who is in doubt about the correct abbreviation to use should write out the word or phrase.


USMLE Score Interpretation Guidelines

Posted: October 30, 2014

USMLE Score Interpretation Guidelines (SIG) have been posted to the USMLE website. Topics include:

  • Description of Examinations
  • Understanding Your Score
  • Recent Means and Standard Deviations (SDs)
    • Norm Table
    • Passing Scores
  • Precision of Scores
  • Guidelines for Use of USMLE Step Scores for Selection Decisions

The means and SDs and the norm table will be updated annually. Because percentile ranks depend on the cohort of examinees, you should always use the most recent norm table available on the USMLE website to obtain percentile ranks.


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