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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 information materials for the Step 2 CK examination available

Posted: July 25, 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)

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/Competenciesoutline. 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.

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


USMLE Physician Tasks/Competencies

Posted: July 10, 2014

USMLE Physician Tasks/Competencies, a publication that provides a common organization of competencies and tasks assessed in USMLE examinations, is now available.

The outline comprises seven major sections:

  • Medical Knowledge/Scientific Concepts
  • Patient Care: Diagnosis
  • Patient Care: Management
  • Communication and Interpersonal Skills
  • Professionalism, including Legal and Ethical Issues
  • Systems-based Practice, including Patient Safety
  • Practice-based Learning

While this outline is common to all USMLE examinations, each Step will continue to have test specifications specific to that Step and will emphasize certain parts of the outline.

The USMLE Step 3 Content Description and General Information booklet contains a description of physician tasks/competencies covered in the restructured Step 3 examination for examinees taking the Step 3 examination on or after November 3, 2014. An updated USMLE Step 2 CK Content Description and General Information booklet containing a description of physician tasks/competencies covered in that examination will be available in July 2014.

USMLE Physician Tasks/Competencies is useful for understanding competencies assessed by multiple-choice question (MCQ) formats such as Step 1, Step 2 Clinical Knowledge, and the MCQ portion of Step 3. The outline will be updated as work to identify competencies covered by non-MCQ exam formats progresses.


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