Step 2 CS Content Description
Apply & Prepare for Step 2 CS
Step 2 CS Announcements
Bulletin of InformationOverview
Step 2 of the USMLE assesses the ability of examinees to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to the principles of clinical sciences and basic patient- centered skills that provide the foundation for the safe and effective practice of medicine.
Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.
Other Step 2 CS Resources
What To Bring (& What Not To Bring)
Important: If you do not bring acceptable identification, you will not be admitted to the test. In that event, you must pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your assigned eligibility period.
On the day of your examination you must bring:
- The Scheduling Permit you received when your registration was completed
- Your Confirmation Notice
- An unexpired, government-issued form of identification that includes a photograph and signature. (i.e current driver's license or passport)
- Lab coat and stethoscope (not required, but strongly recommended, as there will be a limited supply available at the test center)
Each test center contains locked storage. You will be able to place personal items that you might need during breaks or during the exam at your seat in the orientation room. Luggage may not be stored in the center. There are no waiting facilities for spouses, family, or friends; plan to meet them elsewhere after the examination.
*Your name as it appears on your Scheduling Permit must match the name on your form(s) of identification exactly. The only acceptable differences are variations in capitalization; the presence of a middle name, middle initial, or suffix on one document and its absence on the other; or the presence of a middle name on one and middle initial on the other.
Please bring only necessary personal items with you to the center. You may not possess pens, cellular telephones, watches of any type, pagers, personal digital assistants (PDAs), two-way communication devices, or notes or study materials of any kind at any time during the examination, including during breaks. These items must be stored during the examination.
If you believe that you have a medical condition that requires you to use medication, an external appliance, or electronic device in the secure areas of the test center you will need to request permission at least four weeks prior to your test date. Contact information and examples of appliances and devices to which this policy applies include are listed in the Bulletin: Applying and Scheduling Your Test Date.
Bulletin: Testing contains more information about the rules and regulations during the test.
What to Wear & When To Arrive
Wear comfortable, professional clothing and a white laboratory or clinic coat. The proctors will cover with adhesive tape anything on the laboratory coat that identifies either you or your institution.
The time you should arrive at the test center is listed in the Confirmation Notice you will print after scheduling your appointment.
Proper Behavior - Testing Regulations and Rules of Conduct
You cannot discuss the cases with your fellow examinees, during breaks or at any time.
Conversation among examinees in languages other than English about any subject is strictly prohibited at all times, including during breaks. Test center staff will be with you to monitor activity. To maintain security and quality assurance, each examination room is equipped with video cameras and microphones to record every patient encounter.
The USMLE program retains the right to remove any examinee from the examination who appears to represent a health or safety risk to the standardized patients or staff of a clinical skills evaluation center. This includes, but is not limited to, examinees who appear ill, are persistently coughing or sneezing, have open skin lesions, or have evidence of active bleeding. Examinees who are not feeling well are encouraged to seek medical advice prior to arrival at the center and, if consistent with medical advice, should consider rescheduling the date of their examination. This can be done at the website of your registration entity.
Clinical skills evaluation center staff monitor all testing administrations for the Step 2 CS examination. You must follow instructions of test center staff throughout the examination. Failure to do so may result in a determination of irregular behavior. The USMLE Bulletin of Information provides a complete description of irregular behavior and the consequences of a finding of irregular behavior.
Irregular Behavior:
Irregular behavior includes any action by applicants, examinees, potential applicants, or others when solicited by an applicant and/or examinee that subverts or attempts to subvert the examination process.
1. On-Site Orientation
Each examination session begins with an on-site orientation. If you arrive during the on-site orientation, you may be allowed to test; however, you will be required to sign a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test. You will have to reschedule your testing appointment and will be required to pay the rescheduling fee.
*The clinical skills evaluation centers are secured facilities. Once you enter the secured area of the center for orientation, you may not leave that area until the examination is complete.
2. The Patient Encounter
Your Step 2 CS administration will include twelve patient encounters. These include a very small number of nonscored patient encounters, which are added for pilot testing new cases and other research purposes. Such cases are not counted in determining your score. You will have 15 minutes for each.
Announcements will tell you when to begin the patient encounter, when there are 5 minutes remaining, and when the patient encounter is over. In some cases you may complete the patient encounter in fewer than 15 minutes. If so, you may leave the examination room early, but you are not permitted to re-enter. Be certain that you have obtained all necessary information before leaving the examination room. Re-entering an examination room after leaving will be considered misconduct.
If you are unsuccessful at Step 2 CS and must, therefore, repeat the examination, it is possible that during your repeat examination you will see similarities to cases or patients that you encountered on your prior attempt. Do not assume that the underlying problems are the same or that the encounter will unfold in exactly the same way. It is best if you approach each encounter, whether it seems familiar or not, with an open mind, responding appropriately to the information provided, the history gathered, and the results of the physical examination.
The Standardized Patient & Physical Examination
You should perform physical examination maneuvers correctly and expect that there will be positive physical findings in some instances. Some may be simulated, but you should accept them as real and factor them into your evolving differential diagnoses.
You should attend to appropriate hygiene and to patient comfort and modesty, as you would in the care of real patients. Female patients will be wearing bras, which you may ask them to loosen or move if necessary for a proper examination.
With real patients in a normal clinical setting, it is possible to obtain meaningful information during your physical examination without being unnecessarily forceful in palpating, percussing, or carrying out other maneuvers that involve touching. Your approach to examining standardized patients should be no different. Standardized patients are subjected to repeated physical examinations during the Step 2 CS exam; it is critical that you apply no more than the amount of pressure that is appropriate during maneuvers such as abdominal examination, examination of the gall bladder and liver, eliciting CVA tenderness, examination of the ears with an otoscope, and examination of the throat with a tongue depressor.
When you enter the room, you will usually encounter a standardized patient. By asking this patient relevant questions and performing a focused physical examination, you will be able to gather enough information to develop a preliminary differential diagnosis and a diagnostic work-up plan.
You will be expected to communicate with the standardized patients in a professional and empathetic manner. As you would when encountering real patients, you should answer any questions they may have, tell them what diagnoses you are considering, and advise them on what tests and studies you will order to clarify their diagnoses.
The elements of medical history you need to obtain in each case will be determined by the nature of the patient's problems. Not every part of the history needs to be taken for every patient. Some patients may have acute problems, while others may have more chronic ones.
You will not have time to do a complete physical examination on every patient, nor will it be necessary to do so. Pursue the relevant parts of the examination, based on the patient's problems and other information you obtain during the history taking.
You should interact with the standardized patients as you would with any patients you may see with similar problems. The only exception is that certain parts of the physical examination must not be done: rectal, pelvic, genitourinary, inguinal hernia, female breast, or corneal reflex examinations. If you believe one or more of these examinations are indicated, you should include them in your proposed diagnostic work-up. All other examination maneuvers are completely acceptable, including femoral pulse exam, inguinal node exam, back exam, and axillary exam.
Another exception is that you should not swab the standardized patient's throat for a throat culture. If you believe that this diagnostic/laboratory test is indicated, include it on your proposed diagnostic workup.
Synthetic models, mannequins, or simulators provide an appropriate format for assessment of sensitive examination skills such as genital or rectal examination. Specific instructions will be provided in cases where this is nessecary.
Excluding the restricted physical examination maneuvers, you should assume that you have consent to do a physical examination on all standardized patients, unless you are explicitly told not to do so as part of the examinee instructions for that case.
The cases are developed to present in a manner that simulates how patients present in real clinical settings. Therefore, most cases are designed realistically to present more than one diagnostic possibility. Based on the patient's presenting complaint and the additional information you obtain as you begin taking the history, you should consider all possible diagnoses and explore the relevant ones as time permits.
Telephone Patient Encounters
Telephone patient encounters begin like all encounters; you will read a doorway instruction sheet that provides specific information about the patient. As with all patient encounters, as soon as you hear the announcement that the encounter has begun, you may make notes about the case before entering the examination room.
When you enter the room, sit at the desk in front of the telephone.
- Do not dial any numbers.
- To place the call, press the yellow speaker button.
- You will be permitted to make only one phone call.
- Do not touch any buttons on the phone until you are ready to end the call - touching any buttons may disconnect you.
- To end the call, press the yellow speaker button.
- You will not be allowed to call back after you end the call.
Obviously, physical examination of the patient is not possible for telephone encounters, and will not be required. However, for these cases, as for all others, you will have relevant information and instructions and will be able to take a history and ask questions. As with other cases, you will write a patient note after the encounter. Because no physical examination is possible for telephone cases, leave that section of the patient note blank.
3. The Patient Note
Immediately after each patient encounter, you will have 10 minutes to complete a patient note. If you leave the patient encounter early, you may use the additional time for the note. You will be asked to type (on a computer) a patient note similar to the medical record you would compose after seeing a patient in a clinic, office, or emergency department. Examinees will not be permitted to handwrite the note, unless technical difficulties on the test day make the patient note typing program unavailable.
You should record pertinent medical history and physical examination findings obtained during the encounter, as well as your initial differential diagnoses (maximum of three). The diagnoses should be listed in order of likelihood. You should also indicate the pertinent positive and negative findings obtained from the history and physical examination to support each potential diagnosis.
Finally, you will list the diagnostic studies you would order next for that particular patient. If you think a rectal, pelvic, inguinal hernia, genitourinary, female breast, or corneal reflex examination, or a throat swab, would have been indicated in the encounter, list it as part of the diagnostic studies. Treatment, consultations, or referrals should not be included.
A program for practicing typing the patient note is available in the Practice Materials
Calendar of Test Dates
Applicants registered for Step 2 CS can use the Step 2 CS Calendar and Scheduling system, available at the website of their registration entity (listed below), to check available test dates at the five Clinical Skills Evaluation Centers. This calendar is updated continuously to reflect applicant scheduling, rescheduling, and the opening of additional test dates, based on demand.
If you are interested in taking Step 2 CS, you are strongly encouraged to use the Step 2 CS calendar to monitor the availability of test dates. The only way to ensure a test date is to complete registration and scheduling through the Step 2 CS Calendar and Scheduling system.
NBME
For students / graduates of LCME-or AOA-accredited medical programs in the US or Canada:
access Step 2 CS Calendar and Scheduling through NBME on NLES
ECFMG
For students / graduates of medical schools located outside the US and Canada:
access Step 2 CS Calendar and Scheduling through ECFMG On-line Services
If you are registered for Step 2 CS, please be aware that:
- The Step 2 CS scheduling system does not allow an applicant to reserve his/her scheduled testing appointment for another applicant, nor does it allow the transfer of a testing appointment from one applicant to another. When an applicant cancels a scheduled appointment, the appointment returns to the pool of available testing appointments where it can be claimed by other registrants.
- At any given time, many applicants registered for Step 2 CS may be attempting to schedule or reschedule testing appointments. It is common for appointments that become available to be claimed immediately by another applicant.
- The Step 2 CS scheduling system allows registered applicants to indicate their preferences for test dates and centers. When a testing appointment is canceled, all applicants participating in the email notification system who have expressed a preference for this date/center are notified immediately by email.
If you have any questions about the application process, you may fill out our Contact Form »
Test Centers
You may schedule a Step 2 Clinical Skills exam at any of five Clinical Skills Evaluation Collaboration (CSEC) test centers.
View map of Los Angeles location »Scoring
Step 2 CS is designed to evaluate your ability to gather information that is important for a given patient presentation. During your physical examination of the standardized patient, you should attempt to elicit important positive and negative signs. Make sure you discuss with the patient your initial diagnostic impression and work-up plan. The patients may ask questions concerning their complaints. You should address each patient's concern as you would in a normal clinical setting.
The ability to communicate effectively with patients, demonstrating appropriate interpersonal skills, is essential to safe and effective patient care. Step 2 CS is intended to determine whether physicians seeking an initial license to practice medicine in the United States, regardless of country of origin, can communicate effectively with patients. Carefully developed rating scales, as well as intensive training in their use, are used by the standardized patients to assess communication, interpersonal skills, and English-speaking skills.
Your ability to document in the patient note the findings from the patient encounter, diagnostic impression, and initial diagnostic studies will be rated by physician raters. You will be rated based upon the quality of documentation of important positive and negative findings from the history and physical examination, as well as your listed differential diagnoses and diagnostic assessment plans. As is the case with other aspects of Step 2 CS scoring, physician raters receive intensive training and monitoring to ensure consistency and fairness in rating.
Scoring the Subcomponents
Examinees are scored in three separate subcomponents: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). Each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS.
The ICE subcomponent includes assessments of both data gathering and data interpretation skills. Scoring for this subcomponent consists of checklists completed by the standardized patients for the physical examination portion of the encounter, and scoring of the patient note by trained physician raters. The patient note raters provide global ratings on the documented summary of the findings of the patient encounter (history and physical examination), diagnostic impressions, justification of the potential diagnoses, and initial patient diagnostic studies.
The patient note is scored by trained physician raters. Copies of the patient note template, sample patient note styles, and software to practice typing the note are available in the practice materials.
The CIS subcomponent includes assessment of the important communication skills of fostering the relationship, gathering information, providing information, helping the patient make decisions, and supporting emotions. CIS performance is assessed by the standardized patients, who record these skills using a checklist based on observable behaviors.
Examinees demonstrate the ability to foster the relationship by listening attentively and showing interest, care, concern, and respect.
Skills in gathering information are demonstrated by establishing a chronology of the primary problem, including any additional concerns of the patient, and by encouraging the patient to explain the situation in his/her own words, including describing priorities, worries, and/or explanations of how the health issue has affected the patient.
Skills in providing information are demonstrated by giving an explanation of what is likely occurring, using clear and understandable statements; matching the amount of information and content to a patient’s need and preference; and encouraging and answering questions, while checking for patient understanding.
Helping the patient make decisions is demonstrated by outlining what should happen next, linked to a rationale, and by assessing a patient’s level of agreement, willingness, and ability to carry out next steps.
Examinees demonstrate ability to support emotions when a clinical situation warrants by seeking clarification or elaboration of the patient’s feelings and by using statements of understanding and support.
The SEP subcomponent includes assessment of clarity of spoken English communication within the context of the doctor-patient encounter (for example, pronunciation,
word choice, and minimizing the need to repeat questions or statements).
SEP performance is assessed by the standardized patients using rating scales and is based upon the frequency of pronunciation or word choice errors that affect comprehension, and the amount of listener effort required to understand the examinee's questions and responses.
Score Reporting Schedule
Step 2 CS examinees are grouped into testing periods according to the dates on which they test. The first results for a given testing period will be issued on the first day of the corresponding reporting period, and it is expected that results for the vast majority of examinees who take the exam during the testing period will be reported on this date. However, it is important to note that there will likely be a small number of examinees for whom scoring and quality assurance are not completed by the first day of the reporting period; these will typically be examinees who took the exam in the latter part of the testing period. Results for these examinees will be reported each week throughout the reporting period, and should be reported no later than the last day of the score reporting period.
2013 Reporting Schedule now available>>2012 Reporting Schedule - Step 2 CS
First three reporting periods released June 30, 2011
Complete calendar released September 29, 2011
Revised September 28, 2012
| Testing Period | Reporting Start Date | Reporting End Date |
|---|---|---|
| January 1 - January 28 | February 29 | March 28 |
| January 29 - March 24 | April 25 | May 23 |
| March 25 - May 19 | June 20 | July 18 |
| All Test Centers Closed No testing May 20 through June 16 |
||
| June 17 - August 25 | October 10 | October 31 |
| August 26 - November 3 | December 5 | January 2 (2013) |
| November 4 - December 31 | January 30 (2013) | February 20 (2013) |
For each "Testing Period" in the above schedule, Step 2 CS scores are released every Wednesday over a corresponding four-to five-week "Reporting Period." It is expected that results for the vast majority of examinees who take the exam during the testing period will be reported on the first Wednesday of the Reporting Period. Results for 98%-99% of examinees who take the exam during the testing period are reported by the third Wednesday in a Reporting Period. For a small percentage of examinees (1%-2%), scoring and quality assurance may be not completed in time for these examinees to be reported by the first three reporting dates; these will typically be examinees who took the exam in the latter part of the testing period or who tested during the first administration after the May 20 through June 16 shutdown. Results for these examinees will be reported each week throughout the reporting period, and should be reported no later than the last day of the score reporting period.
This schedule allows USMLE staff to enhance the quality assurance and data collection/scoring procedures performed prior to score reporting. Additionally, it provides examinees, as well as others who rely on Step 2 CS results, with guidelines regarding when a result will be reported for a given exam date. These guidelines allow examinees to plan their exam registration and scheduling in order to have their results in time to meet specific deadlines, such as those related to graduation or participation in the National Resident Matching Program (NRMP), or "the Match."
Changes to the assessment of communication skills and patient note were made in mid-2012. In order to introduce these changes to the examination, no Step 2 CS examinations were administered from May 20 through June 16, 2012. Please note the following information regarding the testing schedule in the second half of 2012:
- Additional testing sessions - including evening and weekend sessions - have been added to the calendar before and after the May/June shutdown.
- The reporting schedule for examinees testing from June 17, 2012 through November 3, 2012 will be 2-4 weeks longer than for examinees testing during other periods.
- Individuals who tested on or after June 17, 2012 will see less detailed feedback on their graphical performance profiles than has been provided to examinees in the past. The performance profiles are provided as an assessment tool for the examinee’s benefit and are not reported or verified to any third party. The profiles summarize relative areas of strength and weakness to aid in self assessment.
- Examinees who test on or before December 31, 2012 will have results reported in time for the 2013 "Match."
2013 Reporting Schedule - Step 2 CS
Released June 21, 2012
| Testing Period | Reporting Start Date | Reporting End Date |
|---|---|---|
| January 1 - January 26 | February 27 | March 20 |
| January 27 - March 23 | April 24 | May 22 |
| March 24 - May 18 | June 12 | July 10 |
| All Test Centers Closed No testing May 19 through May 31 |
||
| June 1 - July 13 | August 14 | September 11 |
| July 14 - September 7 | October 9 | November 6 |
| September 8 - November 2 | December 4 | January 1 (2014) |
| November 3 – December 31 | January 29 (2014) | February 19 (2014) |
For each "Testing Period" in the above schedule, Step 2 CS scores are released every Wednesday over a corresponding four-to five-week "Reporting Period." It is expected that results for the vast majority of examinees who take the exam during the testing period will be reported on the first Wednesday of the Reporting Period. Results for 98%-99% of examinees who take the exam during the testing period are reported by the third Wednesday in a Reporting Period. For a small percentage of examinees (1%-2%), scoring and quality assurance may be not completed in time for these examinees to be reported by the first three reporting dates; these will typically be examinees who took the exam in the latter part of the testing period.
Results for these examinees will be reported each week throughout the reporting period, and should be reported no later than the last day of the score reporting period. This schedule allows USMLE staff to enhance the quality assurance and data collection/scoring procedures performed prior to score reporting. Additionally, it provides examinees, as well as others who rely on Step 2 CS results, with guidelines regarding when a result will be reported for a given exam date. These guidelines allow examinees to plan their exam registration and scheduling in order to have their results in time to meet specific deadlines, such as those related to graduation or participation in the National Resident Matching Program (NRMP), or "the Match."
