USMLE Step 2 CS Exam

Clinical Skills / Doctor-Patient Communication

Minimum score to pass	No score – Pass/Fail . Mast pass (ICE) Integrated Clinical Encounters, (CIS) Communication and Interpersonal Skills And (SEP) Spoken English Proficiency subcomponenets.
# of questions	12 standardized pacients ( 11 scored)
Duration	8 hours
Additional information	Step1, Step 2CK and Step 2CS can be taken in any order. Score is valid for 7 years.

Overview

Step 2 CS is a one-day, live exam that resembles a physician's typical workday in a clinic, doctor's office, emergency department, and/or hospital setting in the United States. Examinees have fifteen minutes to examine each "standardized patient" (SP), who is an actor chosen from a broad range of age, racial, and ethnic backgrounds and trained to portray a real patient. During the examination, examinees are expected to communicate with the SPs in a professional and empathetic manner, elicit important historic information, perform a physical examination, answer any questions from the SPs, tell them what diagnoses are being considered, and inform them of what tests will be ordered to clarify their diagnoses. After each encounter, examinees must record pertinent history and physical examination findings, list diagnostic impressions, and outline plans for further evaluation, if necessary.

Total Examination Length:	8 hours with two breaks (30 minutes; 15 minutes)
Patient Encounters:	11 or 12 (11 are scored)
Length of Each Patient Encounter:	15 minutes
Time Allotted for Writing Each Patient Note:	10 minutes

Step 2 CS will be administered at regional Clinical Skills Evaluation Centers (CSEC).

Scoring

Score performance on the USMLE Step 2 Clinical Skills (CS) exam will be reported as pass or fail. The scoring will be non-compensatory, thus examinees will be required to pass all three of the following areas in order to obtain a passing designation:

1. An Integrated Clinical Encounter score (ICE) consisting of Data Gathering (History and Physical) + Patient Note
2. A doctor-patient Communication and Interpersonal Skills score (CIS) based on checklist rating scales of these skills
3. A Spoken English Proficiency score (SEP) based on checklist rating scales of these skills

Examinees that do not pass the Step 2 CS will receive basic performance data to guide them on areas where their performance needs to improve. In addition, there will be a mandatory 60-day wait before examinees can re-test including a 3 times per year maximum.

Step 2 CS Passing Standard Increase!

Performance levels required to pass the Step 2 CS examination have increased in two of the three Step 2 CS subcomponents. Those categories affected are Communication and Interpersonal Skills (CIS) and Spoken English Proficiency (SEP).

Test-Taking Strategies

The Step 2 CS is unlike any exam you've likely experienced in your medical career. For many candidates, part of the difficulty in taking the Step 2 CS is getting over the fact that the patients aren't "real." It is important that you treat the Step 2 CS's standardized patients as if they were real patients; if you don't, your performance will be compromised. The other major challenge is taking the patient's chief complaint and quickly narrowing down the differential so that you can perform a directed history and physical in only 15 minutes.

Maintaining a positive personal manner

Step 2 CS Interpersonal Skills Advice Communication skills are a large part of success on the Step 2 CS. When a doctor relates to a patient in an empathic way, asks questions clearly, listens carefully, and involves the patient by explaining, paraphrasing and summarizing, then the patient responds more readily and fully. The more skilled the doctor's interpersonal style and the clearer his communication, the easier it is to elicit the significant data from the patient.

After you finish an encounter on the Step 2 CS, the Standardized Patient will complete a checklist that rates your skills in interviewing and collecting information, counseling and delivering information, establishing rapport, and maintaining a positive personal manner.

Six Tips

This following six tips can help you maintain a positive personal manner. This advice isn't specific to the Step 2 CS; it's also great general advice for your clinical career.

1. Always knock before entering the examining room. Knocking on the door before entering is the first step in building trust and showing respect.
2. Introduce yourself by name. After entering the room, you should introduce yourself by name and address the patient as Mr. or Mrs./Ms. ________ . Don't address the patient by his/her first name, as this is considered less respectful. An appropriate introduction might be something like: "Hello Mr. Smith, I'm Dr. Jones and I'll be taking care of you today." You should also shake the patient's hand as you introduce yourself. An exception: if the patient is doubled over in pain, you can forgo the handshake out of deference to the patient's comfort.
3. Maintain comfortable eye contact. During most of the encounter, you should look directly and easily into the eyes of the patient. It's ok to break eye contact to take notes or perform some of the physical exam maneuvers. In general, however, if the doctor seems embarrassed to make eye contact and avoids doing so, or keeps looking distractedly around the room, he/she would not be given "credit" for eye contact on the checklist.
4. Focus your attention on the patient. Throughout your 15 minutes with the patient you should focus your attention on the patient- not on your watch, not on your notepad. While this seems obvious, in the stressful environment of a high-stakes test, it's easier said than done.
5. Convey a sense of concern. You will be evaluated on whether you appear empathic. You can convey empathy in a number of ways, including attending to the patient's physical comfort. You should extend the leg rest when the patient lies back and push it back in when he/she sits back up. If the patient seems to be in pain, you should ask if there is anything you can do to help him/her feel more comfortable. If the patient appears to be in emotional pain, you must be supportive as well. A few minutes of silence are appropriate, followed by an expression of concern such as "this must have been a difficult time for you, can you tell me about it?"
6. Be respectful of the patient's modesty. To convey this respect, you should drape the patient's legs no later than the beginning of the physical examination. You should also ask permission or let the patient know when you're going to untie the gown or move the drape and you should expose as little of the body as necessary to perform the physical exam maneuver. Once you complete the maneuver, you should immediately replace the drape or retie the gown.