Post USMLE Step 2 CS Recap

This post is long overdue.

I took the Clinical Skills portion of Step 2 of the United States Medical Licensing Exam (USMLE Step 2 CS) at the end of September; I meant to write about the experience soon afterward, but life got in the way.

In its current state, Step 2 CS is an exam unlike any of the other “steps” that medical students take.  Instead of spending countless, wordless hours in front of a computer screen at a local testing center, groups of students conduct mock clinic visits with standardized patients at one of five testing sites across the country (including Atlanta, where mine was held).  Depending on the case, students may be expected to take a brief history, perform a focused physical exam, relay a brief assessment and diagnostic plan based on the patient’s presenting complaint and physical findings, and write up a patient note.  Repeat this 12 times and add a few breaks (one of which includes lunch).  It’s a long day, but somehow it actually goes by quickly; probably because you get to talk and walk around.

Another difference between this test and preceeding parts of the USMLE is the scoring.  There is a scoring system, which is divided into Communication and Interpersonal Skills, Spoken English Proficiency, and Integrated Clinical Encounter (read: the part where you’re graded on your actual ability to function as a doctor). However, the test is reported as pass or fail.  I feel like one of the pieces of reassurance that’s offfered to U.S. medical students who are nervous about this test is that you’re evaluated in part on how well you speak English.  I liked another point that was made by one of the Vanderbilt faculty earlier this year: “It’s not about being perfect, it’s about being barely competent.”  I can certainly relate to that…

Scheduling the test is almost as nerve-wracking as taking it.  Spots fill up quite quickly on the registration site; in fact, we were advised to schedule the test 6 months in advance just in case.  And of course there’s the issue of where to take it.  With it only being available in 5 cities (Atlanta, Chicago, Houston, Philadelphia, and Los Angeles), it may take some extra planning even after the test date is secured.  Plus, it’s expensive.  Like, over $1000 expensive.  One of my classmates was convinced that she’d accidentally paid for the test three times.  But the amount makes sense once you consider that you’re paying for the facilities, standardized patients, and enough lunch for all of the examinees.

The nature of Step 2 CS makes it somewhat difficult to study for, at least when compared to the other Steps.  There is a First Aid for Step 2 CS which, although somewhat dated, is good to read through once or twice.  This book allows one to get an idea of the types of chief complaints that a standardized patient may present with, in addition to tips about passing in Communication and Interpersonal Skills (e.g. offering water to a patient who starts coughing in the room, or responding empathically to a patient’s distress).  There’s also a section with longer cases, including “scripts” that a standardized patient might use based on what questions s/he is asked; these can be useful to go over with a buddy to simulate the experience somewhat and help with thinking through the situations.  Working in a clinic site–especially on a primary care rotation–can also be useful preparation.

Hope this helps demystify the test a bit!  Good luck!


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