The Step 2 Clinical Skills (CS) is a practical "hands-on" exam that tests the examinee's clinical and communication skills through his/her ability to gather information from standardized patients, perform a physical examination, communicate the findings to the patient, and write a patient note. This exam must be taken at a testing center in the US.
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.
Step 2 CS at a Glance
Total Examination Length: 8 hours with two breaks (30 minutes; 15 minutes)
Sessions: AM and PM
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
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
As of July 2007, passing standards for CIS and SEP were increased. If this increase in passing standards were applied to a recent group of test-takers, the passing rate for examinees from US schools would have decreased less than one percent and the passing rate for examinees from international medical schools would have decreased approximately eight percent.
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.