USMLE Step 2 CS exam in action

Dr. Mark Swartz demonstrates examination techniques in a C3NY Step 2 CS Exam Preparation Workshop

The USMLE Step 2 CS exam is a practical examination using standardized patients (SP’s): individuals trained to simulate the signs and symptoms of disease, and act as a real patient. The examination evaluates communication and clinical skills in history taking, physical exam and writing up a patient note.

The eight hour Step 2 CS examination consists of 11 scored SP scenarios which evaluate the candidate’s knowledge of his/her clinical and communication skills. The candidate has 15 minutes for each encounter during which time he/she will take a history, examine the patient, and counsel the “patient” as would be done in a real clinical encounter.

After the candidate leaves the room, the SP recalls the details of the session and fills out a checklist indicating what was performed during the physical examination and rating scales evaluating communication and spoken English.  At the same time, the candidate has 10 minutes to write up the Patient Note which includes the pertinent positive and negative findings of the history and physical examination, as well as providing differential diagnoses with reasons to support these diagnoses, and a management plan. All Patient Notes are entered on a computer.

At designated times during the year (, the candidate will receive a Score Report indicating his/her score (Pass or Fail) in each of three domains: Integrated Clinical Encounter (ICE); Communication & Interpersonal Skills (CIS); and Spoken English Proficiency (SEP).  The ICE Score consists of Data Gathering (the physical examination checklist) and Data Sharing (the Patient Note). The candidate must pass in each of these three areas in order to obtain a Pass on the entire exam.  Failure in any one of these domains will require retaking of the exam.

The Step 2 CS examination is conducted almost every day of the year at five regional Clinical Skills Evaluation Centers located in Philadelphia, Atlanta, Houston, Chicago, and Los Angeles. Approximately 35,000 candidates, nationally and internationally trained, take this exam annually.

For more information about the exam, see the following web sites: