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USMLE Step 2 CS - continued

Scoring: USMLE Step 2 CS is a pass/fail examination. 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 order to achieve a passing performance on Step 2 CS.
The ICE (Integrated Clinical Encounter) subcomponent includes assessment of:
  • Data gathering – patient information collected by history taking and physical examination
  • Documentation – completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up
Data gathering is scored by checklists completed by the standardized patients. The checklists are developed by committees of clinicians and medical school clinical faculty and comprise the essential history and physical examination elements for specific clinical encounters. The patient note is scored by trained physician raters
The CIS (Communication & Interpersonal Skills) subcomponent includes assessment of:

• Questioning skills (eg, use of open-ended questions, transitional statements, not interrupting the patient)
• Information-sharing skills (eg, avoidance of jargon, responsiveness to patient questions or concerns, provision of counseling when appropriate)
• Professional manner and rapport (eg, concern for patient's comfort and modesty, examinee's attention to personal hygiene, expression of interest in the impact of the illness)

CIS performance is assessed by the standardized patients using rating scales. The domains included in these scales are, in part, based upon the scales used in the Clinical Skills Assessment (CSA) of the Educational Commission for Foreign Medical Graduates, with enhancements based upon national consensus statements on essential communication skills and upon review of other commonly used rating forms.

The SEP( Spoken English Proficiency) subcomponent includes assessment of:
• Clarity of spoken English communication within the context of the doctor-patient encounter (eg: 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.

Eligibility: Both medical school students and graduates must have passed the USMLE Step 1 to take Step 2 CS. TOEFL is no longer required after implementation of Step 2 CS in June, 2004.
Eligibility Period: A 12-month period of your choice. You must schedule your CSA within four months of the date on your notification of registration. You must take CS within 12 months of the date indicated on your notification of registration

Fees: The fee for Step 2 CS is $ 1,200. Step 2 CS is administered at regional Clinical Skills Evaluation Centers (CSECs) in Atlanta, Chicago, Houston, Los Angeles, and Philadelphia in the United States. You will not choose a CSEC when you complete the application. Once registered, you will select a CSEC, subject to availability, when you schedule your testing appointment. If you are unable to keep your testing appointment at the CSEC you select, you can reschedule for a different center, subject to availability, for a fee.

Step 2 CS is administered in both morning (AM) and afternoon (PM) sessions. Although you will select your test date and center, you will not be able to choose your test session. When you confirm a testing appointment, you will be assigned to either an AM or PM session. A PM session is assigned if, for that test date and center, AM sessions have been filled and PM sessions have been opened. When reviewing available test dates, you will be informed whether AM or PM sessions are currently being assigned for each date, and you can continue to check available dates for one offering your preferred session. Before you confirm a testing appointment, you will be informed once again whether an AM or PM session will be assigned.

Retaking the exam: If you reapply for Step 2 CS, the eligibility period assigned to you will be adjusted, if required, so that it does not begin during the sixty-day period after your last attempt. Additionally, you cannot take the same Step or Step Component more than three times in any twelve-month period. For Step 2 CS, attempts at the former ECFMG CSA count toward this limit. If you do not take an exam during your assigned eligibility period, you must reapply, including payment of the appropriate fee(s), if you wish to take the exam. In this event ECFMG cannot process a subsequent application for this exam until two weeks after the end of the eligibility period for the exam you did not take.

Books Recommended for Step 2 CS:
a) Mastering the Objective Structured Clinical Examination and the Clinical Skills Assessment
b) Kaplan Medical USMLE Step 2 Clinical Skills
c) Lecture Notes on Clinical Skills
d) Textbook of Physical Diagnosis: History and Examination
e) First Aid for the USMLE Step 2 CS
f) NMS Review for the Clinical Skills Assessment Exam
g) Bates' Pocket Guide to Physical Examination and History Taking

Step 2 CS Courses Available:
a) USMLE-World Step 2 CS Course
b) 5-Day Prep USMLE Step 2 CS - Kaplan
c) 1 Day USMLE Step 2 CS Prep - Kaplan
d) 1-Day USMLE Step 2 CS Simulated Exam - Kaplan
e) History Taking Workshop - Kaplan
f) Exam Master USMLE Step 2 CS Online
g) FALCON Physician Reviews - USMLE Step 2 CS
h) 6 days USMLE Step CS - Kaplan
i) Physical Exam Workshop - Kaplan

Score Rechecks for Step 1 & Step 2 CK: For Step 1 / Step 2 CK, standard procedures ensure that the scores reported for you are an accurate reflection of the responses recorded by the computer on the exam date. A change in score based on a recheck is an extremely remote possibility. However, a request for a recheck will be honored if you submit a Request for Recheck of Score on USMLE™ Step 1 and Step 2 CK (Form 265) and the fee for this service to ECFMG. Your request must be received at ECFMG no later than ninety days after your score report release date.

USMLE Step 2 CS - continued


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The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) sponsors USMLE.
The Three Steps of the USMLE
Step 1 tests the important concepts of basic sciences basic to the practice of medicine. It also places special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of the sciences that provide a foundation for the safe and competent practice of medicine. It also tests the scientific principles required for maintenance of competence through lifelong learning.
Step 2 CK tests the medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. It also includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills.
Step 2 CS tests your capacity to practice and provide good medical service in real-life situations. It also tests your communication skills.
Step 3 tests your medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.


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