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STEP 2 CS ( Step 2 Clinical Skills): uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues. The patients you will see are lay people trained to portray a clinical problem. This method of assessment is referred to as a standardized patient examination. Step 2 CS is required for ECFMG certification.
The cases that make up each administration of the Step 2 CS examination are based upon an examination blueprint. An examination blueprint defines the requirements for each examination, regardless of where and when it is administered. The sample of cases selected for each examination reflects a balance of cases that is fair and equitable across all examinees. On any examination day, the set of cases will differ from the combination presented the day before or the following day, but each set of cases has a comparable degree of difficulty. The intent is to ensure that examinees encounter a broad spectrum of cases reflecting common and important symptoms and diagnoses. The criteria used to define the blueprint and create individual examinations focus primarily on presenting complaints and conditions. Presentation categories include, but are not limited to, cardiovascular, constitutional, gastrointestinal, genitourinary, musculoskeletal, neurological, psychiatric, respiratory, and women's health. Examinees will see cases from some, but not all, of these categories. The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.
Your Step 2 CS administration will include eleven or twelve patient encounters. These include a very small number of non-scored patient encounters, which are added for pilot testing new cases and other research purposes. Such cases are not counted in determining your score. The examination session lasts approximately 8 hours, and two breaks are provided. The first break is 30 minutes long; the second break is 15 minutes long. You may use the restrooms before the exam and during breaks. A light meal will be served during the first break, and there are vending machines available for drinks. You may also bring your own food, provided that no refrigeration or preparation is required. Smoking is prohibited throughout the center.
The testing area of the Clinical Skills Evaluation Center consists of a series of examination rooms equipped with standard examination tables, commonly used diagnostic instruments (blood pressure cuffs, otoscopes, and ophthalmoscopes), non-latex gloves, sinks, and paper towels. Outside each examination room is a cubicle equipped with a computer, where you can write the patient note.

Before each patient encounter, you will have an opportunity to review information posted on the examination room door (examinee instructions). The examinee instruction sheet gives you specific instructions and indicates the patient's name, age, gender, and reason for visiting the doctor. It also indicates his or her vital signs, including heart rate, blood pressure, temperature (centigrade and Fahrenheit), and respiratory rate. You can accept the vital signs as accurate, and do not need to repeat them unless you believe the case specifically requires it. However, if you do repeat the vital signs, continue to consider the vital signs as originally listed when developing your differential diagnosis and work-up plan.
When you enter the room, you will usually encounter a standardized patient. By asking this patient relevant questions and performing a focused physical examination, you will be able to gather enough information to develop a preliminary differential diagnosis and a diagnostic work-up plan. You will be expected to communicate with the standardized patients in a professional and empathetic manner. As you would when encountering real patients, you should answer any questions they may have, tell them what diagnoses you are considering, and advise them on what tests and studies you will order to clarify their diagnoses. You should interact with the standardized patients as you would with any patients you may see with similar problems. The only exception is that certain parts of the physical examination must not be done: rectal, pelvic, genitourinary, female breast, or corneal reflex examinations. If you believe one or more of these examinations are indicated, you should include them in your proposed diagnostic work-up. You should perform physical examination maneuvers correctly and expect that there will be positive physical findings in some instances. Some may be simulated, but you should accept them as real and factor them into your evolving differential diagnoses. You should attend to appropriate hygiene and to patient comfort and modesty, as you would in the care of real patients.
An announcement will tell you when to begin the patient encounter, when there are 5 minutes remaining, and when the patient encounter is over. In some cases you may complete the patient encounter in fewer than 15 minutes. If so, you may leave the examination room early, but you are not permitted to re-enter. Be certain that you have obtained all necessary information before leaving the examination room.
Immediately after each patient encounter, you will have 10 minutes to complete a patient note. Note: If you leave the patient encounter early, you may use the additional time for the note. You will be asked to handwrite or type (on a computer) a patient note similar to the medical record you would compose after seeing a patient in a clinic, office, or emergency department. You should record pertinent medical history and physical examination findings, as well as your initial differential diagnoses. Finally, you will list the diagnostic studies you would order next for that particular patient. If you think a rectal, pelvic, genitourinary, female breast, or corneal reflex examination would have been indicated in the encounter, list it as part of your diagnostic workup. Treatment, consultations, or referrals should not be included in your workup plan. 
The patient note is considered a communication tool; poor legibility or spelling errors that interfere with the patient note rater's ability to comprehend the note may have a negative impact on your score. If your handwriting is difficult to read, you should probably type your patient note. The patient note is considered a communication tool; poor legibility or spelling errors that interfere with the patient note rater's ability to comprehend the note may have a negative impact on your score. If your handwriting is difficult to read, you should probably type your patient note.



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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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