Step 2 CS Exam

To apply for USMLE examinations, you must submit an application through the appropriate registration entity as described below.
 

USMLE Step 2 Clinical Skills - Wikipedia

 
 
Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) is an exam administered to medical students/graduates who wish to become licensed physicians in the U.S. It is similar to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates
 
 
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The USMLE is a three-step examination for medical licensure in the United States. Step 2 of the USMLE has two separately administered components, the Clinical Knowledge (CK) component and the Clinical Skills (CS) component. The Step 2 CS exam is administered by CSEC at all six of its test centers in the United States.
 
apply for Step 2 CS early, provided you meet the eligibility requirements (click here for eligibility requirements listed at the USMLE website).
 

Step 2 CS Content - USMLE.org

 
 
PDF
Examinees are scored in three separate subcomponents: Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE). Each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS.
 
 

USMLE Step 2 CS exam – an 8-hour, pass/fail examination that is designed to test the examinee's ability to:

  • Perform focused histories and physical examinations
  • Communicate findings and diagnostic steps to patients in a clear and empathic manner
  • Recognize and counsel patients on relevant issues regarding health promotion and disease prevention
  • Document patient encounters efficiently
  • Apply knowledge of clinical science to suggest preliminary differential diagnoses and related diagnostic workup plans

 

  • every examinee sees 12 standardized patients who simulate common medical conditions seen in various healthcare settings (e.g., outpatient clinics, emergency departments, etc.).
  • The test day is approximately 8 hours long, including 50 minutes of break time (two 10-minute breaks and one 30-minute lunch break; see also “Breaks” below).

Outline of the encounters

    1. Direct patient encounter (15 minutes)
      • History
      • Physical examination
      • Counseling
    1. Writing the patient note (10 minutes)
      • Documentation of the history and physical examination findings gathered during the direct patient encounter
      • Proposal of one or more preliminary differential diagnoses with supporting arguments
      • Creation of a diagnostic workup plan

Special case formats

  • Telephone patient encounters
    • The examinee must conduct a relevant patient history, counsel the patient or caregiver, and/or help with decision-making via a phone located in the examination room.
    • No physical examination is possible. The physical examination section of the patient note can be left blank.
  • Caregiver scenarios
    • The examinee interacts with a patient caregiver (e.g., of a child or elderly patient) and has to conduct a relevant patient history, counsel the caregiver, and/or help with decision-making.
    • No physical examination is possible. The physical examination section of the patient note can be left blank.
  • Skill demonstrations
    • Tasks include performing (sensitive) physical examinations on models or mannequins (e.g., rectal examination).
  • Tablet encounters
    • The examinee is presented with a digital image on a tablet (e.g., imaging or photo) and is asked to interpret it and explain it to the patient.
  • Communication scenarios
    • Tasks may, e.g., include counseling a patient on various health issues or discussing a difficult situation with a patient (e.g., breaking bad news).
 What is ICE?
a) Integrated Clinical Encounter (ICE): Evaluates your skills at doing a history and physical, as well as your ability to write the Step 2 CS note. This is scored via checklist by a physician. b) Communication and Interpersonal Skills (CIS): Judges your ability to gather information and develop rapport with patients.
 
What is CIS? https://www.usmle.org/pdfs/cru/CISFunctionsandSubfunctions.pdf

 

Communication and InterpersonalSkillsBehavior ListFunctions Sub-Functions

1. Fostering the RelationshipExpressed interest in the patient as a personTreatedthe patient with respectListened and paid attention to the patient

2. Gathering InformationEncouraged the patient to tell his/her storyExplored the patient’s reaction to the illness or problem

3. Providing InformationProvidedinformation related to the working diagnosisProvidedinformation on next steps

4a. Making Decisions:BasicElicited the patient’s perspective on the diagnosis and next stepsFinalized plans for the next steps

4b. Making Decisions: AdvancedSub-functions yet to be developed

5a. Supporting Emotions: BasicFacilitated the expression of an implied or stated emotion or something important to him/her5b. Supporting Emotions: AdvancedSub-functions yet to be developed

6. Helping Patients With Behavior ChangeSub-functions yet to be developed

 
What is SEP?

Spoken English Proficiency (SEP) - includes assessment of clarity of spoken English communication within the context of the doctor-patient encounter (for example, pronunciation, word choice, and minimizing the need to repeat questions or statements). SEP performance is assessed by the standardized patients using a global rating scale, where the rating 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.

 

In a nutshell the USMLE/ECFMG STEP 2 CS EXAM IS :https://en.wikipedia.org/wiki/USMLE_Step_2_Clinical_Skills

The USMLE Step 2CS exam consists of a series of patient encounters in which the examinee must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. Examinees are expected to investigate the simulated patient's chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.

Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. The patient note is slightly different from a standard SOAP note. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The examinees will then state up to 3 differential diagnoses relating to the simulated patient's symptoms, and tests or procedures to investigate the simulated patient's complaints.[5] The examinees should also list pertinent positive and negative findings to support each potential diagnosis.[5] The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters. Examinees are required to type patient notes on a computer.[6]

USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16, 2004. When the CSA first started it was strictly for Foreign Medical Graduates while US graduates were not required to do it. That was considered a double standard in the US medical licensing process. Later the CSA was replaced with the USMLE step 2 CS and became inclusive to all medical graduates.

Grading

The test is graded on a pass/fail basis, without any numerical score associated with it (as opposed to the other parts of the USMLE series). Examinees are scored on three separate subcomponents: Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE). Each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS.

  • Communication and Interpersonal Skills (CIS) - includes assessment of the patient-centered communication skills of fostering the relationship, gathering information, providing information, helping the patient make decisions, and supporting emotions. CIS performance is assessed by the standardized patients, who record these skills using a checklist based on observable behaviors.
  • Spoken English Proficiency (SEP) - includes assessment of clarity of spoken English communication within the context of the doctor-patient encounter (for example, pronunciation, word choice, and minimizing the need to repeat questions or statements). SEP performance is assessed by the standardized patients using a global rating scale, where the rating 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.
  • Integrated Clinical Encounter (ICE) - includes assessments of both data gathering and data interpretation skills. Scoring for this subcomponent consists of a checklist completed by the standardized patients for the physical examination portion of the encounter, and global ratings provided by trained physician raters. The patient note raters provide ratings on the documented summary of the findings of the patient encounter (history and physical examination), diagnostic impressions, justification of the potential diagnoses, and initial patient diagnostic studies.

 

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