Tips to Prepare for and Ace the USMLE Step 2 CS

As med students know, the USMLE is a challenging set of assessments that all prospective physicians must pass to practice medicine in the U.S. If you’ve gotten beyond Step 1 and Step 2 CK, knowing which skills are measured and how to prepare for Step 2 CS will give you the confidence to get over this next hurdle successfully as well.

A Brief Recap of Step 2 CS

Step 2 CS is unique among the USMLE exams, in that it demands that you act like a physician in mock encounters with trained “specialized patients.” Over the course of eight hours and 12 patient encounters, you will be assessed on your ability to take a medical history, perform a physical exam, and communicate effectively in both written and verbal English.

Because this portion of the series is most closely aligned with the role that medical students actually fill during clinical rotations, many test-takers assume the exam will be easy, and fail to prepare sufficiently. Indeed, it’s not uncommon for candidates to show up at their testing center supplied only with their stethoscope!

For more detailed information on the USMLE Step 2 CS, you can learn about the skills that are assessed in Dr. Miller's overview.

How You Can Prepare

While Step 2 CS is not designed to trick you with rare diagnoses or medical test results, it still requires preparation and strategy. Here are five strategies you can use to get ready:

1. Understand the scoring system.

Step 2 CS is scored on a pass/fail basis, and students must pass each of the three subcomponents below to achieve an overall successful result on this step of the exam series.

Spoken English Proficiency (SEP)

The SEP assessment is designed to evaluate the clarity of your spoken English, taking into account pronunciation, word choice, and whether a patient must ask you to repeat questions or statements. It is scored by the standardized patients (people trained to act in mock medical encounters) using a scale to rate mistakes in pronunciation or word selection that make it difficult to understand your meaning. These individuals also assess how much effort they need to expend to understand what you are asking or explaining.

Integrated Clinical Encounter (ICE)

In the ICE portion, standardized patients use a checklist to grade your skills in gathering and interpreting data during the physical exam. In addition, physician-evaluators rate the content on the note you entered into the computer following the exam. There are a number of actions that lead to higher scores:

  • Use of correct medical terminology (avoid slang)
  • Detailed documentation of patient history and physical exam (such as “regular rate and rhythm with no murmurs, rubs, or gallops” rather than “heart normal”)
  • Diagnoses supported with findings obtained from history and physical exam
  • Diagnoses listed in correct order of likelihood

Communication and Interpersonal Skills (CIS)

The CIS subcomponent measures the soft skills of patient care, such as patient-centered communication, putting a patient at ease, gathering and providing information in an understandable manner, and assisting her to make decisions about next steps.

This is where much of the acting of Step 2 CS comes into play; even though the situation is contrived, you must get into character and make your patients feel that you are a physician who cares about them. As in the ICE portion, standardized patients use a checklist to score your performance on this section of the exam.

2. Read These Helpful Resources

Unlike the other parts of the USMLE exam, Step 2 CS doesn’t have hundreds of preparation books to choose from. Most medical students suggest the following two resources:

This manual is written by the Step 2 CS authors and covers all vital information, from content to scheduling to scoring.

This book’s greatest asset is that it includes sample test cases, which you can use to practice with others. Editions are updated periodically, so be sure to check for the most recent version.

3. Practice With Your Peers

The most important part of Step 2 CS preparation is practicing as many cases as possible with friends who are willing to serve as standardized patients. Fortunately, it’s not hard to find willing candidates — all of your medical school classmates have to pass the test as well, and this is an ideal opportunity to trade roles to help each other get ready.

When you’re practicing cases (which you can find in “First Aid for the USMLE Step 2 CS”), remember these five points:

1. The note may be different from what you are accustomed to writing when you are on the wards. Use the free official USMLE software to practice with the actual note template you will use on exam day.

2. Time yourself according to the official exam requirements, only allowing 15 minutes with the patient and 10 minutes to type the note — you’ll be amazed how quickly time goes by. And remember that you are not asked to perform a complete history and physical on each patient; the exam requires a focused approach.

3. Practice on a peer who is wearing a patient gown. It’s hard to remember to ask permission to untie or move part of the gown for the exam unless you practice with it — and asking for permission is the sort of question that establishes a rapport with your patient.

4. Practice typing quickly and accurately. Understand that you will be penalized for typos and that there will be no spell-check. People tend to think they are better typists than they actually are. Practice, practice, practice ...

5. A week or two before your testing date, simulate a full exam. Perform 12 cases with the allotted breaks. This will help you to develop the stamina required to excel on the exam day.

Plan Your Test Day

Since there’s a good chance you’ll need to travel to another city for this part of the USMLE, it’s helpful to plan ahead and try to maintain as much of your routine as possible. For example, follow these steps to set yourself up for success on exam day:

  • Arrive the day before the test in case there are any travel delays. If you’ll have a significant change in time zones, try to arrive a few days before to allow yourself to acclimatize.
  • Get a good night’s sleep both the night before and the night-before-the-night before the test.
  • Be sure you know how to travel to the test site and that you have backup plans in case your first mode of transportation fails.
  • Dress in professional and comfortable clothes.
  • Eat your usual breakfast.
  • Pack snacks and a lunch you are accustomed to eating.
  • Bring a non-expired picture ID, your scheduling information center, and a stethoscope to the test.
  • Relax and enjoy playing doctor!

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