Changes to the USMLE Step 2 Clinical Skills Exam

Residency BlogThe USMLE Step 2 Clinical Skills (CS) exam has gone through significant changes. On June 17th, a revised CIS section debuted, and a new patient note was introduced. These changes not only improve the testing methods for Step 2 CS, but they will help examinees prepare for residency.

The Communication and Interpersonal Skills (CIS) subcomponent of Step 2 CS changes will help assess a fuller range of competencies.  The CIS now divides communication skills into a series of functions, which have been divided into sub-functions. The CIS scale will focus on five functions:

1. Fostering the relationship
2. Gathering information
3. Providing information
4. Making decisions: basic
5. Supporting emotions: basic

Other functions are being developed, including:  making decisions: advanced; supporting emotions: advanced; and helping patients with behavior change. You can find a list of the functions and sub-functions on the USMLE website:  CIS Behavior List

Examinees complete the Patient Note (a large portion of the Integrated Clinical Encounter component) after the standardized patient encounter. Examinees will continue to document relevant history and physical examination findings and to list initial diagnostic studies to be ordered. Examinees will create a reasoned, focused differential (up to three diagnoses) listed in order of likelihood and show the evidence from the history and exam that supports (or refutes) each potential diagnosis.  Examinees can now document their analysis of a patient’s possible diagnoses.

These changes to the CS exam will have some notable effects on examinees, especially IMGs:

1. Typing speed on the Patient Note is more important. The new patient note format requires the test taker to write more, so examinees need to make sure they are practicing their typing.

2. Diagnostic thinking is more important. Examinees used to be able to get by just asking all the standard history questions. Now students need to concentrate on ruling in or ruling out certain diagnoses so they can effectively write the diagnosis part of the patient note.

3.  The challenge is that Standardized Patients (SPs) will be more reactive than in the past so it is through successful communication with the SP that the examinee will be able to extract the medical info they will need for their patient note.   This new encounter experience will lead to a different interaction experience, not only between the test taker and each SP they see, but also a different interaction experience between the SP and each test taker who walks in his/her room. It will be a different conversation and a different relationship every time.

The exam now aligns more with real medical practice. A real-life clinical encounter doesn’t happen in a vacuum; instead it can involve an intense mix of emotions ranging from apprehension to helplessness and anger. Examinees will now have to navigate patient encounters with real time human interaction skills. It will no longer be enough to come to the right conclusion; the diagnosis must now be justified to peers and patients alike.

The USMLE website offers USMLE Step 2 CS practice materials, which we strongly recommend.  Look through the Step 2 CS Content Description and General Information Booklet, onsite orientation video, sample patient notes, and a Patient Note Interactive – a simulation of the program for writing patient notes. Kaplan Medical also offers free med advising to help students develop their overall study plans.

Even though the exam has changed, the Match calendar hasn’t. If you want to Match in 2013, you’ll have to take Step 2 CS by December 31st, 2012.  Make sure you are well-prepared!

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