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USMLE Step 2 Clinical Skills Examination


The USMLE Step 2 CS is required of all U.S. graduates and must be taken at one of the five designated national testing locations. (Atlanta, Chicago, Houston, Los Angeles, Philadelphia).

Students may schedule an examination date online. Students are strongly encouraged to schedule USMLE Step 2 CS AFTER receiving feedback on their performance in the Clinical Skill Assessment. Wichita students wishing to schedule USMLE Step 2 CS before CSA results are available must discuss this with Dr. Minns.


The examination uses standardized patients (SPs) to test medical students and graduates on their ability to:

  • gather information from patients
  • perform physical examinations
  • communicate their findings to patients and colleagues.

The 12 SPs portray common ambulatory problems. Each session lasts for 15 minutes followed by 10 minutes to complete a post-encounter note.

Regulations concerning time and conduct during the examination are very strictly enforced.

The two available textbooks provide information, examples of cases, and general advice. They are pretty good resources but REMEMBER the details of the examination are confidential and things change over time so the textbooks are no guarantee of what the exam actually will be like for you.


The scoring system uses three components.

  • Integrated Clinical Encounter (ICE)
  • Communication and Interpersonal Skill (CIS)
  • Spoken English Proficiency (SEP)



Data gathering

Key items in history
and physical exam

Scored by SP
using checklists



Post encounter note

Scored by physicians
using template






Questioning skills

Questioning style
Allowing patient to talk

Scored by SP using



Response to patient concerns
Avoiding jargon

Scored by SP using


Professional manner,

Attention to SP comfort, modesty
Hand washing, general appearance
Interest in patient agenda/concerns

Scored by SP using






Clarity of language

Clarity, pronunciation, SP effort needed to hear and understand

Scored by SP using

Note that the SPs are responsible for almost all of the scoring. They are trained to be alert for the KEY items of data gathering (history and physical exam), communication, and professional behavior for their cases.

The USMLE textbooks give examples of checklist items used in scoring. The actual items used in the examination are strictly confidential but those in the textbooks can be helpful in preparing for the exam. Note the items used to assess communication and behavior as well as the clinical data items.

The documentation score is generated by your Post-Encounter Note. 

The theory behind the scoring of Post-Encounter Notes and the scoring template are in an article:
Boulet JR, Rebbecchi TA, Denton EC et al . Assessing the written communication skills of medical school graduates. Advances in Health Sciences Education 2004;9:47-60.

Note: USMLE Step 2 CS post encounter notes only ask for history, physical examination, differential diagnosis and diagnostic strategy. They do not have a management section as in the formative SP sessions during clerkships.

What’s Different Between the KUMC-CSA and the USMLE-Step 2 CS?

The two exams have different purposes. The KUMC-CSA aims to assess your competency in the skills required by our curriculum and to provide feedback to educational programs. The USMLE-Step 2 CS is oriented to your suitability for a medical license. Although both test your basic clinical skills and follow the same general format, you may notice some differences.

Based on feedback from students who have done both, differences are in:

  • USMLE scores the Post-Encounter Notes after every encounter
  • SPs in USMLE are very strictly trained to give the same information to every student. If you ask a complex question, they may only answer one part e.g. “Do you have any nausea or vomiting?” may be answered ”I did have nausea” – you can’t assume anything about vomiting from this reply
  • You still need to ask open questions in CSE but don’t expect to get as much information as from a real or Wichita SP. In CSE, specific questions are most reliable – if in doubt, ask a specific question
  • SPs in USMLE see hundreds of students. They may not appear as involved/interested as the KUMC SPs. You must remain professional and appropriate even if the patient is negative or unhelpful
  • In addition to the principal medical problem, each CSE case has a “challenge”. This may be a behavior or an unexpected question/comment that complicates the encounter e.g. “I can’t pay for my medicine”. The purpose is to assess how well you handle unexpected or awkward items in an encounter. One of the textbooks gives examples and more information
  • The CSE has several pediatric cases that involve talking to parents/caregivers about problems of children. These feel artificial as you want to examine the child but the assessment is how you manage the parent. Focus on what data you need from the parent and on advising the parent/caregiver
  • Staff at the national centers are trying to process hundreds of students. They may not be able to be as helpful as KUMC staff

You have been well-prepared for CSE and have much more SP experience than most medical students. Stay calm, remember the specific advice you have received, and just follow the instructions for each case. Remember the purpose is to assess how well you handle COMMON situations so don’t make it too complicated or   look for hidden traps. 

KU School of Medicine-Wichita

1010 North Kansas
Wichita, KS 67214-3199