1. Preparing for USMLE Step 2 Clinical Skills
David Becker

2. Step 2 CS
US students first required to take it for 2005 graduating class
Only offered in 5 cities
Is expensive ($1290 doesn’t include travel, hotel)
Pass rate adjusted in fall 2017
KU better than stated rate but not 100%

3. KU’s Preparation Mid-Clerkship Assessment (MCA)
Dry run
Formative, will get very precursory feedback
Lower performers will get more
Clinical Skills Assessment (CSA)
Runs in May
Follows same format as Step 2 CS
Timing: 12 patients with 25 minutes to complete each encounter
Will get more robust feedback
Lower performers will meet with Skills Lab faculty
Will be able to reach out to Skills Lab faculty if you wish

4. Step 2 CS Timing Recommend spending June preparing for Steps
Take about 3 weeks studying for CK
Schedule CS 1 week after CS
You are studying for CS while studying for CK
If you are worried about losing skills get to Jaydoc

5. Study Materials
Read all the materials supplied by USMLE (
Use First Aid for Step II CS
Practice the USMLE style note (usmle-cspractice.com)
Review common abbreviation list during travel too (page 13 of manual)

6. Test Day Sleep well night before Bring a clean white coat, stethoscope
Light lunch provided, you may bring your own

7. Patient Visits
Read the face sheet but don’t anchor before going into room
Wash hands—soap and water v alcohol solution
Introduce with first and last names; establish roles
You have 15 total minutes for visit
7-10 minutes for history
3-5 minutes for physical exam
2-4 minutes to give assessment and negotiate plan

8. History Open ended at beginning
HPI is most important to make sure you hit well
Don’t need full H&P but need all key elements
Tobacco, drugs and alcohol almost always needed
Sexual history or living situation probably not always necessary
Logical transitions and organization

9. Physical Exam Focus on the things that will define your differential
Take notice of anything abnormal and bring it up
Obvious things like visible cigarettes or black eyes are there for a reason
Sensitive exams not part of the test
If need one, make it part of your diagnostic plan on the note

10. Assessment and Plan Remember, you are a doctor Close the case!
Use simple language but give your concerns and obtain confirmation
Don’t forget to negotiate a plan

11. Patient Notes Character limits in each section
Give facts, positive or negative, that tell the patient’s story while leading the audience to the DDx you come up with
Narrative or bullet pointed okay
List vitals and general statement in PE
Most will need CV and Pulm exams and more indepth on the main issues
Have more than 1 DDx and give supporting information for all them, prioritize the DDx
Be specific in DDx and plans

12. Grading No score beyond pass of fail Must pass all three components
Graded by the standardized patients and physicians
Will take several weeks to get score back, come in bunches
st time pass rate 96% for US MD candidates
Late fall 2017 adjusted scoring, pass rate aimed at 92-94%

13. Grading, continued Spoken English Proficiency (SEP)
Scored by SP, you’ll have no problems
Communication and Interpersonal Skills (CIS)
SP scored based on checklists
Open ended questions, active listening, delivering news, showing concerns and gauging understanding

14. Grading, continued Integrated Clinical Encounter (ICE)
Data gathering and interpretation skills
Physical exam scored by SP
Physician ratings based on note
“Pharynx without exudate or erythema” scores higher than “HEENT, throat clear”
Correct DDx and appropriate order of likelihood
Non-exact terminology—pulled muscle—scores lower
Not using evidence (even if right Dx) or listing improbable Dx with no supporting evidence

15. Closing Take the MCA and CSA seriously Ask for CSA feedback
Use First Aid for Step II and usmle-cspractice.com together while preparing
Read the USMLE materials