1
© 2016 American University of the Caribbean School of Medicine. All rights reserved.
The United States Medical Licensing Examination
®
(USMLE)
Step 2 Clinical Skills (CS) Exam - FAQs
1. What is the USMLE Step 2 CS? It is part of the USMLE Step 2 exam which tests your ability to take
medical histories and perform physical exams on standardized patients, your interpersonal skills, and
your proficiency in English. USMLE Step 2 CS is the National Board of Medical Examiner®’s (NBME)
answer to the public clamor about testing medical students on competency in relating with patients
(empathy, body language, etc.).
The test is composed of 12 clinical encounters.
For each encounter, you have 15 minutes to perform a history and physical and 10 minutes to
write a patient note.
You will see 5 patients before a 30-minute lunch break followed by 4 patients before a 15-
minute break and then 3 patients.
Evaluation of your performance is based on three separate criteria:
a) Integrated Clinical Encounter (ICE): Evaluates your skills at completing a history and physical, as
well as your ability to write the aforementioned Subjective, Objective, Assessment, and Plan
(SOAP) 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.
c) Spoken English Proficiency (SEP)
2. Is USMLE Step 2 CS a requirement for graduation? Yes, AUC students must pass both parts of the
USMLE Step 2 exam (CK and CS) and receive their scores prior to graduation.
3. Are there any prerequisites for USMLE Step 2 CS? While there are no formal prerequisites for taking
the USMLE Step 2 CS, we recommend that you complete your five core rotations prior to sitting for
the examination as well as take
Becker Professional Education’s complimentary live USMLE Step 2
Clinical Skills Assessment (CSA)
at least six weeks prior to taking USMLE Step 2 CS.
4. When should I take USMLE Step 2 CS? The Educational Commission for Foreign Medical Graduates®
(ECFMG) recommends International Medical Graduations (IMGs) participating in the 2017 Main
MATCH℠ apply in February 2016. To help insure that the results will be available in time to participate
in the 2017 Main MATCH, you must take the USMLE Step 2 CS by December 31, 2016 at the latest.
Students should sign up for the
ECFMG Reporter
and monitor the ECFMG Website in order to stay up-
to-date on important information related to IMGs such as recommended times for registering for
examinations.
2
© 2016 American University of the Caribbean School of Medicine. All rights reserved.
5. What are the logistics I need to consider for USMLE Step 2 CS? You will need to travel to a regional test
center in Atlanta, Chicago, Houston, Los Angeles or Philadelphia to take the examination. Even more
importantly than with USMLE Step 2 CK, because of limitations in testing locations, you should register
as early as possible for the USMLE Step 2 CS so that you get the most flexibility with respect to dates and
location.
6. How much does USMLE Step 2 CS cost? The 2016 fee is $1,535. Please
reference
ECFMG’s Fee Page
for more information.
7. What resources should I use in preparing for the exam?
1)
Becker Professional Education’s complimentary live USMLE Step 2 Clinical Skills Assessment (CSA)
Program
2) In-depth review book such as First Aid for the USMLE Step 2 CS
3) If you are working with a Clinical Fellow, s/he can be an excellent source of knowledge and tips for
preparing for both Step 2 exams
The USMLE Website also has very useful interactive practice materials including
sample patient
notes.
8. How is USMLE Step 2 CS graded? USMLE Step 2 CS is a pass/fail examination. You must pass each of
the three sections of the exam to pass the entire exam.
9. How long will it take to receive my USMLE Step 2CS score? USMLE Step 2 CS scores are not typically
reported until at least a month after the exam. This is important to note if you have taken a leave of
absence to complete the exam. Your score must be reported before your leave of absence expires.
Specific time frames based on test dates may be found on
ECFMG’s 2015 and 2016 Schedules for
Reporting USMLE Step 2 CS Results
.
10. Now that I understand better the logistics of scheduling and taking USMLE Step 2 CS, what types of
cases might I see on the actual exam?
Acute vs. chronic cases
Counseling vs. physical exam cases
Follow-up lab results
Telephone cases
Pediatric cases with the child out of the room
11. Tell me more about the first major section, the ICE?
The ICE includes the following components:
Taking a full history
Completing a focused physical exam
Post-exam discussion with patient
Completing a post-encounter note
3
© 2016 American University of the Caribbean School of Medicine. All rights reserved.
Tips for taking the history include:
Focus on the process
Keep diagnostic possibilities wide open
Don’t focus on an obvious diagnosis early
Open-ended questions first, second and third. You can be specific later.
One question at a time
Get all the concerns on the table early--“Anything else?”
Ask ALL appropriate attributes of a symptom
Location
Other symptoms
Chronology/Timing
Alleviating factors
Things that make it worse
Experience of the symptom/Quality
Severity
Always ask about:
Past Medical History
Medications
Allergies
Social History
Occupation, Smoking, Alcohol, Drugs, Sex
Family History
Review of Systems
After you have gathered all the necessary history, explain to the patient that you will be transitioning
into the physical exam. Ask the patient if s/he is comfortable with proceeding.
Tips for performing the physical exam include:
This is a focused exam
Think about your differential before you do your exam
Wash hands every time
Technique matters
Keep your patients modestly draped
ALWAYS listen with stethoscope on the skin, never ever through clothing
Vitals will be given, but you may want to repeat them
No GU/breast/corneal exams—goes in write up—do talk to your patient about these
There may be abnormalities!
May be real or simulated
If you observe something abnormal, it is supposed to be that way
Tips for the managing the post-encounter discussion with the patient include:
Don’t just leave the room!
Discuss differential diagnosis with patient
Discuss your diagnostic plans with patient (GU exam, for example)
Be prepared for patient questions
4
© 2016 American University of the Caribbean School of Medicine. All rights reserved.
For example, “Am I going to die?” “Did I do something to cause this?”
Don’t let these sidetrack you from your task.
Tips for writing the post-encounter note include:
10 minutes per note
Character limit in each area of 950 characters or 15 lines
Abbreviations must be acceptable to USMLE
Typing is required
You will only be handwriting anything if computer glitch
Post-encounter note
History and Physical
History: Describe the history you just obtained from this patient. Include only
information – pertinent positives and negatives relevant to this patient’s
problem(s).
Physical examination: describe any positive and negative findings relevant to this
patient’s problem(s). Be careful to include only those parts of examination you
performed in this encounter.
Data Interpretation
Based on what you have learned from the history and physical examination, list up
to 3 diagnoses that might explain this patient’s complaint(s). List your diagnoses
from most to least likely. For some cases, fewer than 3 diagnoses will be
appropriate. Then, enter the positive or negative findings from the history and
physical examination (if present) that support each diagnosis.
Lastly, list initial diagnostic studies (if any) you would order for each listed
diagnosis (e.g., restricted physical exam maneuvers, laboratory tests, imaging,
ECG, etc.)
12. What should I do if I get a telephone case?
Treat the encounter as if the patient were in the room
Take your time
Ask all your usual questions
These are usually pediatric cases
13. Tell me more about the second major section, CIS? The CIS focuses on five functions designed to
assess a fuller range of competencies:
1. Fostering the relationship
Expressed interest in the patient as a person
Treated the patient with respect
Listened and paid attention to the patient
2. Gathering information
Encouraged the patient to tell his/her story
Explored the patients reaction to the illness or problem
3. Providing information
Provided information related to the working diagnosis
Provided information on next steps
5
© 2016 American University of the Caribbean School of Medicine. All rights reserved.
4. Making basic decisions
Elicited the patient’s perspective on the diagnosis and next steps
Finalized plans for the next steps
5. Demonstrating basic supporting emotions
Facilitated the expression of an implied or stated emotion or something important to
him/her
Helped patients with behavior change
The examinee must also demonstrate the following abilities during the CIS:
Questioning skills – examples include:
Use of open-ended questions, transitional statements, facilitating remarks
Avoidance of leading or multiple questions, repeat questions unless for clarification,
medical terms/jargon unless immediately defined, interruptions when the patient is
talking
Accurately summarizing information from the patient
Information-sharing skills – examples include:
Acknowledging patient issues/concerns and clearly responding with information
Avoidance of medical terms/jargon unless immediately defined
Engaging in the teach back process
Clearly providing
Counseling when appropriate
Closure, including statements about what happens next
Professional manner and rapport – examples include:
Asking about expectations, feelings, and concerns of the patient; support systems and
impact of illness, with attempts to explore these areas
Showing consideration for patient comfort during the physical examination; attention to
cleanliness through hand washing or use of gloves
Providing opportunity for the patient to express feelings/concerns
Encouraging additional questions or discussion
Making empathetic remarks concerning patient issues/concerns; patient feels
comfortable and respected during the encounter
Other CIS tips include:
Introduce yourself every time
Call your patient Ms. or Mr. or ask!
Ask open-ended questions
Make transition statements
Don’t interrupt your patient!
Don’t use jargon (Say “high blood pressure” not “hypertension”)
Empathize
Be culturally sensitive
Partner with the patient
Ask the patient what they think/want to do
Ask the patient if they have questions (and answer them)
Teach back
Explain what you think and want to do
6
© 2016 American University of the Caribbean School of Medicine. All rights reserved.
Make sure your patient is ok with the plan!
Counsel patient if appropriate
Don’t forget about closure
Provide hope and a follow-up plan
Helpful Mnemonics for CS Patient Encounters
LIQOR
L – Location
I – Intensity
Q – Quality
O – Onset
R – Radiation
AAA
A – Aggravating Factors
A – Alleviating Factors A
– Associated Factors
PAM
P – Past Medical History
A – Allergies
M – Medications
HUGS
H – HITS – Hospitalizations, Injuries, Trauma, Surgeries
U – Urinary Problems
G – Gastro-Intestinal Problems
S – Sleep Problems
FOSS
F – Family History
O – OB/GYN
S – Social History
S – Sexual History
Dostları ilə paylaş: |