Scroll down to learn more about the Step 2 Clinical Skills portion of the U.S. Medical Licensing Exam


 Dr. Mark Swartz demonstrates examination techniques 

Dr. Mark Swartz demonstrates examination techniques 

The USMLE Step 2 CS exam is a practical examination using Standardized Patients (SPs), who are individuals trained to simulate the signs and symptoms of disease and act as a real patient. The examination evaluates communication skills, as well as clinical skills in history taking, physical exam and writing up patient notes.

The eight-hour Step 2 CS examination consists of 11 individually-scored SP scenarios which evaluate the candidate’s knowledge of his/her clinical and communication skills. The candidate has 15 minutes for each encounter, during which time she/he will take a history, examine the patient, and counsel the patient as if it was a real clinical encounter. 

After the candidate leaves the room, she/he will have 10 minutes to write up the Patient Note which includes the pertinent positive and negative findings of the history and physical examination, as well as providing differential diagnoses with reasons to support these diagnoses, and a management plan. All Patient Notes are entered on a computer. During these 10 minutes, the SP will be recalling the details of the session and filling out a checklist indicating what was performed during the physical examination. The SP will also be evaluating communication skills and spoken English proficiency, using rating scales.   

At designated times during the year, the candidate will receive a Score Report indicating her/his score (Pass or Fail) in each of three domains: Integrated Clinical Encounter (ICE); Communication & Interpersonal Skills (CIS); and Spoken English Proficiency (SEP).  The ICE Score consists of Data Gathering (the physical examination checklist) and Data Sharing (the Patient Note). The CIS Score is based on the SPs' evaluation of the candidate's communication and interpersonal skills during the exam. The SEP Score is also assessed by the SPs, using a global rating scale. The candidate must pass in all three  of these three areas in order to obtain a Pass on the entire exam.  Failure in any one of these domains will require retaking of the exam. For more detailed information on the scoring of each component in the Step 2 CS exam, click here

The Step 2 CS examination is conducted almost every day of the year at five regional Clinical Skills Evaluation Centers located in Philadelphia, Atlanta, Houston, Chicago, and Los Angeles. Approximately 35,000 candidates, nationally and internationally trained, take this exam annually.

For more information about the exam, see the following websites: