USMLE Step 2 CS: Is time management really the problem?

“15 minutes? I have to do all of this in 15 minutes? No way. It’s impossible!” Many of our students claim that their problem with CIS (communication and interpersonal skills) in the USMLE Step 2 CS exam is the lack of time. For better or worse, the candidate can really not blame the lack of time.  Take a look at the following article:

Poor Physician-Patient Communication – Is “Lack of Time” Really the Problem?

Generally accepted time management guidelines for the USMLE Step 2 CS exam 15 minute patient encounter are:

  • 1 minute for the introduction, and to get to the all important first open ended question
  • 6-8 minutes for the history
  • 3-4 minutes for the physical (if there is one)
  • 1-2 minutes for closure

You *can* get everything done within the 15 minutes allowed to you on the exam. But knowing where the priorities lie in this encounter is essential. And they do not lie with “getting all the questions on your list” answered. They lie with LISTENING TO THE PATIENT, following the patient’s leads, and conducting a patient-centered interview.  If the patient mentions their job, then ask them what they do for a living; not when it occurs in your “list of questions to ask” but right then, because the patient mentioned it. It will SAVE you time in the end if you approach the exam this way. Perhaps their stress at work is the number one contributor to their headache. And perhaps they work in a factory that has noxious fumes. Your focused history taking just hit paid off with your possible first diagnosis of exposure to noxious fumes.

Lets look at the items explored in the above mentioned article:

  • More Time Will Not Change How Physicians View the Physician-Patient Relationship
  • More Time Will Not Change a Physician’s Communication Style
  • More Time Will Not Likely Change a Physician’s Reliance on Observable Patient Characteristics When Deciding How to Treat Patients

It is HOW you use your time in the USMLE Step 2 CS exam that is the most important thing, not getting upset about the lack of it. From the article again, illustrating that more time will not change a bad communication style:

While even the most physician-centered physician can incorporate elements of patient-centered communication in the medical interview process, the reality is that providers revert back to type. A provider with physician-centered directed orientation will still most likely interrupt the patient, not ask if the patient has questions and not use “teach-back” to make sure the patient understood what the physician said and so on.

So don’t ignore the clock, but use your time wisely in the USMLE Step 2 CS exam. Follow the leads of your patient, and you will finish right on time — and right on top!

Yours in excellent Step 2 CS prep,

The team at C3NY


Matthew Callahan

freelance writer of policy, politics, religion, and tech. web designer, social media manager, a/v installer, computer question-answerer.