Micanopy, FL

After nearly 2 months of waiting, today I finally got the official word that I passed the clinical skills portion of the USMLE Step 2 exam!

This is a huge relief, especially after such a long wait, and I celebrated today by going out with my brother Jimmy and my sister-in-law April to explore the cute little town of Micanopy, just south of Gainesville. Micanopy is rustic and beautiful with its historic houses dwarfed by grand oak trees filled with Spanish moss. Going there and spending time with family was a real treat for me.

The USMLE Step 2 cs (where “cs” stands for “clinical skills”) tests you on your skills with patients. The exam is administered only at 5 different special testing centers in the United States. I went to the one in Atlanta, as this was closest to home. The testing centers are set up with patient rooms, similar to what you’ll find in a real clinic, and you see a series of patient actors. The patients present with all sorts of medical problems and for each one you have exactly 15 minutes to interview, examine, and counsel the patient, and after that, you have exactly 10 minutes to type up your findings, list your work-up (lab orders or additional exams you want to do to find out what’s going on), and list up to 3 differential diagnoses (possible causes of your patient’s problems). In addition, you have to list pertinent positive and negative findings from your patient encounter that would support your chosen differential diagnoses. During the 8-hour exam, you see 12 patients total (5 patients, followed by a lunch break, then 4 patients, followed by a short break, then 3 patients). Among those 12 patients, you may also get one that is a phone encounter in which you interview the patient over the phone.

People often say the Step 2 cs is the easiest of the US medical licensing exams, and I can see why they say that, considering that most of us by the time we take the exam, we have already had tons of practice interviewing, examining, and working up patients in real settings. Nevertheless, because of the time constraints, exam formatting, character-limit on the write-up, and scoring system, you still need to make sure you get plenty of practice (with a partner) and studying done in preparation for the exam.

The Step 2 cs exam scores you on three components: Integrated Clinical Encounter (how well and efficient you gather data from the patient and present it in the write-up), Communication and Interpersonal Skills (“bed-side manners”), and Spoken English Proficiency (if you are a native English speaker, this should be no problem). All three components must be passed separately in order for you to pass the entire exam. The component that people generally score the lowest is the Integrated Clinical Encounter, and it is the biggest reason why people fail. Because of this, it’s especially important to practice asking the right questions that lead to the most helpful answers, deciding which physical exams to focus on (especially given the limited time you have to do all this), and practice writing notes.

My biggest tips would be:

• Don’t underestimate this exam! While most students may pass, there are people who also do fail, both US and international medical students, and it’s usually not due to English proficiency reasons, as commonly misperceived, but due to data gathering (Integrated Clinical Encounter). While it may be the easier of the medical licensing exams, it still requires practice, practice, and practice!

• Get First Aid for the USMLE Step 2 CS!! This is THE book to get for this exam. The book is filled with cases that are meant for 2 people to practice together. The cases present the most common cases you’ll encounter on the exam (i.e. headache, hemoptysis, dizziness, etc.), and explains everything you’ll need to know about the exam.

• Practice with a real partner, with real medical equipment, and a real timer set exactly at 15 minutes for the patient encounter and 10 minutes for the write up! Type up the patient note on the template provided on the USMLE site because that is exactly how the exam patient note entry form will look like. It’s important to practice typing the patient notes within the word-limit constraints of the exam.

• Memorize the mini-cases in the First Aid Step 2 CS book. It will make coming up with differential diagnoses a whole lot easier and faster. This is especially important when you first read the patient’s chief complaint before you enter the door to see the patient. With the mini-cases memorized, you can easily come up with a preliminary list of differential diagnoses based on the patient’s chief complaint before you even set foot into the patient room. With that preliminary list in mind, you can focus your questioning and physical exams around those possible diagnoses.

• Get plenty of sleep before the exam! You’ll be more alert and pleasant.

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