Step 2: Clinical Skills Exam (CS)

Step 2CS is one of the two exams that comprise Step 2 of the medial boards sequence. Unlike its 2CK counterpart, 2CS is an experiential simulation of clinical contacts designed to represent essential initial encounters with patients, and to assess readiness of trainees for upcoming residency training. 

The 2CS experience of 12 total encounters is challenging but likely familiar for trainees completing the clinical training years. Step 2CS consists of 12 clinical encounters (25 minutes each) and assesses 3 components: Communication & Interpersonal Skill (CIS) (first 15 minutes of each encounter - assesses patient-centered skills and information gathering); Integrated Clinical Evaluation (ICE) (final 10 minutes of each encounter - this is the written portion of the exam that assesses your ability to integrate and synthesize information from the encounter and devive initial impressions and plans); and, Spoken English Proficiency (SEP) (this will assess your ability to communicate clearly with patients).

C-Q-A Preparation Model

C - Content Resources

Preparation for Step 2CS differs from the more familiar MCQ-based formats for Steps 1 and 2CK. The Content portion of 2CS really resides in having a base familiarity with the range of cases you are likely to encounter during the exam, and how this will guide your approaches to them.  The key here is working with the First Aid review guide for 2CS.  Live review options have also been helpful for students wanting added assurances of successfully completing requirments of this exam:

  • USMLE First Aid for 2CS
Live Review Options:

Q - Question Resources

While 2CS doesn't rely on the familiar MCQ format for assessing outcomes, the Question component of CS revolves around common objectives of familiarity with examination format and expectations, as well as comfort in having an effective, reliable appoach to each of the clinical encounters.  The following resources are provided as prospective guides in assisting with these objectives - notably for the CIS and ICE components of the exam:

Commonly used 2CS resources:

A - Assessment Resources

Unlike its written (MCQ) exam counterparts, 2CS doesn't offer as many readily available, structured self-assessments to guage trainee preparedness. This said, NBME does provide some helpful preparation tools (notably for the ICE component of the exam) that are noted below. Additionally, the Medical School provides a formative exam in Spring of year 4 called the CCA (Comprehensive Clinical Assessment) developed to provide practice and feedback for trainee 2CS preparation.


What is a passing score for Step CS and how well have UM students generally performed?
Step 2CS is assessed on a Pass / Fail basis.  There are 3 sections of the exam: 1. Communication and Interpersonal Skills (the 15 minute encounter portion of each case); 2. Integrated Clinical Evaluation (the 10 minute written portion of the exam); and, 3. SEP (Satisfactory English Proficiency).  Students are required to pass all 3 components of the exam;

Are there any Medical School policies I should know about regarding Step 2CS?
You are required to complete 2CS by December 31st of year 4.  This is a strict deadline to ensure that your 2CS result will be available for the MATCH ranking deadline – results wlll not be available to programs if 2CS is taken after this deadline.  

What steps are needed to sit for the Step 2CS exam?

  • Step 2CS has a 1 year eligibility window – thus students can register almost any time after January of year 3;
  • Same as for Step 2CK, pay your exam fee via NBME, wait to be verified by the Registrar, and sign up for a testing date at one of 5 locations nationally (Chicago, Atlanta, Philadelphia, Los Angeles, and Houston);
  • Unlike Steps 1 and 2CK, you will use your scheduling permit via NBME, not Prometric.  

Do I really need to prepare for the Step 2CS exam – doesn’t everyone pass it?

  • While it is true that there is a high pass rate for Step 2CS, it is still a high stakes exam, and following some exam revisions in 2013, the fail rate for 2CS has increased
  • Despite the excellent training you’ll receive through clerkships, 2CS is still an exam that presents challenges students should be aware of. Bottom line is to exercise due diligence by being aware of the testing format and requirements and taking 2-4 weeks for dedicated study preparation;
  • You’ll likely find First Aid for 2CS to be an excellent guide and that you’ll benefit from practicing both use of the standard report template and your typing skills.
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