Everything You Need to Know about the USMLE Step 2CS

United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The exam is sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners. USMLE is taken by persons who intend to practice medicine in the United States or might be taken to assess the possibility of practicing medicine in the Unites States. As common with United States exams, all steps of the USMLE require a lot of hard work and studies to be successful. All three steps of the USMLE exam must be passed before a physician with an M.D. degree is eligible to apply for an unrestricted license to practice medicine in the United States. 

The USMLE Step 2CS exam consists of a series of patient encounters in which the examinee must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. Examinees are expected to investigate the simulated patient’s chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.

Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. The patient note is slightly different from a standard SOAP note. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The examinees will then state up to 3 differential diagnoses relating to the simulated patient’s symptoms, and tests or procedures to investigate the simulated patient’s complaints.[5] The examinees should also list pertinent positive and negative findings to support each potential diagnosis.[5] The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters. Examinees are required to type patient notes on a computer.[6]

USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16, 2004. When the CSA first started it was strictly for Foreign Medical Graduates while US graduates were not required to do it. That was considered a double standard in the US medical licensing process. Later the CSA was replaced with the USMLE step 2 CS and became inclusive to all medical graduates.

The test is graded on a pass/fail basis, without any numerical score associated with it (as opposed to the other parts of the USMLE series). Examinees are scored on three separate subcomponents: Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE). Each of the three subcomponents must be passed in a single administration in order to achieve a passing performance on Step 2 CS.

Communication and Interpersonal Skills (CIS) – includes assessment of the patient-centered communication skills of fostering the relationship, gathering information, providing information, helping the patient make decisions, and supporting emotions. CIS performance is assessed by the standardized patients, who record these skills using a checklist based on observable behaviors.
Spoken English Proficiency (SEP) – includes assessment of clarity of spoken English communication within the context of the doctor-patient encounter (for example, pronunciation, word choice, and minimizing the need to repeat questions or statements). SEP performance is assessed by the standardized patients using a global rating scale, where the rating is based upon the frequency of pronunciation or word choice errors that affect comprehension and the amount of listener effort required to understand the examinee’s questions and responses.
Integrated Clinical Encounter (ICE) – includes assessments of both data gathering and data interpretation skills. Scoring for this subcomponent consists of a checklist completed by the standardized patients for the physical examination portion of the encounter, and global ratings provided by trained physician raters. The patient note raters provide ratings on the documented summary of the findings of the patient encounter (history and physical examination), diagnostic impressions, justification of the potential diagnoses, and initial patient diagnostic studies.

The eligibility to write USMLE steps are different for Step 1& 2 and Step 3. (Click here to read our comprehensive summary sheet on USMLE steps and requirements)

Step One & Two: For Nigerians, any medical student officially enrolled in, or a graduate of a medical school that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements, and that meets other eligibility criteria of the ECFMG.

To be eligible:

  • You must be enrolled as a medical student in Nigeria.
  • The medical school must be listed in the World Directory of Medical Schools (as a school which has met the ECFMG eligibility)
  • The medical school must meet other eligibility criteria of ECFMG

The good news therefore is that most of the medical students in Nigeria can write Step One of the USMLE.

Currently (as at August 2018) on World Directory of Medical Schools, students of 37 Nigerian medical schools can write USMLE. The list is below:

Medical School Name                                                                                                                                   City Name

Abia State University Faculty of Medicine                                                                                                        Uturu

Afe Babalola University College of Medicine and Health Sciences                                   Ado Ekiti

Ahmadu Bello University Faculty of Medicine                                                                            Zaria

Ambrose Alli University College of Medicine                                                                                Ekpoma

Bayero University Faculty of Medicine                                                                                            Kano

Benjamin S. Carson School of Medicine, Babcock University                                             Ilishan Remo

Benue State University College of Health Sciences                                                                                      Makurdi

Bingham University College of Health Sciences                                                                          Karu

Bowen University College of Health Sciences                                                                              Iwo

Chukwuemeka Odumegwu Ojukwu University College of Medical Sciences           Uli

Delta State University College of Health Sciences                                                                                        Abraka

Ebonyi State University College of Health Sciences                                                                  Abakaliki

Ekiti State University College of Medicine                                                                                                        Ado Ekiti

Enugu State University of Science and Technology College of Medicine                     Enugu

Gombe State University College of Medical Sciences                                                               Gombe

Imo State University College of Medicine                                                                                                          Owerri

Kaduna State University Faculty of Medicine                                                                               Kaduna

Ladoke Akintola University of Technology (LAUTECH)                                                                        Osogbo

Lagos State University College of Medicine                                                                                    Ikeja

Madonna University College of Medicine                                                                                                          Elele

Niger Delta University College of Medical Sciences                                                                   Amassoma

Nnamdi Azikiwe University College of Health Sciences                                                        Nnewi

Oba Okunade Sijuade College of Health Sciences, Igbinedion University  Benin

Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University           Ago Iwoye

Obafemi Awolowo University College of Health Sciences                                                                      Ile-Ife

University of Abuja College of Health Sciences                                                                            Abuja

University of Benin School of Medicine                                                                                            Benin

University of Calabar College of Medical Sciences                                                                                        Calabar

University of Ibadan College of Medicine                                                                                                           Ibadan

University of Ilorin College of Health Sciences                                                                             Ilorin

University of Jos Faculty of Medical Sciences                                                                               Jos

University of Lagos College of Medicine                                                                                           Idi-Araba

University of Maiduguri College of Medical Sciences                                                               Maiduguri

University of Nigeria Faculty of Medicine                                                                                                         Enugu

University of Port Harcourt College of Health Sciences                                                         Port Harcourt   

University of Uyo College of Health Sciences                                                                                Uyo

Usmanu Danfodiyo University College of Health Sciences                                                   Sokoto

The Step 2 CS and the Step 3 can only be taken in the United States. There is no fee for taking the test in the United States and in Canada. (Click here to read our comprehensive summary sheet on USMLE guidelines and requirements)

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