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USMLE Step 2 CS (Clinical Skills) - The Basics

USMLE Step 2 CS (Clinical Skills) - The Basics 

2nd part of step 2 is called clinical skills although it is not really clinical rather it is more about the communication skills and professional behavior. Following facts should be addressed:


This is misconception that CS can only be taken after step 2 ck as the clinical knowledge in CK helps In CS. CS can be taken at following points:

a) As undergraduate while you are in USA for electives.This gives you enough confidence that you have entered in the journey of steps and passed one of its exams without being crushed by long hours studies as required for other steps. Fez Malik took CS at this level.
b) Can be taken after step 1. I will not recommend to take cs at this level as you are in habit of reading long hours for step 1. You should continue this habit and take CK rather than rushing to CS which is different exam than theoretical exams of Step 1 and CK. Farrukh Abbas took CS at this level.

c) can be taken after CK as most of people do. One advantage is that god forbids if one fails , he can re attempt without getting his other step exams being suffered by that psychological trauma. Aftab Ahmed and me took CS at this level.


On average takes 40-45 days but people have done it in as short as 18 days period.

First Aid
Neeraj Notes
Iqbalian notes
U world ( for minor cases )

CS exam tests communications skills, professional behaviour and English proficiency more than medical knowledge. All the patients are actors, so one cannot find any wheeze or crackles on lung exam. But what they will see that whether you asked for permission for exam or not l; whether you washed your hands ; whether you properly undressed and then re dressed the patient etc. How did u start the case and how did u close it; you are supposed to use specific greeting words to start the case ; and in end you should explain what is your interpretation about the patient's disaese and what options you have to treat him.


CS needs 2-3 reads. Before starting , 1st go through iqbalian notes and learn all pnemonics. Pnemonic strategy really hepls in cs. Then start 1st read ; there 45 major cases and 10 minor cases. In 1st read , 4 cases can be done per day .So it takes 15 days in 1st read. One should perform and time each case on partner; then partner should perform that case on him and note each other timing and mistakes.

Dont worry about typing in 1st read. In second read , one can do 6 cases per day . each case should be typed and timed in this read. Second read takes 12 days.
In third read , also add minor cases from Uworld and watch CD .Should be completed in 7 days .

It is misconception that preparing on skype can get you through. There are examples when people passed like this but these are really few. There must be a prtner who can see and analyze your skills. In usa, you can find many partners in APPNA house in Philadelphia, New York and Detroit. For USMLE Step 2 CS prep in Pakistan, you can go to hostel to prepare for it

Each case is followed by one challenging question which should be answered in diplomatic way:e.g
"doc my father died of pancreatic cancer; do you think i have abdominal pain due to pancreatic cancer "
"well having pancreatic cancer in your father does not necessarily mean taht you have that too. After history and physical; pancreatic cancer is very remote in my considerations but still i will order few investigations to rule it out "
These challenging questions are given in 1ST AID.

CS is very unpredictable; having double 99 does not guarantee that one will pass in CS. Most people fail in communication skills and typing . If fail, one can re attempt but to be realistic these days having an attempt in CS really reduces interview calls to half.


This is misconception that one must be really good in eng for passing CS. Americans are really professional; they know that you dont belong to their country and you cannot speak like them; they only want to see how you deal with patients. All the patients speak simple english and your fluency is rarely tested.


Discussion about USMLE Step 2 CS

- Since last year the ICE component of the exam has been made a lot more competitive i.e. you SHOULD KNOW YOUR DIFFERENTIALS WELL as only then you will b able to document a properly formatted pt.note..the mnemonic strategy does help but if one is not able to justify the differentials through the pt.note, its very easy to fail the ICE component. So spend a good deal of time on it.

- The reason that some people now suggest taking CS after CK. Otherwise you shud be comfortable with differentials if taking CS earlier. Though they can be done with First Aid,  the differentials have to be arranged from most likely to least likely with points supporting each one. That needs little bit of clinical knowledge surely. Still if u give it after your final year then good to go. As you sure have good differential diagnosis skills just after taking prof..

- The cases tested in CS really dont need a profound knowledge of CK or step 1 for that matter. 10/12 cases are very basic and simple. 2-3 will be most likely the atypical ones. But even then I wont say that having a CK or step 1 already in the bag, will give you an edge. The opinion may vary from person to person. However,I along with 8 of my class fellows took CS without either step 1 or CK and passed it. The trick is to NARROW down a broad list of differentials pertaining to a case to just 1-2 MOST relevant ones. Do keep in mind that most of the US students take their CS during their last year of med school and CS is a well structured exam which puts you equally at par with them. So plz do not underestimate yourself with this fact. The clinical /bed side knowledge offered in 4th n final year is sufficient to make out the differentials for CS. You just have to master the art of narrowing them down in a limited time. Of course the US students are good at that and thats only because they do it every day . P.S-we DO THE VERY SAME in our wards too. We are just not used to the time management, documenting the data in the "american" format (which is slightly different terminology wise) and lastly the closure on any particular case presentation.

- Having a roatation (observership/elective) at any US school will give you an edge regarding the above. But even if you havent done any clinical rotation you really dont have to sweat much about it. As in the end its all about PRACTICE!!!!!!.
So in a nutshell--if you're a grad with step 1 and CK in ur hand, it'll take you 2-3 weeks to get done with CS and if you're a fish fresh outta the boat i.e. graduate with no step 1 or CK or USCE for that matter, just spend 30-35 days FULLY DEDICATED with a LIVE study partner for CS prep and you'll ace it i.a

- Taking CS in start and with proper prep: Its relatively easy exam and once u pass it it gives u early sense of satisfaction and accomplishment in pathway of USMLE and keeps u going towards the match goal. Its a support during mind wreck depressive phases of USMLE step 1 and Step 2 CK knowing you are already done with 1 of the 3 exams.


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