All About the USMLE Step 2 CS

Step 2 CS follows Step 2 CK in the United States Medical Licensing Examination (USMLE). It’s an interactive test where you’ll examine and diagnose actors who are pretending to be patients with specific health conditions. It’s meant to test your ability to interview patients, do physical exams, fill out medical charts, and explain your findings.
Because you’re an IMG, once you’ve completed Step 1, Step 2 CK, and Step 2 CS, you are certified by the Educational Commission for Foreign Medical Graduates (ECFMG). That means you’re eligible for the National Resident Matching Program (NRMP).
Check out these questions to learn more about what to expect from the USMLE Step 2 CS.

Who takes the USMLE Step 2 CS?

Just as with the USMLE Step 1 and Step 2 CK, to be eligible to take Step 2 CS you must be in one of these categories at the time you apply for Step 2 CS and on the day of the exam:

You can register for Step 2 CS on the National Board of Medical Examiners (NBME) website.

When should I take the USMLE Step 2 CS?

According to the USMLE, most students take Step 2 CS in their fourth year. One of the unique aspects of Step 2 CS is that it’s the only portion of the USMLE not taken on a computer. Because it assesses a student’s ability to act like an intern with primary responsibility for a patient, many students take the exam late in the clinical years of their med school journey.
By the fourth year, you’ve completed coursework and rotations in U.S. hospitals. These things (along with USMLE prep) help give you the experience—and confidence—you need to pass Step 2 CS.
Also, remember that the peak season for the USMLE Step 2 CS is between September and December. You may want to register and schedule early for Step 2 CS to make sure you get an opening when you want it and where you want it.

Where will I take the exam?

The USMLE Step 2 CS is taken at Clinical Skills Evaluation Collaboration (CSEC) test centers in five locations: Atlanta, Chicago, Houston, Los Angeles, and Philadelphia.
When you add up the cost of the exam (which is over $1,200) and expenses for USMLE prep, travel, food, and lodging, it’s certainly not cheap. A relatively nearby test center may help offset some of the cost.

No prep is complete without experiencing the test itself under exam-like conditions. Practice live with a one-day full-length exam with 11-12 standardized patient encounters and a detailed performance analysis report with feedback. With a practice exam you really can perfect your performance.

What’s on the exam?

The USMLE Step 2 CS is an eight-hour pass/fail exam that includes 12 individual patient encounters.

  • You’ll be expected to communicate with the test patients in a professional, empathetic, and responsive way; answer their questions; and complete a patient note.
  • You’ll cover common situations a doctor is likely to experience in U.S. clinics, doctors’ offices, emergency departments, and hospital settings.
  • You’ll be tested on physical systems that may include these categories:
    • Cardiovascular
    • Constitutional
    • Gastrointestinal
    • Genitourinary
    • Musculoskeletal
    • Neurological
    • Psychiatric
    • Respiratory
    • Women’s health

How can I make sure I’m prepared?

One of the major outcomes of this exam is that it determines whether you speak English well enough to communicate effectively with your patients. Bottom line: The best test prep is to know what to say and how to say it.
As an IMG, you may want to consider extra practice and review so you’re confident you’ll ace the exam.Look for test prep that helps you learn how to quickly build rapport, earn a patient’s trust, and show empathy. While knowledge of the content is vital, it’s key that you treat every encounter as if you’re dealing with a real patient. If you can do that, you’ll be well on your way to becoming a doctor in the U.S.