How to do well on your USMLE Step 2 CS exams

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Renee-Marinelli-MD-380x380We sat down with Dr. Marinelli, MedSchoolCoach advisor and former admissions committee member at University of California Irvine School of Medicine. She shared with us some secrets about doing well on the USMLE exams!

Could you tell us a little about the different USMLEs (Step 1, Step 2 and Step 3) and you would recommend a student approach Step 2 specifically

Sure, so Step 1 is taken after your second year of medical school. I think that is probably the hardest step test that most students will take, just because the material and the volume of information on that test is very large and it is weighted heavily on the residency program. So kind of like the MCAT is for medical school admissions, the USMLE step one is similar for residency admission. It’s very heavily based and depending on your score really reflects what type of residency program you will get in, in a large majority of residencies. USMLE Step Two, also is a lot of information, but since it’s more about clinical skills and about clinical practice, most people find this one a little bit easier to take and this is usually taken in your fourth year of medical school. Then finally USMLE step 3 is the last step thankfully and that is most often taken in the first year after medical school. That one is, I would say from my experience and talking with most of my peers, usually the easiest. It’s a very lengthy test, it’s actually two days long, but since that one is the easiest, people don’t normally prepare much for that. That’s because again- in clinical practice- you are really using your skills that you are using every day in practice; you are using those on the test, so it’s a little bit less stressful and then you’re done at that time. USMLE Step 2 consists of two parts, so there is the CK which is the written part where you are actually being tested on clinical knowledge and it’s more question- answer multiple choice based, that most medical students are used to. The CS part or the clinical skills, is a test that does exactly as it sounds. It tests your clinical skills, so it is a test that’s based on using twelve standardized patients and you are graded on several different things including your ability to communicate with patients, ability to think through a differential diagnosis and then also your ability to write patient encounter notes after the visit with the standardized patient.

In terms of diagnosing patients in the USMLE Step 2 CS test, is there any specific material or any specific preparation students should do when they begin to study for the step two?

I was thinking of kind of three strategies on how you should really best prepare for this exam, so I broke it down into three parts. First, you want to plan for the exam. So when you plan it of course you are scheduling the exam, there are only certain test centres throughout the United States that offer the test, so students have to fly to certain test centres, to take the exam. When you do plan out your test, make sure you check out the USMLE website where they have information on hotels and they also have information on updates on the test site, if there are any changes or anything that you should know. Then also, I think that since a lot of people have to go to different cities and different areas to take these exams, make sure when you arrive there the day before, or the day of, make sure you know where you are going, you know where parking is, you know exactly what time you are going to arrive. It’s going to really really remove a lot of stress on the day and on the day of exam you don’t want to show up late too, so just make sure you just really plan your exam day and that’s going to help you really prepare. I think another big huge part in preparing for this test is going to be practice. So all through medical school, your first two years of medical school, you are going to be seeing standardized patients, where you have people that come into the medical school and are actors and they act out having certain symptoms or certain diseases and you as a medical student have to treat them and pretend that they are actual patients presented with actual diseases and symptoms. So this is very similar to what the USMLE Step two CS is going to consist of, so practice using those scenarios. Definitely take advantage of your medical school standardized patient testing, because most medical schools have what they call OSCEs, where they use standardized patients to test you. So take advantage of those, take those seriously because those will be preparing you for the CS. If you have the chance, have your friends help you and have them be standardized patients, it’s very easy to have somebody pretend that they are a patient and most people actually enjoy pretending that they are a patient. I also recommend practice doing limited physical exams on a time limit. On the real exam day, you are allowed 15 minutes to perform a history and physical exam on the patient. So you should have somebody pretend that maybe they are presented with stomach pain and you have to perform a history that is completely related to stomach pain and an exam that is related to stomach pain and limited at that. You are not going to perform a full neurological exam or a full muscular skeletal exam, only unless it is applicable and practice that in that constrained time limit so you make sure you have that down on the actual test day. Finally, I think practice writing timed notes, the USMLE website for Step Two CS, has a great page that has a sample note that they expect you to put in their format. They give you ten minutes on the actual test day, to write a patient encounter note, so practice writing the note in that time limit. Make sure you are writing thorough notes, you are writing all pertinent positive and negative findings that you have discovered on your physical and history exam. Also, make sure that you are being able to discuss thorough differential diagnosis and what tests and treatments to order. Finally, I think the last thing and I will be brief on this, I want to just say on the actually day after you have prepped and you’ve practiced the last thing is actually to perform. You are really an actor, a player, because you are walking in on this test day and you are acting like you are a doctor. That’s what you are doing, you are seeing people that are actors and you are supposed to act like you are their doctor. You should really walk into the room and be confident that you have had the last three or so years of training, to know how to evaluate patients and know how to perform a thorough and comprehensive history, physical and obtain relevant information. Then also, make sure that you are empathetic, and that you are patient and kind to all the people, to all the patients. If they are frustrated, if they are angry with you, make sure that you are constantly compassionate and understanding, because that is something that you are going to be graded on during the exam as well.

That’s very useful, thank you. Can you share with us a little bit about how the exam is scored?

Yes, luckily the exam is a pass or fail, so you are not going to be graded specifically with a scoring system like the CK or Step One, you are going to receive a pass or fail. That does relieve a lot of anxiety for most people. But the breakdown of the scoring system is in three different parts so, you are going to be graded by qualified examiners selected form the USMLE on Communication and Interpersonal Skills, so that’s pretty self-explanatory there. It’s how well you are able to talk with patients and communicate ideas with them and respond to their needs or their questions. The next area that you are graded on is Spoken English Proficiency, so this test was somewhat designed to measure the students ability to speak English clearly, so that is going to be assessed here. Then finally you are going to be graded on what they call ICE or Integrated Clinical Encounters. This is really where you are going to be graded on how well you interpret the patients’ history, physical, in order to parade a knowledge of differential diagnosis, also your ability to write notes and make relevant clinical decisions.

Alright. Is there anything else that you think will be important for students to know while they either prepare for the exam, or advance towards their journey of becoming a doctor?

I think in terms of the Step 2 CS, I think take it seriously, a lot of people don’t take it seriously, and I have heard of people that don’t pass. I think it’s rare that most people in the US medical schools don’t pass. There is a very good pass rate for students in MD schools here in the United States, but it is something to be taken very seriously, because you don’t want to fail this exam. It’s expensive, you don’t want to have to take it again, it’s a long day, something you want to take once and put it behind you. Make sure you do take it seriously.

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