USMLE Step 2 CS – Live Practice Methods for Patient Interaction
Arguably the most critical part of the USMLE Step 2 CS (Clinical Skills) exam is the personal interaction between the patient and doctor. During the Step 2 exam each candidate is required to perform in 12 patient encounters. Unlike the Step 1 and Step 2CK examinations, this particular exam is where medical knowledge and clinical skills are applied together during simulated real-world experiences. If it seems daunting, and you feel apprehensive, you are not alone.
The overall exam involves collecting data, making some preliminary decisions about diagnosis and work-up, and completing a patient note. But establishing the appropriate interpersonal relationship between doctor and patient is where many IMGs have the most difficulty. Such stress can also diminish a test candidate’s ability to apply their analytical skills, knowledge and training, and too often limits their ability think and communicate clearly. This is especially true for foreign doctors who must overcome additional obstacles including language and differences in cultural norms with regard to personal interaction.
The general consensus among experts in the field is that international medical graduates, especially those who struggle with spoken English proficiently, have the most difficult time navigating the various requirements of the Step 2 CS exam. Learning written English for academic study is very different from conversing during real (or even simulated) human interaction in the clinical environment. The burdensome task of translation from a native language to a less familiar one also requires extra time which can make it more difficult for examinees to finish the cases. Combine that particular difficulty with the added stress of being evaluated by the patients themselves on so many different sets of criteria, and the CS exam can be exceedingly challenging.
How does one overcome these difficulties? There are three ways; practice, practice and more practice! For any exam in any field, preparation is a key factor. However, possessing sound medical and even clinical ‘knowledge’ alone is not enough to pass the USMLE Step 2 CS exam. Examinees must be able to demonstrate a comfort level with themselves as well as with the standardized patients who assess them. They must be familiar with what to expect and how to best establish patient rapport through appropriate verbal and non-verbal communication. Perhaps the best way to accomplish this is to practice these interpersonal skills in a supervised environment with professional SPs and instructors who are experienced with the exam, and can provide valuable feedback for improving performance deficits.
Supervised practice with personalized feedback has proven to be particularly helpful for foreign medical graduates who face these additional challenges of cultural and language obstacles when preparing for the exam. In fact, the latest statistics indicate that passing rates among IMGs and foreign graduates improve dramatically with this kind of preparation component, where specific areas of weakness can be identified and corrected. These types of programs also boosts student confidence through the positive reinforcement of appropriate clinical behaviors, and help to reduce the anxiety and nervousness which so often is responsible for failure. Unfortunately, all too many test takers continue to rely on the popular cs preparation books and online sources which often provide faulty advice and cannot address individual areas of needed improvement.
Many candidates choose to find practice partners or get involved with a study group of doctors who are all preparing for the exam. They meet and practice on each other to hone their clinical skills and develop a familiarity with the exam. This may be good in the sense that it is, in fact, practice. However, without accurate and knowledgeable input from someone who understands the assessment criteria, it may become an exercise in futility. Many come to realize, only after failure, that a more professional and expert approach is warranted for such an important exam.
The best advice may be to consider a Step 2 CS training workshop that combines instruction with live full case practice and feedback. Review classes that utilized specially trained professionals who have experience in standardized patient education as well as clinical skills assessment, will usually provide the most comprehensive approach for success. This will also allow for a more focused and productive practice experience leading up to the exam.
The USMLE Step 2 CS exam can be a formidable and trying exam. For international students, this is especially true. Getting involved with a study group is a good step, but seeking out professional training classes or workshops that specialize in live practice and individualized feedback with professionally trained SPs is the most optimal method of preparation. Doing so will greatly improve one’s chances of passing the step 2 cs exam the first time.