USMLE Step 2 CS for IMGs – All You Need to Know

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By now, you must be more than familiar with the fact that the USMLE is a three-part exam, with the second part divided into the USMLE Step 2 CK (Clinical Knowledge) and USMLE Step 2 CS (Clinical Skills) exams. USMLE Step 2 CS for IMGs can be very daunting, as they not only have to learn to operate within a foreign medical system but also within a different language and culture. Step 2 CS is a unique exam in that it involves candidates going through a series of 12 live patient encounters in the course of 8 hours. These ‘patients’ are actors trained to display clinical problems and give standardized answers when prompted by the examinee. For each one, you are expected to elicit histories, perform physical examinations, make and communicate diagnoses, and draft a patient note. 

Given the importance of Step 2 CS, USDoctors.co has prepared a comprehensive overview of the exam. Through this blog, we will detail information about the registration process, the format of the exam, the basis upon which you will be scored, and what to do if you fail the exam.

Registering for the USMLE Step 2 CS for IMGs

ECFMG is the entity responsible for registrations of USMLE Step 2 CS for IMGs. Before you apply for Step 2 CS, you must submit an Application for ECFMG Certification, along with Form 186, known as the notarized Certification of Identification. Once you have submitted and received the approval of your application, you may apply for the Step 2 CS exam through the ECFMG’s Interactive Web Application. The application must be accompanied by a verification of your graduate status from your medical school along with other required documents. 

Following the completion of these steps, you will be assigned a 12-month eligibility period for taking the exam at one of six centers in five cities within the United States. Once you have received your eligibility period, it cannot be extended or altered. However, within your eligibility period, you may choose any available test date and even reschedule the test date as long as it is within the eligibility period. 

The ECFMG’s calendar and scheduling system will show you all the available dates on which you can reserve a testing appointment. The system also allows you to set a preference for a slot, even ones that are already booked. If the original candidate cancels their date, the space becomes available again, and all candidates who had expressed that slot as their preference will receive email notification of the update. Additionally, be mindful of deadlines imposed by the National Residency Matching Program when registering for a testing appointment. Sooner or later, you will need to make the necessary arrangements for travel to the United States, which includes applying for a visa. To help with the process, the ECFMG can provide you with a letter confirming your registration for the Step 2 CS exam.

USMLE Step 2 CS Exam Format

The USMLE Step 2 CS exam can be divided into three main parts:

1- Arrival at the Testing Centre

Upon arrival at the testing center, it is required as part of the USMLE Step 2 CS for IMGs to produce a scheduling permit and an identification. The latter could be your passport, driver’s license with photograph, or national identity card. Your name on this document must match your name on the scheduling permit. Following this, you will participate in the on-site orientation. The orientation is not a scored component of the test, and its sole purpose is to help you become familiar with the facility and inform you of how to navigate the premises during your time there.

2- The Patient Encounter

The exam will be 8 hours long and include 12 patient encounters. You will receive 15 minutes per patient during which you are expected to build rapport with the patient, elicit a patient history, conduct a physical exam based on the information provided, share your diagnosis and reasoning based on the findings and counsel the patient. For telephone patients, the expectations remain largely the same; however, you will not be able to conduct a physical examination. Remember that you can’t learn everything about the patient in such a limited time, so it is important to focus only on the most relevant questions.

3- The Patient Note

After you’re through with the patient encounter, you will have 10 minutes to draft a patient note. In case you finish before the allotted duration, the time left over gets added to the time assigned to you for writing the patient note. In the patient note, the exam expects candidates to share a maximum of three differential diagnoses, along with supporting evidence from the patient history or physical exam. List down your diagnoses in order of likelihood along with relevant tests to confirm them.

Scoring Guide for the USMLE Step 2 CS for IMGs

Your score on the USMLE Step 2 CS exam is based on three subcomponents, each of which you must have a passing grade on to pass the entire test. The subcomponents are CIS (Communication and Interpersonal Skills), ICE (Integrated Clinical Encounter), and SEP (Spoken English Proficiency). The SEP component is pretty self-explanatory. In the CIS component, you will receive a score from the patient based on your ability to build a positive relationship with them. This comes down to how well you collected and communicated information without using medical jargon, helped them make an informed decision, and dispensed emotional support at appropriate places.

The ICE component is a test of your clinical knowledge. You are rated on your ability to gather and interpret data from the patient encounter. The score for this component is a combination of the scores given to you by the patient on whom the physical exam was conducted, and by the physician evaluators who examined your notes from the encounter.

After the Step 2 CS Exam

Once you’re finished with the USMLE Step 2 CS exam there is a period of 4-5 weeks during which the scores are supposed to be released; however, it is not unusual for the ECFMG to take longer – it can, in some cases, take up to 13 weeks for scores to arrive. The USMLE Step 2 CS for IMGs is a pass/fail exam, and you are allowed to retake the exam a maximum of three times within your eligibility period. To get it right the first time around, be sure to check out the excellent resources available at the USDoctors.co blog.

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