USMLE Step 2 CS Exam was added in 2004 to USMLE series by NBME and FSMB. USMLE STEP-2 CS is the 3rd component which is administered to the medical students or medical graduates who wish to become licensed Physicians in the USA.


Some of the recommended articles by author:

USMLE [A General Study Guide To All USMLE Steps]


USMLE Step-1 [A Comprehensive Guideline]


USMLE STEP-2 CK [Study Guideline]

USMLE Step-2 CS Brief Overview

USMLE Step 2 CS consists of 12 Patients encounter and the examinee is required to encounter standardized patients. Standardized patients are the professionals who are trained to portray actual patients in order to check the clinical skills and knowledge of the examinee. UMSLE Step 2 CS exam is quite different from USMLE STEP-1 or STEP-2 CK as it is not theoretical and not multiple choice questions based exam. In USMLE Step 2 CS exam a medical student is in an actual encounter with a live patient and this makes this exam more of a practical exam.

In UMSLE STEP-2 CS exam, an examinee is required to take the brief history of the patient, do a physical examination, counsel the patient and then take patient note based on his/her determinations.

USMLE Step 2 CS consists of the following components:

  • Patient Encounter
  • Physical Examination
  • Patient Note
  • Telephone Patient Encounter (Sometimes)


Eligibility Criteria

Step 2 CS can be taken by students while in Medical School,

  • US and Canadian Med-School Students recognized by Liaison Committee on Medical Education (LCME)
  • US and Canadian Med-School Students recognized by American Osteopathic Association
  • Students outside US and Canadian Med-Schools recognized by International Medical Education Directory (IMED) and Educational Commission for Foreign Medical Graduates. (ECFMG).


USMLE Step 2 CS or Clinical Skills Components

What is asked? Application of ‘Clinical Skills’ on ‘Standardized Patients’.

  • Fostering Relationship
  • Information Provision
  • Decision Making
  • Emotional Support
  • Patient Behavior’s Handling

When to take? Usually during the 4th year of medical school.

Time Duration: 8 hours (one day)

Format: 12 patients, 15 minutes for encountering patient and 10 minutes to take notes.

Test Place:  5 Test Centers (Philadelphia, Huston, Atlanta, Chicago, Los-Angeles)


Exam Criteria

As this exam is based to test the clinical skills of the examinee the exam criteria or the procedure is entirely different from that of Step-2 CK or Step-1. There are no MCQs in this exam rather an examinee has to deal with a standardized patient under the supervision. This exam actually tests proficiency and efficiency of the examinee. USMLE Step 2 CS is more of a practical exam rather than theoretical.


USMLE Step 2 CS Comprehensive Study

For USMLE Step 2 CS exam, an examinee must have a strong grip on the clinical skills of the:

  1. Internal Medicine
  2. Surgery
  3. OB/Gynecology
  4. Pediatrics
  5. Psychiatry

USMLE Step 2 CS Study Material/Content

When it comes to the sources to study for USMLE STEP-2 CS, many of the students get confused. A lot of resources are available to study for STEP-2 CS but most of the students and graduates who have cleared their STEP-2 CS exam suggest only one source to study from:

FIRST AID for the USMLE Step 2 CS

USMLE STEP 2 CS 231x300 - USMLE Step 2 CS Exam Pattern | What is Step 2 CS

Exam Time Length:

The USMLE Step 2 CS administration includes 12 patient encounters. The examination session lasts approximately 8 hours. You will have 50 minutes of break time:

  • 10-minute break after the 3rd patient encounter
  • 30-minute lunch break after the 6th patient encounter
  • 10-minute break after the 9th patient encounter
  • In the end, you will encounter 3 more patients and then it’s done


The test center is unable to accommodate special meal requests. However, you may bring your own food, provided that no refrigeration or preparation is required.

Smoking is strictly prohibited throughout the centers.


Time Management

Time management is very important regarding the USMLE Step 2 CS. You are provided with only 15 minutes to encounter the patient and only 10 minutes to take patient notes. Managing time is the key to success in this exam. To save yourself from wasting a lot of time, follow this routine:

Patient Encounter Patient Note
You are given only 15 minutes for the patient encounter. Use your time wisely:

·       8 minutes for taking History

·       4 minutes of Physical Examination

·       3 minutes for Closure and Counseling of patient


Now, this is a tricky part and you have to manage the time very wisely. You will have to type the Patient Notes on a computer. You only have 10 minutes to do this all stuff:

·       Do not take it lightly

·       Master Keyboard typing as to save your time

·       Reach a possible correct diagnosis

How to Study?

To study for USMLE STEP-2 CS exam, follow these tips:

  • Studying for 1-2 Months will be enough for your preparation
  • Take a Study Buddy; this is the most important part you should focus on. Taking a study buddy means you have got someone to apply your skills to as a patient. Then you can switch the turn and repeat this again and again until you have a very strong hold on it.
  • Master all the cases from your FIRST AID
  • Make flash cards, probably with mnemonics on them and read them again and again (Acronyms)

Principles for Success in USMLE Step 2 CS:

Some of the principles which can assure your success in the USMLE Step 2 CS exam are:

Principle 1 Principle 2 Principle 3 Principle 4
To Master the art; how to answer the difficult and challenging questions:

·       Giving your attention to patient,

·       Not denying or confirming anything to patient,

·       Counseling the patient in a positive way; you will do anything in your power,

·       Changing tone for sympathy and empathy,

To master the art of Building Rapport:

·       In this section, you only have to be master of how you are going to build your rapport?


Master of efficiency:
  • Not wasting a second,
  • Taking most out of the time,
  • Developing a feel of how much time you have spent and how much is left,
  • Mastering efficiency takes time, so give it as much time as possible,


Must have very strong Clinical Knowledge:

·       Make very strong Differential Diagnosis,

·       Must have very Strong CK knowledge

·       Taking an excellent Patient Interview

·       Accurate Diagnosis

·       Asking right questions



To succeed in USMLE Step 2 CS exam:
  • Strengthen your knowledge,
  • Practice again and again with your study buddy or the group you are studying with,
  • Identify your weaknesses and try to strengthen them,

Exam Day:

Make your schedule. In last 2 days before exam revise all your cases thoroughly. On the exam day following this routine would benefit you:

  • To go to bed early (10 Pm – 6 AM)
  • Take your breakfast
  • Take your lunch with you
  • Use your break time wisely
  • Don’t indulge yourself in meaningless activities

 Scoring/Grading Criteria:

There are no marks for this test. The test is graded on Pass/Fail basis. The three components on which an examinee is graded as pass/fail are listed below:

  • Integrated Clinical Encounter
  • English Proficiency
  • Communication with patient
  • Interpersonal Skills

Common Abbreviations for taking Patient Note

Screenshot 43 - USMLE Step 2 CS Exam Pattern | What is Step 2 CS

Common Presenting Signs and Symptoms:

Screenshot 44 - USMLE Step 2 CS Exam Pattern | What is Step 2 CS

Registration and Fee Structure:

For registration procedure and fee structure please read the below-mentioned article;


USMLE [A General Study Guide To All USMLE Steps]



Follow the following tips to save your precious time:


  • Study in groups
  • Read the instruction sheet at least once before entering the examination room
  • divide the sheet into 4 parts and add ( LIQURA, PAM, HITS, FOSS and relate them to mnemonics to save time)
  • Come up with at least 3-4 diagnosis before entering the room so that you are prepared to ask specific questions
  • Memorize Basics again and again
  • Make flashcards (very important)
  • Write Mnemonics on flashcards and memorize them again and again
  • Look for patterns
  • Connect all the information
  • Do ask for help from others before the exam day


A word from Author

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Disclaimer: All contents of this article are for informational purposes only and not a substitute for professional advice, diagnosis, or treatment. Reliance on any information is solely at your own risk.



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