we have helped several thousands of students pass the USMLE step 2 CS over the past decade and have successfully helped them reach their desired residency program. We here at GoldUSMLE Review will do our best to help IMGs and AMGs excel on their upcoming USMLE examinations and eventually secure a residency position.

Step 2 CS: Live and Online USMLE Step 2 CS Classes

The United States Medical Licensing Examination (USMLE) Step 2 CS is an 8-hour long examination in which each student is tested for Clinical Skills through twelve patient encounters. To pass this exam it is mandatory to pass all three components: The integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS) and Spoken English Proficiency (SEP).

It is best to schedule your exam at the earliest, as the dates get filled very quickly. You can also post your preferred dates on the USMLE Official Website, so that when a student cancels his exam, you will get a notification email. The exam centers for USMLE Step 2 CS Exam are based in Houston, Chicago, Atlanta, Los Angeles and Philadelphia.

USMLE Step 2 CS Exams

The United States Medical Licensing Examination (USMLE) Step 2 CS exam consists of a series of patient encounters in which the examinee must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. Examinees are expected to investigate the simulated patient’s chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.

Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. The patient note is slightly different from a standard SOAP note. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The examinees will then state up to 3 differential diagnoses relating to the simulated patient’s symptoms, and tests or procedures to investigate the simulated patient’s complaints.[5] The examinees should also list pertinent positive and negative findings to support each potential diagnosis.[5] The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters. Examinees are required to type patient notes on a computer.[6]

USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16, 2004. When the CSA first started it was strictly for Foreign Medical Graduates while US graduates were not required to do it. That was considered a double standard in the US medical licensing process. Later the CSA was replaced with the USMLE step 2 CS and became inclusive to all medical graduates.

Why do students Fail Step 2 CS Exam?

Almost one third of students fail The Step 2 CS Exam. There are numerous reasons for a failed Step 2 CS Exam.

  • Most of the students focus on demonstrating their clinical knowledge. However, the way you communicate with the patient, your smile and your empathetic behavior are of the same importance as your clinical knowledge.
  • Another reason why students fail is the lack of confidence. The students start feeling nervous as they enter the exam hall. The best way to overcome this exam anxiety is by practicing many times before taking the exam.
  • Bad pronunciation is also a reason many foreign students fail this test. This test requires solid English proficiency — especially in using medical terminology.
  • Poor time management is one of the leading causes of failure. Students tend to spend too much time on questioning and the physical examination. As a result they have insufficient time to complete the counseling session.
  • Most of the students think that their typing speed is fast enough to complete the patient notes within the given time. If you don’t practice and improve your typing speed, this places additional stress on you on exam day. Incomplete patient notes are also a leading cause of failing students.

How to Pass USMLE Step 2 CS Exam?

To pass this exam you will require extensive learning alongside thorough practice.


Where to study? Gold USMLE Review is the most reliable and comprehensive source for preparing for the exam. The step 2 cs course compiles most of the cases usually given in the test. Don’t try to use different sources — you may become confused.

Practice with a live partner: Practicing with a live partner is the step most of the students tend to skip. Practicing on Skype doesn’t give the opportunity of face to face practice. It is not essential to select a fellow medical student for practice. You may practice with any friend or a family member.

Practice with a Timer: Practicing with a timer is very important. Most of the students think that they can manage well without practicing with a timer. On the day of the exam, they are stressed enough to think about time. If you practice all the cases using a timer, your brain will automatically manage your time.

Patient Gown: If you practice with a patient gown, on the day of exam you will feel comfortable while asking before removing the gown. Most of the students lose their valuable points because they don’t follow this protocol.

Note Cards: After practicing all the cases from “First Aid for USMLE Step 2 CS,” start making note cards for a second round. On each card there is a patient’s name, age, presenting symptoms and chief complaint. For difficult cases, practice over and over again.

Practice the Mnemonics: Mnemonics will help you ask all the questions that are required to prepare a complete patient note card.