USMLE Step 2

Working through the test

Step two of the USMLE is typically written during year four of medical school, around two years after the USMLE step one was written. Your *preparation[Prep USMLE] for the test should include both clinical knowledge and your 'bedside manner,' as the exam is administered in two sections based on these skills.

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Section One: Knowledge of Clinical Fundamentals

The first section of step two tests your understanding of the basics of clinical medicine. The test focuses on basic knowledge that you've acquired during pre-med and other undergraduate courses. It's strictly multiple choice questions divided into several types, including:

  • Choose the best answer
  • Match one to one
  • Match more than one answer

Section Two: Clinical Skills

Put on your lab coat and stethoscope for section two, as you will be examining a "patient" in a typical 15 minute re-creation of an examination. This test was formulated with foreign medical graduates in mind, but has been expanded in recent years to include all USMLE takers. Section two tests and scores you on three important aspects of clinical practice:

Integrated Clinical Encounter (ICE) is graded on the following subcomponents:

  • Data gathering. Your skills in questioning the patient and the physical examination.
  • Documentation. Your notes on the patient will be graded by trained physician raters. You're expected to follow the required template.

Communication and Interpersonal Skills (CIS) covers the following:

  • Questioning skills. You'll be tested on your understanding of questioning strategies and on your ability to listen to the patient's responses.
  • Information sharing. Your ability to interact with the patient, how you overcome any lack of clarity (about their symptoms, for example) and how you express yourself to the patient.
  • Professional rapport. Your concern for the patient's comfort and modesty. Your use of maneuvers (especially any kind of physical touch) is assessed, as it affects your ability to properly and appropriately diagnose the patient's problem.

Spoken English Proficiency (SEP) looks at:

  • Clarity of communication in the exam. This was originally put into the examination assessment with foreign medical graduates in mind, but has now been adapted more broadly. All students are expected to speak clearly, to use proper word choice and pronounce all words and phrases accurately.

All of these aspects are graded according to standardized USMLE rating scales.

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