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  AMSA Test Prep Corner, in affiliation with the authors of First Aid and USMLERx  

Step 2 Clinical Skills PROtips

First Aid for the USMLE Step 2 CS, Fifth Edition is now Available on!

Great Expectations

Step 2 Clinical Skills PROtips

Step 2 Clinical Skills is the final national examination you will take as a medical student. It is required for most medical school graduations.

According to the USMLE website, “Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.”

On test day, you’ll see 12 patients for 15 minutes each and then have 10 minutes to write a note. Many medical schools will provide mock exams to help prepare their students; others encourage students to use a clinic day at a primary care physician’s office to simulate test day. However, inevitably Step 2 CS will present a few surprises that are unlike the real world clinic patient. This is entirely because Step 2 CS is not the real world clinic.

The most striking difference you may encounter may be the reticence of the patients. In preparation for the exam, students are often trained to ask at least four open-ended questions before moving to more pointed questions to narrow the differentia – questions such as “what brings you in?” “what else has been bothering you?” “have you noticed anything else lately?” and “tell me more.”

But this strategy may not work with standardized patients.

After the initial story telling (about two minutes of interview time), open-ended questions don’t always garner much information. Some students have reported that asking any more than two open-ended questions appeared to annoy the standardized patient. However, a quick transition to the review of systems will reveal a host of other associated symptoms that could not be elicited by open-ended questions.

So, here’s the first point: the patients will not go off script. They have a very specific, limited amount of information that they are willing to tell only if asked the correct question. Once your line of questioning reaches the bottom of the information well, the patient will shut down. It’s your responsibility to know when to start on a different line of questioning.

You may also experience pitfalls when interviewing patients that have a complaint in your particular area of interest. Don’t run out of time interviewing these patients because you give in to the temptation to do a detailed exam with specific maneuvers. For example, if you’re interested in orthopaedics and you have a patient with shoulder pain, you’ll be tempted to do every shoulder test you know (of which there are many to cover in a comprehensive exam). In the face of complex maneuvers, the standardized patient no longer knows what is supposed to “hurt” or not, and so you will not only waste time doing maneuvers that won’t give you points, they may also be confusing.

Stick with the basics! And never leave out your heart, lung, and abdomen exam in a rush to do an intense thyroid or ankle exam.

Finally, be sure to practice writing the note. Students often have ample experience writing notes, but each part of the note on the exam has a character limit. In all likelihood, when you see a patient in the clinic, you write much, much more than the character limit on the CS exam. Take time to practice succinct notes in bullet point format. Don’t let panic set in when you are only halfway through the HPI and can’t type any more information.

CS is the final component of your medical boards in medical school. Be your regular personable and caring self, and patients will always respond in kind.

Good luck!


First Aid for the USMLE Step 2 CS, Fifth Edition is now Available on!

With this edition of First Aid for the USMLE Step 2 CS, we continue our commitment to providing students with the most useful and up-to-date preparation guide for the USMLE Step 2 CS exam. This edition has been completely updated to reflect the latest exam format.

In this edition, the authors strive to help students avoid common mistakes in preparing for the Step 2 CS by including:
  • 44 full-length practice cases that simulate the real exam--including pediatric and telephone interviews as well as suggested closing statements for each case
  • A revised and expanded set of minicases representing common complaints, designed to help you rapidly develop a set of differential diagnoses
  • Updated content based on feedback from recent U.S. and international test takers
  • Step-by-step strategies for interacting with standardized patients, including "difficult patients"
  • Detailed descriptions of high-yield physical exam maneuvers that will win you points without costing time
  • Time management advice to maximize your clinical encounters
  • Proven study and exam strategies from students who passed the exam
Get your copy now on!

Great Expectations

As a new resident, you will be expected to meet and exceed the requirements of your patients, colleagues, and supervisors. There is a mixture of excitement about managing patients independently (almost!) and the trepidation of being stuck in an unfamiliar clinical situation with no help in sight. The long and arduous process of becoming an independent physician is well and truly in full swing.

Managing your expectations well is a challenge as it is those expectations that will definitely help you stay motivated throughout residency. But at the same time, you don’t want them to be your own personal albatross as well. It is vital that self-improvement targets are attainable (for you) in the least stressful way without risking professional burn out.

The crux of my argument is this… we are lucky to get this opportunity and perhaps we can learn vital skills for our future careers and enjoy the process at the same time. Of course, it is very easy to be introspective when one has free time, but holding the line in the face of incessant work and personal demands will be the real challenge.

Ultimately, you have to be the best resident you can be and not measure yourself by someone else’s measuring stick. Expectations that are beholden to our coworkers’ performances and that are comparative are bound to be short sighted and unfulfilling in the long term.

Ultimately our performance is based on the standard of patient care that we can provide as a team, and no professional or personal goals can be of higher priority.

Here’s to hopes and great expectations! May they always keep our lives fresh, exciting, and enjoyable.

Vol. 6, Issue 6
June 2014

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