step 2 cs usmle

Step 2 CS USMLE: Everything You Need To Know!

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Are you about to take Step 2 CS USMLE?

In this article, I will give you everything you need to know about Step 2 CS USMLE.

I’ll let you know what it is all about, its difference with Step 2 CK, all preparations you need, what to expect during the test day, and the frequently asked questions on Step 2 CS USMLE!

What Is The Step 2 CS Exam?

step 2 cs usmle

Step 2 CS USMLE challenges your clinical judgment. It tests how you will integrate all medical knowledge and skills you learned and cumulatively apply them to patient care.

It focuses on the principles of basic patient-centered skills and clinical sciences for an effective and safe clinical practice.

The test utilizes standardized patient-based assessments in which the students could perform medical history-taking and physical examinations and communicate pertinent findings.

Standardized Patient–Based Assessments

The test involves people who act as real patients. Established for over 35 years ago, the standardized patient-based assessment is tested and validated worldwide.

It’s called standardized since each examinee will receive the same information as they perform all the required tasks. Therefore, they’ll have an equal chance to demonstrate their skills.

The quality of the portrayal of each patient is controlled. Scoring depends on observation and review of records.

Examination Blueprint

Each student is provided with accurate and appropriate examination blueprints containing cases that are developed by practicing physicians and educators.

It presents the most common cases encountered in the US. Cases differ on each examination day but they have a comparable degree of difficulty.

The exam aims to elicit patient-centered communication ability among the students. There are different patient personalities and disease manifestations that the students need to deal with.

What To Expect

  • A total of 12 patient encounters that include very few non-scored cases used for research purposes and pilot testing of new cases. These non-scored cases will not affect your score.
  • You will also be provided with Appendix A as an example list of expected common signs and symptoms.

Testing Day

Bring the following:

  • Scheduling Permit – the one you received upon registering.
  • Confirmation Notice
  • Valid government-issued ID. Take note that your name in the scheduling permit must match the one in your ID. No ID, no test. You will be asked to pay a fee to reschedule your test.
  • Make sure to arrive on time according to your Confirmation Notice.
  • Wear comfortable and professional clothing with your white laboratory clinic coat.


  • Only personal items are allowed in the testing center. You may put these items in a locker or cubicle before entering the testing room.
  • All eyeglasses, hair accessories, and neckties will be subjected under inspection upon check-in. It is advised not to wear any hair accessories at all since you will be asked to store them in your locker.
  • Jewelries, except for wedding and engagement rings, are prohibited.
  • The only medical equipment allowed is an unenhanced standard stethoscope which is subject to inspection. All other medical equipment will be provided by the facility.
  • Guests are not allowed inside the testing facility. They may wish to wait outside.
  • Smoking is prohibited inside the vicinity.
  • Discussion of cases with fellow examinees is strictly prohibited.

Examination Length

Lasts for 8 hours with 50-minute total break time:

  • A 10-minute break after the 3rd patient encounter
  • 30-minute lunch break after the 6th patient encounter
  • A 10-minute break after the 9th patient encounter

On-Site Orientation

You are expected to arrive before the on-site orientation. You are still allowed to take the test if you arrived during the orientation, but you are required to sign a Late Admission Form.

Failure to arrive before and during the on-site orientation time disallows you to take the test and must reschedule and pay for the corresponding fees. 

Few Minutes Before Patient Encounter

  • You will be provided with a clipboard, blank paper for taking notes, and a pen.
  • Wait for the announcement at the beginning of each patient encounter. This is the ONLY TIME when you can review the patient information written in the examinee instructions posted on the door.
  • You are allowed to take notes at this time.
  • The instruction sheet will contain the patient’s name, age, gender, chief complaint, and vital signs which you could consider as accurate unless otherwise required to reassess.
  • Laboratory test results may also be provided.

Patient Encounter

You have 15 minutes for each patient encounter. As you meet the standardized patient, you are expected to perform a focused physical examination – enough to arrive at a preliminary differential diagnosis.

You are expected to treat each standardized patient as a real one. Foster a therapeutic environment. Communicate with care and empathy. Always assist the patient in terms of decision making.

Physical Examination

You are expected to perform physical exam maneuvers correctly. Expect to elicit positive signs –  some are real while some are simulated. Always treat each patient as real.

Observe proper hygiene and ensure patient safety and privacy.

Telephone Patient Encounter

Before the telephone encounter, you’ll be provided with an instruction sheet that contains specific information about the patient. Once an announcement of the start of the encounter was made, you may take down notes before entering the examination room.

Upon entering, sit at the desk in front of the telephone.

  • Don’t dial any numbers.
  • Only press the yellow button to place a call.
  • Only one phone call is allowed. Never touch any buttons until you want to end the call. Pushing any button will disconnect you.
  • If you wish to end the call, you may press the yellow button again. Write a patient note after the encounter.

Patient Note

You only have 10 minutes to complete a note. Unless you finish the patient encounter early, you could have more time making a patient note.

Patient note is like the usual medical record you have observed in the health facility. You will be asked to type your data on a computer.

Record only pertinent data that will help in arriving at a maximum of three initial differential diagnoses arranged in order of likelihood. Support these diagnoses with relevant PE findings and medical history. List the possible diagnostic procedures you wanted to request.

Write only what you noted and not what you ought to do or should have done or asked as no credit will be provided on the latter.

Never write treatment, consultations, or referrals.

At rare times, technical problems might occur. In these instances, you will be asked to write down your patient notes instead.

Stop once the time has ended. Writing beyond the allotted time is a violation that will be reported to the USMLE. Always check the countdown timer at the upper right-hand corner to know how many remaining minutes you still have.

Character Limits On Each Field

History 950 characters or 15 lines
Physical Examination 950 characters or 15 lines
Diagnosis100 characters for each diagnosis
History Findings and
Physical Examination Findings
100 characters for each field
Diagnostic Study/studies100 characters for each study recommendation

You may add a maximum of 8 rows each to the history, PE, and diagnostic study sections.

You may refer to the video below concerning the Step 2 CS USMLE Examinee Orientation to give you a brief background on the exam.

What Is The Difference Between USMLE Step 2 CK And CS?

Here are the main differences between the two:

ComponentStep 2 CSStep 2 CK
FocusDesigned to evaluate the student’s ability to gather information from a standardized patient by performing physical examinations, and communicating their findings to patients and colleaguesChallenges the student’s ability to apply medical knowledge and skills and principles of clinical science

in managing patient for health promotion and disease prevention

Eligibility period and scheduling test date12-month eligibility period

The eligibility period starts with acceptance of application form and verification of eligibility


Once registration is completed, scheduling and eligibility permits will be issued.

Then, schedule a test date through the USMLE website.

3-month eligibility period  

Once registration is completed, scheduling and eligibility permits will be issued.


Then, schedule a test date through the Prometric website.

Note that scheduling is not allowed six months in advance.


Application Process and Fees$1,600 – Examination FeeStep 2 CK$965 – Examination Fee + International Test Delivery Surcharge, if testing outside the United States and Canada
Exam Pattern8-hour test session

12 patient cases:

  • 15 minutes for each patient encounter
  • 10 minutes to record each patient note

Administered in the US at six test centers: Atlanta, Chicago, Houston, Los Angeles, and Philadelphia (2)

9-hour test session

Around 318 multiple choice questions, divided into eight 60-minute blocks



Computer-based test administered at Prometric test centers.

How Long Does It Take To Prepare For Step 2 CS?

Roughly, less than a week will do. All you need to focus on is enhancing your communication skills and your ability to apply medical knowledge and skill to patients.

Since you’ve been somehow exposed to patient interactions activity, the time to spend preparing for Step 2 CS USMLE may not be too long.

Here are some testimonies of students who already took the Step 2 CS USMLE:

Testimony 1

‘I took two days to study – make sure you do the following:

  1. Watch the orientation video online
  2. Read through the mini cases and practice cases in CS
  3. Practice writing out your interview sheet

For example, on mine I would write:

Name, Age, CC, Abnl Vitals

HPI, PMHx, PSHx, Meds, Allergies….etc

Before I entered the room! This helped me to stay organized.”

Testimony 2

“I ended up studying maybe 4-5 days, never practiced with a partner, did practice writing notes for the cases I tried studying and didn’t finish all the First Aid cases. Did pretty well on the actual exam thank god, but I do recommend studying a bit more than that especially for timing sake and nerves. Make sure to come up with acronyms to remember history taking if you don’t already have some. It’s amazing how easy it is to forget stuff when you’re nervous. Be organized with a system to follow for each case and just be a nice person. “

Testimony 3

“I did 1 week of 3 hours/day which is what most people I know did. About 25% of the folks I know did 2 days or less. Some people do a couple of hours the night before.”

Testimony 4

“Dedicated CS? 4 hours.

Otherwise, I spent maybe half an hour a day over the course of 1-month reading and memorizing cases.

Had a friend come over to pretend to be an SP for 2-hour practice sessions. I did only 2 sessions. Mainly worked on timing (made myself finish with 2 min remaining each encounter). Eternally grateful to her.”

What Is The Pass Rate For Step 2 CS?

step 2 cs usmle

Here is data from the Educational Commission For Foreign Medical Graduates(ECFMG):

USMLE Step 2 Clinical Skills (CS)



IMG Registrations

IMG Pass Rate – First Takers* 82%


What Is A Good Step 2 CS Score?

step 2 cs usmle

Aim at least a 245. That’s a good score for Step 2 CS USMLE.

This is the average score needed in most specialties. With this score, you have a greater chance of applying to any specialty you desire.

The test assesses how well you could communicate effectively and at the same time utilize all this information to arrive at the right diagnosis.

If you’re wondering how the Step 2 CS USMLE scoring takes place, it is based on three subcomponents: 

1. Communication and Interpersonal Skills (CIS)

This mainly evaluates your patient-centered communication skills through building rapport, gathering and providing information, supporting and acknowledging patients’ emotions, and helping the patients in decision making.

This would show how therapeutic you could be both verbally and non-verbally to your patients. It’s time how you could show care and genuineness in managing them.

2. Spoken English Proficiency (SEP)

This evaluates how well you could communicate in English. It assesses your word choice and pronunciation capability as you communicate with your patient.

 3. Integrated Clinical Encounter (ICE)

This subcomponent focuses on your ability to gather and interpret data. You put your assessment notes, diagnostic impressions with their corresponding diagnoses, and other initial diagnostic studies indicated. 

You must pass each component to gain a passing performance in Step 2 CS.

If you want to get higher patient note scores, try to observe the following:

  • Using correct medical terms
  • Providing detailed documentation of pertinent history and physical findings
  • Listing only diagnoses supported by the history and findings
  • Listing the correct diagnoses in the order of likelihood, with the most likely diagnosis first
  • Supporting diagnosis with pertinent findings obtained from the history and physical examination

On the other hand, try to AVOID the following:

  • Using vague, nonmedical terminology
  • Listing improbable diagnoses with no supporting evidence
  • Listing an appropriate diagnosis without supporting evidence
  • Listing diagnoses without regard to the order of likelihood

How Are Patients Notes Scored?

It’s a hybrid of computer-assisted scoring and expert rating schemes. Licensed board-certified physicians and experienced medical educators score your patient notes. All raters undergo intensive training to apply the standard scoring instrument. The ratings are monitored through a Step CS Quality Assurance Program.

Score Report 

There is a so-called 4-5-week reporting period at each testing period. Scores are released up to 13 weeks after the test date. You may see the exact reporting schedules on the USMLE website.

What To Do If I Failed the Exam?

Retakes are possible for three times within the 12-month eligibility period. You are required to submit a new application for each retake you make. You may appeal to your score. US medical students may seek assistance from their dean or office of student affairs on when to retake the exam.

You may check other tips here on how to pass Step 2 CS USMLE.

When To Take Step 2 CS?

Test dates vary on availability. Make sure to check first and monitor the availability of your preferred test date in the Calendar of Test Dates.

The USMLE recommends scheduling exams early to reserve an appointment quickly especially if you’re planning to participate in the Residency Match the following year.

By any instance you need to reschedule a test date, you may do so without incurring any cost, provided that you give notice for more than 14 days.

Best Place To Take Step 2 CS

All test sites have consistent architectural layout and operational features for security, staffing, training for standardized patients, and scheduling. Consistency is essential to ensure that all students will have equal examination experiences.

Here is the list of test centers where you could take Step 2 CS:

CSEC Center – Atlanta

Address: 4130 SkyTrain Way Suite 300 College Park, GA 30337

CSEC Center – Chicago

Address: First Midwest Bank Building, 6th Floor, 8501 West Higgins Road, Suite 600 Chicago, IL 60631

CSEC Center – Houston

Address: 400 North Sam Houston Parkway East, Suite 700, Houston, TX 77060

CSEC Center – Los Angeles

Address: Pacific Corporate Towers, 100 North Pacific Coast Highway, 13th Floor, El Segundo*, CA 90245

CSEC Center – Philadelphia

Address1: Science Center, 3624 Market Street, 3rd Floor, Philadelphia, PA 19104

Address2: 3700 Market Street, 2nd Floor, Philadelphia, PA 19104

FAQs About Step 2 CS

Is Step 2 CS Easy? 

Step 2 CS USMLE is considered as one of the most difficult of all the other steps. Most students fail because they underestimate it and fail to get fully prepared for it.

Here are tips on how to pass Step 2 CS:

Type Quickly

You only have 10 minutes to type your patient note. If you type slowly at a speed of 1 word per second, then you must practice how to type fast. You may have the most accurate data, but if you cannot put it all on your patient note, then they might be useless and affect your score.

Practice Focused PE

Keep your eye on the case. Doing a comprehensive PE is not ideal. Imagine as if you’re in an ER setting. Perform physical exams in relevant areas only. Rely on the chief complaint, with that, you could easily know where to probe for more data.

Write the Appropriate Differentials

Use appropriate medical terms. Before the exam, take note of key buzzwords for prototypic cases to have an idea during your patient encounters.

Foster a Therapeutic Environment

Remember that one of the criteria for scoring is knowing how well you are in communicating with patients. Show some empathy. Be a good listener. Relate yourself to your patients and be accepting.

Practice Makes Perfect

Step 2 CS USMLE is a practical exam. It simulates what you will most likely encounter in real life. The more cases you study, the more chance you’ll pass Step 2 CS. Kaplan offers courses that provide access to several real-life clinical case scenarios. Reading and memorizing might not be enough. You must learn how to apply your learnings.

Is Step 2 Pass or Fail?

Step 2 CS USMLE is an 8-hour pass/fail examination. Unlike Step 1, Step 2 results don’t come with a numerical grade or a graphical representation of your performance.

Is Step 2 CS Required for Residency?

Yes, it is required to pass the first Step 2 CS USMLE before you could participate in the National Resident Matching Program® (NRMP®) Main Residency Match.

Does Step 2 CS Provide Lunch? 

Fortunately, yes.

The test runs for 8 hours in an outpatient setting. You have 15 minutes to perform history taking and physical examination and 10 minutes to write your findings in a Step 2 CS USMLE note. You will have a 30-minute lunch provided by the testing facility.

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


Hopefully, we’ve got all things covered for your upcoming Step 2 CS exam!

If you still need more tips on how to pass Step 2 CS USMLE, you could check out my article on the top 11 tips on how to study and pass Step 2 CS on the first try. 

Always remember that practicing more cases is the key!

Whenever you’re ready, there are 4 ways I can help you:

1. The Med School Handbook:  Join thousands of other students who have taken advantage of the hundreds of FREE tips & strategies I wish I were given on the first day of medical school to crush it with less stress. 

2. The Med School BlueprintJoin the hundreds of students who have used our A-Z blueprint and playbook for EVERY phase of the medical journey so you can start to see grades like these. 

3. Med Ignite Study ProgramGet personalized help to create the perfect study system for yourself so you can see better grades ASAP on your medical journey & see results like these. 

4. Learn the one study strategy that saved my grades in medical school here (viewed by more than a million students like you). 

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Until the next time, my friend…

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