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Tips to Nail the USMLE Step 2 CS: How to Work Well with SPs

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Standardized patient and USMLE

It is important to know what is expected of you in the USMLE Step 2 CS exam. During the exam, you are subjected to two types of patient encounters: Standardized Patient and the Telephone Encounter. It is equally important to know what not to do during Step 2 CS so that you refrain yourself from making mistakes that can cost you points and time. Read on to get tips to prepare for Step 2 CS and understand what you should not be doing during USMLE Step 2 CS patient encounters.


A. Things to avoid during in-person encounters on the USMLE Step 2

  • Avoid performing prohibited tests

Tests such as pelvic, inguinal hernia, female breast, rectal, or corneal reflex examinations are prohibited. If you think the patient needs any of the tests, recommend it in the Patient Note.

  • Avoid asking for patient’s consent for the permitted physical examinations

Other than the prohibited test mentioned above, you are allowed to carry on the physical tests, such as back exams assuming that you have the patient’s consent. Asking permission for every physical you perform will unnecessarily consume a lot of your time.

  • Avoid being too forceful with the patient

While conducting physical examination, be gentle and avoid using too much force when examining the abdomen, gall bladder, liver, ears, etc. If you apply more pressure than required you might lose points.

  • Avoid invading patient’s modesty

It is important that you use your time well to make your patients comfortable. It is necessary that you treat your standardized patient in exactly the same way you would treat a real patient. All during your patient encounter, you are required to remain courteous and professional.

B. Things to avoid during telephone patient encounters during USMLE Step 2 CS

  • Avoid playing with phone buttons
  • During the telephone patient encounter, you are required to use the yellow speaker button to call or end the call. Pressing any other button during the exam may disconnect the call.
  • Avoid calling back the patient after ending the call
  • The end of the call means the end of the encounter. Do not try to call the patient back if you need more information or have got a question. Do the best with whatever information you have.
  • Avoid making assumptions based on your past experiences
  • Making assumptions based on your past experiences can affect the diagnoses and treatment strategy of your exam.
  • Avoid guessing whether or not an encounter was scored

Most of the twelve patient encounters you have during your exam are scored. However, do not waste your time trying to guess which ones were unscored. The best way to approach it is by treating each of the twelve patient encounters with equal seriousness.


  1. Smile to please Most students let the stress of performance affect their ability to be warm to the standardized patients. You need to remember that these standardized patients do not know how strong your clinical knowledge is – all they know and remember is how comfortable you made them feel during the patient encounter. So, greet them with a smile and treat them well.
  2. Keep your calm On exam day, most students get too nervous and forget to ask important questions to their SPs. To overcome exam day anxiety, the most effective method is practice mock tests.
  3. Practice on your pronunciation IMGs have a tough time speaking in English with correct pronunciation. That is why, it is difficult for them to clear Step 2 CS exam. Since Step 2 CS assesses the student’s English speaking skills, the students are expected to pronounce the words correctly so that the patients can understand them. So, practicing your pronunciation is the key.
  4. Understand which portion of the exam has more worth It is important to know that counseling the patient is worth more points. Most students spend a lot of time on the physical examination and interviewing the patients that they fail to provide counseling to the patients and due to time constraint they don’t do justice to the patient notes.

Fortunately, you can prepare for USMLE Step 2 CS with the help ofStep 2 CS prep courses available that uses various strategies to help students overcome anxiety. These prep courses also conduct mock tests in an exam-like environment to help students practice their clinical skills and work on their English-speaking skills to enhance their English-Speaking-Proficiency.

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