How to Rock the Step 2 Clinical Skills Exam

by Nicholas Valentino

There are three grading areas for the Step 2 CS Exam and students must pass all three sections in order to pass the exam:

SPE – Spoken English Proficiency

ICE – Integrated Clinical Encounter

CIS – Communication and Interpersonal Skills

The area where IMGs struggle the most is the CIS section  The Step 2 CS is all about establishing a relationship with your patient and ensuring you are working with them through out the encounter.


The SP (standardized patient) grades you on:

  • Communication and Interpersonal Skills
  • Spoken English Proficiency
  • Integrated Clinical Encounter
  • Physical Exam

MDs only grade on:

  • Integrated Clinical Encounter
  • Patient Note

What are some reasons that students fail the exam?

Students can fail this exam for a variety of reasons including; time management, incomplete history and data gathering, lack of a clear diagnosis, lack of empathy and lack of relationship building with the patient.  SEP (spoken English proficiency) scores and overall issues with lack of typing/Patient Note practice are also common factors.

What are biggest changes to the CS exam over the past few years?

The Step 2 CS has seen a lot of changes over the past few years, mainly around the Communication and Interpersonal Skills expectations.

  • Standardized Patients are now more reactive.  Each encounter will be different.
  • Your score will reflect your individual performance based on the USMLE standard
  • Patient notes also need to focus and support how the patient interaction led to the diagnosis.
  • Kaplan curriculum and cases have been updated to reflect Step 2 CS Exam changes


What are the most important things students can do to prepare for the exam?

Many people are familiar with the term “practice makes perfect” but with the CS exam it needs to be “perfect practice makes perfect”   If you are practicing with your friend and not remembering to knock on the door or wash your hands before you do the physical exam, those habits are going to come out on test day.  You need to train under exam like conditions at all times.

Also, regardless of what you use to prepare for the CS exam make sure you are using up-to-date materials.   Many students fail CS because they are using old editions of review materials which do not meet the current competencies needed to pass this exam.   Do not underestimate this exam!

Comparison of Kaplan Offerings


Dr. Barone and I wish you the best of luck with your preparation!

Nicholas Valentino is a Medical Licensing Exam Preparation expert and Senior Medical Programs Consultant at Kaplan Medical in New York City.  He can be reached at  This email address is being protected from spambots. You need JavaScript enabled to view it.

Category: CS

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