Over the last few weeks, we’ve been talking about the USMLE exams, which are essential for earning ECFMG certification and becoming eligible to apply for a medical residency program in the United States. In one of these posts, we introduced you to the USMLE Step 2 – CS, which tests your clinical skills. In another post, we took a more specific look at what you can expect in the two types of encounters on the USMLE Step 2 – CS: the Standardized Patient and Physical Examination and the Telephone Patient Encounter. Going into the USMLE Step 2 – CS, it is important for you to know what the examiners expect you to do — but you also need to know what NOT to do. That way, you can avoid making mistakes that cost you valuable time and/or points off your score. Read on to get tips on what NOT to do on the USMLE Step 2 – CS patient encounters.

What NOT To Do On the Standardized Patient and Physical Examination Encounters

Here are a few things that you definitely want to avoid during the in-person encounters on the USMLE Step 2:


  • Do NOT perform any of the prohibited tests. The testmakers specify that you should not conduct rectal, pelvic, genitourinary, inguinal hernia, female breast, or corneal reflex examinations. Also, you should not swab the patient’s throat for a throat culture. If you think that the patient needs any of these tests, you can call for them in the diagnostic workup you propose in your Patient Note.
  • Do NOT ask the patient for consent for other physical examinations. Aside from the above-mentioned prohibited tests, you can assume that you already have patient consent for all physical examinations. This includes femoral pulse exams, inguinal node exams, back exams, and axilllary exams. Asking for the patient’s consent on any of these exams will unnecessarily take up valuable time.
  • Do NOT be overly forceful with the patient with the patient. You need to be gentle during the physical examination avoid being too forceful when conducting maneuvers that involve palpating or percussing. You will lose points if you apply more than the appropriate amount of pressure when conducting an abdominal examination, examining the gallbladder or liver, using an otoscope to examine the ears, examining the throat with a tongue depressor, or examining the gall bladder and liver.
  • Do NOT forget about the patient’s modesty. During the exam, you must treat the patient just the way you would treat a patient in a real-life situation. Therefore, it is important to take the time to consider their personal comfort during the physical examination. For instance, if part of the exam requires a female patient’s bra to be moved or loosened, you should ask her before doing it yourself. It only takes a few seconds, and it will demonstrate your ability to remain courteous and professional, regardless of the time constraints of the exam.

What NOT To Do On the Telephone Patient Encounters

These are some things to avoid on the Telephone Patient Encounters:


  • Do NOT play around with the buttons on the phone. During the Telephone Patient Encounter, all you need to do to place the call is  press the yellow speaker button. After that, touching any buttons could disconnect your call. When you are ready to end the call, press the yellow speaker button again.
  • Do NOT try to call the patient back after ending the call. Once you end the call, the encounter is over. Even if you think of another question for the patient, you cannot reach them again. Trying to call the patient back will only cut into the time you have for the Patient Note, so you should just do your best with the information you have.
  • Do NOT make assumptions based on your previous test experiences. This tip actually goes for both the Standardized Patient and Physical Examination Encounters and the Telephone Patient Encounters. If you are taking the USMLE Step 2 – CS for a second time, you may notice similarities between an encounter on your exam and an encounter on one you have taken before. However, you should NOT assume that the correct diagnosis or treatment strategy is the same as the one on your previous examination, as the test preparers often make slight changes between exams.
  • Do NOT make assumptions about whether or not an encounter counts toward your score. You may know that some of the twelve patient encounter are unscored — that is, they are only used for test development purposes. However, it is a bad idea to try to guess which encounters are unscored. Even if a particular encounter seems to stand out as easier or harder than the others, it may not be one of the unscored encounters. You should treat each one of the encounters — including both the in-person and telephone encounters — with equal seriousness.



Following these tips can help you avoid potential pitfalls when taking the USMLE Step 2 – CS. For more help preparing for a U.S. medical residency program, contact FMG Portal today!