Preparing for the Two Types of Patient Encounters on the USMLE Step 2 CS


Last week on the blog, we talked about the United States Medical Licensing Examination (USMLE) Step 2 – Clinical Skills (CS). In order to earn ECFMG certification, which is required for all foreign medical graduates who are applying for a residency in the United States, you need to pass all three steps of the USMLE. The USMLE Step 2 – CS tests your ability to perform professionally and effectively in clinical settings.

After the On-Site Orientation to the exam, you will be faced with twelve patient encounters. Each encounter will last for fifteen minutes. Most of the encounters will be Standardized Patient & Physical Examinations, but some of them will be Telephone Patient Encounters. Read on to learn what you can expect — and what is expected of you — in each of these two types of encounters.

The Standardized Patient & Physical Examination

In the Standardized Patient encounters, you will meet with a live patient. Within the fifteen-minute encounter, the you will be expected to do three things: come up with a preliminary diagnosis (or several diagnoses) for the patient, develop a basic work-up plan, and establish a positive and effective relationship with the patient.

In order to make the correct diagnosis and propose an appropriate treatment plan, you will need to utilize multiple strategies, including:

  • Asking the patient questions about their current condition
  • Asking the patient questions about their medical history
  • Conducting a physical examination

However, because you only have fifteen minutes available for each patient encounter, you will not have time to get a complete picture of the patient’s medical history or even conduct a comprehensive physical examination. Instead, you have to be strategic and pursue the most promising leads as you obtain more information from the patient.

However, coming up with the correct diagnosis and an adequate preliminary treatment plan is not the only thing you are being evaluated on when you take the USMLE Step 2 – CS. You also need to demonstrate your professional and interpersonal skills. That means relating well with the patient and establishing a good rapport, regardless of the time pressure. Some of the keys to earning a good score include:

  • Speaking to the patient in a courteous manner
  • Exhibiting empathy toward the patient
  • Responding appropriately to the patient’s questions, comments, and body language
  • Maintaining an awareness of the patient’s modesty during the physical examination

The Telephone Patient Encounter

In the United States, telemedicine — that is, the provision of remote clinical services, often by phone — is becoming increasingly common. Through some telemedicine platforms, it is possible for a patient to call a doctor from their home to discuss a medical issue without having to come to a clinic. In other cases, a physician might talk on the phone to a patient who is at a medical facility where staff and services are limited, such as a clinic in a rural area. As the prominence of telemedicine grows, a doctor’s ability to communicate effectively with patients on the phone is an ever more relevant skill — which is why it is important to perform well on the Telephone Patient Encounters on the USMLE Step 2 – CS.

For the Telephone Patient encounters, the general expectations are the same as they are for the Standardized Patient encounters. Specifically, you are expected to develop a basic diagnosis and treatment plan, and you need to communicate with the patient in an appropriate, effective, and caring manner. The main difference between the two types of encounters is that it will not be possible for you to perform a physical examination during the Telephone Patient encounters. Instead, you will have to rely solely on oral communication with the patient. This can may seem like a major obstacle but rest assured that the USMLE Step 2 – CS is designed so that the Telephone Patient encounters are challenging — but not impossible. Still, as long as you can quickly assess the relevant information and identify the most promising leads, you can come to a conclusion that will earn you a passing score.

The Patient Note

After each one of the twelve patient encounters — including both the Standardized Patient Encounters and the Telephone Patient encounters — you will have ten minutes to write a patient note. The content of the note is expected to be the same as what a practicing physician would write in a patient’s medical record after an in-person or telephone meeting. Just like the patient encounters, you will be under pressure to complete the note within the allotted time, but if you finish a patient encounter early, you will have extra time to write the note.

Ultimately, success on the USMLE Step 2 CS is one of many steps on the way to getting matched to a U.S. medical residency. For more help with the process, contact FMG Portal today!