After successfully passing USMLE Step 1 with 230 marks and after you have completed your 2 years of Clinical Green book rotation from a ACGME approved teaching hospital in USA, the next step is to clear USMLE 2 exam. Also named as Step 2, it is divided into two parts. USMLE 2 CK (Clinical Knowledge - Theory) and USMLE 2 CS (Clinical Skills - Oral and Practical). Step 2 is a qualifying exam leading to the residency. Of course, the letter of recommendation received by your mentor doctor at the hospital carries a huge weight to succeed in successful residency match.
USMLE Step 2 checks your capability of application of medical knowledge, skills, and understanding of clinical science essential for the provision of patients. It also includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and your basic skills for patient-centred. It ensures thorough knowledge on the foundation for the safe and competent clinical and medical practice. USMLE is all about practical and fundamental knowledge and your application !
Almost 87% of the Indian students from Caribbean Islands pass Step 2 in their first attempt. There is no competition among the students. Lot of Indian students from Spartan Health and Science University have already qualified through this exam. Many of them are in their residency period and few more who are practising in USA successfully.
Step 2 CK is a one-day examination. The test items are divided into blocks. The test item formats would vary in each of the blocks. The number of items in a block is displayed for each block when you start the test. This number will vary among blocks with maximum of 44 items per block. The total number of items on the overall examination form will not exceed 355 items. Regardless of the number of items, the student needs to complete the test within 60 minutes only!
On the USMLE 2 CK test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires. The test questions focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training. It is basically treated as your first step towards PG.
USMLE Step 2 Clinical Knowledge (Step 2 CK) consists of multiple-choice questions (MCQ). The question paper is prepared by medical college faculty members, investigators, , teachers and professional practitioners with recognized and reputed prominence in their respective fields (examination committees composition). The Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States of America as well as Canada.
The USMLE Step 2 Content Outline organizes content according to general principles. It also includes the individual organ systems. Test questions are classified in one of 18 major areas. They focus on concepts and principles that are important across organ systems or within individual organ systems.
Sections focusing on individual organ systems are subdivided as per 'normal' and 'abnormal' processes. It also includes the principles of therapy. In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology. (See Tables below).
The curriculum for USMLE 2 is vast and is only for the study guide. There are many study materials available in the market to prepare for this exam. The Indian students can give this exam. The categorizations and content coverage of Step 2 CK are subject to change.
|General Principles of Foundational Science**||1% – 3%.|
|Immune System. |
Blood & Lymphoreticular Systems.
Nervous System & Special Senses.
Skin & Subcutaneous Tissue.
Renal & Urinary Systems.
Pregnancy, Childbirth, & the Puerperium.
Female Reproductive System & Breast.
Male Reproductive System.
Multisystem Processes & Disorders.
|85% – 95%.|
|Biostatistics & Epidemiology/Population Health. |
Interpretation of the Medical Literature.
An additional organizing construct for Step 2 CK design is physician tasks and competencies, as shown in Table 2. Items are constructed to focus on assessing one of the following competencies:
|Medical Knowledge/Scientific Concepts.||10% – 15%.|
|Patient Care: Diagnosis. ||40% – 50%.|
|Patient Care: Management Health Maintenance/Disease Prevention. ||30% – 35%.|
Systems-based Practice/Patient Safety.
|3% – 7%.|
USMLE Step 2 assesses the ability of examinees to apply medical knowledge, skills, and understanding of clinical science. It includes emphasis on health promotion and disease prevention. USMLE Step 2 CS is a pass/fail examination. The physician has to be present in USA to give this exam.
Step 2 CS uses standardized patients to test medical students. It tests your ability to gather information from patients, perform physical examinations. It checks your professional capability to communicate the findings to patients and colleagues.
Reference from : USMLE Step 2 CK
Each examination session begins with an on-site orientation. If you arrive during the on-site orientation, you may be allowed to test; however, you will be required to sign a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test. You will have to reschedule your testing appointment and will be required to pay the rescheduling fee.
*The clinical skills evaluation centers are secured facilities. Once you enter the secured area of the center for orientation, you may not leave that area until the examination is complete.
Your Step 2 CS administration will include twelve patient encounters. These include a very small number of nonscored patient encounters, which are added for pilot testing new cases and other research purposes. These cases are not counted in determining your score. You are given 15 minutes for each.
There are 3 announcements done for you. When you need to begin, Alert for last 5 minutes and finally for time over. In case you complete your patients examination early, you may leave the room early. Re-entering an examination room after leaving will be considered misconduct. It will be reported to the USMLE, and could jeopardize your continued participation in the USMLE program.
Immediately after each patient encounter, you will have 10 minutes to complete a patient note. If you leave the patient encounter early, you may use the additional time for the note. You will be asked to type (on a computer) a patient note similar to the medical record like a live clinic.
You should record pertinent medical history and physical examination findings obtained during the encounter. You are also expected to mention your initial differential diagnoses (maximum of three). The diagnoses should be listed in order of likelihood. You should also indicate the pertinent positive and negative findings obtained from the history and physical examination.
A physician should be able to recognize findings that rule out certain serious or life-threatening diagnoses. The task for Step 2 CS examinees is also to record only the most likely diagnoses, along with findings (positive and negative) that support them.
Finally, you need to list the diagnostic studies you would order next for that particular patient. If you think a rectal, pelvic, inguinal hernia, genitourinary, female breast, or corneal reflex examination, would have been indicated in the encounter, list it as part of the diagnostic studies. Treatment, consultations, or referrals should not be included.
USMLE Step 2 CS is designed to evaluate your ability to gather information . During your physical examination of the standardized patient, you should attempt to elicit important positive and negative signs. Make sure you engage the patient in discussion of your initial diagnostic impression and the diagnostic studies you will order.
The patients may ask questions, and you will see a range of personalities and styles in asking questions and presenting information. You should address each patient's concern as you would in a normal clinical setting.
The ability to communicate effectively with patients, demonstrating appropriate interpersonal skills, is essential to safe and effective patient care. USMLE 2 CS is intended to determine whether physicians seeking an initial license to practice medicine in the United States, can communicate effectively with patients. The standardized patients for Step 2 assess communication skills, interpersonal skills, and English-speaking skills. A carefully developed rating scales on which the standardized patients (SPs) have received intensive training is designed for the purpose.
On the patient note, your ability to document the findings from the patient encounter is tested. The diagnostic impression and initial diagnostic studies will be rated by experienced physicians. You will be rated based upon the quality of documentation of important positive and negative findings. Your notes have to be based on the history and physical examination and the differential diagnoses. You should have given justification of those diagnoses, and diagnostic assessment plans that you list.
Reference from : USMLE Step 2 CS