Later the CSA was replaced with the USMLE step 2 CS and became inclusive to all medical graduates.
That was considered a double standard in the US medical licensing process. When the CSA first started it was strictly for Foreign Medical Graduates while US graduates were not required to do it. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16, 2004.
USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. Examinees are required to type patient notes on a computer. Over the course of an 8-hour exam day, the examinees complete 12 such encounters. The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). The examinees should also list pertinent positive and negative findings to support each potential diagnosis. The examinees will then state up to 3 differential diagnoses relating to the simulated patient's symptoms, and tests or procedures to investigate the simulated patient's complaints. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The patient note is slightly different from a standard SOAP note. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.Įxaminees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. Examinees are expected to investigate the simulated patient's chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology.
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The USMLE Step 2CS exam consists of a series of patient encounters in which the examinee must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. On January 26, 2021, the USMLE announced that the work to relaunch a modified form USMLE Step 2 CS had been discontinued citing rapidly evolving medical education and changes in other standardized exams, like computer-based simulations in Step 3, that would supplement medical students' education in place of Step 2 CS. On May 26, 2020, in response to the COVID-19 pandemic, the USMLE "suspended Step 2 CS test administrations for the next 12-18 months."
However, now that more residency programs require students to record a passing score, many US medical schools recommend students take Step 2 CS in the fall of their senior year. Historically, US students have taken Step 2 CS late in their senior year, prior to graduation. These fees do not include costs associated with travel and lodging to take the test. For medical students at non-US medical schools, the tests cost is higher-currently $1,535. For US medical students, the exam fee is $1,300 (as of 2020). It is similar to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates who seek licensure as physicians in the U.S. Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) was an exam administered to medical students/graduates who wish to become licensed physicians in the U.S.
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