USMLE Step 2 Clinical Skills
Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing ExaminationTM (USMLETM) is an exam that is currently administered to all medical students/ graduate who wish to become licensed physicians in the U.S..

# Exam Structure
The USMLE Step 2CS exam consists of a series of patient encounters in which the examinees must see the simulated patient (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations.  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 Gynaecology.  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.
Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter.  The patient note is slightly different than a standard SOAP note.  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 examinees will then state up to 5 differential diagnoses relating to the simulated patient's symptoms, and up to 5 tests or procedures to investigate the simulated patient's complaints; the examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (ie, IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters.
USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16 2004.

# Grading
The test is graded on a straight pass/fail basis, without any numerical score associated with it (as opposed to the other parts of the USMLE series). In order to pass, one must achieve a grade of "pass" in each of the three sub-components of the exam.
- Integrated Clinical Encounter (ICE) - This component includes the ability of the examinees to collect pertinent clinical information from the SP, and to write an appropriate patient note with differential after the clinical encounter.  The former part is graded by the simulated patient, and the latter by a practicing physician.
- Communication and Interpersonal Skills (CIS) - This component includes evaluating the examinees' question asking skills (asking open ended questions, avoiding repetition and medical jargon), information sharing skills (acknowledging patient concerns, providing counseling and information about what will happen in the future), and professionalism / rapport (asking about feelings and concerns, showing consideration for patient comfort, proper hygiene during examinations, providing empathy and respect for the simulated patient).
- Spoken English Proficiency (SEP) - This component includes clarity of spoken English communication in the context of pronunciation, word choice, and minimizing the need to repeat questions or statements.

# Exam centers
The exam can be taken only in the USA.
Currently there are 5 testing centers called the Clinical Skills Evaluation Center (CSEC) throughout the USA:
- Atlanta, Georgia
- Chicago, Illinois
- Houston, Texas
- Los Angeles, California
- Philadelphia, Pennsylvania