IMG Info: Step 2 CS IMG Study Tips

By Sarah Wesley

Among English-speaking graduates, the Step 2 Clinical Skills exam generally produces the least amount of study angst. As long as you can take a decent history, communicate effectively, exhibit empathy, and come up with a reasonable differential diagnosis and plan, you will pass. There is no numerical score, and the exam consists of only twelve patient stations with actors. The tasks of communication and note writing under pressure can be more daunting when you are dealing with a language barrier or/and an unfamiliar system of notation for writing your assessment.

You will need to assess your individual study needs for this exam. If you need to practice conveying bad news or explaining a medical plan to a patient in English, then I recommend practicing frequently with a native English-speaker in the months leading up to the exam. Communication is arguably one of the most important skills in medicine, so this study exercise will serve you well both for the exam and in your residency.

If you have not done sub-internships in the U.S., it is unlikely you will be familiar with the American method of progress note writing, called SOAP notes: Subjective (what the patient tells you, in their own words), Objective (physical exam, labs and imaging), Assessment (summary in 1-2 lines of patient history and current status), and Plan (numbered problem list with brief explanations of current status of problem and bullet points with plan for treating the problem).

Before I attended the exam, I used the patient scenarios from First Aid Step 2 CS and had a family member pretend to be a patient.  The physical exam does not have to be pristine with actual findings; you simply have to do the motions and the patient actor will make noises to indicate a positive finding, and then they can give you credit for doing various maneuvers on their grading list. I also practiced timing myself right after the history and physical in order to come up with a differential diagnosis and plan in less than 10 minutes. I highly recommend going through all of the scenarios in the First Aid CS book if you are in any way insecure about your history taking skills and your ability to derive a differential and plan when faced with time constraints.  Also the American system might work up an illness in a different order than would be done your home country, and you should be aware of any differences.

The day before, relax and review any management strategies that are not “second nature” for you or that are different from your home country’s typical mode of operation. Assuming you have attended medical school and learned basics about all the common illnesses, presentations, and managements, having a clear head and staying calm while talking to patient actors and working under time pressure to write your assessment are the biggest components of success on test day.