By Sasmit Sarangi
The Step 2 Clinical Skills (CS) exam is a fundamental step toward the process of residency. The basic purpose of the exam is to assess the core clinical competence of a future physician in the context of a typical clinic visit as seen in a US hospital. IMGs are often lulled into a false sense of security by the format of this exam, which stresses absolute fundamentals. However, in my opinion, and based on my experience, the Step 2 CS is perhaps the single most important exam in the current residency application process.
Over the last few years, the number of residency applicants has risen very rapidly. As an applicant, it is important to not have any obvious deficiencies in your application. Such deficiencies could lead to the exclusion of your application as programs cannot be expected to go through the complete applications of thousands of applicants. As a result, IMG candidates with a second attempt on Step 2 CS are not considered by a huge number of programs. I have to admit that this is based on my own experience as an applicant who failed Step 2 CS on his first attempt. My failure to pass the exam on my first try severely limited the number of programs that would even consider me for an interview.
Looking at the performance statistics for IMGs on Step 2 CS, one might draw the conclusion that this is a limited problem. For example in 2011-2012, 77% of all IMGs passed the Step 2 CS exam. It is important to keep in mind that in January 2013, the minimum passing performance in the components of Communication and Interpersonal Skills (CIS) and Integrated Clinical Encounter (ICE) were raised. This change has been predicted to decrease the passing rate of IMGs by a very significant 18%. While no data is officially available for 2013, this change would likely mean a predicted IMG passing rate of below 60%.
I, personally, did not take the CS exam lightly at all. I practiced a significant variety of sample cases and worked on writing a clinical note in the allotted time. During the day of the actual exam, I felt that I had managed to satisfactorily demonstrate my clinical skills. In spite of my best efforts, I received a marginal failing level on the CIS subcomponent. This was a huge shock to my efforts towards securing a residency position, and I spent several weeks agonizing over what I could have done differently. I had to retake the exam quickly because the application dates were fast approaching. It was immensely stressful to quickly prepare and retake an exam when I wasn’t sure what I should do differently.
Thankfully, I managed to pass comfortably on my second attempt and reassure myself regarding my interpersonal skills. If any of you are currently preparing for Step 2 CS, it is important to thoroughly practice cases, particularly with someone who has already passed Step 2 CS. If you unfortunately fail, know that you are not alone and try to get feedback from others about what you could have done differently. There are a lot of things that I could further discuss regarding the exam but in the interest of keeping this post focused, I would encourage everyone to post their questions and comments below. I will try to help you to the best of my abilities.