In March 2019 I took the USMLE Step 2 CS in Los Angeles. As I am an IMG, this was 1,5 years after I took Step 1 and Step 2 CK, but only 4 months after I graduated from my university in Germany. I applied at the beginning of November, so that I got my scheduling permit and was able to sign up for an appointment for my Step 2 CS in mid-November. I was still able to choose between many test centers as there were many places available, because most Americans take their exam between June and November for being able to participate in the Match in the following March. So those of you, who want to apply for the Match, should also apply to take Step 2 CS at least half a year before your desired exam date.
After I had figured out the date of my exam as well as the location, I started to look for flights and accommodations. I applied for a Visa 1,5 months before my departure. You’ll get a Visa Letter from the USMLE, so it shouldn’t be a problem for anyone to get approved. Due to the time difference (8 hours) I decided to fly to the U.S. one week before my scheduled date. I can highly recommend doing so, as my jetlag was really bad even though I’ve never had one on other trips before. I decided to abandon my mother tongue for this whole week and concentrated on communicating only in English. There are many Facebook groups where other examinees are looking for study partners. Just look for “USMLE Step 2 CS location”. I got to know a really nice doctor from the Philippines, who took the exam with me. That was really comforting on exam day, as I already knew someone and we could encourage one another.
The USMLE Step 2 CS costs about $ 1500. Furthermore you have to think about the flights, accommodation and the Visa. I rented a nice apartment in Los Angeles, which cost me $ 2000 (for 22 days, I took a vacation after the exam), $ 800 for direct flights from Europe (which I had booked 3 months in advance) and $ 14 for the Visa. Don’t forget to calculate enough money for food and drinks. It’s a lot more expensive than in Europe and most of it is quite unhealthy. Therefore I decided to take some bread as well as cereals with me, so that I wouldn’t be tired because of the food.
The USMLE Step 2 CS consists of 3 categories: You have to pass all of them. The Integrated Clinical Encounter (ICE) is about medical knowledge – have you asked all the necessary questions, performed all the relevant exams and have you interpreted it correctly regarding your differentials, tests ordered and your Patient Note. Communication and Interpersonal Skills (CIS) rates how patient-oriented you are, it’s about empathy and politeness. So think about how to introduce yourself to the patient, always ask him if it’s alright to perform an exam before you touch him, and remember to say thank you every now and then. Spoken English Proficiency (SEP) rates your language. This is definitely doable. If you abandon your mother tongue for a few days before the exam, you should be alright. If your pronunciation is not that good, try to improve it and always remember to speak clearly and distinctly in the exam.
My USMLE Step 2 CS preparation slowly began in January, after the celebrations of my graduation came to an end. I think everyone can imagine, that I was not motivated to go on studying, so my progress went sluggishly. I thought I’d be prepared quite well due to my recent graduation, but unfortunately I was wrong. The exams differ a lot, even though they’re both practical, so I do highly recommend to take enough time for the preparation. I graduated with a grade 1, which is the best possible result in Germany, but I wasn’t able to handle the Step 2 CS cases efficiently.
How I studied: At the beginning I tried to play some First Aid cases with my boyfriend (mother tongue German, not doing medicine), but he was working full-time and my bad performance frustrated me a lot, so we only did about 3 cases together. I had actually never really learned to ask structured questions out of my head, which lead me to stuttering and asking pointless questions while forgetting important ones. Furthermore I experienced big problems performing the physical exam in 2-3 minutes. So I decided to first have a look at a summary about the differential diagnoses, so that I would know when to perform which specific exams and when to order which specific tests. To my horror I had to ascertain that there was no such summary. Therefore I decided to write this myself. Today you can easily access the latter with 90 pages of completely revised content, the perfect Blue Sheet (I’ll come to that later) and the most important mnemonics online (gumroad.com/usmle2cs). After I finished this, I just had 2 weeks left until my departure and I realized that the medical knowledge would help me a lot regarding the correct exams, diagnoses and test, but I still wasn’t perfectly prepared at all. I decided to visit my dad who is retired, so that he could play my patient. He has never worked in a medical field nor is he a native English speaker, but I couldn’t find anyone who was also studying for the USMLE Step 2 CS, so it just had to be sufficient. At the beginning we concentrated on the patient interview, so that I could get a structure in my conversations. After that we started playing the whole encounters including the Patient Note, just like in the real exam. The USMLE has put the original template for the Patient Note online and I recommend using it, especially as they will show you how much time you’ve got left. In the evenings I went through the explanations of the cases in the First Aid book and reviewed my summary.
Time for my departure!
When I arrived in Los Angeles, I went on Facebook and found two study partners, with whom I met in person to go through the First Aid cases. As we all had to practice, I have to say that I probably learned more with my dad, but it’s still very important to also do some cases with other examinees as they can give you better feedback about the correct techniques of your exams and you will see their exam strategies. Therefore I highly recommend you to also study with other students. Four days before my exam one of the guys told me about the structure of his Blue Sheet, which is great and which I optimized afterwards. The Blue Sheet is the empty sheet on which you are going to write your notes during the encounter. I had always left it empty before the patient interview and had just written some notes on it, which would have definitely cost me many important points in the exam. So I decided to go for a completely new tactic just four days before my exam, which was really stressful for me.
The day of the exam was challenging, don’t underestimate 12 patient encounters. After checking in, you’ll enter a room with all the other examinees and you’ll be asked to lock away all the personal belongings which you won’t need. In this room you’ll also find the devices for the physical exam as well as the examination couch and I recommend that you’ll take a look at all of them so that you know how to use them in the encounters. After a short introduction, everyone will be placed before his or her first room. You’ll only be allowed to look at the Doorway Information and to write on your Blue Sheet after they rang the bell. Due to my new tactic regarding the Blue Sheet, I was almost always the last one to enter the room, but also always one of the first ones, who left the encounter. Hence I had more time to write my Patient Note. That was really important for me, as our keyboard is arranged a bit differently than the American one. I knew this before and had bought an American one for my studies but the size of it was different than the one in the exam. So if you’re in the same situation as I was, please buy a middle-sized keyboard, the one in my exam was as big as the one of a normal laptop, not as small as a MacBook keyboard, but also not as big as those old freestanding ones. In my exam we had a short break after the third encounter, lunchbreak after the 6th in which they had organized a nice buffet, and another short break after the 9th encounter. The time will pass quickly as you have to hurry from one patient to another. At the end of our day we were all very tired and no one knew whether he would have passed or not. But the most important thing was that the exam was over for now.
I spent two more weeks of holidays in Los Angeles and started working 1,5 months afterwards in one of Germany’s best university hospitals.
I got the results for the USMLE Step 2 CS 2-2,5 months after the exam. Just have a look at the USMLE homepage, they usually announce the expected dates for the release of the results there. I passed my exam with obvious “above average” scores in all three categories. I attribute this particularly to my summary, from which I remembered the most important differences between the diseases and the specific exams and test for all of them as well as the great tactic for my Blue Sheet, which all helped me to come to the right diagnoses and to decide how to handle the problems ahead. If you’re interested in it, you can find it at gumroad.com/usmle2cs. I really don’t think it’s necessary to pay for one of those massively overpriced Tutoring programs, where you have to pay more than $ 100 for one hour (most commonly more than $ 200), which is out of all proportion to your benefit. So just get a study partner, if you don’t find one just try skype, and fire away!
I hope my experience report was helpful for you. I’m honestly convinced that everyone is able to pass the USMLE Step 2 CS at the first attempt, if he’s well prepared.
I wish you all the very best for your exam!