CS2 Substance

The Education Commission Of Foreign Medical Graduates(ECFMG) has assembled the Clinical Skills into 3 Domains. Each of which has to be passed separately to attain an overall PASS. Failing one section and passing the rest of the sections will result in an overall FAIL. Expert Consult will offer correct understanding and learning of all CS 2 elements. The USMLE Step 2 CS is a composite of the following sections.


1) Fostering The Relationship: Develop a secure, caring and encouraging relationship with the SP at the same time fulfilling all Ethical Responsibilities like providing Emotional support,talking on Preventive and Mismanaged/Legal issues.Bottom line is a facilitative behavior is required with positive verbal reinforcement showing Empathy and reassuring the SP that he is in safe hands.

2) Gathering Information: In order to elicit correct clinical information from the SP its crucial to develop a confidence level and provide optimal medical/psychiatric and emotional care possible in this way you can get most information possible.

3) Providing Information: This part covers the Closure which has multiple steps all of which will be covered during sessions. On a brief note this section covers mandatory elements such as;Summarization of Hx and P.E , Displaying provisional diagnosis, SP Satisfaction level for planned work up ,Handling Challenging Qs,Providing standardized Counseling, Offering Preventive measures for a certain illness.

4) Making Decisions:Your responsibility is to provide SP with In Visit work -up that includes Diagnostic Labs, Radiological scans Procedures such as Mammography, Colonoscopy, Rectal/Vaginal Exam, Orthostatic vitals. All is done in order to clarify and conclude suspected Diagnosis. You also have to take initiative of Post Visit Follow-up Visits. Your accountability also includes providing support system in case of need and providing access for any query or related concerns.

5) Supporting Emotions:CS2 also scales your ability to show gesture to SP's emotional concerns and needs. How?? By showing sympathy, displaying humble expressions,offering help .Your goal is to relieve SP's despair and agitation.

SPOKEN ENGLISH PROFICIENCY (S.E.P)Your linguistic interaction has to be understandable to SP in terms of

  • Vocabulary
  • Grammar
  • Semantics
Bottom line is your speech has to be clearly understandable to SP.


As Per ECFMG the I.C.E Domain of the USMLE Step 2 CS Exam includes assessments of 1) Data gathering

Obtained from History of presenting complaint, Sub components of History and P.E Findings.

2) Patient Note Documentation

PATIENT NOTE RATERS HIRED BY ECFMG SCORE I.C.E BY GLOBAL RATINGS. The I.C.E sub component consists of checklists completed by;

1. The Standardized Patients for the Physical Examination portion of the encounter and, 2. Scoring of the Patient Note by trained Physician Raters.

Patient Note will be rated based upon the QUALITY OF DOCUMENTATION of important positive and negative findings obtained from the history and physical examination, as well as the list of Differential Diagnoses, justification of those diagnoses by Positive symptoms obtained from Hx and P.E, and Diagnostic Assessment Plans such as Labs/Imaging and Procedures.

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