Performance profiles are intended to give examinees a very general sense of relative strengths and weaknesses in the major subcomponents of Step 2 CS; they should not be over-interpreted.

"Borderline performance" is an approximate representation of where the scores of high failers and low passers would fall in the profile.

The width of the bands is based upon the idea of measurement precision, and is intended to reflect the approximate variation in scores, both higher and lower, that would be expected to occur if an examinee were tested repeatedly using comparable sets of clinical skills cases.

If a subcomponent is failed, but the band of X's extends into or beyond the "borderline performance" area, this does not reflect a mistake in scoring but does indicate that it represents a relatively high failing performance.

The Step 2 CS recheck process involves retrieval of the ratings that the examinee received from the SPs and from the physician note raters. These values are re-summed and re-converted into final scores, in order to confirm that the reported pass/fail outcome was accurate. There is no re-rating of the original encounter or of the patient note.

Videos are not used in the score recheck process. Video records of encounters are not precise enough to rescore examinees. Videos are primarily used for general quality control purposes.

The possibility of a score change is extremely remote, due to the many verification and quality assurance procedures built into the scoring process.

Please see information on scoring the Step 2 CS exam

The CIS checklist used by the standardized patients allows them to assess examinees in crucial communication skills areas, such as fostering the relationship, gathering information, providing information, helping the patient make decisions, and supporting emotions. Examinees demonstrate the ability to foster the relationship by listening attentively and showing interest, care, concern, and respect. Skills in gathering information are demonstrated by establishing a chronology of the primary problem, including any additional concerns of the patient, and by encouraging the patient to explain the situation in his/her own words, including describing priorities, worries, and/or explanations of how the health issue has affected the patient. Skills in providing information are demonstrated when an examinee gives an explanation of what is likely occurring, uses clear and understandable language, matches the content and amount of information to a patient’s needs and preference, and both encourages and answers questions, while checking for patient understanding. 

Standardized patients mark these skills on the CIS checklist after observing an examinee’s behavior. The standardized patient training process is extensive and ongoing, and CIS rating is monitored through our Quality Assurance program. As part of standard quality control measures, the CIS scale is also monitored and reviewed to ensure that it is appropriate and serving the needs of the exam.

Your patient notes are scored by trained physician raters. These individuals are licensed physicians, and have experience in medical education. The physician note raters undergo rigorous training to apply a standard scoring instrument, and their ratings are monitored as part of the Step 2 CS quality assurance program.

Occasionally, due to technical or administration problems, the option of typing the patient note may not be available for one or more patient encounters. When this happens, examinees will be required to write their patient notes by hand. This problem is rare, but it can happen. All examinees should be prepared for the possibility that they may have to write one or more patient notes by hand.

Patient notes are rated by physicians who are thoroughly trained at reading notes and can interpret most handwriting. However, extreme illegibility will be a problem and can adversely impact a score. A handwritten patient note should be as legible as possible.

A simulation of the computerized patient note program, which examinees may use to practice typing the patient note, is available.

Character limits for the fields of the patient note program have been set as follows:

The patient note screen that appears during your examination has a status bar for each field, indicating how much space remains.

CIS measures your ability to gather and share information and to establish a rapport with the standardized patient. SEP performance is based upon the frequency of pronunciation or word choice errors that affect comprehension, and the amount of listener effort required to understand the examinee's questions and responses. Although these two traits are related, they are still different, and it is possible to have different pass/fail outcomes for each.

Videos are not accurate enough to override the assessment of standardized patients, who are carefully trained to evaluate examinees and report their findings. Videos are not used in the initial scoring or as part of the score recheck process. Videos are mainly used for quality control and research.

The collection of data is needed during the score reporting cycle time period to conduct calibration and equating measures to ensure the comparability of exams across multiple test forms and five testing sites. The NBME cannot accelerate the scoring process for any single individual or group. The score reporting schedule is posted on the web in order to assist examinees in planning, and to provide a general idea of when to expect the score report. View the Reporting Schedule »

The current volume is sufficient to support the cost of building the five centers, developing the content, training and monitoring standardized patients, and providing support for the on-going delivery of the examination. If we increased the number of centers sufficiently to have a genuine impact on scheduling and travel for a large part of the domestic and international examinee population, the result would be a substantial increase in costs that would have to be borne, in part, by examinees. We are aware of the limitations of a five-center system and will continue to monitor changes in the student populations that could allow for the building of additional space.