Updated November 2026.
USMLE Step 2 CS (Clinical Skills) no longer exists. The exam was suspended in 2020 during the COVID-19 pandemic and permanently discontinued by the USMLE in January 2021. If you are preparing for residency today, you do not need to take it.
What was Step 2 CS?
Step 2 CS was an in-person exam in which candidates saw standardized patients (trained actors), took a history, performed a focused physical exam, explained findings, and wrote a patient note. It tested communication, English proficiency and basic clinical skills on common complaints such as chest pain, abdominal pain, headache, back pain, cough and fatigue.
What replaced it for international medical graduates?
For ECFMG Certification (required for IMGs to enter the Match), the clinical and communication skills requirement is now met in one of two ways:
- An accepted ECFMG Pathway, which includes a satisfactory score on OET Medicine (an English test for health professionals). Pathways run on a seasonal cycle and expire, so check the dates for your application season.
- A valid passing result on the former Step 2 CS, for those who passed it before it ended.
US and Canadian medical students have their clinical skills assessed by their own medical schools instead.
How to prepare for the communication requirement today
- Prepare for OET Medicine early. Practice the speaking role-plays (explaining a diagnosis, breaking bad news, giving instructions) and writing referral letters.
- Use English every day. Listen to medical podcasts and news in English, and practice explaining conditions in plain language to friends or family.
- Get US clinical experience (observerships or externships). Programs value it, and it builds the same skills Step 2 CS used to test.
- Keep your clinical knowledge strong. Step 2 CK is now the key score for residency applications.
Always check the latest requirements on the official ECFMG and USMLE websites, since they change from season to season.
Practice Step 2 CK questions
Start with our free Step 2 CK clinical review questions, or browse the full USMLE question bank by subject. To learn how the exams work today, read What is the USMLE?
Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.
