usmleUSMLE updated clinical skills information guidelines today in an effort to be more transparent about scoring of patient notes.

A new statement has been added in the description of the exam reading:

“An examinee demonstrates skills in providing information by giving an explanation of what is likely occurring in terms the patient can understand, and by providing reasons that the patient can accept. Statements need to be clear and understandable and words need to be those in common usage. The amount of informa- tion provided needs to be matched to the patient’s need, preference, and ability. The patient should be encouraged to develop and demonstrate a full and accurate understanding of key messages.” – Page 11-12 

In Appendix B how patient notes are scored is also explained, some of the most important points that have been elaborated are as follows:

Physical Exam Section:

  • Providing more detailed description of the system affected including positive or negative findings will result in higher score.
  • Writing a full physical exam (e.g. writing a CVS, Abdominal and Respiratory System) in a case of spinal stenosis where leg exam is indicated will neither be beneficial nor harmful to the examinee’s score report.

Writing diagnosis:

  • “Including a diagnosis without supporting information will result in a lower score even if the diagnosis is correct.” – Page 17
  • If only two diagnosis are likely based on the presentation NBME warns against writing a third diagnosis.
  • Writing non-medical, non-existent terminologies on patient note “diagnosis” section or “diagnostic studies” section will likely result in a lower score.

Diagnostic Studies:

  • Putting more aggressive and costly diagnostic tests instead of a cheaper, simpler more sensitive or specific diagnostic test will result in a lower score.

For more detailed and in-depth reading you should read the Official Release of USMLE Step 2 CS Information Guide