(This article was originally published 9/14/16)
First of all understand this: The USMLE Step 2 CS exam does NOT necessarily determine how intelligent or how good of a physician someone will be. That is an unfair assessment for someone to make because that is not the design or purpose of this exam. There should be no reason for any person to feel "better" or "worse" than another residency candidate because of this. Exam results have little bearing on that.
Although the overall pass rate seems high, it still equates to around ~4500 examinees that don't pass annually. That is a significant number! These are the top 4 reasons why an examinee does not pass the Step 2 CS on the first attempt
1) The examinee did not UNDERSTAND what was being tested - Many try to do things from a memorized "standard checklist". Some try to pick and choose things randomly because of a rush for time and hope that works. Others just try to "act nice" and likable expecting that the SPs will be generous with scoring. The problem with all these approaches is that the examinee does not truly understand what IS being scored and what isn't. This is the reason that the most common thing we hear from students with prior attempts is: "I don't know what I did wrong!"
2) The examinee did not take the 2 CS SERIOUSLY - This occurs most commonly to those examinees in which English is a first language. It's a common misconception that this is the "easy" USMLE step and that this exam is more meant for IMGs that are not accustomed to the American style of communication and culture. That's not necessarily true! All USMLE examinees seem to be obsessed with the Step 1 and 2 CK exams because they know that merely passing those steps is not enough. It's the score matters. Yet when it comes to the 2 CS their mentality is that a "pass" is enough; therefore they seek to do the minimum. That's a risky way to approach the exam. In addition to that, they will invariably see that some of their "less than deserving friends" seem to waltz through casually and pass the exam on their own. Yes, the fact is that many people manage to sneak past the filter. And this also proves why this exam is not perfect nor a good measure of intelligence or overall ability to be a good physician one day.
3) The examinee RUSHED exam preparation - This usually happens because the examinee had a tight study schedule due to school/work obligations. Or it may be related to what was previously stated; the examinee just didn't take the exam seriously. Whenever possible try to avoid putting yourself in a high-risk situation because it's just not worth it. There's never a good reason to rush! The cost of retaking this exam is immense. All USMLE steps are considered high stakes and this means that it demands the priority of your TIME! Be willing to sacrifice and put in what it takes. The USMLE loves to catch "corner cutters". If preparing well and passing in the first attempt means that you'd have to push your exam date or not meet a deadline; that would be better than cramming and ending up sorry. What would come next is the the pain of disappointment, the expense of taking the exam again, and worse, this would now be on your ERAS. We advise a window of 4-6wks for full preparation for the USMLE Step 2 CS from beginning to end. This is what works for most full-time students.
4) The examinee was overwhelmed with ANXIETY - This is quite a challenging barrier to overcome even from the teaching standpoint. The fact remains that no matter how much a course can prepare you, come real exam day, YOU have to perform. And no course can fully emulate that exam environment perfectly. Only on the actual exam day at the CSEC center will you fully experience reality. Sometimes that reality is quite different than what you anticipated. Unless you're in an optimal state of mind, all kinds of unforeseen things can go wrong that day. Examinees are under the pressure of an unnatural exam environment (instead of a real medical clinic), new faces everywhere (SPs, proctors), not to mention the fact that you are under extreme time constraints. All these factors can combine into a recipe for overwhelming stress. This is a "confidence killer" to say the least. Apprehension regarding the exam center environment has to be managed well in order to ensure your success.
The pass rate of the USMLE Step 2 CS seems high but it's deceiving to look at it this way. In 2014 nearly 5000 examinees were unsuccessful! That's quite an eye-opening number when you really think about it. Weigh your risks carefully.