# Step 2 CS Patient Note **Step 2** of the United States Medical Licensing Examination (USMLE) assesses medical students' ability to apply medical knowledge, skills, and an understanding of clinical science essential for patient care, with an emphasis on health promotion and disease prevention. The USMLE **Step 2 Clinical Skills (CS) exam** consists of a **series of learner-patient encounters** in which the medical students are expected to: * Investigate the simulated patient's chief **complaint,** * obtain a thorough assessment of their **medical history** (*medications, allergies, social history*) and **family history**, * then complete a **physical examination**, * determine **differential diagnoses**, * Then write a **patient note** based on their findings. LearningSpace offers a pre-structured section called **Step 2 CS Patient Note** to facilitate such an assessment.  It is available at the bottom of the **New Item** list when creating a **Post-Encounter Learner** checklist. Clicking it inserts a fully prepared individual section into the checklist, consisting of items best suited for the Step 2 CS assessment. ![](https://outline-production-attachments.s3-accelerate.amazonaws.com/uploads/03fa1014-cf0e-4191-ba80-50d24eef65d4/ff1cb516-9bb9-4ede-9967-0ca5b136948d/image%20%285%29.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA4EOUDTOVUICLPZ4P%2F20260909%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20260909T120000Z&X-Amz-Expires=86400&X-Amz-Signature=a32b6a21289f9be5e83ba9a9454d1f7eb4b2870f62a2590d999cc56e15ea33c6&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject) :::warning Due to its purpose, this item type is only available for the **Post-Encounter Learner** part. ::: You can modify the textual parts by clicking the desired field. For more information, see the [**Text**](/doc/1edd90f0-6f66-4e9f-8ff3-54e52f7beada) and [**Structured text**](/doc/f7fa6064-7bbe-4653-88b3-85cfd4c3700b) pages. As the Step 2 CS assessment requires learners to **phrase their responses**, the system cannot calculate point values. Scoring of responses necessitates the **active participation of an evaluator**: scores are determined by a professionally competent Faculty member. Such an evaluation is referred to in LearningSpace as [**Open-Ended Question Scoring**](/doc/open-ended-question-scoring-oeqs-F51zi8XITN) (OEQS). :::warning ***IMPORTANT:*** As with all other item types, Step 2 CS Patient Note is **NOT scored** by default. If the default setting is not changed, answers will not be displayed for OEQS. > :::success > Based on user practice, it is recommended that the **last item be set scored** (by questionnaire), meaning that a **Special Section** part is created with the necessary questions along which the Step 2 CS section can be scored, then that Section is selected from the drop-down prompted when setting the scoring to ***Questionnaire***. > > ::: > > :::tip > The Special Section used for scoring does not necessarily have to be created within the same Case. > > ::: ::: :::warning ***IMPORTANT:*** During OEQS grading, answers entered for a Step 2 CS Patient Note item will be displayed on a single page for the faculty member submitting the grading. However, if the items are added separately, that is, not as a single pre-compiled section of the Step 2 CS Patient Note. Still, as a series of [**Text items**](/doc/test-activity-management-1tG6YAbQx1) (for History and Physical Examination) and [**Structured Text**](/doc/structured-text-Ut7O0LkBNp) items (for Data Interpretation), the answers for the items will be separately displayed for grading - one item per page. ::: :::tip For further information, visit our [Case Manager](/doc/case-manager-QdAIr4bLwJ) and [Cases - How to](/doc/cases-how-to-S8rL7UJ2ib) pages or watch our [Case Manager Training Videos](/doc/case-manager-training-videos-r2kVtDydfr). ::: --- **Documents** - [User Guide](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/user-guide-WPv4VxhtWB) - [FAQ](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/faq-YoxOQOjvnY) - [Training Videos](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/training-videos-D2ycsEwqPt) - [Module Introduction Videos](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/module-introduction-videos-I6OQ6H7SUT) - [Release Notes](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/release-notes-BcFFMsc0RV) - [Distance Learning with LearningSpace](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/distance-learning-with-learningspace-eAfwW23Hxg) - [Preventing Copy-Paste in LearningSpace](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/preventing-copy-paste-in-learningspace-sPD0IIUuk0) - [Important Technical Notification Regarding Adobe Flash Player](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/important-technical-notification-regarding-adobe-flash-player-eQtMLwLmTJ) - [iPad support - Technical information](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/ipad-support-technical-information-dLmeFvKofC) - [TeamViewer Link](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/teamviewer-link-QyKZBMqUT9) - [YouTube videos about LearningSpace](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/youtube-videos-about-learningspace-TMb3zdc0LC) - [Customer Aftercare One-Pager](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/customer-aftercare-one-pager-GBWMe1BcfS) - [Case Studies](https://kb.learningspace.elevatehealth.net/s/ent-hs/doc/case-studies-VcAbFqXSz7)