考生还需注意另外二个方面：
1. 标准病人：标准病人在美国医学教学中已存在30余年，所以每一个考生面临的标准病人具有相同和极为相式的临床病例。标准病人本人只具有普通医学知识常识，所以考生不必关注你所陈述和回答病人问题的严格性和正确性，但要注意对病人的尊重和职业同情心态。
2. 考生方面：考核过程重点在你的诊疗过程，不要把太多时间和工作用在“做出正确诊断”,而应做到整个病例的宏观思维和时间的合理安排。
对每个病例，考生将会得到一份病人的基本资料：描述病人的姓名，年龄、性别、就诊原因及生命体征。考核过程中，最困难的是保持正确的时间进度。 你必须在15分钟内完成整个病情的询问及检查，所以对应该进行的每一步骤应相当熟悉：
病史：
Step 2 CS Blueprint: Content Categories - Common and Important Medical problem/Patient Presentation -Acuity -Age -Gender -Race/Ethnicity |
- 介绍及问候：
“Hello, Mr./Ms. Smith, Good morning/Afternoon.”
“I am Dr XX. It’s nice to meet you. ” (握手)
然后问：
“What brings you to see me today?” or
“What brings you in to day”.
标准病人（SP）会告诉你主诉:（CC）
接下来的一个开放式问话：
“Could you please describe to me exactly what is going on or what were your problems (issues)?”
在SP答述后，你提醒式询问他是否有其他相关的重要情况还未讨论:
- 定位（Location）:
查问病症部位：
“Where is the problem?”或
“Could you please show me exactly where it hurts?”
- 发生时间及时程
为了解病症是急性, 亚急性或性慢性, 应询问：
“When did it first start?”或
“When did you first notice the problem / pain?”
然后了解发作情况：
“Was the onset all the sudden or progressive?” 接下来还要询问有关主诉的其他情况;
- 病症强度:
应记录病情的严重性及程度，如果是疼痛，你可询问疼痛程度：轻、中、重, 或用0-10来记录:
“On a scale of 0-10, with 0 being the least painful and 10 being the most painful, how would you scale your pain from 0 to 10?”
- 病症性质：
疼痛性质可能与疼痛原因有关，你可问：
“How do you describe your pain?”
- 发作频率：
总是询问发作的频率 如：
“Is it constant?”或
“Does it come and go?”
如是间断性的
“How often does if occur? How long does it last? How do you feel between attacks?”
- 症状放射性：
如果症状是疼痛，需问
“Does the pain go somewhere?”
- 加重与减轻因素
询问有否意识到病重或减轻症状的因素有利于分析病和做出诊断，如食物的影响，运动的影响，体位的影响等等:
“what were you doing when it first began?”
“Have you ever found anything that makes your pain / problem worse?”
“Do you have any idea of what might have brought this out?”或“what brings it on?”
- 药物治疗及效果
了解是否进行过治疗及治疗效果，并注意治疗副作用.
- 过去史：
- 手术史：
- 家族史：
- 个人史：儿童应包括疫苗接种史; 妇女应有血经及生育史;
- 过敏史：
- 当前用药：
体检(PE):
体检前总是用肥皂洗手，为节约时间，洗手时仍然保持与标准病人谈话. 绝不要透过患者服装检查. 检查时仅暴露检查部分，其余部分应遮盖；对“女患者”检查心脏时不要表现出犹豫不决，保留胸罩，清SP推起自己的乳房以便听诊心尖部；不要检查乳房, 同时告诉“患者”你准备做的检查，可以这样开始：
“Ok. Mr/Ms. Smith, now I would like to do a physical examination on you. For that, I need to untie your gown. Is that OK with you?”
标准病人（SP）：“Yes, it’s ok.”
医生：“Thank you.”
如果SP表示不愿意：你应该解释其检查的重要性，比如：“Mr./Ms. Smith, I understand your feelings, but to clearly understand your problem. I have to do this examination. It won’t take more than 1 minute. Don’t worry, I am here to help you and I will let you know whatever I’m going to do. If you feel hurt, let me know. I’ll stop right away.”
SP可能以面部表情来表示病痛, 检查时要留意SP的表情;
体检时，由于时间关系，重点做与病史相关的检查.
小结
在结束病情资料收集前，应向“SP”说明你的诊治计划和一些相关健康建议, 比如停止吸烟，参加运动或减少体重等等：
“All right, Mr./Ms. Smith, thank you so much for your kind corporation. Now, I’d like to sit down and talk about what I think. First, let me summarize:
· You just told me that … and …. Also, you mentioned that … and …. Is that right?
· According to the information I got from you and the examination, I am considering a couple of possibilities. It may be..(probable diagnosis) or possibly (differential diagnosis).
· I need to run some tests in order to find out exactly what the problem is.
· As soon as I get the results, let’s meet again to go over everything. At that time, I will explain the details and we will talk about your options for treatment. Does this sound OK?
完成病情资料收集后，你有10分钟时间完成病情记录（patient note ）. 以下是在进一步检查（work-up）中可能考虑并应注意的治疗计划。 会诊咨询及转诊均不属(work-up).
头颈面部（HEENT）
- 头：X-ray, CT , MRI
- 眼：Snellen’s 表，视力
- 耳：分泌物培养，听力检测 ( audiometric, tympanometry)
- 中枢神经系统：（CNS）
CBC + diff, ESR
X-ray, CT, NRI
Lumbar Puncture
Carotid Doppler Study
EEG
EMG and Nerve Conduction Studies
常用检测
- CBC（Complete Blood Count）/ Coags (PT、 PTT、 INR)
- Urinalysis
- Electrolytes
- Arterial Blood Gas
- EKG
- Chest x-ray
前面已经讲过，Step 2 CS 相对较Step 1和Step 2 CK 容易。只是大多数中国医学生在学医过程中以自我消化知识为主，所以在以要求表达自我和交流能力为主的Setp 2 CS考核中多少有些吃亏。Step 2 CS 考试的重点并非医学知识，而是interpersonal communication方面，那么从现在起如果你注意培养这方面的能力. 当你把Step 1 和Step 2 CK 考完后，准备Step 2 CS 也就不成问题了。
临床考核许分以通过或未通过（Pass/Fail）为准考评内容及报告为
Step 2 CS Scoring
ICE | CIS | SEP |
Data Gathering
Patient Note | Communication Inter Personal Skills | Spoken English Proficiency |
Sample Score Report
Examination Components | Decision |
Integrated Clinical Encounter | Pass |
Communication/Interpersonal Skills | Fail |
Spoken English Proficiency | Pass |
Examination Decision: Fail
Next 三.赴美考试及旅行
