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The Relationship Between USMLE Step 2 CS Patient Note Ratings and Time Spent on the Note: Do Examinees Who Spend More Time Write Better Notes?

Background During the United States Medical Licensing Examination Step 2 Clinical Skills examination, examinees rotate through 12 standardized patient (SP) encounters. Examinees have 25 minutes per encounter to interact with SPs and complete postencounter patient notes (PNs), and they may end the SP interaction early to spend extra time on the PN. The current work assesses the time examinees are spending on PNs and whether this is related to performance on the PN. Method Encounters from 2,479 examinees' videos were time-stamped to indicate total encounter time and PN time. Hierarchical linear modeling was employed to assess how well total and PN time, along with other examinee and case-rater variables, predicted PN scores. Results Examinee variables explained a significant portion of within-case-rater variability, but while PN time was significantly related to PN ratings, the effect was small. Conclusions The results suggest that spending additional time on the PN does not translate to a meaningful score increase.