A medical student's interpersonal life is dependent upon his facility for making his thoughts, feelings, and needs known to other colleagues and on his receptiveness to the attempts of others to share similar data with him. In the same way, the same receptiveness will be conveyed to patients when as he or she tackle the requisites of USMLE Step two CS. With Step 2 CS, a medical student's knowledge of medical concepts, especially on assessment, is evaluated. The success of this USMLE Step will rely on his or her capacity to communicate effectively.

Communication is a multifaceted phenomenon. It is the results of efforts by individuals. It can be considered in simple terms – the sending and receiving of messages – since both elements must be present for communication to take place. However, with Step 2 CS of the USMLE, the fundamental transaction of messages sent and received does not presuppose that communication has occurred. The medical student should know how to provide effective feedback. Here are some helpful suggestions:

• Find out which ineffective feedback behavior you most want to get rid of. You can do this by paying careful attention to what you do in significant interactions.

• Do not expect miracles. Feedback that does not conform almost always carries some sting, no matter how carefully given; and some people are more easily stung than others, especially the ill person. Relationships marked by a relatively high degree of open, competent feedback are likely to be richer, more complex, and more interesting than those marked by little feedback. They are, however, also likely to be more prickly and intense and require more time and energy.

• If for one reason or another, like with relationships with other colleagues, you think you don't want to try to be more open and use more effective feedback behavior, then don't. But pay attention to the choice you are making – there may be some important learning in it for you. Or you may want to test out some feedback in very small increments to see what happens.

• Don't become a feedback addict. Sometimes medical students get excited about new learning and use them all the time and in every place. This can wear thin quickly. Not every event needs to be worked through. Not every utterance has to be perfect. Remember to allow for some slippage in your interactions, take small risks, be willing to approximate and see what happens. Above all, do not use others as guinea pigs on which to practice your skills.

By now, you may be muttering, "But it's so complicated and it sounds like hard work." Yes and the same can be said of many of the things that are important to you – success with every USMLE Steps. If you value your patients, and your role in every clinical encounter with your patients, you have no choice but to do the hard work, take the risk, suffer the losses and be enriched by the gains.