Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) is an exam that is currently administered to medical students/graduates who wish to become licensed physicians in the U.S. It is comparable to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates who seek licensure as physicians in the U.S. From January 2011, the registration fee for the test is $1,355. Historically, US students have taken Step 2 CS late in their senior year, prior to graduation. However, some residency programs (such as those at the University of California, San Francisco) now require students to record a passing score for both Step 2 CS and CK prior to February 15 of the application year. This has led some US medical schools in 2009 and 2010 to begin recommending that students take Step 2 CS in the Fall of their senior year.