The Step 2 Clinical Skills (CS) is a one day test requiring medical students to examine and evaluate a series of standardized patients. It was developed in response to the need for an objective measure of clinical skills. This study examined the relationship between achievement on the Step 2 CS and future clinical performance as evaluated during the first year of residency. Study participants were the 2001 and 2002 classes of fourth-year medical students at the Medical University of South Carolina, where passing a prototype of the Step 2 CS was required for graduation. Researchers tested associations for Step 2 CS prototype scores, grade point average (GPA), USMLE Step 1 scores and USMLE Step 2 scores with quartile ranking and average competency score as given by residency directors' evaluations.