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Step 2 CS Examination intends to assess student readiness to enter into supervised practice. The Patient Note (PN) component requires examinees to summarize the patient history and physical examination, list possible diagnoses and follow-up tests. However, the PN does not provide examinees with an opportunity to support their diagnoses. Thus, in scoring notes, raters are forced to make assumptions regarding examinees’ understanding of the case. Moreover, merely reporting findings is likely too simple a task for the level of maturity of a typical examinee. A pilot study was undertaken to study the modified PN including a Clinical Reasoning component. The present paper reports on the psychometric impact of this change. The preliminary findings support the feasibility of this approach.