USMLE Changes in Step 2 CS - New Plan of Study?

[evilbooyaa]

My school had a session recently that included the changes in Step 2 CS. One of the attendings (who apparently grades Step 2 CS exams) said that all the current review books are worthless (at least in terms of the note, as that seems to be the most important change to the exam). She also was very adamant that you should only put down as many diagnoses as you can justifiably have evidence for (don't put a 3rd BS diagnosis just to have 3).

A couple questions regarding this change:
1) Anything in the HPI/PE that has changed? Traditional wisdom was to do Heart and Lungs on every patient and otherwise go with the specific complaint. Is it necessary to do H & L (and document this)?

She also said that doing a full ROS was not necessary to document, and to only put pertinent positives and negatives. Does this mean I should only ask the ROS questions that would be considered pertinent positives or negatives?

2) I've heard that previously, you are supposed to spend a couple minutes 'recapping' your assessment and plan with the patient. With the new format, is this still required? Should you be telling the patient what tests you're going to do, and what disease(s) you think they have?

3) For people who have taken Step 2 CS within the past year(?), did you change your study methods, or was it just FA for Step 2 CS alone?

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[y2potato]

1. I think a lot of people still do heart and lung ( and abs if you have more time) + focused PE. Even though they might not be relevant for certain patients the idea is that heart and lung are the essential exams for every pt's well being.

2. I would still recap and explain the pt about plan. I think this is important from the perspective of respecting patients (CIS part).

3. I think FA still prepares you well for the exam except the PN format, which Kaplan is good with. Then Kaplan's ddx and w/u for each case sucks (for some cases I had to make my own ddx instead of taking their words) . I would still stick to FA.

 

[futuredoctor10]

How are they changing Step 2CS?

 

[thehundredthone]

She also was very adamant that you should only put down as many diagnoses as you can justifiably have evidence for (don't put a 3rd BS diagnosis just to have 3).

Yep. You need to put down points for and against every diagnosis you make.

A couple questions regarding this change:
1) Anything in the HPI/PE that has changed? Traditional wisdom was to do Heart and Lungs on every patient and otherwise go with the specific complaint. Is it necessary to do H & L (and document this)?

I would, unless your system is going to take up all your time, and even then I would try and squeeze them in.

She also said that doing a full ROS was not necessary to document, and to only put pertinent positives and negatives. Does this mean I should only ask the ROS questions that would be considered pertinent positives or negatives?

ROS was always about pertinent positives and negatives. For chest pain you want breathlessness, palpitations, PND, etc. Not (in most cases) insomnia, mood changes and the like.

2) I've heard that previously, you are supposed to spend a couple minutes 'recapping' your assessment and plan with the patient. With the new format, is this still required? Should you be telling the patient what tests you're going to do, and what disease(s) you think they have?

Yes, definitely. It is an important part of CIS.

3) For people who have taken Step 2 CS within the past year(?), did you change your study methods, or was it just FA for Step 2 CS alone?

FA for Step 2CS and remembering to communicate properly.

 

[DTiop]

The CS content description says that

"scoring for ICE consists of a checklist completed by the standard patients for the physical examination portion of the encounter, and global ratins provided by trained physician raters. "

does this mean that the standardized patients are no longer using a checklist for the questions we ask? it sounds we are no longer graded by the SPs for questions, but only on what physical exam we did. It seems that the note will now carry the weight in terms of how thoroughly we asked questions.

Is this correct?

 

[DryHopped]

The CS content description says that

"scoring for ICE consists of a checklist completed by the standard patients for the physical examination portion of the encounter, and global ratins provided by trained physician raters. "

does this mean that the standardized patients are no longer using a checklist for the questions we ask? it sounds we are no longer graded by the SPs for questions, but only on what physical exam we did. It seems that the note will now carry the weight in terms of how thoroughly we asked questions.

Is this correct?

Yeah, the SPs grade you on your physical exam and CIS stuff. The note is used to grade the history and diagnostic components of the ICE part.