Indomethacin's Step 2 CS Journal

[indomethacin_]

Alright, I originally wasn't going to make this journal and was using a word document to track my work. But I seemed to be getting sidetracked non-stop.
May be it's a mental thing, but an online journal always seems to help me in my progress and keeps me focused.

So I have decided to make a journal for this exam as well.

Began studying on 5/3/15.
- Following Laura Miranda's & Distant's advice for the CS bluesheet and mnemonics. Made some notes.

5/4/15
- Read Step 2 CS Content Description and General Information Booklet - updated February 2015.
- Saw the Onsite Orientation for Step 2 CS (Video).
- Read the two Sample Patient Notes.
(Skipped reading USMLE Step 2 CS Travel Guide, since I am already in a location near the testing center.)

5/10/15
- Finished 1st pass FA Step 2 CS today.
Felt I could have done much more, but spent the entire days from 5/5/15 till now just reading the FA CS book.
I haven't worked on the patient note yet or done any cases with my study partners, but will begin doing that this week.

Plan for Step 2 CS:
1.) Mondays, Tuesdays, Wednesdays 4 cases a day timed with Study partners
2.) Sundays 12-16 cases timed with Study partners
3.) Will use rest of the time at home to work on patient note and memorizing mnemonics.

Since I have clinicals on Mondays, Tuesdays, and Wednesdays from 8am to 6pm; these study days will be shorter.
But I will bring all of my mnemonics with me in a notebook, along with my blue sheet set up, this way I can memorize them if there is any downtime throughout the rotation days.

Will watch all Laura Miranda videos today for her CS prep and see what I can gather from her.

Also, one of my friends passed CS, and he was willing to spend an hour or two explaining to me a few things he thinks is important for this test. I will be meeting him tomorrow night after clinicals; very thankful for his help.

Will update later.

EDIT1:

- Saw all Laura Miranda videos on youtube learned a few things.
- Read 20/75 pgs of Kaplan Step 2 CS Core cases. Really good info here. Will wake up early tomorrow and finish reading this tomorrow morning.

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[indomethacin_]

- Finished reading 75/75 Kaplan Step 2 CS Core cases.
Again, really good info here, will try to find a hard copy of this book because it seems that a 10-15 pages were missing from the online preview of this book.

EDIT1:
- Read Neeraj's Step 2 CS Notes.
Seems to be very good information as well, and what to do and what not to do.

My friend was unable to see me today, we will do practice cases on friday.
Would have preferred this to be done today, but will gather as much as I can on friday.

I will start mock practice cases on my own for now.
Will tape myself, time myself for the 15 minute encounter, and then time myself for the patient note.
Will compare patient note to First Aid and see how it goes.

EDIT2:
- Did Case #1 on my own.
Talked it out with myself with guidance from the FA CS book and recorded myself. Did patient note afterwards.
Forgot to introduce my position as a physician on duty, remembered to wash my hands and counsel, but left out a few important questions.
Missed a few physical examination maneuvers.
Patient note was very brief compared to First Aid especially in the physical examination portion of the note which was not as detailed.

Definitely need work, but I know things will get better from here.
I'm thankful I'm at least able to be my own critic.

Will try cases with study partners starting as soon as I can this week.

Will push to get much more work done tomorrow.
It is now 1:06 am, will go to bed now and wake up at 6:00am for clinicals.

 

[indomethacin_]

5/12/15

- Spent most of the day of clinicals memorizing mnemonics that I have made on my blue sheet.

- Went home and contacted study partner for a session, and said "He was doing hw" and then when I messaged him and said that I am going to look for another study partner since I need someone who is available. The he said "I am tired just today."
I had given my word that I would have this guy as my study partner until I felt it was compromising my studying. And I felt exactly that, I need someone reliable, my exam is too close.
I guess when people's exams are not around the corner, they don't push themselves as much as they can, and I can't afford to waste time.

So I have one of my good friends I met at clinicals willing to help me out and go through the cases.
Although I was really disappointed that I couldn't get any cases done, I will pick things up as best that I can.

I slept two hours this night, and took the time to finish all my course work logs, case reports, and soap notes.

I know things will get only better from here.

 

[indomethacin_]

5/13/14

- Completed Cases #1-#5 with study partner throughout the clinical day.
The preceptor working with us was very thoughtful and helpful in letting me and my friend practice with the downtime throughout the day.

- Saw physical examination videos for General, Head&Neck, Thorax and part of Abdomen.

Will update later.

EDIT2:

- Read through Mini Cases in FA CS. 2nd time through.
Now 1:33 am, will update tomorrow.

 

[indomethacin_]

5/14/15
- Earlier on in the day on bus ride to clinicals, read through Challenging Questions ONLY in Cases #1-44 and read through Patient Encounter Chapter 2nd time through during downtime in the day.

- Made a script of what I am going to say after I knock and walk into the room. As well as wrote out transitions and important phrases to say in between the following components.
HPI ---> ROS ---> PMH ---> FH ---> Sexual & Social Hx ---> Summarize ---> Physical exam ---> Differential diagnosis ---> Counseling ---> Closure.

- Memorized mnemonics for HPI, ROS (Adults & Peds), PMH (Adults & Peds), as well as few other menmonics for LOC, Forgetfullnes/Confusion, Depression, MMSE, Urinary Symptoms, and Domestic Abuse.

Slept for around 1hr and a half somewhere between 8 pm and 11:30 pm, don't know when, just sort of fell asleep while studying.
4:13 am now, will go to sleep now.

Will meet up with my study partner at 7:45 am, and we will go practice cases till about 2 pm.
Then have to meet up with my friend who passed CS around 3:30pm, and try to gather any advice he would have for me.

I will work very hard to do well for CS, I have a good feeling about things.

 

[indomethacin_]

5/15/15

- Started studying early on, and went up to Cases #7-#22 with study partner today.
We didn't do the patient note section or the physical exam, we were focusing on the history taking portion.

- Then I went to go see my friend who had passed CS. He immediately made up a case of 25 yr old male with fatigue and told me to show him what I've learned so far.
I went ahead and did my best to go through the HPI, ended up asking most of ROS in which the answer was NO to nearly everything I asked. Also he had a blank face the entire time while I was asking him the questions, so I was completely thrown off by that. Then I went on to physical exam (Which I had not been practicing this whole time), and missed a lot of things and did some poor maneuvering. The only thing that he had was pain under his left neck for this case.

Also I forgot to counsel (Although I was counseling fairly well all day today with my study partner), and I gave a very vague impression on the diagnosis when it was something apparently that could've been put in more concrete words. The diagnosis was mono and does sound seemingly simple enough, but in the middle of the encounter with the constant NO answers steered me away from the correct diagnosis.

He showed me the important maneuvers of physical examination and told me that once I hear a chief complaint I should be able to come up with 8-11 differentials, and should aim to obtain at least 2 from the patient encounter with an ideal 3 differentials when possible.

He showed how to do a proper MMSE, Cranial Nerves Examination, and Systemic examinations, and it was super helpful.

These two hours with my friend felt like a big uppercut to the balls, equivalent to how I felt when I took my first Step 2 CK NBME.

I am so thankful for his advice, and now I know better what I need to do.

I will go to a nearby Kaplan Center to practice after my clinicals every Mondays, Tuesdays, and Wednesdays. And then will review with study partner on Thursdays, Fridays, Saturdays, and Sundays. This way I will be doing tons of practice nearly every day of the week. I know things will be good.

Will update later.

- Read 5 pages of Mini Cases. On pg 92/138.
Not very thrilled with the amount of pages I got done here.
But was working on my differentials and reviewing notes regarding that. Will pick it all back up tomorrow.

 

[indomethacin_]

- Did Practice Cases #23-34 at Kaplan Centre with my study partner.
A lot of helpful students around, it is nice to see students and their history and examination skills at various stages of the studying process.

Have yet to practice the patient note, will try to start working on the patient note tomorrow.

Realized today that I need to work on my physical exam and maneuvers, so will spend most of today watching the remaining physical exam videos.

I was doing a general physical exam in this way:
1.) Have the patient look up check conjunctiva, Have the patient look down check conjunctiva.
2.) Check pharynx, have patient open mouth and say "Ah."
3.) Check lymph nodes
4.) Check thyroid, have them swallow.
5.) Have the patient take their hands out palmar aspect of palms parallel and facing the floor to check for tremor.
6.) Have patient supinate both hands while dorsum of palms are parallel and facing the floor and check the radial pulses.
7.) Check for edema.

EDIT 5/17/15: Figured it out, never mind.

EDIT1:
- Finished watching Physical Exam videos for:
Abdomen
Upper and Lower Extremities
Spine
Hip
Foot & Ankle
Knee
Hand & Wrist
Elbow
Shoulder
Coordination
Gait
Reflexes & Clonus
Sensory & Romberg
Motor & Pronatory Drift
Cranial Nerves

 

[indomethacin_]

- Read ALL Challenging questions and Responses on pages 67-77 and in Cases #1-44 3rd time through in FA Step 2 CS.

Will update later.

PLAN for this Week:
1.) Finish remaining cases in FA Step 2 CS, and restart doing them with a full encounter.
(My study partner and I are practicing with a 13 minute timer for the patient encounter, and will practice with a 8 minute timer for the patient note. This was upon recommendation of my friend who passed CS.)
2.) Start working on patient notes today.
3.) There are 29 Physical Exam videos in total. I will watch 5 videos a day and finish them a second time through in 6 days. Videos are roughly 5-10 minutes each, so it won't be bad at all.

EDIT1:

- Finished Practice Cases #35-44 in FA Step 2 CS.
Marks 1st past practice completion of Practice Cases with a study partner.

I am already feeling much more confident about things. I feel within the next two weeks, I will be ready to take this exam.

EDIT2:
- Watched 5/30 Physical exam videos.

EDIT3:

- Practiced 3 Patient Notes today with an 8 minute timer.
Could have done more but will work on at least 4 patient notes a day starting tomorrow to keep my mind prepped for the things I need to add and look out for while writing a patient note.

 

[indomethacin_]

- Talked out Two practice patient scenarios with my in clinical rotations with my psychiatry doctor .
I am thankful that he is being helpful during my studying period.

- Watched 10/30 Physical Exam Videos.

Note to self; I will go through Practice Cases in FA Step 2 CS three times before I write my Step 2 CS.

Will update later after I complete more work.

EDIT1:
- On pg 101/138 of Mini Cases 3rd time through.
EDIT2:
- Practiced writing 3 Patient Notes under the restriction of 8 minutes. Will continue practicing these, notes. I know this will get better and better with practice.
http://www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html

Will push to get more work done tomorrow. I plan on going to the Kaplan Center directly after clinicals tomorrow.

 

[indomethacin_]

- On page 109/138 of Mini Cases.
- Practiced 2 Practice Patient Scenarios & worked on differentials with study partner during Clinical Rotations.
- Practiced 3 Practice Patient Scenarios at the Kaplan Centre, was surely helpful, but I don't know if the 3 hr bus total travel time was worth this.Study partner is busy after clinical days so had to take the bus.
Might just save Mondays, Tuesdays, and Wednesdays after clinicals to just memorize mnemonics, work on physical examination skills, working on differentials, and work on patient notes.

Will update after I complete more work.

EDIT1:

-Watched 15/30 physical exam videos.

Will wake up early tomorrow and get more work done.

 

[indomethacin_]

- Did differentials with study partner throughout clinical day.

- Watched 20/30 physical exam videos.

- Read up to page 117/138 of Mini Cases.

Will update later after I complete more work.

EDIT1:
- Worked on and practiced 8 Patient notes with an 8 minute timer limit. So far it's a fight that's going well; I believe that I'll be able to do these comfortably very soon.

 

[docphd]

You are doing really good work!
I am also preparing for CS these days and wanted to ask you which physical exam videos are you watching?
Also are you planning to do uworld cs online course?

 

[indomethacin_]

- Read up to page 138/138 of Mini Cases 3rd pass completed. Marks 3rd pass of reading Mini Cases.

- Went to Kaplan Center after clinicals and was thankful enough to do 1 Practice Case with a Standardized Patient. I totally screwed this up, it was a case of fatigue. I got caught up in the depression symptoms that I completely neglected to ask ROS, didn't rule out thyroid, CA, or anything. Something I am otherwise capable of doing really well; the nerves got the best of me.
However, I think my brain was purposefully prepared to fail, as nothing for me is a better learning tool than failing while practicing before I take these license exams.
I know today's poor performance will fuel my success in the next few weeks to come.

Very thankful for today, as I know I will do better in my upcoming days.

In other news, bought 15 books for $0.50 each at the hospital I am doing rotations. I will read these books after my CS examination.

Will update later.

EDIT1:

@ docphd, Thanks. I am using some random video series that one of my friends used. It's seems pretty old and out of date to be quite honest. Just looking at it to familiarize myself and increase my confidence for physical exams.

I don't plan on doing uworld cs online course. My friend who has taken and passed CS told me practice is the most important thing for this exam, and I am going to stick to his advice.

- Watched 26/30 physical exam videos.

Felt a bit down, but this helped me.

Time to push forward, with all of my might.

EDIT2:
- Finished 2 Patient Notes.
Just working on typing speed mostly. Working backwards from Case 44 downwards; up to case 35 now.

 

[indomethacin_]

- Up to case 24 in FA Step 2 CS. Did 18 Practice Cases today with study partner with a 13 minute time limit. On case 24/44 on second pass of practice cases.
Today was a good day, I am sticking to the mnemonics and what has worked for me in the past. I feel a lot better about things.

- Watched 2nd pass of 30/30 physical exam videos.

Will update later.

EDIT1:
- Did 4 patient notes from cases I did today.
Could have done more, but picking things back up. Will push more to do get more work done.

 

[indomethacin_]

- Did 20 practice cases with study partner today (I did 10 and study partner did 10.); completed up to Practice Case 44 in FA Step. Marks 2nd pass of Practice Cases with Study Partner.

- Watched 1/4 physical examination videos my study partner gave me today. These videos also seem old and are longer around a few hours, but very informative.

Will update later.

EDIT1:

- Worked on All 10 Patient Notes from earlier practice today with 8 minute time limit.
I am getting the hang of this now. I am feeling much better about things.

EDIT2:

- Practiced 6 patient notes; Working on speed of typing patient notes downwards to case 30. Setting a timer that beeps at 6 minutes, and then 8 minutes, so I know when I have the last two minute warning.

 

[indomethacin_]

- Watched 2/4 physical examination videos.

Will update later.

EDIT1:

Study partner was not feeling well today, so will spend the rest of the day watching these physical examination videos, reviewing ddx, and working on the patient note.

- Watched 3/4 physical examination videos.

EDIT2:

-Watched 4/4 examination videos.
Nearly 9 hours of video completed today, very thankful I was able to go through it.

EDIT3:

- Worked on typing speed of patient notes at 8 minutes timer.
I set the timer and try to rewrite the FA Step 2 CS patient note. Practice is definitely helping.
Practiced 11 Patient Notes Practice cases #30-#20.
(Working backwards from 44 cases; 19 more Practice Cases patient notes to practice.)

Was going to go to sleep, but then came across this video.


Will now stay up a little later and push to get some more work done.

EDIT4:
- Read about 10 random ccs, and worked on ddxs.
I try to come up with 5-10 ddx everytime I see the vitals and chief complaint info.

 

[indomethacin_]

So I did 1 practice case with yet another classmate who took CS, and he said that throughout the encounter I came across as anxious.

For a person, that is very forward, can walk up to anyone and have a conversation with them, has no self-esteem issues, or any anxiety during presentations, I was actually surprised to hear this today.
However, it did make me realizing something.
I tend to be pent up with energy all the time that I like to use towards the gym, music, and other things. But sometimes when I study, I sacrifice everything and just study, and the pent up energy just builds up and keeps me attentive and slightly neurotic. Although this may work in CK, my friend said for CS I need to relax.
I didn't realize I get so caught up in my rigidity that I overlooking simple things that would otherwise make a big positive difference in the encounter.

Just like I said in my CK journal, sometimes it's not about the knowledge but also about the mindset.
I believe that statement is more so true in this exam.

So today,
Spent a few hours looking at my expression in the mirror and my way of presenting myself.
I have presented numerous times before, but I now I know that I need to do this in front of a mirror for myself to make things more fluid throughout the real encounters.

Just my collective mindset now:
I am confident in the hard work I have done, and the knowledge that I know.
I will speak slowly and clearly.
I will not use the word "um."
I will treat the patient like I would any other real patient, not just like a test object.
I will not back down from a challenge.
I will not act nervous.
Positive vibes that I am here to help the patient and they are here to help me as well.
I know things will be good.

Will update later.

EDIT1:
These videos spoke to me tremendously.




Will update later.

EDIT2:

- Worked on ddx of 11 cases.
- Spent another hour and a half, practicing in front of the mirror. I feel things coming together nicely now.

 

[indomethacin_]

Flooding in my area today, so clinical rotations are cancelled for the day.

- Worked on the ddx of 38 cases.

EDIT1:

- Wrote down all of the important questions or examinations I missed during my second run with my study partner, along with top ddx and other ddx in the 44 practice cases from FA Step 2 CS into a Marble Notebook. Comes out to around a total of 15 pages. Also read through these notes after I finished writing them.
Took around 2 and a half hours doing this, sort of blazed through due to my familiarity with the book after spending so much time with it.

For example:
Case 1
46 M CP BP 165/85, RR 22
Sweating? Nausea? Vomiting?
Neck exam: JVD, Carotids
MI, Cocaine Induced MI, GERD, Ao dissection, Pericarditis, Pneumothorax, PE, Costochondritis

I believe this will helpful for me so I don't miss anything important.

- Read ALL challenging questions and responses from the Practice Cases #1-44.

Will update later.

EDIT2:

- Did 8 randomly chosen FA Step 2 CS Practice cases with my roommate.
Very thankful to have gotten this help today. I am not worried about my presentation anymore. I feel I will be presentable and confident when I speak to the patients on exam day.

I still tend to miss a few simple questions here and there still.
So will push my very best to work on that, and try to cover most of the important information.

 

[indomethacin_]

- Did Practice Case #1-2 from FA Step 2 CS with roommate.
Will push to do more cases tomorrow, the repetition helps me. This is my 3rd time through; I plan on going through these practice cases 4 times.

- Practiced typing 19 patient notes.
Practiced my typing speed today again was up to Practice Case #19. Worked my way backwards and completed copying patient notes 1-19 today from FA Step 2 CS under 8 minute timer limit with a 2 minute warning.

Mondays, Tuesdays, Wednesdays, I have clinical rotations. Thursdays, I recently started doing an externship, so wasn't able to get as much done today as I do on my off days. However, still thankful for the work I have completed today.

It is 3:09 am right now, will go to sleep now and then wake up in a few hours and do more CS studying.

 

[indomethacin_]

- Practiced Cases #3-#11 from FA Step 2 CS with study partner.
Still missing things here and there, but I learn from constant repetitions so I know I will be okay after my 3rd and 4th time through.

Will update later.

- Read ALL mini cases and differentials again.
All this rereading may sound useless to most, but it helps keep my mind fresh of differentials and workups when I am in the middle of doing an encounter.

 

[indomethacin_]

- Went to the Kaplan Center and did 7 practice cases with the students today. And was a patient in 6 practice cases. So 11 cases today.
My study partner was not available so I studied at the center for about 5 hours.
Then with weather took me nearly 4 hours to get home.

I made notes of the questions I missed and put them in a notebook for each of the particular cases I did today, this is essential for not missing important information imo.

Will update later.

EDIT:
- Sat down with roommate and tutored him for a few hours for CK. Was unable to get any more CS studying done this day. Will push tomorrow to do more work.

 

[indomethacin_]

- Did Practice Cases #12-#39 from FA Step 2 CS with study partner. Total of 28 cases today with a 13 minute timer, I was the doctor for all cases.
Thankful to how much I got done today.

- Read first 78 pages of Kaplan Step 2 CS Book 2nd time through.

Will try to work on at least 3-4 patient notes before I go to sleep tonight. Will update later.

EDIT1:
- Did 1 Patient note within 8 minute time limit.
Will push to get more patient notes done tomorrow. I could use the practice.

 

[indomethacin_]

- Read ONLY the differentials and supporting history and physical findings, and patient note recommendations for 43 cases in Kaplan Step 2 CS Book.
I may read the cases section in its entirety if I have time, but for right now. I am going to work on practicing the cases, physical examinations, and patient notes.

- Did 2 random practice cases (Case #43 was one of these) from FA Step 2 CS with one of other friends who passed CS.
He said my physical exam is on point, and I am doing good in the cases so far. He gave me a few pointers will pay attention to that.

Will update later.

- Did FA Step 2 CS Practice Case #40 and #41 with roommate.
Missed a few questions that were important, silly mistakes that I'll make sure not to make again.
(Only have case #42 and #44 left before marking my 3rd pass of FA Step 2 CS Practice Cases.)

 

[Gooby]

Is it normal for someone to prepare this much for Step 2 CS?

I admire your dedication and everything, but we're not trying to re-invent the wheel here for this exam. Go in there, be friendly, listen to their story, ask pertinent questions (or don't), touch a few body parts specific to where their chief complaint is, tell them what you think, and tell them to stop smoking/drinking/giving other people herpes/being a fat ass/etc.

 

[indomethacin_]

Is it normal for someone to prepare this much for Step 2 CS?

I have two friends who did ALL cases in Kaplan Step 2 CS, ALL mini cases as practice cases from FA Step 2 CS, ALL 44 FA Step 2 CS practice cases, and USMLE World CS qbank.
I have another friend that went through FA Step 2 CS cases 4 times,and ALL mini cases as practice cases from FA Step 2 CS 4 times.

They all passed CS.

Quite humbly, I don't think I am working anywhere near as hard as they have worked.

I admire your dedication and everything, but we're not trying to re-invent the wheel here for this exam. Go in there, be friendly, listen to their story, ask pertinent questions (or don't), touch a few body parts specific to where their chief complaint is, tell them what you think, and tell them to stop smoking/drinking/giving other people herpes/being a fat ass/etc.

I don't believe in reinventing any wheels, I just believe in a lot of practice.
I needed a minimum of 3 revisions to feel comfortable for this examination as a whole in terms of doing the encounter on time, doing the proper physical examination maneuvers, proper interaction including counseling and challenging questions, and typing up a good patient note.

It might be hard to understand the way I do things, but this is just how I study.

I do appreciate your concern though, thanks.

 

[Gooby]

More power to you. It just seems like you're chasing after some sort of perfection. The exam is geared more towards efficiency rather than accuracy. It's about accepting that 15 minutes just might not be enough to perfectly execute all those physical exam maneuvers you practiced, and just showing that you're a human being capable of making the most out of an imperfect system.

Don't get me wrong, I'm reading through FA for CS... once. I have a system in place for proper time management in the encounter and the note. I'm relying on all the information I've learned from 3 years of medical school. I'm relying on what brought me to med school in the first place, and that's to help people and make a difference in their lives. Is any of this even close to perfect? Not at all.

I'm not by any means saying that you're doing it right or wrong. Everyone prepares differently. It really seems like you're going to crush this exam. I was just alarmed at how differently your preparations have been from everyone I know at my school (who have also passed CS).

 

[indomethacin_]

More power to you. It just seems like you're chasing after some sort of perfection. The exam is geared more towards efficiency rather than accuracy. It's about accepting that 15 minutes just might not be enough to perfectly execute all those physical exam maneuvers you practiced, and just showing that you're a human being capable of making the most out of an imperfect system.

I think you might be misunderstanding a bit here. When I started studying on May 3rd, I didn't even know how to do a proper full physical exam for any organ system at all. And if I did for certain things, I wasn't comfortable with it because I had not done it enough times.

My school has taught us very well for basic sciences, but it lacked the practical component while I was there on the island. It's getting much better now, but in MD5 (End of 2nd year), it was more so self study and watch physical exam videos in class rather than actually doing them.
Also, my first few rotations were more so me observing doctors rather than actually being taught how to do a full examination.

I am studying this hard so I can be competent on the day of the exam, not so I can be perfect.
I fully understand the limits of a 15 minutes encounter.

Don't get me wrong, I'm reading through FA for CS... once.

I read the challenging questions and answers from FA Step 2 CS two to three times before I was able to answer them in my practice patient encounters without any hesitation.
I was still flustered with a few patient encounters asking challenging questions on my first read through.
And now that's why I decided to spend so much time with FA CS differentials and works ups, so I don't get flustered with the differentials.

I have a system in place for proper time management in the encounter and the note.

Likewise, I don't think time will be an issue for me. I am able to finish the cases on a 13 minute timer and the patient note with an 8 minute timer in a timely fashion.

I'm relying on all the information I've learned from 3 years of medical school. I'm relying on what brought me to med school in the first place, and that's to help people and make a difference in their lives. Is any of this even close to perfect? Not at all.

Same here man, we both have the same goal in mind which is to make a difference.
And like I've wrote before, just trying to be competent, not perfect.

I'm not by any means saying that you're doing it right or wrong. Everyone prepares differently. It really seems like you're going to crush this exam. I was just alarmed at how differently your preparations have been from everyone I know at my school (who have also passed CS).

Thanks man, I'd like to think so that it'll go well also.

I do know a few friends that study for 2 weeks and take the test, but I like to revise things so they are strong in my mind, and I've always been this way.

For example, I read my FA Step 1 book seven times before I took my exam, and it wasn't until the 4th time where things were at a good level of memorization and understanding.
I'd love to read things once and remember, but for certain things I have to revisit it many times.

Not defending myself here, just trying to put my preparation methods into perspective.

 

[Gooby]

You put something very important into perspective. I forgot that some schools don't integrate clinical skills into the first 2 years of education. At my school we have two practice SPs every week for first and second year. Then we have an OSCE at the end of every 3rd year rotation. We also have 2 mock Step 2 CS exams with 6 SPs each. I was under the impression that most med schools do something similar but now I can understand why you may need to put in more time to make up for something your school may not have taught you.

Anyway, sorry to tarnish your journal with my rambling.

 

[indomethacin_]

- Practiced typing up 2 patient notes so far.
Will be sleeping 8 hours a day starting today 11 pm to 6 am.
Study partner were not available today, so probably won't be able to do many cases today.

Will update later.

EDIT1:

- Finished practicing 2 more patient notes with 8 minute timer.
I am able to type up a note within a timely fashion. Just need to work on the supporting diagnosis lines and differentials.
Feeling fairly comfortable with the note for the most part.

In other news,
Started reading one of the 15 random books I bought from the bookstore at my hospital where I do clinicals.

Read Master of Karate by Richar Brightfield.
Quick read, probably meant for kids; but learned a thing or two by Japan.

EDIT2:

Plan for last days before my examination:
1.) Review supporting differentials with pertinent positives and negatives in patient note. Will reread this section in FA Step 2 CS.
2.) Review which physical examinations are pertinent to which chief complaints.
3.) Finish the two remaining cases for FA Step 2 CS.
4.) Do a few cases/patient notes a day to keep my mind fresh with what is required of me.

EDIT3:

1.) Review supporting differentials with pertinent positives and negatives in patient note. Will reread this section in FA Step 2 CS. (COMPLETED)


11 days out.

 

[indomethacin_]

6/3/15

- Went to Kaplan center after clinicals. Missed a stop and ended up wasting 45 minutes. So arrived there by 5:10 pm, and most students left by 7:30pm. Still I was able to do 1 case as a doctor and 4 cases as a patient.

10 days out.

6/4/15
- Doing a surgery externship, was there from 8:00am - 10:00 pm, just got home.
Roommate is sleeping so was unable to do any cs studying per say. However, talking to patients and surgeons all day still counts for something in my book.

Will push to get much more done tomorrow.

9 days out.

 

[indomethacin_]

- Did Practice Cases #42 and #44 in FA Step 2 CS. This marks 3rd pass of actively practicing all practice cases from FA Step 2 CS.

- Did additional 6 random case scenarios.
Did a total of 8 cases today with study partner today, I was the doctor for all cases. Practiced all physical examination maneuvers again today.
Aside from running out of gas on the way towards our practice location and getting his car towed, I'm thankful my study partner was able to make time away from CK prep to study with me today.

Plan for the rest of the day:
1.) Work on the patient notes from today.
2.) Work on core rotations coursework.
3.) Practice suturing with a few tools I was given from my rotations yesterday.
4.) Finish reading Troubled Waters by Rachelle McCalla. Started reading it yesterday 48 pages in.

Will update later.

EDIT 1/2:

Plan for the rest of the day:
1.) Work on the patient notes from today.(COMPLETED)
2.) Work on core rotations coursework. (COMPLETED)
3.) Practice suturing with a few tools I was given from my rotations yesterday. (COMPLETED)
4.) Finish reading Troubled Waters by Rachelle McCalla. Started reading it yesterday 48 pages in. (86 pages in now.)

8 days out.

 

[indomethacin_]

- Went to the Kaplan Center today from 10:30 am - 4:00 pm. I was a doctor for 3 cases, and was a patient for 6 cases.
Did a total of 9 cases today.
- Did 1 patient note of the 3 cases while at the Kaplan center.

Thankful for what I completed today.

Will take tomorrow morning to go to the CS testing center and scope out the place.

Will update later.

EDIT1:
4.) Finish reading Troubled Waters by Rachelle McCalla. (COMPLETED)
Good book, an interesting perspective of love was described in this book.

EDIT2:

Learned the two handed square knot.

Had to watch this video three times. A total of a few hours and I was finally able to do this knot with good speed and efficiency.


7 days out.

 

[Brain Bucket]

Love your enthusiasm.

 

[indomethacin_]

Love your enthusiasm.

Thanks, appreciate the kind words.

 

[indomethacin_]

- Went to check out the testing center for CS. Just wanted to familiarize myself with the surrounding area.

- Started and finished reading The Couple Who Fooled the World by Maisey Yates.
(I preferred the innocent and old fashioned love story much more in Troubled Waters by Rachelle McCalla.)
SPOILER ALERT
(I usually won't do this for other books, but maybe this will save someone 4-5 hours/flipping 191 pages of their life):
This book is about two business tycoons that had a history of being sexually abused when they were 16 years old, this book contained pages upon pages of the main characters having sex from around the early middle through the end of the book, messing up a huge business deal which apparently was the first reason these two main characters joined forces for (Now, I wonder why their presentations didn't go well [sarcasm]. Probably because they were having sex nonstop throughout the entire book.), and then ending with the seemingly uncaring guy proposing to her, while completely leaving out the fact that the business deal they lost to was a tyrant who will now continue his habits of sexually harassing his female employees which will even worsen with his new found power and prestige in the world of business. The author made it seem like this is a happily ever after with the two main characters opening up a new GPS company to the 50,000 people that liked their technology on facebook, I didn't think so.

I'm actually a big believer in ridiculous love stories and am really open to all kinds of possibilities, but I thought this "love story" was beyond ridiculous in my opinion. So I think that's saying something.
I will probably not read another book by this author in the future.

Anywho, will probably just work on patient notes for today, and do some coursework.

Will update later.

EDIT1:

-Finished ALL Internal Medicine Coursework.

PLAN FOR LAST FEW DAYS
1.) Do a few patient notes a day.
2.) Do practice cases on Wednesday, and Friday.

6 days out.

 

[MANGAMANGA]

Goodluck for the CS and residency application .Keep up the same awesome energy !

 

[indomethacin_]

Goodluck for the CS and residency application .Keep up the same awesome energy !

Thanks for dropping by, appreciate the good words.

Today,

- Finished rereading my CS notes of the questions I missed asking while practicing the FA Step 2 CS Practice Cases.

- Reviewed commonly used drugs mentions by SPs from Kaplan Step 2 CS book.

- Read 88 pages of Twisted by Jeffery Deaver.
Great book so far.

Did not get as much done today, as I would've liked. Will push to get much more work done tomorrow.

5 days out.

 

[indomethacin_]

- Practiced typing up 2 patient notes today.

- Read through some advice on this blog second time through; read it earlier in my prep but just felt wouldn't hurt to go through it again and solidify it in my mind.
http://cs-protocol.blogspot.com/

- Reviewed differentials for 50+ cases, and any questions that are important to ask granted the chief complaints within a particular context.

Will go to the Kaplan Center tomorrow immediately after clinicals and do as many practice cases as I can.

4 days out.

 

[indomethacin_]

- Did 4 practice cases as a doctor, 6 practice cases as an sp, and observed another 4 cases.
Total of 10-14 cases completed today.

Very thankful that I was able to get through all of these cases at the Kaplan Center.

3 days out.

 

[indomethacin_]

- Reviewed patient notes pertinent positives and negatives.
- Reviewed work ups and important examinations.
- Reviewed some differential dx of Mini cases.

Will go to Kaplan Center tomorrow after rotations and do at least 4 practice cases.

2 days out.

 

[indomethacin_]

- Reviewed patient notes pertinent positives and negatives.
- Reviewed work ups and important examinations.
- Reviewed some differential dx of Mini cases.
- Kaplan center was closed by the time I got out of clinical rotations today, but I was able to go through the remaining material fairly well.

Will spend the last few hours of the day packing my food and organizing the required things before I walk into my exam.
I know that things will be good, positive vibes.

EXAM TOMORROW.

 

[indomethacin_]

I have had people write this statement before, and I would like to use it now.
I felt like I got hit by a truck when I walked out of this exam. More so than walking out of Step 1 and certainly more than Step 2 CK.

In hindsight, most of the sps were really nice, time wasn't an issue, I did closure and counseling for all patients. Had a few rude patients, but they were generally very helpful.

I felt bad walking out of the test because I felt I missed some really important questions in about 4 of the cases and messed up a ddx for one of the cases, and also missed an important physical examination maneuver in one of the encounters.
Most of the patients were very helpful when I asked them "Before I do my physical examination, is there anything you would like to add that I might have missed?"

I hope that the hard work I've done will pay off, and I would like to think that things will be good.
Will keep everyone updated with how the scores go.

 

[neverenoughtime]

congrats on finishing all your exams bro. Seriously you deserve the best of the best for all the hard work you have done. I am planning on following your exact study plan and approach for step 2ck and cs.

 

[indomethacin_]

I Passed Step 2 CS!!!!!!!!!!

Firstly, I am thankful to God. As none of my success in these exams would have been possible without God's grace watching over my humble shoulders.

Exam center: Houston
Exam taken: June 13th, 2015
Results received: August 12th, 2015
Attempt: First attempt.


I had thought I had royally failed this exam when I walked out, even more so than the feeling after Step 1 or Step 2 CK.
So bear with me as I write down everything I did which I thought was good, and everything I did which I think was bad. As well as my thoughts on how to pass this exam.

My experience of the exam:
All of my USMLE examination have been on a bright sunny day, but it was raining and very dark; the day started off a little freaky. My roommate was out of town, and he was unable to drive me like he did to the Step 2 CK exam, so I ordered a cab.
The man in the cab had some disgusting smelling incense burning, so I asked him to open all windows and kindly dump it out as my exam requires me to not smell of anything. I tried to keep my composure but I was a little concerned with smelling of the incense. Thankfully when I smelled my coat it smelled like nothing.

As more students walked in some students were not very receptive to even saying hi, I remember this one girl was studying her FA CS while in the waiting room, and she didn't respond to anyone saying "Good morning."

Anyways, I had brought my own food, like I do to every USMLE exam. As the day went on it seemed most students there was getting more laid back and nonchalant despite one to two weeks of studying, while I was getting more stressed as the day went on. As other students were making small talk, I found myself being more closed off like that girl with FA in the morning, so I had an idea of what she might have been going through.

By the end of it, I was so convinced that I had failed and was so distraught.

Anywho, I went home, and refrained from telling people that I genuinely think I totally failed, and tried to keep a positive attitude. But for the next 17 days, I was thinking about all of the wrong things I did, and that it could lead to my failure. So it was dreadful, and I even said something negative once about my experience, which in retrospect I would not have done something like that.

So definitely put in your best efforts, and don't overthink things, we all make mistakes.



Things That I did Good:
1.) Studied and practiced my heart out. Let the words of naysayers and haters fall upon deaf ears, as I treat every USMLE exam as a once in a lifetime shot.
2.) Knocked on door, introduced myself, made eye contact, and firm handshake with all patients.
3.) Washed my hands for EVERY single encounter.
4.) Closure for EVERY single patient.
5.) Did physical exam of heart, lungs, and focused for EVERY single patient.
6.) Asked the patient how these symptoms are affecting their everyday life, and was GENUINELY compassionate when patient made any comments regarding any difficulties they may have been having.
7.) Asked 11/12 patients if they had any questions for me.
8.) Made relevant small talk while washing my hands, tried to relate the patient's difficulties. Even made a few SPs laugh with relevant sense of humor.
9.) Was extra careful and respectful while performing physical exam on female patients.
10.) Always told the patients what is NEXT for them. For example, "I would like to take some images of your stomach as well as some blood work. As soon as I receive the results, we can sit down together and figure out what may be the best treatment options for you. How does that sound?"
11.) Counseled every patient regarding smoking and sexual habits. AS WELL AS REFRAINING from any hard activity if they are presenting with any musculoskeletal pain.
12.) Completed ALL patient notes with TONS of minutes to spare.
13.) 4/12 SPs gave me information to come to a differential when I asked them, "Is there anything you would like to add that I might have missed?"
14.) Spoke English slowly with impeccable fluency and articulation.
15.) Asked ALL patients if they were comfortable in the room after I introduced myself.
16.) Got my white coat dry cleaned a few days out before my exam.
17.) Scouted out the test center a week before my exam date, just so I may be familiar with the area.
18.) Always ordered Physical Exam for patients that were not physically there.
19.) Answered questions without flustering or stuttering.
20.) Did not use the word "um."
21.) Had GENUINE facial expressions of concern, happiness, laughter with the SPs.
22.) Treated this Sps as if they were real patients.
23.) Had 5 minutes to spare per encounter.
24.) Pulled out footrest for every patient when it was necessary.

Things That I did Bad:
1.) Had an awkward encounter where I almost went off into a rant about myself being a professional model in college.
2.) Began to lose confidence and freak out by the 11th case. Cases 11 and 12 went not so good in terms of my composure. I remember walking into the bathroom and telling myself before the last 3 cases that "I can do this." I only said it once, I probably should have said it a few more times to myself as this helped me from losing it completely.
3.) Was worrying if I was capable doctor amongst the other students that were seemingly more nonchalant as the day went on. Destroy self doubt, if you have come this far, and if you practice and study with all of your might. YOU CAN DO IT.
4.) Forgot to do relevant physical maneuver in about 2/12 cases.
5.) Forgot to order essential exams for primary diagnosis in 2/12 cases.
6.) Turned my head back to look at one SP after I said my farewell. Was a very awkward moment.
7.) Screwed up royally the diagnosis for 2/12 Sps.
8.) Only put 2 differentials for 6/12 cases, and 3 differentials for the other 6/12 cases, so I guess it's not so bad. But it freaked me out at the time.
9.) Didn't clean my stethoscope with a tissue or rub it with my hands before examining any of the patients.
10.) Asked sexual history for 2/12 cases when it was not relevant.
11.) Did not do HEENT when it was warranted.
12.) Forgot to document VS in 3/12 cases.
13.) Put a really odd differential not even found in first aid. (Most differentials are in first aid, so be aware not to come out of left field and overcomplicate things.)
14.) Said "Wow." by mistake when patient and I were having small talk. Thankfully it wasn't during his chief complaint, but it's best to stay away from that word compltely.
15.) Was intimidated when the US students would walk in the door and say hi while looking at the Sp info for about 5 seconds literally before the encounter. (In retrospect I am glad I took my 30 seconds to one minute of organizing my blue sheet and putting a few differentials.)
16.) Did not do thyroid exam in 3/12 cases where it may have been warranted. But performed the thyroid exam on 2/12 cases where it was not warranted.
17.) May have performed draping technique IMPROPERLY on two female patients!

My thoughts on How to Pass this exam:
1.) Surround yourself with positivity and the belief that you can do it. Get advice ONLY from people who have PASSED, and stay away from any negativity. Be nice, humble, patient, and treat these standardized patients as you would treat your own loved ones.
2.) Find a STEADY study parrtner and PRACTICE, PRACTICE, PRACTICE the FIRST AID cases at least 2-3 times over. Not just the encounter, but the Physical exams, as well as TYPING the Patient note (NOT just saying the things you would do to your partner.) ONE MONTH is more than enough for IMGs and US grads. Kaplan center is a wonderful place to practice as well.
3.) Follow a protocol for your blue sheet. I watched this video and this is a tremendous help.

4.) Read this website a few times.
http://cs-protocol.blogspot.com/2010/03/usmle-step-2-cs-protocol.html
5.) Don't say the word "um." Write it down if you have to, like I did in my journal. I wrote down for myself "I will not say the word um." I read that to myself 4-5 times, and it became a part of me. I no longer said the word "um" and I appeared much more confident and sure of myself as a examinee. Utter silence is better than saying "um."
6.) Write down a script for your introduction, for your transitions, for your closure. And PRACTICE until it becomes natural.
7.) Concerned about coming off a little strange to SPs? Practice in front of a mirror until you have the confidence that you look good while presenting.
8.) Stay away from hysteria, if you work hard, you will pass. There is nothing more to it.

Sources:
1.) First Aid Step 2 CS
2.) Kaplan Step 2 CS Core Cases First 80 or so pages, on how to speak with the SPs.
3.) Steady study partner.
4.) Nearby Kaplan Center to practice with students.
5.) The video, and the link I have provided.

This is a very passable exam, you can get away with a lot of mistakes.
Be hard working, humble, and compassionate, and things will all go well.

If I remember more, I will write it down. Cheers!

 

[takeuponeidea]

can u recommend source for PE videos and all special tests

 

[indomethacin_]

Bates videos is perhaps overkill, but will more than suffice as I did watch all of them twice.

The best physical exam maneuvers knowledge during my prep I found from:
1.) Physical exam maneuver advice from students who PASSED the Step 2 CS exam.
2.) Physical exam maneuver advice from Kaplan Center students a few days/weeks out of their CS exam.