CS Experience

Babycatcher2B · Aug 30, 2008

So I took my CS yesterday in Houston. And I felt like I either did really good or really bad. For some reason I finished most of my encounters before they called the 5 minute warning. There were a few where I was actually in the room when they called it. But when they did I was already wrapping up and explaining to the patient what I thought and the plans that I had. For alot of the encounters I was the first one (or one of the first ones) of the the room. I took a really focused history and physical. I stuck to all the questions that were relevent to the chief complaint. The whole experience wasn't really that bad because it felt like I was just seeing regular patients in clinic and I pretty much acted the same. I was only nervous on the first encounter. All of the encouters I stood directly in front of the patient and kept good eye contact the whole time. I hope I did okay, of course many times after I was done I realized I had forgot to ask a question or had forgot to respond in a certain way, but I didn't stress about it because according to First Aid, the test is not about being perfect, it is about being efficient. And that I think I was. Even though I was one of the first ones out, I didn't go directly inside the door when they made the announcement because I spent a few seconds writing down a differential based on the chief complaint. Which I think helped me with history taking, because I would glance at my differential and tailor my questions according. And also I wrote all of my notes out. It seems like the other doctors who were typing were typing forever. So as I mentioned, I'm not too sure exactly how I did on this test. Most of the cases weren't challenging at all. If anybody else would like to share their experience I'd appreciate it.

lord_jeebus · Aug 30, 2008

sounds to me like you probably passed

cbass1350 · Aug 30, 2008

I'm sure you did fine. I was done early on most of mine too. The cases were very straight forward (with a couple of exceptions), but I did not worry because I knew all I needed was a pass. Towards the end, I felt confident enough to pretty much blow a couple of cases off. There was this weird gyn case with some "teenage" girl in the end and I was tired of the whole circus by that point. So I just handed her a bunch of BS and walked out after a couple of minutes :laugh:

.

Dr McSteamy · Aug 30, 2008

your experience sounds like mine.

my first pt, i sorta got nervous because i almost ran out of time, and had to rush the PE.

after that, i paced myself and didn't try to do all the PE's completely anymore.
I didn't even ask all the questions in the lists provided by First aid. There's only time to ask the important questions, and get out of there.
i did that, and i came out of the rooms 5 minutes before the limit.

i was like: "you got palpitations and tachycardia? you snorted coke yesterday?" ok bingo. time to wrap it up and do a quick auscultation of heart and check head,
blah blah say no to drugs! kthxbye.

i didn't dwell on extraneous crap.
if i don't pass, oh well......

oh yeah. the one issue i'm worried about is that my differentials aren't exactly listed in the highest-lowest likelihood. But I'm pretty sure the most likely diagnosis is listed within the first 3 that I wrote.
I don't know if I will be dinged for that on my score.

smq123 · Aug 30, 2008

Babycatcher2B said:
For some reason I finished most of my encounters before they called the 5 minute warning. There were a few where I was actually in the room when they called it. But when they did I was already wrapping up and explaining to the patient what I thought and the plans that I had. For alot of the encounters I was the first one (or one of the first ones) of the the room. I took a really focused history and physical. I stuck to all the questions that were relevent to the chief complaint.

I don't think that finishing early is a concern, as long as you:

a) remembered to wash your hands before each physical exam,
b) took the time to give your patient the unfolded drape (VERY important in real life!

), and
c) uncovered the patient's "hidden agenda." Because they each had a hidden agenda, and as soon as they said it, I felt like I could relax and stop asking questions.

Babycatcher2B said:
And also I wrote all of my notes out. It seems like the other doctors who were typing were typing forever.

Yeah, I had to keep going back and fixing what I had previously typed. For some reason, I kept running out of room, so it took me almost the full 10 minutes each time to type the note. Oh well, whatever. I passed.

Csv321 · Aug 31, 2008

So I took mine in LA last week and I have been *trying* to convince myself I won't have to shell out another $1200. I forgot to wash my hands for one encounter, realized that the patient's husband was probably abusing her AFTER I left the room, forgot the fundoscopic exam on some patients, and didn't feel like I did a good job wrapping up and explaining things. In fact, there was some minor stuttering at the end. Somebody please tell me they passed with similar mistakes....please?

Or you could just be honest and tell me I should start saving my pennies and nickels...I can take it...

radiomedicine · Aug 31, 2008

well seems like i made the biggest blunders ever ;;
1. had many cases which needed counselling for alcohol or smoking or diabetes care but. . counselled only two. .

2. had 3 cases which warranted asking about abuse or depression due to stress or adjustment problems. . completely missed out on those 3 cases. . another gross mistake. . HUGE

3. didnt tell anyone about any specific diagnosis. . just said it could be this system problem. . we will do tests and find out and tll you. .

4 came out 6 minutes early in most cases. . and at least 2 mins before in others. . couldnt finish neuro exam or do counselling in one. .

5. badly screwed a paediatric case. . didnt ask ANY history related to paeds case.. that was the worst case i guess..

6. pt coughed but absolutely ignored it..

Babycatcher2B · Aug 31, 2008

The patients were too damn grochy to me, alot of them I wanted to smack the **** out of them, because no matter what you said they reacted the same (unlike real patients).

Dr McSteamy · Aug 31, 2008

Babycatcher2B said:
The patients were too damn grochy to me, alot of them I wanted to smack the **** out of them, because no matter what you said they reacted the same (unlike real patients).

i had 2 that were between 16-18 yo.
they were like robots. no emotion at all.

UCLAstudent · Aug 31, 2008

Csv321 said:
So I took mine in LA last week and I have been *trying* to convince myself I won't have to shell out another $1200. I forgot to wash my hands for one encounter, realized that the patient's husband was probably abusing her AFTER I left the room, forgot the fundoscopic exam on some patients, and didn't feel like I did a good job wrapping up and explaining things. In fact, there was some minor stuttering at the end. Somebody please tell me they passed with similar mistakes....please?

Or you could just be honest and tell me I should start saving my pennies and nickels...I can take it...

Just curious, did you take it on Monday?

lord_jeebus · Aug 31, 2008

Dr McSteamy said:
i had 2 that were between 16-18 yo.
they were like robots. no emotion at all.

I asked one "dad" about his sick kid. "Is he still able to walk around the house, or is he too sick for that?"

The answer, in a robotic monotone - "My son started walking when he was 6 months old."

smq123 · Aug 31, 2008

lord_jeebus said:
I asked one "dad" about his sick kid. "Is he still able to walk around the house, or is he too sick for that?"

The answer, in a robotic monotone - "My son started walking when he was 6 months old."

Mine were oddly robotic, too.

Me: "Have you had any nausea or vomiting?"
Patient (monotone): "No, I have not had any nausea or vomiting."

Me: "Have you had any diarrhea?"
Patient (monotone): "No, I have not had any diarrhea."

Me: "Have you had any fevers or chills?"
Patient (monotone): "No, I have not had any fevers or chills."

Maybe they're instructed to be robotic and emotionless?

UCLAstudent · Aug 31, 2008

smq123 said:
Mine were oddly robotic, too.

Me: "Have you had any nausea or vomiting?"
Patient (monotone): "No, I have not had any nausea or vomiting."

Me: "Have you had any diarrhea?"
Patient (monotone): "No, I have not had any diarrhea."

Me: "Have you had any fevers or chills?"
Patient (monotone): "No, I have not had any fevers or chills."

Maybe they're instructed to be robotic and emotionless?

I noticed that every single patient would respond to my review of systems questions in complete sentences just like you mentioned. They must be trained to do that. It was so weird to me because the SPs at my school usually answer with a simple "no." It actually started to annoy me at the end of the day. :laugh:

Skills of House · Aug 31, 2008

smq123 said:
Mine were oddly robotic, too.

Me: "Have you had any nausea or vomiting?"
Patient (monotone): "No, I have not had any nausea or vomiting."

Me: "Have you had any diarrhea?"
Patient (monotone): "No, I have not had any diarrhea."

Me: "Have you had any fevers or chills?"
Patient (monotone): "No, I have not had any fevers or chills."

Maybe they're instructed to be robotic and emotionless?

OMG!! You had a SP do this too?! I only had one person do this and it was killing me...I mean I wasn't really getting annoyed (probably because I only had one pt do this and it was one of my last encounters), I just thought it was hilarious...I mean so much so that I could barely look at him without nearly busting out in laughter. Seriously, I had to keep looking down at my chart, praying that whoever was watching on the other side of the mirror would not catch the smirks on my face. I just kept telling myself "Please don't start laughing....please don't start laughing." I couldn't figure out why he was answering like that...I later prayed that it wasn't a symptom of some psych disorder that I was completely clueless to!

Csv321 · Aug 31, 2008

UCLAstudent said:
Just curious, did you take it on Monday?

Yeah...I was there on Monday. I wasn't stressed when I first got there but I think the environment they set up totally makes you nervous. It's completely different than with a real patient and I found myself staring at my clipboard in between questions, pretending to write down notes when I was really trying to think of the next question.

And for some of the SPs, I walked out of there with no idea what they were supposed to have. I didn't think that all the cases were that straightforward but maybe it's 'cause I didn't do enough bonding with my First Aid.

radiomedicine · Sep 22, 2008

i also had these weird cases where i couldnt even figure out what exactly was making the patient act so grouchy.. did they hate me .. did they have depression or were they just told to act uncooperative.. i was trying to be as polite as i can.. i almost lost my nerve in a few of these cases and came out of the room without asking so many things..

jayboyadams · Sep 23, 2008

I agree with everyone who posted above. All the SPs I had were so robotic and monotone. No emotion. Responded with a "No, I do not have so and so." Looking back, I think this may have affected the amount of the time that I was smiling. Hope I passed.

Things I did do: Good eye contact, always gave the pt the drape, washed my hands before each PE, and answered their one question usually with something like "It's hard to tell what you have right now. After we go through the history and physical, and after ordering some tests, we will have a better idea of what you might have and we can figure out the treatment from there." Always asked if they had any more questions before I left the room. My notes were fine (thank God we could type them!).

Things I didn't do well: Felt like I didn't give great counseling on most cases, only mentioned like 1-2 differentials to the pt, some of which I had no idea what the pt had. Felt like I was doing a lot of just listening to the heart, lungs, and abdom on a lot of the cases. Dont think I did that many special PE maneuvers; did Rinne and Webber for hearing loss, neuro exam for a stroke pt, cant think of anything else but that may be about it. My PEs were not spectacular.

Overall, I really hope I passed and that I dont have to do this stinking test over again. I guess I understand why it costs so much to take this test, but still, $1100?! WTF could you bleed any more money out of us please??

Dr McSteamy · Sep 23, 2008

if they grade this based on how long/often you smiled, then this is the dumbest test ever.

i can be nice without smiling.

even in the official demo video, i didn't see the test takers smile......

i just acted like myself. i only smiled maybe 10% of the time. smiling just looks silly.

lovely22 · Sep 26, 2008

For those of you who took CS and passed, I was wondering how complete you did each part of the physical exam?

For example, for the heart exam, you are supposed to feel for the PMI and for thrills at each position . .but did you all really do that?

Or for the HEENT exam on a patient with a cough/cold, did you test for visual acuity? Did you palpate ALL of the pulses when checking for them?? things like that.

i just don't see how it's possible to do all of those parts and complete the the history and plan discussion

i'm just freaking out =/

KYTNOH · Sep 27, 2008

I took the full 15 minutes for every patient encounter. I mentally formed a routine before I arrived and refined it somewhat after the first 3 patients. Here's what I did. Hopefully it worked.

1. Knock, shake, introduce, cover legs with the drape like all good physicians do (sarcasm).
2. Get CC and HPI standard questions
3. Run through ROS - Very robotic and I learned they only answer about the last thing you mentioned. So if I asked, "any chest pain, SOB, or cough" most would only say "No, I have no cough." So by the end I was asking each individual question which took forever but I got the feeling that was the way they wanted it done.
4. Med Hx - It was amazing how few people had med hx. Not lifelike at all, but I was thankful.
5. Surg hx -
6. Medications - We would have no prescription drug cost problems if real people took at few meds at the SPs did. How many 65 year olds don't take anything in real life?
7. Family hx
8. Social hx (married, kids, work, smoke, drink, dope, and sometime sex if needed) - and then do a brief CAGE or smoking cessation thing
9. Travel hx
10. Allergies
11. Summarize
12. Answer their "concern" that always came out after I summarized like clockwork.
13. Put gloves on. I stopped washing my hands after the third patient because it took too long. Since we're supposed to scrub for 30 seconds I was afraid they were going to count off if I only washed for 5 seconds. Couple 30 seconds of washing with another 30 seconds of drying and that's a lot of time.
14. Physical - I always did CV, Lung, abdomen - Plus anything remotely relevant.
15. Discuss diff dx and need for imaging, labs, etc.
16. Ask for any questions (after the first question in #12 above I never received another question at this point)

Abram Hoffer · Sep 27, 2008

KYTNOH said:
I took the full 15 minutes for every patient encounter. I mentally formed a routine before I arrived and refined it somewhat after the first 3 patients. Here's what I did. Hopefully it worked.

1. Knock, shake, introduce, cover legs with the drape like all good physicians do (sarcasm).
2. Get CC and HPI standard questions
3. Run through ROS - Very robotic and I learned they only answer about the last thing you mentioned. So if I asked, "any chest pain, SOB, or cough" most would only say "No, I have no cough." So by the end I was asking each individual question which took forever but I got the feeling that was the way they wanted it done.
4. Med Hx - It was amazing how few people had med hx. Not lifelike at all, but I was thankful.
5. Surg hx -
6. Medications - We would have no prescription drug cost problems if real people took at few meds at the SPs did. How many 65 year olds don't take anything in real life?
7. Family hx
8. Social hx (married, kids, work, smoke, drink, dope, and sometime sex if needed) - and then do a brief CAGE or smoking cessation thing
9. Travel hx
10. Allergies
11. Summarize
12. Answer their "concern" that always came out after I summarized like clockwork.
13. Put gloves on. I stopped washing my hands after the third patient because it took too long. Since we're supposed to scrub for 30 seconds I was afraid they were going to count off if I only washed for 5 seconds. Couple 30 seconds of washing with another 30 seconds of drying and that's a lot of time.
14. Physical - I always did CV, Lung, abdomen - Plus anything remotely relevant.
15. Discuss diff dx and need for imaging, labs, etc.
16. Ask for any questions (after the first question in #12 above I never received another question at this point)

Just took it in ATL. Same exact experience. Do these things, and I cannot see how you will go wrong. Only to add... use gloves, it's faster. Write out your DDx and general work-up before you go into the room. All of these points are so true. After the challenge question, there was never another question.

DOme2009 · Sep 29, 2008

i called one pt by the wrong name (accidentally used the name of the pt i had just gotten done with), i forgot to auscultate the RML of the lungs on every pt (even one with chf and one with pna) and i wrote outside of the box they tell you to write inside of since nothing outside of it gets scored. i still passed. it's ok to make mistakes, just don't try to lie about what you did/didn't do.

i never did reflexes, percussion of anything, visual acuity, or cranial nerve testing. then again, i'm a d.o. student so maybe we're not expected to know all that fancy real doctor stuff :laugh:

Ice dude · Oct 2, 2008

Ok folks!
I took Cs yesterday, it was simple, though I messed it on atleast 4 pts. on first 2 I couldnt finish, I was tense like anythin ( I dont know y, I knew it was not that tough ). The rest 8, I was out b4 15 min, I don't think so on any patient I wrote full 5 diagnostic work up, one diagnosis was so obvious and i just didnt put it on patient note. Wouldnt blame the patients, they were good actors, cooperative, didnt have any trouble dealing with them. But my diagnostic workup sucked, i just couldnt think of any tests.

bobhagopian · Oct 4, 2008

I was examining a patient's ear so closely that she actually said, "Ouch, Doctor, that really hurts." I wouldn't do this in real life, but for purposes of the exam, how bad is this?

radiomedicine · Oct 8, 2008

guys despite all that i ended up passing!!

though not doing counselling is definitely not pardonable..

Noondoo · Oct 12, 2008

do any of you remember how long the character limit is for typing the history portion of the write up? I would like to know this so i can at least practice it one time before the exam.
i read the "typing vs. writing" post and it doesn't answer my questions. thanks

jayboyadams · Oct 12, 2008

Noondoo said:
do any of you remember how long the character limit is for typing the history portion of the write up? I would like to know this so i can at least practice it one time before the exam.
i read the "typing vs. writing" post and it doesn't answer my questions. thanks

I typed all my notes, and there is more than enough room for you to write a good note. I wouldn't worry about the exact character limit. Remember to write complete, but concise notes. If for some reason you reach the character limit, you have written way too much.

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