Best way to study for Step 2 CS

[rs2006]

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Hi all,

Happy Holidays everyone. Just wanted to know the best way to study for step 2 cs. Also, how long did you study for the exam? Any thoughts/ideas would be much appreciated. Thanks in advance.

 

[tridoc13]

Hi all,

Happy Holidays everyone. Just wanted to know the best way to study for step 2 cs. Also, how long did you study for the exam? Any thoughts/ideas would be much appreciated. Thanks in advance.

First Aid USMLE Step 2 CS is probably all you need. I read that and did the mock exam that we have at our school, that's it. Good luck!

 

[tigershark]

If your school does standardized patient exams then you shouldnt need to study at all. I did buy that first aid for step 2 cs and thought it was a waste of money, tried reading a couple of pages and gave up.

 

[sacrament]

If your school does standardized patient exams then you shouldnt need to study at all. I did buy that first aid for step 2 cs and thought it was a waste of money, tried reading a couple of pages and gave up.

I think the First Aid book is very useful for explaining the format of the exam and how things should proceed. My school has standardized patient exams but the general format is somewhat different from that used in the CS exam, and if I hadn't gone through First Aid I probably would have been slightly thrown off. If you aren't 100% sure you understand what is going to happen at the exam, you should pick up a copy (don't even buy it, just browse it at the bookstore) and read the first couple sections.

 

[Jalopycat]

I haven't taken CS yet, but I've heard from friends that a review book is almost necessary because of the tricks the "patients" pull on you. For instance,one of my friends said that he was evaluating shortness of breath, and while auscultating the lungs, the patient would lean over sharply to one side. That was supposed to be simulating a pneumothorax. He told me the only way he knew that was because he read about it in the review book. I also heard the patients will say "hush-hush" while you're listening for heart sounds (like that sounds anything like a murmur). If either one of those things happened to me and I didn't know ahead of time that was supposed to be a "positive finding", I would be tempted to ask the patient why he/she is doing that (and then probably flunked the test).

It's really stupid when you are forced to read a review book just to learn their tricks just so you can pass.

 

[rxfudd]

I've got to be honest with you, I read FA and was ready for their "tricks", but it was pretty pointless. During the exam itself, I was thinking about so many things at once (time, differential, did I wash my hands and drape the pt, pt counseling during the visit, keeping up a smile, etc) that I don't think I would have ever noticed any of these "findings". In fact, except for pt distress and pain on palpation, I did not elicit a single positive PE finding. Whether they were there or not is a different story, but I was frankly far too distracted with everything else to be actually looking for positives on exam. Having said that, I do remember that one of my pts had a real murmur (unrelated to cc), and I completely forgot to put it in my note.

 

[sacrament]

In fact, except for pt distress and pain on palpation, I did not elicit a single positive PE finding.

This was my experience too. In fact, toward the end of the exam I started to get worried because I hadn't noted a single objective positive finding. None of the "patients" I "saw" tried any of the tricks that I've heard about, and I didn't hear any murmurs, real or otherwise.

 

[Rxz]

Hi there. First post fellas - this looks like a neat forum and I'm glad I found it. I haven't taken CS yet but I daresay there's no need to worry about not finding too many positives: from reading the nbme descriptions of the exam and looking at first aid, it looks like the primary stress is on history and communication. They probably minimize (intentional) positives to things that it is fair to expect a student to recognize (pain on palpation, for example); it's a bit much expecting students to decipher a lay person's "hushing" as some sort of cardiac murmur (!). In fact that would be a pretty bad way to test a clinical skill, because it doesn't test whether the student can detect an actual finding, but rather some weird made up thing that is not even close to what we encounter in real life.

So I wouldn't worry about finding few positives : there probably are very few legitimate, reproducible, testable signs that are set in the exam, I think. You probably got all of them, and the SPs would note them in their eval. 🙂

I do have some questions about the exam though.

• Are there many "challenging" cases (ie. angry, crazy pt, tearful pt etc)? My school's OSCEs didn't feature many pts like this, and I'm a bit nervous about encountering them. What's the best way to approach it? Are we expected to abandon the history and try to console them, or something similar?

• I'm also wondering about the draping issue. Are we expected to drape them the moment we enter the room, even if they were sitting up, say over the side of the bed? I normally only drape for abdominal/pelvic exams, because with CVS, pulmo etc you can auscultate by lowering the gown to just below the chest, and everything else is still covered. Does anyone know what we're expected to do?

Thanks fellas. 🙂

 

[Rxz]

Anyone?

 

[robotsonic]

I also heard the patients will say "hush-hush" while you're listening for heart sounds (like that sounds anything like a murmur).

I really hope this is just a rumor, because it makes no sense. Someone saying "hush-hush" will not sound like a murmur - and even if it did, I really doubt those paid actors are able to time their hushes with their heartbeats. If it's out of sync with the other heart sounds, then it won't sound anything like a murmur. I'm guessing that someone was just trying to frighten you, because this just seems ridiculous.

 

[rxfudd]

robotsonicI'm guessing that someone was just trying to frighten you, because this just seems ridiculous.

This is actually straight from First Aid. I think the important thing to remember about FA (and any CS review book) is that even they have no idea how the test is scored and what tricks the SPs might be taught to do. This is pure speculation on their part, and it is sort of frustrating that they include this in their books. I have a feeling its a load of crap, I've never heard of anyone getting anything like this on the real thing.

 

[tigershark]

I think the First Aid book is very useful for explaining the format of the exam and how things should proceed. My school has standardized patient exams but the general format is somewhat different from that used in the CS exam, and if I hadn't gone through First Aid I probably would have been slightly thrown off. If you aren't 100% sure you understand what is going to happen at the exam, you should pick up a copy (don't even buy it, just browse it at the bookstore) and read the first couple sections.

I agree with this, but I dont think it justifies purchasing the book...spend 5 minutes reading that part in the bookstore, it's the only useful section.

All of my cases were bread and butter cheif complaints, and there were zero patient "tricks".

 

[TaiShan]

I've got to be honest with you, I read FA and was ready for their "tricks", but it was pretty pointless. During the exam itself, I was thinking about so many things at once (time, differential, did I wash my hands and drape the pt, pt counseling during the visit, keeping up a smile, etc) that I don't think I would have ever noticed any of these "findings". In fact, except for pt distress and pain on palpation, I did not elicit a single positive PE finding. Whether they were there or not is a different story, but I was frankly far too distracted with everything else to be actually looking for positives on exam. Having said that, I do remember that one of my pts had a real murmur (unrelated to cc), and I completely forgot to put it in my note.

This is so true. I took CS last week and I was simply too busy or distracted to remember any "tricks" or work up ten ddx as the first aid suggests. First aid is an overkill for the test. Just remember to ask OPQRST and PAMHUGSFOSS. It is ok to miss some hard questions but do not get too distracted to remember some easy gimmes. I mean, I did not ask "do you have more questions" in my first four encounters.

Just one more thing, do not take copious notes during interview. I did it in my first encounter and it wasted so much time.

 

[SLUser11]

I just took the exam 2 days ago, and it was a lot easier/more reasonable than I expected. Now that I said that, I'll probably fail, but....

1. If you're efficient with your H and P, it shouldn't take you more than 10 minutes, exception being very difficult situations. For me, having to do a full Neuro exam takes a while, but I only had to do it 1 out of 12 times.

2. If you're efficient with your note, it shouldn't take more than 5-7 minutes. I DID notice that people typing their notes complained about running out of time alot more (not due to slow typing, but due to typos and lack of abbreviations), so if your handwriting doesn't suck I'd write it out.

3. This leaves you with alot of excess time. I seemed to finish 5-10 minutes early on most of the encounters. You can use that time to think about the case, etc. I used it to write haikus on my scratch paper, thinking the moderators would be amused. I don't think they read any of them 🙁

4. Be prepared to forget to do things that are relatively important. Many questions won't come to you until you're writing your note. That's just the way it is, and you're not alone. I also spoke with a guy who said that he forgot to wash his hands in the first 5 encounters. It's just nerves, and I don't think this guy will fail. However, I suggest doing something to remind yourself. I put my stethoscope in my opposite pocket to what I'm used to, so every time I reached for it, my OCD kicked in, and I thought "oh yeah, wash your hands."

5. There are like 25 stations, and you only go to 12 of them, so you're not going to see most of the chief complaints that you prepared for.

6. The patient's history is designed to give you more than one possible diagnosis, so there's no slam dunks. If a young lady has RLQ pain, she's going to be late on her period, h/o STDs, with classic appy symptoms. If a guy has painless hematuria, he's going to be an avid bike rider, have a relative with some hereditary kidney disease, a recent sexual escapade with a prostitute, some coag disorder, and be a smoker.

7. Standardized patients didn't simulate any heart or lung findings FOR ME. I did read in First Aid about the hush hush thing, but I didn't see it. Mostly, they just simulated pain.

8. The moderators are hardcore. I saw one moderator really tear into a nice indian lady who wrote for maybe 2-3 seconds after the time was called.

9. Overall, I thought the test was reasonable. I don't expect everyone to finish with 10 minutes left on each encounter, but if you're efficient, and you have GOAL-DIRECTED history and physicals, 25 minutes is definitely enough.

 

[alimari]

Have a look at "OSCEs Home" website.
They have an ebook specificly helps you to shape up your clinical skills about how to deal with difficult patients at OSCEs.
Have a look it is so good!

 

[sacrament]

• Are there many "challenging" cases (ie. angry, crazy pt, tearful pt etc)? My school's OSCEs didn't feature many pts like this, and I'm a bit nervous about encountering them. What's the best way to approach it? Are we expected to abandon the history and try to console them, or something similar?

There are two answers to this: one is that every patient you'll see has one "challenging" question for you to answer. You'll know it when you hear it, and in general they are not particularly "challenging" so I wouldn't worry too much about them. First Aid has some samples of these, which were fairly representative of what I encountered. But what you're really asking is: am I going to have to talk a patient down from a ledge, or deal with a very aggressive patient... I didn't personally have any encounters like this. Some of the patients were uncommunicative, some were depressed, but none were off the spectrum of what you'd see during a normal clinic day.

• I'm also wondering about the draping issue. Are we expected to drape them the moment we enter the room, even if they were sitting up, say over the side of the bed? I normally only drape for abdominal/pelvic exams, because with CVS, pulmo etc you can auscultate by lowering the gown to just below the chest, and everything else is still covered. Does anyone know what we're expected to do?

Drape every patient before beginning the physical exam, regardless of what you'll be doing. I know this ridiculous, but it only takes a moment so just make sure to do it.