4/2010 update to this post: I passed!! Borderline marks in sharing information, so missing out on those summaries hurt me there but was not in danger of failing. Good luck to all about to take it!
Since I was furiously searching the blogs just a few days ago, trying to find any and all help for the CS2, I thought I would post a little about my experiences while it is still fresh in my mind. I'm a "need to know" person so I appreciated all the previous posts! Will come back in a few months to let you know how successful it was
I've been off rotations X2 months (and after surgery where--let's face it--exams are about 5 minutes if that), and studied FA book (all minicases, PE/DDx pointers on Practice Cases) with some USMLEWORLD. I watched all the PE videos on the site, and did ~10 cases on my parents along with typing the note on the web sample program, all with strict timing. For all those who are wondering (like I did), this web page is very close to the real experience. I did run out of space in the History section several times, but I had written a lot already. FYI you lose space if you hit return to start a fresh line, so I just did run-on lines (ie. PMH: none. Hosp/Surg: none. Allerg: none. etc). Halfway through the actual exam I realized I was spending too much time on the History section, so I changed my note strategy to DDx and Investigations --> PE --> History. Still forgot several times to put down PE findings that I spent precious time getting! Definitely helped to simulate real timing, as I finished early in practice and either didn't or just barely finished in real time. If you handwrite the note you will see the computer clock, but if you type you lose the clock. Watches are completely banned. I felt I had a good sense of the timing from the practice, though.
As far as the actual exam, I took it in Houston, and the experience was very like the video on the website. There's about 60 min of check-in/orientation, and then they line you up in order and file you into the hall with the exam rooms. You stand in front of the door, wait 30" for the SPs to prepare, and then you start. You get 12 scraps of paper, which you CANNOT write on before time starts (I had hoped to write my crib note earlier to save time--you will get a warning and then be reported if you write!). My strategy was to write the pt name in the upper L corner, followed by "PTBR(=P.T.Barnum Returns) to note any significant VS (if WNL I skipped), then the CC, age and sex. This helped when I typed up the note, I didn't need to check for this info again. Then I drew a quick line, and on the R margin I wrote up-and-down "GULSex(=Gee U Look Sexy") for Gi/diet/wt-Urinary-LMP/OB-SexHx. Another line, and then 3 columns: PMH-H/S(hosp/surg)-FH, A-M (allerg-meds), and C-A-D-Soc ("AM cig, alcoh, and drugs are Social"). The only history I missed using this was Meds on one patient (although I think I asked and just forgot it and didn't write it), got all other info down. I didn't write the LIQORAAA mnemonic though, and missed some of the easy intensity/location/radiation, etc...points. I'm the type that forgets in the heat of the moment, so I need a checklist!
I always sat on the stool in front of the SP, which made sure that I draped b/c you would sit on the drape unless you move it. I also asked them if I could write notes while we chatted. I took very long histories, and still started the PE before the 5 min start, but really didn't get to do closure with very many of the SPs. When finishing the History I would try to restate (but didn't do it so often), and would ask "is there anything else you would like to tell me or ask?" Sometimes this prompted the SP to tell me info I hadn't asked for! This usually also allowed them to ask their Gotcha question, which I tried to answer. Sometimes it was a diagnosis ?, and then I gave several possibilities with the caveat that of course we have to do the physical and get tests. Not sure if that will lower my score, but then if I ran out of time I had at least done some counselling.
I did EtOH counselling where I felt it was excessive, smoking cessation on all but the first (I was going to do it at the end but ran out of time, after that did it when the SPs told me), asked Sex Hx ?s but didn't really counsel since all my SPs said they were monogamous. On my PEs I tried to be focused, and if I couldn't think of anything I would start with the CV/Lung exam. I recommend practicing a quick neuro, or quick syncope, or HTN exam, etc. If you have practiced the motions you won't lose time thinking, like I did!
And of course there were lots of things I realized I should have asked and didn't, I felt a real connection with only a few of the SPs (but by the end of the day I could tell they were ready to get this over too), and more than half the time I was stopped for time in the middle of a sentance or even the PE. I used gloves, always undid the tie and tied it back, asked the SP to pull up the gown while I held the drape for the abdom/supine CV exam. Helped them all lay down/sit up/stand up, had a running commentary while doing the PE ("now I'm going to check your legs for swelling, and check your legs for pulses...etc). I'm not such an outgoing person, so excessive smiling is not something I do well. Hopefully they detected warmth and empathy anyway...
So I don't feel great about my performance, and if the stars align badly I think I could have failed, but I just have to hope for the best! To all those about to take the exam: good luck, and whatever happens at least the day flies by!
Since I was furiously searching the blogs just a few days ago, trying to find any and all help for the CS2, I thought I would post a little about my experiences while it is still fresh in my mind. I'm a "need to know" person so I appreciated all the previous posts! Will come back in a few months to let you know how successful it was
I've been off rotations X2 months (and after surgery where--let's face it--exams are about 5 minutes if that), and studied FA book (all minicases, PE/DDx pointers on Practice Cases) with some USMLEWORLD. I watched all the PE videos on the site, and did ~10 cases on my parents along with typing the note on the web sample program, all with strict timing. For all those who are wondering (like I did), this web page is very close to the real experience. I did run out of space in the History section several times, but I had written a lot already. FYI you lose space if you hit return to start a fresh line, so I just did run-on lines (ie. PMH: none. Hosp/Surg: none. Allerg: none. etc). Halfway through the actual exam I realized I was spending too much time on the History section, so I changed my note strategy to DDx and Investigations --> PE --> History. Still forgot several times to put down PE findings that I spent precious time getting! Definitely helped to simulate real timing, as I finished early in practice and either didn't or just barely finished in real time. If you handwrite the note you will see the computer clock, but if you type you lose the clock. Watches are completely banned. I felt I had a good sense of the timing from the practice, though.
As far as the actual exam, I took it in Houston, and the experience was very like the video on the website. There's about 60 min of check-in/orientation, and then they line you up in order and file you into the hall with the exam rooms. You stand in front of the door, wait 30" for the SPs to prepare, and then you start. You get 12 scraps of paper, which you CANNOT write on before time starts (I had hoped to write my crib note earlier to save time--you will get a warning and then be reported if you write!). My strategy was to write the pt name in the upper L corner, followed by "PTBR(=P.T.Barnum Returns) to note any significant VS (if WNL I skipped), then the CC, age and sex. This helped when I typed up the note, I didn't need to check for this info again. Then I drew a quick line, and on the R margin I wrote up-and-down "GULSex(=Gee U Look Sexy") for Gi/diet/wt-Urinary-LMP/OB-SexHx. Another line, and then 3 columns: PMH-H/S(hosp/surg)-FH, A-M (allerg-meds), and C-A-D-Soc ("AM cig, alcoh, and drugs are Social"). The only history I missed using this was Meds on one patient (although I think I asked and just forgot it and didn't write it), got all other info down. I didn't write the LIQORAAA mnemonic though, and missed some of the easy intensity/location/radiation, etc...points. I'm the type that forgets in the heat of the moment, so I need a checklist!
I always sat on the stool in front of the SP, which made sure that I draped b/c you would sit on the drape unless you move it. I also asked them if I could write notes while we chatted. I took very long histories, and still started the PE before the 5 min start, but really didn't get to do closure with very many of the SPs. When finishing the History I would try to restate (but didn't do it so often), and would ask "is there anything else you would like to tell me or ask?" Sometimes this prompted the SP to tell me info I hadn't asked for! This usually also allowed them to ask their Gotcha question, which I tried to answer. Sometimes it was a diagnosis ?, and then I gave several possibilities with the caveat that of course we have to do the physical and get tests. Not sure if that will lower my score, but then if I ran out of time I had at least done some counselling.
I did EtOH counselling where I felt it was excessive, smoking cessation on all but the first (I was going to do it at the end but ran out of time, after that did it when the SPs told me), asked Sex Hx ?s but didn't really counsel since all my SPs said they were monogamous. On my PEs I tried to be focused, and if I couldn't think of anything I would start with the CV/Lung exam. I recommend practicing a quick neuro, or quick syncope, or HTN exam, etc. If you have practiced the motions you won't lose time thinking, like I did!
And of course there were lots of things I realized I should have asked and didn't, I felt a real connection with only a few of the SPs (but by the end of the day I could tell they were ready to get this over too), and more than half the time I was stopped for time in the middle of a sentance or even the PE. I used gloves, always undid the tie and tied it back, asked the SP to pull up the gown while I held the drape for the abdom/supine CV exam. Helped them all lay down/sit up/stand up, had a running commentary while doing the PE ("now I'm going to check your legs for swelling, and check your legs for pulses...etc). I'm not such an outgoing person, so excessive smiling is not something I do well. Hopefully they detected warmth and empathy anyway...
So I don't feel great about my performance, and if the stars align badly I think I could have failed, but I just have to hope for the best! To all those about to take the exam: good luck, and whatever happens at least the day flies by!
Last edited:
Not by much, but still...
