Failed Step 2 CS

[GATO]

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[GATO]

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[Ice dude]

I passed Step 1 & 2CK. I applied to the programs for Match.
I read the thread I can take it by Dec 31 to join in Match . But how can I improve my communication skills and English fluency for 2 months? I don't think my English was bad, though. They thought it was bad.

Gato.

Readin the posts of those who failed is makin me worry a lot.
Man! I am an IMG too, I took Cs on 1st october. Well my problem is I speak a bit fAST and I wasn't great at counsellin the pts either. I hope so they understood me, prayin for the best for everyone.
And yes, u should not stop tryin, u can definitely work in US as a a doctor, so lift up ur spirit and do it.GOod LuCk.

 

[GATO]

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[Ice dude]

Don't take it too seriously, it's just a test, u can pass it easily, yes do try to schedule it as soon as possible. no idea about the kaplan course.

 

[winner123]

Don't take it too seriously, it's just a test, u can pass it easily, yes do try to schedule it as soon as possible. no idea about the kaplan course.

Ice Dude,Not a good advice at all.
GATO,prepare yourself fully before taking this exam again.
Remember ,u can not take another chance.
Can go to C3NY/KAPLAN/STEP-2CS REVIEW.
Try to spend your money wisely.
What u need to do is that u need to interact a lot with standardised patients under exam conditions after learning the appropriate principles governing this exam.
So take a course,some mock tests,and practice a lot perfectly with your fellow colleagues.
Good luck

 

[wahoo2009]

Hi, I have a suggestion. Would you be able to find a clinician to shadow? Since you won't be able to retake it until March at the earliest, I think it would be helpful for you to see and be around patient interactions. I bet the ER would be a good place to shadow - lots of taking histories, doing focused ROS and physical exams. I think this would help alot, even if just through osmosis. But realize that the test you are going to have to do things differently than in real life - if I had a dime for every time I saw an attending auscultate through clothes...

If you could shadow like 5-8 hours a week, and also keep practicing encounters with your native English speaking med student friends I bet it would help a lot.

 

[Terpskins99]

If you could shadow like 5-8 hours a week, and also keep practicing encounters with your native English speaking med student friends I bet it would help a lot.

That is key right there. The ideal situation would be to practice with someone that has already passed Step2CS.

Just a general recommendation for foreigners with thick accents: be careful not to speak too quickly. Have an even pace (talk slowly), make sure to talk loud enough if you have a soft voice and speak clearly.

Outside of that, always follow an algorithm with your encounters.

What I did: knock, introduce yourself, shake hands (maintain eye contact), ask what brings them in, OLDCARTS their symptoms, then history, wash hands, drape patient, perform physical, summarize findings, suggest diagnosis, suggest treatment, ask if they have questions, leave.

 

[Ice dude]

Ice Dude,Not a good advice at all.
GATO,prepare yourself fully before taking this exam again.
Remember ,u can not take another chance.
Can go to C3NY/KAPLAN/STEP-2CS REVIEW.
Try to spend your money wisely.
What u need to do is that u need to interact a lot with English patients under exam conditions after learning the appropriate principles governing this exam.
So take a course,some mock tests,and practice a lot perfectly with your fellow colleagues.
Good luck

Well, i didn't mean not to prepare properly for it. Anyway, hey winner once i read ur post sayin u know the secret of passin CS, would u like to share it with me?

 

[Amy B]

I tried to schedule the next exam, but no places available until March in all test centers! I put my name in the waiting list and also scheduled it in March. I hope I will find the place before January 1st. Otherwise I will have enough study time, can take many CS exams for 2010 Match, and spend a lot of money. Kaplan CS course is good for Communication and Interpersonal Skills? Does it deserve $3,000? I will do anything to pass it. If it doesn't work, I should go back to my country or kill myself.

For the COMLEX CS, you could check the computer on a daily basis and it would change and dates would become avaible.

 

[GATO]

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[Amy B]

Good luck.

 

[GATO]

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[Amy B]

Sound like you are in an uphill battle. You have mentioned numerous issues with how you handled these patients visits. Some of these things are easier to work on such as a smile for your patients, but some are clearly harder such as having your patients understanding what you are saying to them. As to your hands.. You should have used soap. No one wants a doc to touch them without washing their hands prior to that exam. And I think there is a bigger issue here with your comment about not wanting to touch patients due to them sweating and you say you want to wear gloves?? That sounds strange coming from someone who is wanting to be a doctor. You didnt seem to be interested in interacting with your patient as you need to be.
Just my impression to the things you said.....

 

[GATO]

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[GATO]

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[GATO]

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[GATO]

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[GATO]

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[GATO]

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[winner123]

Well, i didn't mean not to prepare properly for it. Anyway, hey winner once i read ur post sayin u know the secret of passin CS, would u like to share it with me?

You are welcome!

 

[Mariah246]

I found the best way is to settle in a comfortable routine for the history taking. Once you've got that, it's much easier to fake empathy and deal with the inevitable "Challenge Questions" the patients have.

My physical exam was brief and cursory at best. People keep stressing it's about efficiency and not perfection so with a thorough history, appropriate counseling, and by leaving enough time to feign empathy/address the challenge question, hopefully it's enough to pass even with a moderate to subpar physical exam.

 

[GATO]

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[winner123]

I created my protocol. I took specific mnemonics for individual system history from OSCE. But not easy to remember them because most of them don't have any meanings. Any comments or suggestions?

• Get dressed neat and use moderate deodorant. Take breath mints and brush your teeth before the beginning and after lunch.
• Write LAST NAME, age, abnormal vitals, DD, the specific mnemonic for the case, the regular mnemonics (OS CD PQRSTUVW AAA, FFAW PAM HUGS FOS SODAS TIME), RECTAL, COUNSELING, JCO (JVD, carotid bruit, ophthalmic exam), CVA
• Knock the door three times; open the door; close the door.
• Smile. “Good morning Mr. XYZ. I am Dr. Hagihara and I am here to see you as your physician today. Nice to meet you. (shake hands). Did I pronounce your name correctly?” Don’t shake hands with the patients in severe pain.
• “Is everything in the room alright for you?”
• “I will cover you with this cloth to make you a bit more comfortable.”
• “Do you mind if I sit down?”
• “Mr. XYZ, I’ll be writing down some notes while we talk. Is that Okay?”
• Never write anything while the SP is speaking!
• “The nurse told me that you are having ….Can you please tell me more about it?”
• “When would you say it started?” “What made you decide to get it checked now?
• “I am so sorry to hear that. I shall try my best to help you. (smile)”
• After asking the patient about the Chief Complaint in detail, repeat what the patient told to you. Do this thing at least twice. Paraphrasing concentrates on only a particular symptom. For example, “You told me you have had 3 days of cough and 1 day of shortness of breath. Is that correct?”
• After initial history taking, take the system-specific history using the specific mnemonic.
• “Mr. XYZ, now I want to ask you some questions about things that may or may not be associated with ….., okay?

• Ped: GEEN MS CAM BINDE
• GI: PAN HSBG JBO
• OBGY: MBDP D U C SOO
• MSK: joint PR STD ROMaN’S Activity MisSNG
• Respiratory: PCS Wheezes HEAT On Us
• Cardiology: PCS OSAP PLC EAR
• Neuro: HLD NeW VHS MTC
• End/Hemo: WENT MSN ENG RPL
• GU: PD UHF SUV FIDO
• Psych: AL MAP CVP SADDD
• Derm: RUSC NJE CHD

• After finishing, go to standard questions.
• “Mr. XYZ, now I am going to ask you some questions about your health that I ask all my patients, okay?”
• Before taking a family history, say “Mr. XYZ, I’d like to know a little about your family.” Empathy for bad news.
• Before taking OB & GY and sexual history, say “Now I’d like to ask you about your gynecological and sexual health. Whatever you will tell me will be kept confidential. Is that Okay?”
• Before taking SODAS TIME, say “Now I’d like to ask you about your lifestyle, okay?

• Fever
• Fatigue
• Appetite
• Weight changes

• Past medical history & past surgical history
• Allergies
• Medications

• Hospitalizations
• Urinary problem
• GIT problems
• Sleep problems

• Family health
• OB & GY
• Sexual history

• Smoking
• Occupation
• Diet
• Alcohol
• Support system

• Travel Hx
• Illicit Drugs
• Marriage
• Exercise

• Do the counseling after you ask about it. The key here is to have the patient see the counselor.
• For Smoking: “Your health will improve if you stop smoking. I’d like you to attend nonsmoking classes run by our counselor.”
• For Alcohol: “For your health, it is important that you stop drinking. I’d like you to speak with our alcohol counselor. I will bring you her number.”
• For Recreational Drugs: “Please stop using drugs. They are hurting your health. I know it can be difficult, so I’d like you to speak to our drug counselor.”
• For Sexual Transmitted Diseases: “Do not have sex until all your treatment is finished and your partners are treated as well. Then I want you to use a condom every time to prevent infection in the future.
• For Diabetes Control: “Not controlling blood sugar, taking fatty foods, not doing regular exercise and not watching your feet regularly puts you at higher risk of getting complications of diabetes. I must advise you to observe strict blood sugar control, take less fat, do regular exercise and observe your feet. I’d also like you to speak to our dietitian.
• For Hypertension: “Not controlling blood pressure, taking salty foods and not doing regular exercise puts you at higher risk of getting complications of high blood pressure. I must advise you to observe strict blood pressure control, take less salt, do regular exercise. I’d also like you to speak with our dietitian.

• For challenging questions: “I understand your problem/concerns that …………… But right now it is difficult for me to say for sure as I need to run some tests/investigations and once the results come back, I will be in a better position to tell you what we are dealing with. I will keep you informed. Is there anything I can do to make you feel more comfortable? Please bear with me. I will very much appreciate your patience.”

• Summarize. “Let me see if I have it straight. …………………… Is that correct?”

• “Do you have any other things to tell me before I start your physical?”
• “Okay, Mr. XYZ. Now I am going to do a physical exam. Is that okay with you?”
• “Alright then, excuse me for a moment here so that I can wash my hands, okay?”
• Use a tissue to turn the knob off after washing your hands.
• Rub your hands and make your hands warm. Ask if the patient feels your hands cold.
• Wipe your stethoscope with an alcohol pad and make it warm by a hand.
• Use the examination table’s leg extension when the patient is reclined.
• Pull out the footstep when you ask the patient to walk.
• Your duty is to just tie or untie the gown.
• If the patient complains of any pain, say “I am sorry, I need to do this test to know what is actually the cause of your problem. Next time I will be gentle.” But don’t repeat.
• Never talk at the back of the patient. If you have to do that, say “Now I am going to examine your back. I may give some instructions from the back. Please follow them.”

• “Mr. XYZ, I have finished your physical exam.”

• “Thanks for your cooperation, Mr. XYZ. Now I would sit and talk over what I am considering so far. You told me that you have had this problem since ….. and it is progressively getting worse and on physical exam, I was not able to find anything significant/I was able to find that you have ………….. Based on this, there are a few diagnostic possibilities like …… and …….But there are other possibilities as well and want I am going to do now is to run a few tests like ……..on you and once the results of these investigations come back, we will sit together again and discuss your problem in more details.

• “Have you understood everything that I have told you today?”
• “Do you have any questions?”
• “Okay then, Mr. XYZ. I am glad that I was able to work with you and I assure you that I am always here to help you. Thanks for your cooperation and it was really nice meeting you. Bye for now and take care.”

• Don’t leave early. You will lose your points. Say “Let me check if I have got all my facts right.”

GATO, mnemonics are not needed at all .
Practice only is needed,because when one practices a lot he automatically knows what he has to do or ask next.
There are many points mentioned above which are really good.
Also, you have to use some sentences which are estabished and frequently used here in America to enhance Doctor Patient Communication.
Sorry to say,but In my opinion you still are not fully getting what USMLE STEP-2CS exam is about.
This exam is about communication and being with the patient.It is about satisfying the patient.It is about making the patient talk.
I hope u understand what I am trying to say.

 

[GATO]

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[Mariah246]

Smile, use the patient's name, ask if they have any ?s/concerns at the end of your history, wash hands, show compassion esp during painful PE procedures, ask again if any ?s/concerns at the end of encounter, provide counseling.

My counseling is weak. I always went with, "We're going to draw some blood for lab tests and do some imaging studies. Once we have that information, we'll contact you for a follow-up visit at which time we'll hopefully provide you with a more definitive diagnosis and treatment. Do you have any ?s or concerns at this time?"

Hopefully that is good enough.

 

[winner123]

Winner123, thank you for your prompt and kind reply. Last time I passed ICE. As you pointed out, I don't think I need to remember mnemonics for system history. I understand this exam about making patients talk. By the way, could you tell me some sentences which are established and frequently used here in the US to enhance Doctor Patient Communication? They sound like magical senteces for me.

GATO.

GATO, always avoid all medical jargon.
Sentences like :
"What brings you in today/How can I help you today?"
"Did I pronounce your name correctly?"
"What do you think might be going on?"
"Do you have any idea what might be causing this?"
"Is there anything else which you would like to tell me and which I have not asked."
"I am glad you came in and I must assure you that I am here for your help and support."
"You seem to be in a lot of pain.Is there anything I can do to make you feel more comfortable?"
"You must be very concerned about your complaint/problem ,but I must assure that I will do everything possible to give you the best possible treatment."
"You look sad.Is there anything which is making you feel sad?"
"Based on your history and the physical exam findings there are many impressions that come to my mind."
"I am going to run you thro' some tests and after the test results come I will be back to you and discuss with you what actually is going."
"Have you completely understood everything which we discussed today?"
"I must assure you that everything you say will be kept confidential and will not be revealed to anyone else without your written consent."
"Do you have anybody to talk to?"
"Whom do you live with?Do they support you?"
"Is anybody treating you badly at home or elsewhere?"
"Are you comfortable sitting or you want to lie down?"
"Will you untie your gown or shall I assist you?

These are some of the sentences.
I hope it helps.

 

[GATO]

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[GATO]

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[GATO]

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[andwhat]

Ice Dude,Not a good advice at all.
GATO,prepare yourself fully before taking this exam again.
Remember ,u can not take another chance.
Can go to C3NY/KAPLAN/STEP-2CS REVIEW.
Try to spend your money wisely.
What u need to do is that u need to interact a lot with standardised patients under exam conditions after learning the appropriate principles governing this exam.
So take a course,some mock tests,and practice a lot perfectly with your fellow colleagues.
Good luck

Kaplan's five day cs course is definitely worth the money. It has cases, and print the USMLE World cases out. Focus on Pnemonics, and everything will start to make sense. I am frustrated for you, that you failed it. Sorry to hear that.

 

[Femtochemistry]

GATO, always avoid all medical jargon.
Sentences like :
"What brings you in today/How can I help you today?"
"Did I pronounce your name correctly?"
"What do you think might be going on?"
"Do you have any idea what might be causing this?"
"Is there anything else which you would like to tell me and which I have not asked."
"I am glad you came in and I must assure you that I am here for your help and support."
"You seem to be in a lot of pain.Is there anything I can do to make you feel more comfortable?"
"You must be very concerned about your complaint/problem ,but I must assure that I will do everything possible to give you the best possible treatment."
"You look sad.Is there anything which is making you feel sad?"
"Based on your history and the physical exam findings there are many impressions that come to my mind."
"I am going to run you thro' some tests and after the test results come I will be back to you and discuss with you what actually is going."
"Have you completely understood everything which we discussed today?"
"I must assure you that everything you say will be kept confidential and will not be revealed to anyone else without your written consent."
"Do you have anybody to talk to?"
"Whom do you live with?Do they support you?"
"Is anybody treating you badly at home or elsewhere?"
"Are you comfortable sitting or you want to lie down?"
"Will you untie your gown or shall I assist you?

These are some of the sentences.
I hope it helps.

wait, let me get this straight...these are the sentences you should avoid?? If that's true, then I am fubar...I said about 1/2 of these

 

[GATO]

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[GATO]

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[GATO]

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[size_tens]

Although I have yet to receive the results of my exam I don't think it's necessary to be terribly thorough with the H&P. Just do the basics and add in any special questions/PE maneuvers appropriate for that particular situation. I know this is vague but in general I rarely took much more than 10 min to complete the patient encounter.

 

[IFNgamma]

hi Gato,

sorry you have to take this awful/crappy/stupid/lame/useless exam again. Believe me I know exactly how u feel cuz I failed it also. And just like you I had to pass it in order to stay in the match. So I retook it and passed it and matched. So don't dispair, it can be done.

Where did you take your exam? I would suggest you schedule it at a different center if you can.

For me I simply cannot stand the thought of seeing the same SPs again.

I took it in LA, failed, then I took it in Atlanta, and passed. And I thought I did worst the 2nd time! And another friend of mine did the exact same thing, failed in LA and passed somewhere else.

Anyways, best of luck to you.

IFNgamma

 

[GATO]

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[Amy B]

There is NO way you could do all that. This is a test that will test you on a FOCUSED exam. Focused as in all dealing with questions related to what the CC is at the time of the visit.

 

[radoncadonc]

My advice: Scrap the pneumonics. You are wasting your brain space trying to remember letters when you don't have to. This is what you need to do:

Intro: Hi, I'm ____________, shake hands, look in eyes. I'm part of the medical team teaming care of you today, (it's your choice whether you say you are a doctor or a student). What brings you in to see us today?

7 Characteristics: Onset, location, durations, severity, exacerbating/relieving factors, blah blah blah, you know them.

As you progress through the history, you will think of a few other questions, ex: if the person is there for passing out, ask if they ever hit their head, ask if they ever get cardiac syx etc. Think to yourself, what causes passing out and then ask a few questions that would help you identify the problem. (your time is much better off learning about the disease then trying to remember a ton of pneumonics or lists, if you know the medicine you can do this easily.) It only has to be a few questions.

Then move on to the ROS (this should also be quick, N/V, D/C, F/C, weight change, HA, CP, SOB), Allergies, Meds, PMHx, FHx, SHx.

Wash hands, Quick physical exam, and examine what you think should be examined. If they have passing out problems, then do a HEENT, chest, quick lung ausculatation, neuro.

When you are done, quickly summarize, "so you pass out, this happens, that happens. On exam I found this. It could be x.y.z. This is what I want to do to find out what's going on. Do you have any questions?"

Done



Do this for each and every encounter. Don't mess with long pneumonics, if you actually know the medicine, you should have no problem with this exam. You are getting bogged down in trying to be perfect. Don't be scared of the FA cases, they are much more complicated then the actual exam. I would also handwrite the note, that way you don't have the temptation to constantly correct your HPI if things get mixed up. Who cares if one sentence should be ahead of another, as long as the information is there you should be fine.

 

[GATO]

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[pocketknife52]

Dude I think you are just complicating it a little bit too much. I mean wear moderate deodorant? brush teeth? brush your teeth the morning of and that is probably all you need.

First of all, the only thing I said to patients was " knock knock, Mrs so and so, Im dr. so and so, shake hands. sit down and say what brings you here today? smile..... you do not need to ask about the room, blahbalbhalbha, unless they are crying or something...... that is all a waste of time.... you can drape the patient before the physical too, you dont have to do it immediately... but you might as well....

if you were repeating many questions it may be purely that your english is not very good.... it is probably as simple as that. I see alot of fmgs here in the states that dont have the best english and it simply annoys the patients (in real life) and they misconstrue it as a lack of interpersonal skills....because you don't talk very smoothly, or something,,,, i cant really explain it but this is what i see alot......i constantly restate what my fmg residents tell patients to clarify what is going on....

anyway;;

i never said do you mind if i take notes?
i wrote when the patient was talking.... but i always looked the patient in the eye while i asked questions
i never said anything about ill try my best to help you, until the very end..... i never warned a patient that i was about to ask personal questions like social history, etc. I counselled few patients, maybe one about drinking, another about condoms. But i also believe i didnt have many smokers or drinkers, and no drug users.... so i didnt really have to counsel them. i never had to assure a patient that i was going to keep things confidential. If a patient told me something embarrassing i said oh thats no big deal.

when moving onto the physical i was like okay now let me wash my hands and examine you real quick ok?

my exams sucked

i always shined light in eyes and mouth

i was looking in a patients ears and i went to go to the other ear and the speculum remained in her ear and i didnt realize it until i tried to look in her other ear...... and i was like oops and smiled

when i listened to patients lungs i always did fremitus and percussed, except for maybe twice, i dont know why i did it at all, i just did.... so anyways i left them untied, did the heart exam, and in order to listen to the mitral and tricuspid areas, i actualyl puleld their gown forward from the left side, and if it was a female her bra was exposed, and i sort of went in from the side and listened, and asked them to lift their breast if it was in the way (hahaha) i thought later on this would cause a problem but it didnt....but if youre feeling for pmi i would think this is the only way to do it...... i actually palpated the abdomen like twice before i listened by accident.....

i did full neuro exams three times.... cranial nerves including weber test, sensation to face i used cotton, strength, reflexes (biceps, knee jerk, ankle jerk), babinski, pin prick to foot, light touch to foot, romberg test, gait, finger to nose, and rapid alternating movements....i only had to do thsi three times....but after all this i was able to do lungs, heart, abdomen

one dude had an injured shoulder and i actually made him do extension, flexion, and abduction and it hurt him everytime and i was like crap, maybe i repeated painful maneuvers cuz it hurt him everytime....

all in all i think the physical exam, it is pretty obvious what to actually do.....its a matter of doing it fast....i think even a full neuro and heart, lungs, abdomen can be done in 5 minutes (i didnt practice any of it)

as far as difficult questions, as strange as it may seem,. i think i answered two of them flat out wrong.....some dude watned to know if he could go and continue his normal routine and im like oh yeahhhhh this should be easy to treat no problem...... when i shoulda said maybe....
oh and i forgot to pull the foot rest thing out like maybe 3-4 times when i laid someone down, one person asked if i could pull it out for them

as far as notes are concerned

i feel like my hpis were solid

i know i left the heart exam off on two of them ( i performed it but forgot to write it)

i left a family history off

i think i had three things in the differential three times, had only three tests ordered those same three times....

then the remaining 9 cases i probably had 5 in the diff, and 5 tests to order most of the time, and maybe 3 cases i only had four thigns listed

i put multiple tests to order per line, like serum glucose, hba1c on the same line, etc

i think i asked the majority of them their occupation, but probably not all of them



the bottom line is i was by no means perfect....and i definitely dwelled on the mistakes i mentioned above...... until i finally passed.... i think the threshold for failing is quite high..... and it sounds to me like your language barrier is the problem...

i never ran out of time and probably on average had 2-3 mins remaining


i always typed my note because i type much faster than i write, and for some reason when i write medical notes i tend to leave letters off the end of words and do stupid stuff, whereas with typing i dont make that kind of mistake.... it does suck to type when you want to move things up and down on the differential, you must be wary of the time remaining because you dont want to erase a line and then have time run out just cuz u wanted to put it somewhere else....

for ROS i always put :negative except as above:

i used abbreviations that first aid commonly used like AXR for abd xray, and whatever else

i only recorded abnormal vitals, but if they were normal , i put VS: wnl

bottom line is i really followed first aid closely when it came to what tests to order and the structure of the note.... though i definitely left off a few tests and left stupid stuff off the differential a few times....

the way i prepared was really overkill......i went through the minicases in first aid like 4 times and really tried to remember what tests to order....

as far as the practice cases in first aid......i would look at the complaint, and type up a list of questions that i would ask.....adn then compare it to the questions the book asked.....i never practiced doing this in real life, so i didnt know if i had enough time to ask as many questions as the book, i think you do if you do them really quickly.....anyway, once i compared my questions to the book's questions, i would practice recording the answers in the book to each question in a shorthand form, so i could write things quickly, and then i would write a note based upon only that shorthand stuff i wrote down.... i did this with each case twice.....

i practice a physical exam once on my fiance...

as you can see though, as far as using first aid, i spent quite a bit of time..... i can say it 100% helped me with my question asking and what tests to order and differential, it obviously didnt help me with physical exam and it didnt really help me practice doing it in real life.....

oh and i always washed hands with soap, i would think if they saw u use only water they would count it against you.....who knows. its not like it took any longer to do it....wearing gloves is probably a bad idea....but supposedly its ok.....


anyways i always said okay mr so and so, i think im done, you could have this and this and this, we are gonna get this and this and this, do you have any questions? okay, nice meeting you, shake hands, smile, bye bye

 

[GATO]

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[pocketknife52]

interesting, i am going into pathology as well....

i meant to write this on the other thing........CS is a pointless test for anyone to take.......certainly for anyone who speaks english as their first language...... i think it is stupid but it is a political move...... certainly proper english is needed to practice in the US....but that should be the only criteria.....not making sure u drape the patient....etc......it is stupid as all hell..... get rid of it, for everyone

 

[GATO]

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[Ice dude]

personally i like the idea of draping. It sounds ethical and how much time does it take to just put a sheet on their lap.

 

[GATO]

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[NPR]

Yes, I like it, too. But I have never seen drape in doctor's office.

GATO.

You'd probably feel differently if you had breasts.

 

[G0S2]

I draped the pt once I began the exam. To me, it makes no sense to walk in and drape. If it costs me, so be it but that's how I feel it makes sense. There shouldn't be this robotic nature to the exam but that is what these SP and OSCE type scenarios breed.

 

[radoncadonc]

Gato,

You are going about this exam all wrong. There is no secret checklist. Your outline is WAY overboard. I can confidently tell you that no person who ever took that exam was that complete. There is a reason that over 95% of native english speakers pass the exam, and that is because this test is designed to evaluate how you relate to patients in the english language. Improving your english should be your main goal, or else you will sound like a rehearsed robot. SPs will see right thought that.

You have obviously learned all the tricks of this exam. You know when to counsel and when to wash your hands, but you are taking it over board. You will never pass this exam if you act like a robot. You need be relax and act casual. You don't need to ask permission to do everything, even if FA says so. If you are stressed and uptight, the SP is automatically going to be weirded out, stressed and uptight as well. If the SP likes you they are much more lenient. If they recognize you are struggling to converse, they grade more difficulty.

You don't have to ask permission before you do everything, you don't have to walk around on egg shells. Act confident and be friendly.

My advice would be to really focus on your english conversation. Remember, this test was designed to evaluate people's english, not to test their medical knowledge. If you get to the point where you are confident with your english conversation you will be more than ready to pass this exam. I would try to practice without ANY notes or checklists or any kind. The longer you get used to having notes as a security blanket the longer it will take you to be comfortable on your own. Read the case, and write only the pts name down. Then go in and talk to the patient. Don't treat them like they are part of a checklist, don't treat them like they are part of an exam. Talk to them like they are a person, you job is to help that person, not answer that exam question.

If you become dependant on checklists and pneumonics you are putting yourself at a huge disadvatage compared to the person who knows english and then confidently talks to the patient.

When I took the exam I didn't take a single note when talking to the patients. There is no need for note taking, it just disrupts the conversation. You will remember the details when you need to write the HPI, so instead of focusing on writing things down, you can focus on conversing with the patient.


Sorry this post is written like some manic pt with flight of ideas, I really want to help you and I am afraid you are going about it ass backwards. You can't beat this exam with a checklist, you need to be comfortable conversing with patients in english.