I need advice

[ciestar]

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Hello wonderful people of SDN.

I need help. If you’ve seen my posts ever, my neuroticism and anxiety likely jump off the screen.. now is no different.

Question is: HOW DO I NOT FREAK OUT DURING CS?!

I tanked step 1. I had a dramatic come back for step 2 but now I am terrified of failing the definite easiest exam of the three.

How do I feel better about this?

 

[Moko]

From what I vaguely remember:
1. Have a mental checklist of 'to-do's for every patient. This will prevent you from losing easy points. A lot of cases in First Aid CS have a lot of overlap, so cue into those. For every encounter, be sure to practice proper hand hygiene, give an introduction, be polite and professional, ask open ended questions and then pertinent ROS based on the differential, a targeted physical exam (cardiopulmonary will usually net you a few easy points), and give an overview of next steps.
2. Everyone has HIV, depression, cancer, thyroid dysfunction, and/or TB.
3. When writing your report, type fast. Quality means nothing if you run out of time (time passes by quickly).
4. When something goes wrong (patient starts crying, gets angry, lashes out, etc), just remember that they're actors and they're doing it to everyone. So respond appropriately.
5. Just remember that the overwhelming majority of US MD students will pass this exam. Don't psych yourself out.

Edit: Also, don't forget preventative counseling when pertinent. If a patient uses tobacco, alcohol, and/or illicit drugs, or has unsafe sexual practices, be sure to counsel against those. Again, easy points.

 

[ciestar]

Stupid question, but, the USMLE Step 2 CS orientation video has it both ways..
Do introduce myself as Dr. Ciestar or Ciestar MS4?

 

[Moko]

Stupid question, but, the USMLE Step 2 CS orientation video has it both ways..
Do introduce myself as Dr. Ciestar or Ciestar MS4?

Doesn't matter in my opinion. I just used student doctor / medical student. You can always ask the staff at the test center too

 

[Med Ed]

Hello wonderful people of SDN.

I need help. If you’ve seen my posts ever, my neuroticism and anxiety likely jump off the screen.. now is no different.

Question is: HOW DO I NOT FREAK OUT DURING CS?!

I tanked step 1. I had a dramatic come back for step 2 but now I am terrified of failing the definite easiest exam of the three.

How do I feel better about this?

Get a fellow student and spend two evenings practicing shortly before the test. Ideally you should be in one of the exam rooms at your school. Use the cases in First Aid for CS and just take turns being the standardized patient and the student. Walk in and out of the room three hundred times if you have to, making the act of saying your name/title and then washing your hands completely rote. Talk out what you may include in your note and workup for each case. You will learn just as much playing the patient as you will being the student.

If the first CS case throws you for a loop just do your best and move on. Most of the cases will be extremely familiar from your prep. When you glide through a couple your confidence will increase.

 

[watermelon master]

Stupid question, but, the USMLE Step 2 CS orientation video has it both ways..
Do introduce myself as Dr. Ciestar or Ciestar MS4?

You're not a doctor. You're a 4th year medical student. Introduce yourself accordingly

 

[Moko]

You're not a doctor. You're a 4th year medical student. Introduce yourself accordingly

Actually, I recall my testing center telling us to pretend that we were the physician taking care of them and to talk to the patients as such. So I don't think it matters either way. I still went by student doctor / medical student because it was more familiar.

 

[ciestar]

Actually, I recall my testing center telling us to pretend that we were the physician taking care of them and to talk to the patients as such. So I don't think it matters either way. I still went by student doctor / medical student because it was more familiar.

The orientation video also says to do this. That is why i was confused

 

[ciestar]

I never thought of this. I introduced myself as medical student and I passed ‍

I would focus on the more important parts like building rapport and gathering pertinent information.

A good thing I did to calm myself down was made small talk with the SP while washing my hands.

Im glad im excellent at the humanistic stuff.

 

[CyrilFiggis]

Question is: HOW DO I NOT FREAK OUT DURING CS?!

Propranolol 20 mg 45 minutes before.

 

[Stagg737]

Also, sit down and make up a patient/case and time yourself writing a note. Have a plan/pattern for how you'll write the SOAP note and be consistent. I did O-A-P and Subjective last (typically the longest portion of the note, so easier to rack up at least some points even if you run out of time). The worst thing that can happen with the note portion is to get to the computer and blank out for the first 2 minutes, so practice those as well and stick to the basics. It's very easy to pass that portion as long as you can at least get some basics written down for each portion.

 

[ciestar]

Propranolol 20 mg 45 minutes before.

I mean.. i could. It is hit or miss with my asthma though lol

 

[ciestar]

Also, sit down and make up a patient/case and time yourself writing a note. Have a plan/pattern for how you'll write the SOAP note and be consistent. I did O-A-P and Subjective last (typically the longest portion of the note, so easier to rack up at least some points even if you run out of time). The worst thing that can happen with the note portion is to get to the computer and blank out for the first 2 minutes, so practice those as well and stick to the basics. It's very easy to pass that portion as long as you can at least get some basics written down for each portion.

Ooh good idea!

 

[Giovanotto]

Are you guys writing on a piece of paper during the encounter and then typing it up right after?

 

[ciestar]

Are you guys writing on a piece of paper during the encounter and then typing it up right after?

This is my plan

 

[NickNaylor]

Work through a review case book. Most of the complaints are likely to be fairly common complaints that you will run into in a "primary care" type setting - for example, SOB, arthralgia, chest pain, etc. When I took the test, most of the scenarios were fairly obvious diagnostically, thus the trick becomes making sure that you check off all of the boxes for the encounter, e.g., doing a ROS, making sure you do appropriate parts of the physical exam, communicating well, etc. When you're writing your "note" afterward, you need to make sure that you can justify your diagnosis. This is where studying using a case review book can be helpful - having at least a brief differential for common complaints and making sure you rule in/rule out "must not miss" diagnoses can go a long way.

Don't get too into your head about it. Remember, you're basically doing the same thing you've been doing for the last year but in a very artificial setting.

 

[Matthew9Thirtyfive]

I mean.. i could. It is hit or miss with my asthma though lol

Ooh ooh. Nitroprusside!

 

[ciestar]

Work through a review case book. Most of the complaints are likely to be fairly common complaints that you will run into in a "primary care" type setting - for example, SOB, arthralgia, chest pain, etc. When I took the test, most of the scenarios were fairly obvious diagnostically, thus the trick becomes making sure that you check off all of the boxes for the encounter, e.g., doing a ROS, making sure you do appropriate parts of the physical exam, communicating well, etc. When you're writing your "note" afterward, you need to make sure that you can justify your diagnosis. This is where studying using a case review book can be helpful - having at least a brief differential for common complaints and making sure you rule in/rule out "must not miss" diagnoses can go a long way.

Don't get too into your head about it. Remember, you're basically doing the same thing you've been doing for the last year but in a very artificial setting.

Ive already read through FA. Exam is tomorrow and I have clinic this morning, which helps the interview stuff. Might page through cases on topics i have a harder time with but I am trying to take it easy today.

 

[ciestar]

Okay well im convinced i failed. Forgot to do things i should have.. made probably illogical guesses on at least one case. Forgot smoking cessation on one..

But i never once ran out of time? 😆

 

[differentiating]

Okay well im convinced i failed. Forgot to do things i should have.. made probably illogical guesses on at least one case. Forgot smoking cessation on one..

But i never once ran out of time? 😆

I legitimately forgot to clean my hands in one station because the patient was sitting right in front of the hand sanitizer and threw me off, and at another station I completely forgot one of the main differentials until I was starting the next one. I still comfortably passed. You remember the mistakes you make, but rarely are they severe enough to add up to a failure.

 

[Redpancreas]

Hello wonderful people of SDN.

I need help. If you’ve seen my posts ever, my neuroticism and anxiety likely jump off the screen.. now is no different.

Question is: HOW DO I NOT FREAK OUT DURING CS?!

I tanked step 1. I had a dramatic come back for step 2 but now I am terrified of failing the definite easiest exam of the three.

How do I feel better about this?

See my signature for a step-by-step breakdown. It's a bit much and may be a bit neurotic, but it worked for me after I struggled with my school's OSCE and went on to pass CS and have gotten 1-2 PMs about how it's helped people who've failed pass the second time (or at least they think it's helped them).

 

[Dave1980]

Before you are done with any of the history taking ask "Is there anything else I should know about?". It's golden. They will prompt you to go over what you missed. I remember one of my patients was an obese woman and after I asked her that she said:

"Well I haven't been eating much and I feel cold all the time. I have these new little hairs on my arm."

So the obese woman was suffering from anorexia and had lanugo...ok...glad I asked.

 

[Medic741]

Hello wonderful people of SDN.

I need help. If you’ve seen my posts ever, my neuroticism and anxiety likely jump off the screen.. now is no different.

Question is: HOW DO I NOT FREAK OUT DURING CS?!

I tanked step 1. I had a dramatic come back for step 2 but now I am terrified of failing the definite easiest exam of the three.

How do I feel better about this?

Hey there, first off *you got this*. I can’t recommend the checklist approach enough. Turn your neuroticism towards developing a checklist method for those encounters and practice practice practice your checklist u til you can do it in your sleep.

In my paramedic program (a long time ago now, yikes!) we were trained to do assessments in a very structured stepwise fashion so when the s— hit the fan we wouldn’t freeze. Plan to do this for CS as well because I know it works well for me & many others. I’ll try to find a few examples and post them later when I have a sec to track them down