Step II Important stuff to avoid failing CS

[studentdoc911]

Post a list in here:

1) Washing hands
2) I hear draping patients before talking to them is important, even before the physical.

 

[Epo83]

I guess I'd add

3) For physical exam if your very limited by time at least auscultate heart and lungs.

 

[septoplasty]

Washing hands ORRRRRRRRRRRRRR gloves.

Also, be sure to change gloves/rewash if something happens between the time you did it originally.. ex shake hands or hold their belonging or something *hint hint*.

I'm not sure if they dock you for it, but i've seen multiple instances where they've done that.

Also.. smile and greet.

and also, don't announce patient name when door is open, do it AFTER closing the door.

 

[chessknt]

Washing hands ORRRRRRRRRRRRRR gloves.

Also, be sure to change gloves/rewash if something happens between the time you did it originally.. ex shake hands or hold their belonging or something *hint hint*.

I'm not sure if they dock you for it, but i've seen multiple instances where they've done that.

Also.. smile and greet.

and also, don't announce patient name when door is open, do it AFTER closing the door.

I hope that last point is not true--did it for every patient (because I have a goldfish memory and forget names quickly).

Always ask if they have any questions or concerns, at least one time. This is crucial since it lets them pitch their challenge question if it did not come up already.

 

[Socrates25]

Washing hands ORRRRRRRRRRRRRR gloves.

Also, be sure to change gloves/rewash if something happens between the time you did it originally.. ex shake hands or hold their belonging or something *hint hint*.

I'm not sure if they dock you for it, but i've seen multiple instances where they've done that.

Also.. smile and greet.

and also, don't announce patient name when door is open, do it AFTER closing the door.

so I guess erroneus interpretations of HIPPA are now being used in CS.

Make sure you ask EVERY patient about whether they are a victim of domestic abuse. We have to make sure we address everybody's victimhood for CS.

 

[emboli]

so I guess erroneus interpretations of HIPPA are now being used in CS.

Make sure you ask EVERY patient about whether they are a victim of domestic abuse. We have to make sure we address everybody's victimhood for CS.

Seriously? 😕

 

[ar2388]

Seriously? 😕

jeez.. really?

 

[fahimaz7]

jeez.. really?

rumor has it.

 

[notamember82]

Do not under any circumstance pass gas in the actual patient room. You won't fail or anything but they are very poorly ventilated.

 

[notamember82]

In all seriousness, if you go through the first aid they had a lot of tips that weren't common sense.

I truly hope they do away with this exam as it really has no merit in the assessment of med students..if you cannot treat people properly or communicate effectively I would let the residency selection process weed you out. I guess a least they provide a "free lunch"

 

[disorder]

In all seriousness, if you go through the first aid they had a lot of tips that weren't common sense.

I truly hope they do away with this exam as it really has no merit in the assessment of med students..if you cannot treat people properly or communicate effectively I would let the residency selection process weed you out. I guess a least they provide a "free lunch"

I agree. I think this test is a complete waste of money.

 

[chessknt]

I find the grading turnaround preposterous--how is it that failing this test essentially dooms your ability to match or get residency because you only have one chance to pass it before the match?

Our entire third year is an exercise in this very test--if we had serious deficits that would limit our ability to be physicians, then our medical school should detect and correct that (and it should be reflected in the MSPE). If they don't trust the medical schools, what is the point of the AAMC and LCME?

 

[disorder]

I find the grading turnaround preposterous--how is it that failing this test essentially dooms your ability to match or get residency because you only have one chance to pass it before the match?

Our entire third year is an exercise in this very test--if we had serious deficits that would limit our ability to be physicians, then our medical school should detect and correct that (and it should be reflected in the MSPE). If they don't trust the medical schools, what is the point of the AAMC and LCME?

well said. 👍

 

[septoplasty]

so I guess erroneus interpretations of HIPPA are now being used in CS.

Make sure you ask EVERY patient about whether they are a victim of domestic abuse. We have to make sure we address everybody's victimhood for CS.

Well obviously this was anecdotal evidence, so i'm not exactly sure how valid it is.

I had also found out about this a few months AFTER my exam, so not sure if there are any obvious repercussions as I had announced the name with the door open too, but did end up passing.

As someone said before, this exam is ****.

 

[NewYorkDoctors]

In Philly, all of the patients I had were draped already.

Not, a drape in the corner waiting to be unfolded and offered

Draped already

Over their laps

Or over their bodies while they were lying down

 

[emboli]

I've been searching through this forum + google and have already read through First Aid. I still can't find a definitive answer on how to handle the female chest/cardiac exam.

The posterior side is no issue. Just untie and auscultate/palpate/etc.

For the anterior side... do I untie the gown and lower it to the patient's upper belly and have her hold it in place while I auscultate the heart? And then when checking the mitral area, just tell her to lift up her breast with one hand and keeping her other on the gown.

I've also thought about having them lower it just enough to hear the aortic/pulmonic area. Then gown them up again and have them lift the gown just enough for the last 2 areas. More hassle than the previous route. Thoughts?

Maybe I'm thinking too much, but don't wanna get dinged for indecent exposure of the female SP.

Please advise!!

 

[zstranger2]

I've been searching through this forum + google and have already read through First Aid. I still can't find a definitive answer on how to handle the female chest/cardiac exam.

The posterior side is no issue. Just untie and auscultate/palpate/etc.

For the anterior side... do I untie the gown and lower it to the patient's upper belly and have her hold it in place while I auscultate the heart? And then when checking the mitral area, just tell her to lift up her breast with one hand and keeping her other on the gown.

I've also thought about having them lower it just enough to hear the aortic/pulmonic area. Then gown them up again and have them lift the gown just enough for the last 2 areas. More hassle than the previous route. Thoughts?

Maybe I'm thinking too much, but don't wanna get dinged for indecent exposure of the female SP.

Please advise!!

You mean, you plan to expose someone's breast because of a stupid exam?

YOU are not allowed to touch the breast and you are not allowed to expose it. Everything else is fair game. Did your school not give you SPs to practice on/with?

 

[emboli]

You mean, you plan to expose someone's breast because of a stupid exam?

YOU are not allowed to touch the breast and you are not allowed to expose it. Everything else is fair game. Did your school not give you SPs to practice on/with?

Of course I know not to expose the breast. I know that the patient will have a bra on. What I meant was lower the gown and expose the chest WITH the bra in place and then having the patient lift her bra up.

 

[zstranger2]

Of course I know not to expose the breast. I know that the patient will have a bra on. What I meant was lower the gown and expose the chest WITH the bra in place and then having the patient lift her bra up.

I think having the patient lift their own breast is fine.

Also, it is important you are not seen staring at their breasts/cleavage.

Also you can have them place the diaphragm/bell for you while you listen. I did that a couple of times.

Irrespective, do whatever you are comfortable with and make sure the SPs know what you want to do ahead of time.

 

[emboli]

Thanks!

 

[medcrazytrain]

oh great - I fart when I'm nervous

 

[andon]

this is why the exam in silly. have you ever seen a cardiologist be adamant about over/under clothes? i have only seen them go to skin if it is readily available -> ICU pt, ward pt with loose gown. Never in the office.

Only one out of 6 cardiologists I rotated with palpated PMI, and he did it with everyone, and he freaking just moved the breast out of the way without asking.

basically, i'm just scared i failed somehow and am venting.

 

[emboli]

So I just have a few questions---

1) In scenarios where they ask you for a doctors note before going back to work... there's no actual note to fill out right? This is just part of the scenario and they really just wanna see how you handle the case? So... it's nto like they give you a paper and fill it out and give it back to them, right?

2) I know 10 out of the 12 cases are graded... Are there two experimental cases or they just take the highest 10 and drop the lowest two?

3) I know this test doesn't require perfection, but is it okay to just list ONE diagnosis in the differential if the case is convincingly that diagnosis without any doubt?

Thanks!

 

[zstranger2]

So I just have a few questions---

1) In scenarios where they ask you for a doctors note before going back to work... there's no actual note to fill out right? This is just part of the scenario and they really just wanna see how you handle the case? So... it's nto like they give you a paper and fill it out and give it back to them, right?

2) I know 10 out of the 12 cases are graded... Are there two experimental cases or they just take the highest 10 and drop the lowest two?

3) I know this test doesn't require perfection, but is it okay to just list ONE diagnosis in the differential if the case is convincingly that diagnosis without any doubt?

Thanks!

At your stage, there will always be more than one diagnosis. Although, when I took it, towards the end I was really tired and didnt care so for my last two patient encounters I only put down three differentials for each encounter. I did that because i was sure I was going to pass. lol

 

[winkleweizen]

So I just have a few questions---

1) In scenarios where they ask you for a doctors note before going back to work... there's no actual note to fill out right? This is just part of the scenario and they really just wanna see how you handle the case? So... it's nto like they give you a paper and fill it out and give it back to them, right?

2) I know 10 out of the 12 cases are graded... Are there two experimental cases or they just take the highest 10 and drop the lowest two?

3) I know this test doesn't require perfection, but is it okay to just list ONE diagnosis in the differential if the case is convincingly that diagnosis without any doubt?

Thanks!

I included one DX, but that was just on one of the cases.....for sure dont make it a habit

 

[emboli]

Things ended up begin okay for you right?

 

[C5toC9]

At your stage, there will always be more than one diagnosis. Although, when I took it, towards the end I was really tired and didnt care so for my last two patient encounters I only put down three differentials for each encounter. I did that because i was sure I was going to pass. lol

It lists on the site that there is only space for 3 differential diagnoses. Was it changed?

 

[emboli]

It lists on the site that there is only space for 3 differential diagnoses. Was it changed?

You are correct that there are on 3 max ddx to list out on the real exam. I think he was trying to point out to me that you should list more than 1. When I was going through FA, I there was a case where it only listed one ddx. I am not sure if there was another one like that.

I'm hoping it's okay. People keep saying this test doesn't require perfection. Also I'm thinking the patient note is only one part of the exam.

 

[LovelyBRass]

So I just have a few questions---

1) In scenarios where they ask you for a doctors note before going back to work... there's no actual note to fill out right? This is just part of the scenario and they really just wanna see how you handle the case? So... it's nto like they give you a paper and fill it out and give it back to them, right?

2) I know 10 out of the 12 cases are graded... Are there two experimental cases or they just take the highest 10 and drop the lowest two?

3) I know this test doesn't require perfection, but is it okay to just list ONE diagnosis in the differential if the case is convincingly that diagnosis without any doubt?

Thanks!

My response from a different thread:
http://forums.studentdoctor.net/showpost.php?p=13182668&postcount=25

I will say that my understanding of how these exams are graded is that the more you write the better (as long as you're not making things up). I consistently erred on the side of writing less for fear of being "wrong" somehow but I don't think there's some point negation for saying something that's wrong (like giving a wrong test or something). Someone please correct me.

 

[dermpathdoc]

they dont trust the medical schools otherwise why would the LCME be doing wholesale slaughtering of
medical school curricla?? hmm?

 

[ArcGurren]

My response from a different thread:
http://forums.studentdoctor.net/showpost.php?p=13182668&postcount=25

I will say that my understanding of how these exams are graded is that the more you write the better (as long as you're not making things up). I consistently erred on the side of writing less for fear of being "wrong" somehow but I don't think there's some point negation for saying something that's wrong (like giving a wrong test or something). Someone please correct me.

I got an "off-the-charts" star for ICE and there were definitely times when I had put down maybe one physical exam finding for each differential and two history findings. I think if you show that you're even somewhat competent you'll be fine.

Tips for the CS:
- keep in mind that vitals count as a PE finding so "tachycardia" and "fever" count
- the ICE component is very loosely graded IMO; there was at least one station where I didn't finish the physical exam and had to say "thanks bye" and walk out of the room, I straight up got the diagnosis wrong for two of them and I still ended up with a little star at the end of my bar for ICE. Don't freak out if your note isn't pristine either. I had at least one instance where I nearly ran out of time and had to BS the labs at the end.
- the CIS component can be graded pretty tough. Make sure to wash your hands or put on gloves before the physical exam at every station (aside from the phone stations of course), and always try to show empathy for the SPs ("I'm sorry to hear that", etc). Close if you can and try to include explanation, counseling, treatment/testing and followup.
- If you're an AMG you should NOT have issues with spoken English proficiency. That should be the least concern for you. If you're an IMG you need to practice speaking certain words out loud. There were IMGs with me during my exam who definitely did have issues with their English and I know of at least one who failed as a result.

 

[justdoit31]

In Philly, all of the patients I had were draped already.

Not, a drape in the corner waiting to be unfolded and offered

Draped already

Over their laps

Or over their bodies while they were lying down

This was how it was with my test in Atlanta too- I think I did have one patient who had the drape on her lap but it was folded in half so I just opened it up for a lil more coverage.

 

[chi773]

So... How far down this list does the listing "physical exam" as part of the workup for peds cases/phone interviews go? I discussed this as the first step with the SPs, but, in the rush of things, I think I might have completely forgot to list it as part of the workup for one or maybe even two cases. :-/ I generally felt comfortable with the rest of the notes/exams and had no such problems forgetting to list rectal/genital exams..

 

[Corbac]

This was how it was with my test in Atlanta too- I think I did have one patient who had the drape on her lap but it was folded in half so I just opened it up for a lil more coverage.

So... How far down this list does the listing "physical exam" as part of the workup for peds cases/phone interviews go? I discussed this as the first step with the SPs, but, in the rush of things, I think I might have completely forgot to list it as part of the workup for one or maybe even two cases. :-/ I generally felt comfortable with the rest of the notes/exams and had no such problems forgetting to list rectal/genital exams..

"Enable patient's behaviour is newly introduced on 2012. Can some one who passed the Step 2 CS let me know what it is ?

Much appreciated .

 

[Nola Doc]

I was reading FA and it recommended maintaining eye contact with the SP while asking question. During my clinicals Ive gotten into the habit of writing notes while doing my H&P. How should I approach taking notes while taking the HPI?

 

[WiseGuy1]

I was reading FA and it recommended maintaining eye contact with the SP while asking question. During my clinicals Ive gotten into the habit of writing notes while doing my H&P. How should I approach taking notes while taking the HPI?

Look them in the eye. Ask a question. Once they start talking feel free to look down and write notes. Be sure to look up occasionally and drop a few "uh-huh's" while writing. Finish taking your notes. Wash, rinse, and repeat.

 

[woeiru]

I was reading FA and it recommended maintaining eye contact with the SP while asking question. During my clinicals Ive gotten into the habit of writing notes while doing my H&P. How should I approach taking notes while taking the HPI?

I think FA is more referring to just having a normal conversation and not looking at the floor (or heaven forbid their chest). But generally if you're asking a question, they're not giving you an answer simultaneously so there won't be much to write. If you do run into such a problem for some reason, I would recommend:

-After introducing yourself ask "Do you mind if I take some notes while we talk?"
-Keep your writing to a minimum (only the important parts you may need help remembering), and keep eye contact the remainder of the time
-Nod occasionally or something if they continue talking while you are writing to show that you are still actively engaged in the conversation.

 

[deleted497653]

I would say maybe peruse first aid cs before the test and try to take your school's OSCE before you take CS to get some practice in. This is just to familiarize yourself with coming up with differentials quickly.

I really don't know how important it is to stand on the patient's right hand. ALot of times I was all over the place depending on how much space I had in the room.

Ascultate on the patient's skin as opposed to through their clothes. I forgot this for the first few because in real life, I hear just fine over thin garments.

 

[stiz]

this happened to me too ... in Atlanta ...
so I'm wondering...did I lose a point in 12 rooms for not draping? or not saying 'Oh, i see you're already draped...'

In Philly, all of the patients I had were draped already.

Not, a drape in the corner waiting to be unfolded and offered

Draped already

Over their laps

Or over their bodies while they were lying down

 

[woeiru]

this happened to me too ... in Atlanta ...
so I'm wondering...did I lose a point in 12 rooms for not draping? or not saying 'Oh, i see you're already draped...'

All my patients were draped as well ...except the one that required you to do an exam that would have been really really awkward without it. I'm guessing you're fine if the drape was already there, just don't get complacent about it because it might not be there on a patient that really needs it.

 

[kjamess]

Didnt get my score today so that sucks, but as time goes by i continue to remember more and more mistakes. Particularly about the part where you have to list physical exam findings to support each diagnosis (which i essentially left blank for nearly all of them, sans vitals). Did others have a similar experience?

 

[kings8490]

hey guys, just wanted some of your input. I took CS in philly last week and overall feel great, except for some reason on all the cases in which i did a pulmonary exam, i only did tactile fremitus, inspection, and auscultation. Forgot to percuss period. Also didn't ausculate any of the anterior lung fields. I'm only nervous because I've heard of people getting screwed over in the Data Gathering section and failing while passing everything else. Has anyone else done anything similar yet still passed? am i freaking out for no reason? Thanks!

 

[Raryn]

hey guys, just wanted some of your input. I took CS in philly last week and overall feel great, except for some reason on all the cases in which i did a pulmonary exam, i only did tactile fremitus, inspection, and auscultation. Forgot to percuss period. Also didn't ausculate any of the anterior lung fields. I'm only nervous because I've heard of people getting screwed over in the Data Gathering section and failing while passing everything else. Has anyone else done anything similar yet still passed? am i freaking out for no reason? Thanks!

When I took it in September, I didn't percuss anything. Not a lung exam, not an abdominal exam, nada. Didn't even think about it at the time.

Got my score back yesterday and I passed. Wasn't even close to failing anything.

 

[Nola Doc]

Just need some feedback on how to prepare for CS. I have a habit of taking notes while taking a HPI. Any advice on how limit note taking and maintaining more eye-contact with the patient?

 

[AA225]

Most people say to wash hands or put on gloves just before the PE but is it ok to shake the pt's hand when you first enter the room and greet the pt?

I ended washing my hands upon entering the room and greeting the pt but before shaking their hand during my OSCEs....I know I'm probably looking into this way too much but just curious