Last minute advice for Step 2 CS!

[5twilight5]

Yes I know it would have been better to take it a lot earlier but of course laziness played a big factor into taking this stupid exam in March...the good news is I am going to celebrate St. Pattys in Chicago the day after and forget about the whole experience!

Any tips on how to do well on the exam? I heard that its more about the patient interaction and being empathetic blah blah blah than the actual written part

THANKS!!

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[paintstick]

Remember this is NOT a test of making a diagnosis - this is a test of process and interactions. They major goal of this exam is to see if you can successfully perform a H & P in order to cover a broad differential for the presenting complaint ALL THE WHILE being a normal human being who can show compassion for the patient and their concerns. It is important to help counsel on lifestyle modifications (smoking, condoms, etc...), as well as to summarize your findings. I would recommend going to the USMLE website and look up the "scoring" of the Step 2 CS CIS portion as that seems to be the most nebulas portion of the exam. Long story short:

1) knock/introduce
2) start with open ended question (what brings you in/tell me about...)
3) closed ended questions covering broad differential
4) Social Hx: Bad habits you can counsel on, support systems and how illness affect them
5) summarize history
6) wash hands
7) focus physical (dont got too nuts here or you will run out of time)
8)wrap things up making sure to tell them what happens next (Based on H&P i think it could A,B, or C - as such I am going to order test X,Y,Z I would like to see you again when we have those test results so we can discuss the findings. In the meantime, be sure to know that we are always here for you if you have questions/concerns...Is there anything else i can help you with today).
9)thank them and say good-bye

10) REPEAT 1-9 x12 patients and GO ENJOY YOURSELF AFTER THE TEST


hope this helps.


best

 

[Eta Carinae]

Trust me, you'll be so upset for studying for this exam after you get your "PASS" report back. If you went to med school here in the U.S., you have nothing to worry about.

Just remember to get a good HPI before you get into PMH etc. Also I heard when listening with a stethoscope to heart, make sure head of bed is tilted 30deg, when listening to abdomen, make sure bed is flat.

For kids, get a good birth Hx.

Stethoscope directly on skin, do NOT listen through clothing...

For abd exam, auscultate FIRST before you palpate. you know those simple, easy to forget rules. Help pt up after abd exam.

Use Ophthalmoscope with lights off. Open the door slightly for a little visibility.

If you suspect pt has TB (bloody sputum, incessant coughing), ask about travel hx, sexual hx and hx of institutionalization (esp incarceration). I had a pt w/ TB and so did like my entire class.

I hear colon CA is huge too. So your 70s-ish year old guy who gets tired easily and says his pants fit loose...

Use abbreviations liberally to conserve time on writing your notes.

Make exams focused. You'll get better at this as the day progresses and you'll be getting out of rooms faster as well.

Be chipper as you enter room, introduce yourself as "Student Doctor..." so and so and NOT doctor. WASH HANDS after hx before you touch the pt and AFTER exam is over. And assume appropriately somber disposition with bad news. EMPATHY, EMPATHY, EMPATHY.

Explain why you're doing everything you're doing at every step during the exam.

The one useful area to study- brush up on differentials for common things like HA, Syncope (endless diff).

I did a bunch of stuff wrong and still passed so unfortunately, I can't tell you what it takes to fail 🙁. But if you've been through OSCEs at your school, you'll be over-prepared for this.

 

[RussianJoo]

i thought i failed that exam when i left the building, i mean honestly i sucked, i rushed through the physical exam part and the note, blanked out on some common differntials or forgot to document some of my findings during the exam and questioning, i was however, polite to the patients, and tried to explain things and show empathy, so in the end i passed without a problem.

 

[5twilight5]

Thanks so much...I will definitely do everything you guys mentioned! Yea I did well on my year end osce but that was last June 2009 and of course 4th year does nothing but deteriorate your PE skills and patient history taking hahahahahaah so that was what worried me

Got it...EMPATHY is key!

 

[lfesiam]

Yes I know it would have been better to take it a lot earlier but of course laziness played a big factor into taking this stupid exam in March...the good news is I am going to celebrate St. Pattys in Chicago the day after and forget about the whole experience!

Any tips on how to do well on the exam? I heard that its more about the patient interaction and being empathetic blah blah blah than the actual written part

THANKS!!

2 shots of tequila and you're good to go!

hehe seriously now though. I read FIRST AID CS "mini cases" section the night before the exam. Passed.

 

[checkov]

Eta's advice is solid. Here's some other material (previously posted on SDN) that I found useful:

I think it's normal to be nervous. This helped me:

Introduced myself and always immediately washed hands so I would not forget. Asked every SP regardless of complaints first the following:

PAM HUGS FOSS
previous episodes
allergies
meds
hospitalization / surgery
urinary complaints
GI complaints
sleep
family hx
obstetric/gyn hx
social/substance
sexual

and LIQOR AAA if in pain.

location
intensity 1-10
quality
origin
radiation
associated sympt
alleviating
aggravating


While doing that, thought about what was specific / relevant for this individual case and asked those after. This test is very far from real life. It is like a game where you have to go along and pick up certain points.

Before leaving, I paused and went through what I might had forgotten and asked even if I had already "rapped the case up"

Good luck.

Like lifesiam, I also thought that the 'minicase' section in First Aid for USMLE Step 2 CS was very high-yield -- the minicase section is roughly 20 pages long, and easily doable in 2-3 days. I found it useful to (1) read the brief clinical vignette, (2) independently figure out a plausible diagnosis and workup, and (3) compare my responses to the book's correct diagnosis/workup. I know it's hard to focus on studying so close to the match, but don't blow the exam off -- a small percentage of US students fail CS every year.

 

[MCYan]

I think missing the parts on counselling the patient and wrapping up what you think can cost you a lot of points. Agree with above that this is not a test of getting the right diagnosis. Basically, go in there with the mentality of spitting out a nice differential and completing the note - and express empathy along the way. For example, any patient with headache - you can automatically put down SAH, meningitis, migraine, tumor on the ddx, and order lytes, CT, MRI, LP - and you should get all the points. There are still questions that you should ask (onset, severity and so on) but it does not matter what their answer is, the ddx and plan is still the same.

I personally think this is really sad and that it is not really testing much of our knowledge. What a waste of money. I know in some other countries they use real patients in their clinical skills encounter and you really have to find out what's wrong with them.