PASSED Step 2 CS YeahNoMind's Experience

[YeahNoMind]

Good Afternoon Everyone!

I received my CS result yesterday & passed on the upper end of the curve which I'm happy about.

For those of you who have yet to take it–There are a few things I'd like to share regarding my experience.

The patient–actors are cooperative with the exception of one or two encounters. You're guaranteed to get a case in which the
patient-actor has been specifically instructed to appear difficult to deal with & uncooperative regardless of your attempts to be empathic. Remain calm in these situations with a constant mental reminder that it's all acting. They are not really trying to make your experience difficult—it's just a test of your ability to Maintain a collected, empathic frame. Be prepared to read a patient–actor's face & body language. If a patient–actor is instructed to appear anxious about something he/she may fiddle with their hands, have poor eye contact, or make repeated glances at the clock in the room. You score MORE points for asking if they are feeling anxious or late for something! Asking this got me insight to a patient's troubles at home, and subsequently another opportunity to perform better. Everything the patient-actor does during the encounter is methodical. It happens for a reason. It's entirely up to you to read their face, and actions.

The only resource I recommend is First Aid for Step 2 CS, & a study partner with an exam date around the same time as yours. I watched the Kaplan videos for CS, they were 5 hours long each, & it was a major time-sink. I do not recommend going through them. However, a useful piece of advice I got from watching the Kaplan videos was that as long as your patient note supports what you think the MAIN diagnosis is—it is not necessary to add a third differential in the list if you don't truly believe the patient has that particular disease.

For instance, if you have a case in which a 52 y/o F complains of:
•Amenorrhea
••Hot-flashes
•••Irritability/Mood swings

Those symptoms, coupled with her age are directly pointing to Menopause, & maybe for the sake of argument—pregnancy. (Pregnancy must be ruled out in any & all cases of amenorrhea)

Now, menopause would be your top differential, & pregnancy the second. First Aid might say that PCOS is the third differential, but the USMLE is testing you on that specific patient, on that day. Not what is written word for word in First Aid. Use it as a guide but trust yourself on exam day.

Instead of focusing on filling in three differentials, it's ok if you have two as long as you have ample EVIDENCE to support your proposed differentials. I had 4 cases in which my history & physical pointed toward two diagnoses very strongly & I did not feel the need to add a third. I still passed very comfortably.

Something that I thought to say to the patient before I left the encounter that helped me IMMENSELY are the following sentences.

"Thank you for allowing me to interview you & perform a physical exam Mr./Ms.(insert name). Is there anything that you would like to share with me that I may not have touched upon during our talk"?

I did that in 8 out of 12 encounters on my test day, & was provided with CRITICALLY important information that led me to the right diagnosis at times when I was unsure.

Everyone makes mistakes in the physical, and forgets some things to order on the work-up. This is not synonymous with failing. If you feel like you didn't do well on a case drop everything in your mind related to that case and focus on the next case in front of you.

I want to wish everyone luck who has this exam coming up & congratulate everyone that is through with it.

Feel free to PM me with questions, I'm happy to help.

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[J ROD]

i would had hyperthyroidism to the differential.

 

[Phloston]

i would had hyperthyroidism to the differential.

The point he's making is that limited DDx is good insofar as they're sufficiently supported. One could probably list at least ten differentials in theory.

 

[Phloston]

Good Afternoon Everyone!

I received my CS result yesterday & passed on the upper end of the curve which I'm happy about.

For those of you who have yet to take it–There are a few things I'd like to share regarding my experience.

The patient–actors are cooperative with the exception of one or two encounters. You're guaranteed to get a case in which the
patient-actor has been specifically instructed to appear difficult to deal with & uncooperative regardless of your attempts to be empathic. Remain calm in these situations with a constant mental reminder that it's all acting. They are not really trying to make your experience difficult—it's just a test of your ability to Maintain a collected, empathic frame. Be prepared to read a patient–actor's face & body language. If a patient–actor is instructed to appear anxious about something he/she may fiddle with their hands, have poor eye contact, or make repeated glances at the clock in the room. You score MORE points for asking if they are feeling anxious or late for something! Asking this got me insight to a patient's troubles at home, and subsequently another opportunity to perform better. Everything the patient-actor does during the encounter is methodical. It happens for a reason. It's entirely up to you to read their face, and actions.

The only resource I recommend is First Aid for Step 2 CS, & a study partner with an exam date around the same time as yours. I watched the Kaplan videos for CS, they were 5 hours long each, & it was a major time-sink. I do not recommend going through them. However, a useful piece of advice I got from watching the Kaplan videos was that as long as your patient note supports what you think the MAIN diagnosis is—it is not necessary to add a third differential in the list if you don't truly believe the patient has that particular disease.

For instance, if you have a case in which a 52 y/o F complains of:
•Amenorrhea
••Hot-flashes
•••Irritability/Mood swings

Those symptoms, coupled with her age are directly pointing to Menopause, & maybe for the sake of argument—pregnancy. (Pregnancy must be ruled out in any & all cases of amenorrhea)

Now, menopause would be your top differential, & pregnancy the second. First Aid might say that PCOS is the third differential, but the USMLE is testing you on that specific patient, on that day. Not what is written word for word in First Aid. Use it as a guide but trust yourself on exam day.

Instead of focusing on filling in three differentials, it's ok if you have two as long as you have ample EVIDENCE to support your proposed differentials. I had 4 cases in which my history & physical pointed toward two diagnoses very strongly & I did not feel the need to add a third. I still passed very comfortably.

Something that I thought to say to the patient before I left the encounter that helped me IMMENSELY are the following sentences.

"Thank you for allowing me to interview you & perform a physical exam Mr./Ms.(insert name). Is there anything that you would like to share with me that I may not have touched upon during our talk"?

I did that in 8 out of 12 encounters on my test day, & was provided with CRITICALLY important information that led me to the right diagnosis at times when I was unsure.

Everyone makes mistakes in the physical, and forgets some things to order on the work-up. This is not synonymous with failing. If you feel like you didn't do well on a case drop everything in your mind related to that case and focus on the next case in front of you.

I want to wish everyone luck who has this exam coming up & congratulate everyone that is through with it.

Feel free to PM me with questions, I'm happy to help.

Awesome to hear you passed. And thanks for this really helpful post/contribution.

 

[noxe]

Great post, thanks for the insight!
Congrats on the pass!

 

[YeahNoMind]

Awesome to hear you passed. And thanks for this really helpful post/contribution.

I've gotten an immeasurable amount of help from you. Thanks.

 

[PeterPanic]

Thanks for sharing your experience. Did you encounter any case that was NOT in FA in terms of chief complaint? Also, how important are the minicases?

 

[YeahNoMind]

Thanks for sharing your experience. Did you encounter any case that was NOT in FA in terms of chief complaint? Also, how important are the minicases?

First Aid covered all the Chief complaints with the exception of one weird one. Small tweaks are made though.

For instance:normally you would expect an older patient to have syncope or maybe heart palpitations at rest. They could very easily turn that First Aid case into a case of a 16 or 17 year old who complains of the same symptoms during exercise.

Use First Aid as a guide but don't give up authority over your medical knowledge on exam day because it's not exactly like what's written in First Aid.

One of my encounters was very similar to one of the mini cases. Definitely recommend going through them once you've gone through the main cases.

 

[PeterPanic]

Thanks very much YeahNoMind. The answer was really helpful.
Another question, do you think it's better to practice first aid cases more than once or move on to another resource like Kaplan CS core cases?

 

[YeahNoMind]

Thanks very much YeahNoMind. The answer was really helpful.
Another question, do you think it's better to practice first aid cases more than once or move on to another resource like Kaplan CS core cases?

I haven't heard from anyone that Kaplan core cases were a necessity to pass. I didn't have enough time to do more than First Aid so I made sure I went through it thoroughly.
If you have time between rotations/shelf exams to go through the cases in First Aid you're unsure on—that to me would be a better use of time than starting another book/resource.