Hello everyone , I am an IMG and gave my exam in Chicago in sep 2017 and failed in CIS component with high performance in SEP and ICE, that moment the result came in was very distressing, for the first 10-15 days I was constantly trying to find out what I did wrong at first go, I went through lot of posts in various forums but could hardly get anything that would help me, so I decided to write it down now that I have passed in 2nd attempt with an Asterisk in CIS, I want to share my experience with everyone specially IMGs so that many people can learn from my mistakes
1. Preparing with someone who is not good in speaking English, this is very important as one has to be quick at understanding what you are listening as there is an American way patients want to be addressed and a way they talk to you.
2. Giving the exam after 2 days of landing in US, Guys if you are going to the US for the first time, US can be intimidating for you, give atleast 3-4 days before you appear for exam.
3. Thinking that this an easy exam- IT IS NOT, mainly because it has a set pattern about how patients want to be treated, so learn that and practice many times.
4. Writing mnemonics on the Bluesheet, it takes lots of time to actually write them and then have a look at them while talking to patients, SO LEARN THEM BY HEART so that you can interact with patient rather than looking at sheet and giving an impression that you are there to fill the sheet rather than comfort the patient. Also it saves lots of valuable time and gives you an early start.
5. Performing the physical examination of 2-3 systems, IT IS NOT AT ALL REQUIRED, we all follow Firstaid and it shows lots of systems to be examined , so just examine the relevant system only and if u have some time then may be another one.
6. I could not finish 2-3 cases in time and proctor came in, also I did not have time to finish counselling for 2-3 patients, SO TIME MANAGEMENT is very important, PRACTICE TO FINISH CASES IN 12-13 MINUTES so that in actual exam you can finish in time.
7. Patients may display various emotions like anger, sadness etc, but remember that’s the part of the case, U NEED TO COMFORT THEM while holding your ground, ITS MORE IMPORTANT TO COMFORT THE PATIENT RATHER THAN TAKING HISTORY AND PERFORMING EXAMINATION.
8. My approach was to extract all relevant info about the case(GOT A HIGH IN ICE) AND I WAS WRONG, IT’S A PATIENT CENTRIC EXAM SO FIRST PRIORITY IS TO LISTEN , UNDERSTAND AND EMPATHIZE WITH THE PATIENT, while taking all the relevant points in history and physical exam, NO MATTER WHAT IT SHOULD BE IN THAT ORDER RATHER THAN REVERSE.
9. MOST IMPORTANT IS – VOICE YOUR EMPATHY, in my part of the world we assume that we are empathetic being doctors, but its very IMPORTANT to practice voicing your empathy for this exam.
10. Make a checklist for the EMPATHY/COMFORT statements , and make sure that u run through this in every case, SPs are going to mark you on these .
Just listing important points for CIS (that I did in 2nd attempt)
1. Enter with a smile
2. Introduce yourself and your role
3. Offer a handshake
4. Ask whether pt is comfortable in the room
5. Ask permission that you will ask few questions and perform a physical exam
6. Ask permission to write few notes for your reference
7. Ask what brings the patient to clinic today
8. ALWAYS EMPATHIZE AFTER LISTENING TO CHIEF COMPLAINT- (I AM SORRY TO HEAR ABOUT THAT/ I WILL DO MY BEST TO HELP YOU)
9. Ask relevant history , don’t run absurdly through mnemonics, present , past, Social, Family, Gynae,medication, allergies
10. AFTER FINSIHING HISTORY ASK whether patient need to tell you anything else (often if you have left something pt will tell you that)
11. OBSERVE THE PATIENT – any gestures/ any marks/discoloration AND COMMENT ON THAT/ASK ABOUT IT
12. Inform the pt before asking social/gynae history that whatever you talk is confidential.
13. WASH YOUR HANDS BEFORE STARTING PHYSICAL EXAM – A. USE SANITIZER TO SAVE TIME , B.DO NOT TURN YOUR BACK TO THE PT WHILE WASHING HANDS, C. HAVE A SMALL TALK WHILE DOING THIS (HOW DO YOU FIND YOUR JOB/HOWS THE TIME WITH KIDS)
14. ALWAYS SAY EMPATHIZING STATEMENTS DURING THE WHOLE INTERACTION – LIKE IT MUST BE DIFFICULT FOR YOU.
15. MAINTAIN GOOD EYE CONTACT.
16. MAINTAIN COMFORTABLE DISTANCE .
17. BE GENTLE AND DON’T BE RUSHED DURING PHYSICAL EXAM
18. Let the patient sit up comfortably (if possible) after the exam.
19. Give a good closure- what you are thinking, what needs to be done
20. Always ask whether patient understands and agrees to the plan.
21. Council for anything that you can- alcohol/smoking/safe-sex/diet/exercise/drugs
22. ASK whether patient has any questions for you.
23. Answer the question THEN ASK AGAIN IF PATIENT HAS ANY MORE QUESTIONS
24. SMILE, SHAKE HANDS AND TELL PATIENT YOU WILL MEET AGAIN WITH RESULTS.
I hope above gives enough info to anyone who needs it and Hope if you are attempting it for the 2nd time, All the best for your exam, any further queries/ questions are welcome.
1. Preparing with someone who is not good in speaking English, this is very important as one has to be quick at understanding what you are listening as there is an American way patients want to be addressed and a way they talk to you.
2. Giving the exam after 2 days of landing in US, Guys if you are going to the US for the first time, US can be intimidating for you, give atleast 3-4 days before you appear for exam.
3. Thinking that this an easy exam- IT IS NOT, mainly because it has a set pattern about how patients want to be treated, so learn that and practice many times.
4. Writing mnemonics on the Bluesheet, it takes lots of time to actually write them and then have a look at them while talking to patients, SO LEARN THEM BY HEART so that you can interact with patient rather than looking at sheet and giving an impression that you are there to fill the sheet rather than comfort the patient. Also it saves lots of valuable time and gives you an early start.
5. Performing the physical examination of 2-3 systems, IT IS NOT AT ALL REQUIRED, we all follow Firstaid and it shows lots of systems to be examined , so just examine the relevant system only and if u have some time then may be another one.
6. I could not finish 2-3 cases in time and proctor came in, also I did not have time to finish counselling for 2-3 patients, SO TIME MANAGEMENT is very important, PRACTICE TO FINISH CASES IN 12-13 MINUTES so that in actual exam you can finish in time.
7. Patients may display various emotions like anger, sadness etc, but remember that’s the part of the case, U NEED TO COMFORT THEM while holding your ground, ITS MORE IMPORTANT TO COMFORT THE PATIENT RATHER THAN TAKING HISTORY AND PERFORMING EXAMINATION.
8. My approach was to extract all relevant info about the case(GOT A HIGH IN ICE) AND I WAS WRONG, IT’S A PATIENT CENTRIC EXAM SO FIRST PRIORITY IS TO LISTEN , UNDERSTAND AND EMPATHIZE WITH THE PATIENT, while taking all the relevant points in history and physical exam, NO MATTER WHAT IT SHOULD BE IN THAT ORDER RATHER THAN REVERSE.
9. MOST IMPORTANT IS – VOICE YOUR EMPATHY, in my part of the world we assume that we are empathetic being doctors, but its very IMPORTANT to practice voicing your empathy for this exam.
10. Make a checklist for the EMPATHY/COMFORT statements , and make sure that u run through this in every case, SPs are going to mark you on these .
Just listing important points for CIS (that I did in 2nd attempt)
1. Enter with a smile
2. Introduce yourself and your role
3. Offer a handshake
4. Ask whether pt is comfortable in the room
5. Ask permission that you will ask few questions and perform a physical exam
6. Ask permission to write few notes for your reference
7. Ask what brings the patient to clinic today
8. ALWAYS EMPATHIZE AFTER LISTENING TO CHIEF COMPLAINT- (I AM SORRY TO HEAR ABOUT THAT/ I WILL DO MY BEST TO HELP YOU)
9. Ask relevant history , don’t run absurdly through mnemonics, present , past, Social, Family, Gynae,medication, allergies
10. AFTER FINSIHING HISTORY ASK whether patient need to tell you anything else (often if you have left something pt will tell you that)
11. OBSERVE THE PATIENT – any gestures/ any marks/discoloration AND COMMENT ON THAT/ASK ABOUT IT
12. Inform the pt before asking social/gynae history that whatever you talk is confidential.
13. WASH YOUR HANDS BEFORE STARTING PHYSICAL EXAM – A. USE SANITIZER TO SAVE TIME , B.DO NOT TURN YOUR BACK TO THE PT WHILE WASHING HANDS, C. HAVE A SMALL TALK WHILE DOING THIS (HOW DO YOU FIND YOUR JOB/HOWS THE TIME WITH KIDS)
14. ALWAYS SAY EMPATHIZING STATEMENTS DURING THE WHOLE INTERACTION – LIKE IT MUST BE DIFFICULT FOR YOU.
15. MAINTAIN GOOD EYE CONTACT.
16. MAINTAIN COMFORTABLE DISTANCE .
17. BE GENTLE AND DON’T BE RUSHED DURING PHYSICAL EXAM
18. Let the patient sit up comfortably (if possible) after the exam.
19. Give a good closure- what you are thinking, what needs to be done
20. Always ask whether patient understands and agrees to the plan.
21. Council for anything that you can- alcohol/smoking/safe-sex/diet/exercise/drugs
22. ASK whether patient has any questions for you.
23. Answer the question THEN ASK AGAIN IF PATIENT HAS ANY MORE QUESTIONS
24. SMILE, SHAKE HANDS AND TELL PATIENT YOU WILL MEET AGAIN WITH RESULTS.
I hope above gives enough info to anyone who needs it and Hope if you are attempting it for the 2nd time, All the best for your exam, any further queries/ questions are welcome.
