USMLE Step 2 CS: Passed. Hope my experience helps. =)

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goodvibes27

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Hi Guys!

I just received my Step 2 CS score and I passed! So relieved and happy, my heart was doing backflips in the hours counting down to the result! So I thought I would share my experience and give some tips regarding how to go about CS. It's a simple exam, I do agree with that, but one can't waltz in and just pass. Personally I struggled a bit, plus the nerves were of no help.

Background: Im an IMG, graduated a few years ago. Gave Step 1 last year, scored below average. Need to give CK Personality type: nervous, over-thinker, self-doubter in regards to CS. Plus loads of people told me not to give CS before CK (this added to the self doubt).

My advice and experience:

- PREP TIME: I think this is where one needs to figure this out for themselves. I was told the 2 weeks is more than enough from multiple people and it turns out that it wasn't for me. I needed a month of good preparation. Don't go by other people's word, assess yourself and your improvement and then decide. It's okay to take a little more time than others.

- CHANGING ONE'S EXAM DATE: I started my prep 3 weeks before my exam, and a week before the exam I realized that I wasn't ready for it. I ended up cancelling my exam date, I cried because it was upsetting and ruined my plans of applying. But I knew that this was better, that I wanted to make sure that I pass the first time. It took me a month to get a new date, which was another 1 month away. So, start your prep early! That way you won't be in a position where you're underprepared. I think 1-1.5 months early is important, it's better to be over-prepared.

- RESOURCES: First Aid was a true help. I feel like its a must. I would say that one should read the cases by themselves and as well as practice each case with a study partner.

- PREP COURSES: I wasn't a fan of my prep course, but I met someone who liked it. I guess everyone's perception is different. I felt that the prep course was helpful in giving an idea of what goes on, but thats about it. Some people that I met really loved their courses.

- STUDY PARTNERS: I would say that it's important to start out with someone who is at the same preparation level as you are. I started with someone way ahead of me, and weirdly that one helped them while I lagged behind. Also, if you are able to find someone who has passed CS and is willing to do cases with you, please practice with them! I found someone who was kind enough to help me out, and it really made a difference in my prep. I would advice one to practice with many partners besides your main one, getting different perspectives is important. If you practice with just one person, you both run the risk of making the same mistakes together and overlooking it.

- PREP ENVIRONMENT: My advise would be to stay at the place where most students stay near an exam center of a city. Firstly, you are near the exam center - just walk over on exam day! Secondly, you are living with multiple people going through the same stress - aka you'll get the support that you need and you'll get multiple study partners.

- SEP: For some IMGs, this component of the can be a struggle and be quite stressful. It would be best if you start practicing speaking in English all the time a few months before your exam. The more you practice speaking, the more comfortable you'll be. Don't be afraid to make mistakes in front of people, English is a tough language. It might be uncomfortable at first, but it'll be worth the struggle. If you rotate in the US before your CS, you'll be lucky enough to meet many people with whom you can practice.

- ICE: This component was my reason to extend my exam. I was freaking out over differentials, panicking and messing up my cases. Important: stay calm. Also, if you are bad at differentials, sit with someone and keep practicing them from Step 1 or CK. Just go over the differentials in those books of the common chief complaints. And do it again and again.

- PATIENT NOTES: I was bad at them. Finally, I opened FA and just retyped each patient note (while referring to the book). I think I did this twice. It gave me a clear idea of the flow of the patient note and obviously helped my typing speed.

-CIS: This was another area where I struggled. One of my study partners called me "icy". So I had to put in a lot of work to come across as warm. It's about walking in and smiling with a hand shake, asking them if they're comfortable, if they would need anything else, etc. My tip here would be to practice with someone who is good at this, and have them critique you.

I'll add a notes on my patient encounter format next. This was just some general tips on how to start. Hope it helps!
 
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goodvibes27

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PATIENT ENCOUNTER:

BEFORE ENTERING: Once the announcement starts, slide the little slider and jot down the info you need for the encounter. Name, age, chief complaint, abnormal vitals. Write your mneumonics. I used - OPDFCSAAA, THENFRCSPUBSAWED, and PAMHITSFOSS. Plus write anything else you need to, once you're in the room and someone's staring at you continuously, its easy to fumble and forget something.
Note: vitals will be given on your computer screen, once you sit down to type your patient note. so don't waste time writing whats normal. And don't feel bad if you are one of the last people in, I was and I didn't care because I knew I wouldn't be blanking out and forgetting must ask questions.

KNOCK: Wait for a response, if you hear someone come in, get in there! If not, wait 3-5 seconds and go in and close the door behind you.

ENCOUNTER:

"Good morning Ms. XYZ."
- Shake hands
"I am Dr. X, I am the physician here and I'll be taking care of you today. Are you comfortable?" (Yes Doc)
"Is there anything else I can do to make you more comfortable?" (No thank you Doc)
"What brings you in today?" / "How can I help you today?"

- Either: The patient will just start off with the chief complaint and tell you some details -> listen, don't interrupt, maintain good eye contact, write notes on your paper intermittently -> "I am sorry that you are going through this, I am here to help you."
- Or: just tell you the chief complaint -> "I am sorry that you are going through this, I am here to help you. Would you please tell me more about it?"
- The patient may say that they are distressed, sad, upset, angry. ACKNOWLEDGE that they're having a tough time and that you are here to help them.

"I am going to ask you a few more questions to have a better understanding of what is going on with you."

- Ask away.
- Transition statements:
"I am going to ask you about your past medical history. Is that okay?"
"I am going to ask you some sensitive questions regarding your social and sexual health. I ask these questions to all my patients as they can be necessary for your diagnosis. Everything we discuss is confidential. May I proceed?"
"I am going to ask you some personal questions regarding your Obs and gynaec health. These are necessary and I ask all my patients. Is that alright?"

- Don't forget to SUMMARIZE: "Alright, Ms XYZ. I am going to summarize what you've told me today." (please only do the important stuff, not every detail that was discussed) -> Look at the patient while you summarize, it's okay to look to check your notes, but not for the entire summary.
- Don't forget to ask if they wanna ADD something - "Is there anything else that you would like to share?"
- COUNSEL here if you want about smoking / alcohol / etc.

PHYSICAL EXAMINATION:

- "I am going to proceed to a physical examination. Is that alright?"
- "Let me just wear my gloves / sanitize my hands" -> If you're slow at either, make conversation. I would ask them what they did last weekend, and make conversation on whatever they talked about their kids, school, sports. Doesn't need to be specific. Just general. Smile.
- I wore my gloves in the opposite hand for one case, and I said "Gosh, sorry I wore the glove the wrong way! I'll just take a minute. So you said you liked ..." In another case, I was about to touch the patient without wearing gloves, but realized in time. So I said "You know what, let me wear my gloves first, then I'll quickly examine you". Smiled and asked about their weekend.
- STUFF TO SAY: "I need to examine ..." - "Let me help you untie your gown" - "Please keep it at the level that is comfortable to you" - "I am going to lift your drape a bit to have a look at your knees/ankles/legs, is that alright?" - "Let me help you tie your gown again" - "I am going to look at the normal side first, and now I'll have a look at this side" - "I shall press lightly, let me know if you have any pain" - "I shall press a bit deeper, let me know if you have any pain" - "Would you be able to lie down for me?" - "Let me help you sit up" - "I am going to take a listen to you heart/lungs/bowel sounds" - "I am going to shine some light in your eyes, please look straight ahead" - "I am sorry to have caused you some pain, I won't be touching that area again." - "I will need to do some special tests, they might be a bit uncomfortable, but it's necessary for my diagnosis"
- Don't forget to pull the FOOT REST out when you make them lie down.
- Don't forget to help RE-TIE the gown or RE-DRAPE the patient.
- Touch the tender area LAST.
- I was in the middle of untying a patient's gown when I realized that I didn't ask for permission. So, I stopped, when back to the front and said that "I am sorry Ms.XYZ, I forgot to ask you if I can help you with your gown!" The patient was really nice and said yes its no problem, please untie it for me.
- When listening to the heart sounds of a lady, just make her lift her left breast ONCE. Listen to the sound and feel for the PMI as well.

CLOSURE:

- "Alright Ms.XYZ. Based on your history and physical examination. I am suspecting a few conditions. (Does matter if you give the medical term, you must describe it; eg: hepatitis isn't enough, say inflammation of your liver). I would like to run a few tests like (eg, colonoscopy: to take some images of your colon) and do some blood work for .... Once I have the results, I will be able to give you an accurate diagnosis and we can work up a treatment plan that would be best for you. In the meantime, I would advise you too ..."
- Emergency case: "For now, I will send my nurse in to give you some medication to relieve your pain / lower your blood pressure / etc"
- Don't forget to mention that you will do a rectal/breast/pelvic/genital exam in the LATER part of the day
- Don't forget to ask for the CHALLENGING QUESTION -> "Do you have any questions for me?" (Ask this after the summary, or after the closure)
- After the challenging question if you want you can say -> "Do you have any other questions for me?" (No Doc, Thanks)
- "It was really nice to meet you Ms. XYZ. I shall see you soon, once we have the results. Have a great day."
- Smile, shake hands and leave
 
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kayblock30

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thank a mil. very thorough. congrats!. Did you use the current FA or do you think an older one shouldnt matter too much? Also where did you test and how did you find that location?
 
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