wamba
Forum Guru
Topics: 148
Posts: 660
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I did CS today. Believe me docs. this exam is not difficult at all, and I think that stress and fear are our most dangerous enemies. It is not easy to keep calm during the encounter but it is the clue. many SP are friendly, some are not, but most are collaborative.
the most important thing you may remember is you are the doctor, the one who receives the SP. take the initiative and feel like you are receiving a guest. you can't feel afraid and shy in front of your guest!! so be warm, show hospitality, PAY ATTENTION to the SP behavior, if he's anxious, irritated, sweaty, in pain, etc. investigate on it, give him help even if it costs u time. you better skip some questions in the history or skip some PE but PAY ATTENTION TO THE SP.
the other advice I can give u is, as everbody says, learn the mnemonics, practice, practice and practice until u get the routine. when u're done with it, start working on a relaxation technique. u will always forget to ask some important thing or to do some important physical exam, but you will still do what is required to pass. unless you panic...
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| amygdalaa
Forum Guru
Topics: 24
Posts: 399
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Hi wamba
I have been wondering how your exam went today. And hoping you might post. Thanks.
I have it on monday in Philly. You advise is well received. Do you have anything more helpful hints on how to handle the day?
Nw you can relax a bit. I know you are done with ck, but are you done with step 1 too?
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"If at any point you feel you cant..... then you MUST"
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| wamba
Forum Guru
Topics: 148
Posts: 660
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Yep man. I'm done with everything but step 3.
At first, I was a bit worried about my exam coz I didn't know what to expect but I'm happy everything went very well. I had a relaxing technique that worked very well and I always kept calm and had the entire control of the situation.
the first step of the exam is THE DOORWAY INFORMATION. many sources advise at this point to think about the differentials. My strategy was to focus on the mnemonics I needed for the history, to write the name of the SP and the chief complaint. It took me 10 to 12 seconds. I then knocked the door and got in.
The next step was, introduction of myself and hospitality. You can find any kind of situations inside but I would advise you to start the history taking only after you have made sure that ur patient is comfortable. if he looks sad, ask him why he looks like this. if he coughs, give him a glass of water, you must use your sense of hospitality to make him feel good, then u drape him and after you can start with the history. believe me guys, it doesn't take too much (1 min max) and if you do it, ur surely on the boat.
third step, the history. this is the major cause of lack of time during the encounter. My strategy was simple. 1. use of the mnemonics, 2. no hesitation, 3. focused questions. remember guys, THE ISSUE HERE IS TIME. so history taking must be like a VOMITING. when you throw up, you don't hesitate. you just throw up. this is why it is so fast  . DON'T WASTE UR TIME THINKING IF U'VE ASKED EVERYTHING (u will still forget things to ask or to do, it's physiologic). just vomit ur questions one time and go on. let a small part of ur brain continue thinking, as u are going on, about the chief complaint and the further questions that might be related to it and don't be afraid to ask them even during the PE or when u are washing ur hands.
third step, the differentials. I never think about them until I'm inside. remember, the SP gives u the clues of the DDs. I used to write my DDs during the history taking. If the SP tell me for exemple that he has burning urination I would write UTI in the lower write of paper.
fourth point. PE is the least important part of the exam. the most important thing to remember here is RESPECT THE SP. when u do the PE, always start with the most important one, the most focused one. and if u lack time skip the least important ones and go directly to the closure and counseling, which are more important.
last point, LISTEN TO THE SP. important clues are hidden in everything he says. and we are graded in our ability to listen to them.
Now guys I think I'll go for a 12 hours of sleep. good luck to everybody
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| amygdalaa
Forum Guru
Topics: 24
Posts: 399
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Hi,
thank you for your detailed feedback. That is very helpful.
What you say is right. Timw is key, and paying attention to the patient is key. However my question for you is this- by the time we finish making sure SP is comfortable and everything, do we have enough time t o reach a reasonable choice of D/Ds?
let me put it this way, were the cases uncomplicated and straightforward enough to find with relatively few qs.
well, enjoy your well earned sleep.
___________________
"If at any point you feel you cant..... then you MUST"
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| retail
Forum Elite
Topics: 37
Posts: 208
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Hi Wamba,
Congrats on passing thru yet another step. Tell me did u have enough time to do a screening neuro + CVS/RS comfortably.
How about Mini Mental?
Thanks
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| mytimenow
Forum Senior
Topics: 12
Posts: 209
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HOW LONG U HAVE STUDIED AND WHICH BOOKS? TELL US ABOUT YOUR TRICKS TO PREPARE THE EXAM?
DID U SIMULATED THE CASES COMPLETELY LIKE FROM KNOCKING TO PN? OR PRACTICED THE DIFF SEGMENTS SPEARATELY.
THANKS.
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| mytimenow
Forum Senior
Topics: 12
Posts: 209
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THE WAY U EXPRESSED YOUR EXAM EXP. I AM YOU WILL PASS IT.
GOOD LUCK
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| djyoti
Forum Newbie
Topics: 0
Posts: 13
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great wamba -- u passed -- seems u aced
good luck though you dont need it --
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| wamba
Forum Guru
Topics: 148
Posts: 660
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to amygdalaa: as I told u b4, it does not take u more than 1 minutes to make the SP comfortable. in complicated cases, when SP is not collaborative, take 2 minutes for it, and then go through the history as I told u b4. If u think that u lack time, be the most focused possible. exemple, if u have a case of abdominal pain in a young woman and u lack time, just do the abdominal PE, tell her that u will do the rectal and the pelvic exam later and go through the counseling and the closure. anyways, all the cases are simple. you will find most of them in UW and FA.
to retail: the neurologic cases are the longest, because the PE is long. u have to do the MMSE, the HEENT, the neurologic exam, the CV and pulmonary exam, and sometimes the abdomen. again, if u lack time just do the most specific PE. I usually do the MMSE during the history: orientation, memory and count down. thats it.
to mytimenow: I prepared it in 20 days. I did
1. I studied mnemonics for each type of cases: for the pain, for the psychiatrics, for the follow ups, for the obs\gyn, for the pediatrics, etc. and I practised them until they flew naturally.
2. I studied the D\ds but this took me only half day because u study them as u practise.
3. separately, I studied how to write the PN (in 8 minutes). this was the easiest part of my prep. if I can give u a clue, take the PN as a history: who is the SP (34 yo, F) why he comes (c\o headache that started yesterday), the description of the why he came ( is intermittent, 8\10 severity, sharp and nonradiating), the associated complaints (the pain is accompanied with fever, etc.) and the lacking complaints (the patient denies fever, etc,). This is the essential part of the history. the remaining part, u can study it from FA.
I then practised my cases with a private SP. I used to finish everything in 14/15 minutes but at the exam I did better because the real SPs used to answer to my questions more quickly than my private used to. so I used to complete my encounter in 12 minutes.
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| amygdalaa
Forum Guru
Topics: 24
Posts: 399
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great thanks wamba. Good luck for your match.
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"If at any point you feel you cant..... then you MUST"
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