vradojc1
Forum Elite
Topics: 21
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So, I took it on June 8th in testing center in LA.
Compared to both Step 1 and 2 CK, this one seemed more "casual" and less stressful. Although, having a lab coat to cover sweat stains is more than helpful. 
I arrived to the center ~30 mins before the beginning (at 8 AM). Testing site staff was very friendly and hospitable and they explained everything in detail. The intro lecture/presentation was basically the USMLE CD video so if you do that "task" at home, you might use the time to focus on your inner "peace".
The drill, as described so many times is: 5 SPs - 30 min lunch - 4 SPs - 15 min break - 3 SPs - go home!
I could say that I had enough time to do history and exam. In all cases I was done with the patient before allowed 15 mins elapsed. Key is having clinical knowledge and bringing up differential dxs fast so you can ask targeted questions. SPs are not "talkative" as most of the usual pts so you have to "pull out" the answers by good questions.
Always summarize before asking whether the pt would like to add sth or if you might have forgotten to ask them sth. It seems to me that it nicely wraps the history taking part and can "incite" PTs to provide you with some extra information.
And then wash hands! I forgot it on the 2nd SP and he warned me - I just apologized and continued, although I wished I'd said that I just did it before entering the room (or sth similar).
As for the physical exam - targeted is again the key word. I didn't listen chest/heart in patients that were complaining of pain in right thumb/Achilles tendon (well there were no signs pointing me to do so, otherwise I probably would).
The hardest part with a patient is to elaborate your possible Dx and further diagnostic plans. How to say what it is without putting to much weight on a most probable cause, or by using layman words. Even if I messed a bit, I think nice closure is sth like "I'll get the tests scheduled ASAP and as soon as I have results I'll give you a call to discuss what to do next". I counseled, but there were virtually no smokers/drinkers/drug abusers. So I pulled out ones about cancer screening...
As for PT note, I used computer. I practiced using USMLE CD and since I tend to forget things and then need to "insert" them where they belong, using a sheet would make it look very unprofessional. If you're tidy, I'd suggest using paper since by adjusting the size of your font, you might write more. I had to cut out some things since they wouldn't fit in the allotted fields.
Start with differential Dx and tests will just come out of it. Although they say "one per line", you can group similar ones like CBC/Iron/Ferritin...
As for the prep goes, I can say that I had approximately 3 weeks for it after returning from "vacation" following Step 2 CK exam. I didn't use the time well. Had busy schedule in lab and actually didn't feel like preparing. But I read FA and practiced ~20-25 cases with my girlfriend who is an American MD/PhD student so that was really helpful in terms of phrasing questions/summarizing/counseling...
Therefore I cannot with certainty claim that the cases were either from FA or UW. What I can say is that they were pretty vaguely described and virtually no physical exam would put you on track confirming one more than the other. So, the clinical knowledge seems very important.
As it probably happens to all of us, I didn’t remember to ask some questions. In some cases I was puzzled what to ask at all. If I were to take it again, I’d definitely review orthopedic/pediatric cases.
We’ll see the results, hopefully by the end of July. I hope I passed, I really want to go for Step 3 in August/September.
Good luck to everyone taking it!
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| zerocool79
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Topics: 8
Posts: 75
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Thank you vradojc1 for a great review. i'll be taking the CS on Monday June 18th. I'm just brushing up on my clinical knowledge right now. Trying to get a good idea of the differentials associated with each cc.
Generally, is it a good rule of thumb to think about DIRECTION (drugs, infection, rheuamological, endocrine, trauma, inflammation, other, neoplasm) when throwing out differentials if you can't think of anything...
generally, with any type of pain or neuro problem.. it is good practice to rule out infection, neoplasm, inflammation, CVS as possible causes right?.. and then that just leaves you with 1 other Dx to come with on your own. Do you think it's a decent idea for me to have that as a fall back for ddxs?
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| vradojc1
Forum Elite
Topics: 21
Posts: 309
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I don't think you'll come to the point where you have no clue. My cases presented with a single major problem (that is how all of them are), and it was really easy for most of them to write down a meaningful list of differentials. No need for DIRECTION at all!
Edited by vradojc1 on 06/17/07 - 09:20 AM
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| nadiabarati
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congratulations for having done it. I just wonder how soe peole say without clinical knowledge you can do this exam?!!! It's all about clinical knowledge I think.
If someone has not had much practice in medicine but had good scores in step 1 and 2, do you think it's possible to pass this exam??
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| vanshita
Forum Guru
Topics: 26
Posts: 895
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thanks for sharing
GOOD LUCK for result
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| vradojc1
Forum Elite
Topics: 21
Posts: 309
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Step 2CK was most helpful for CS!
Forget about "proper" physical exam. You are not supposed to repeat painful maneuvers/exams, and SPs respond to the minimal touch if they are supposed to fake it. You should not perform deep palpations - it is hard to assess anything with superficial touch in overweight...and so on, and so on.
You should basically wrap up your PT note based on history and some of the exam findings, but latter are really limited.
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| izn
Forum Senior
Topics: 17
Posts: 133
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hi vradojc1,
you said your result will be out by the end of July ...i just took my exam on 6th June but according to the ECFMG they show 15th August as probable result date....can the result come earlier?
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| vradojc1
Forum Elite
Topics: 21
Posts: 309
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I just checked it - don't expect it earlier. I will not.
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