mildanemia
Forum Newbie
Topics: 3
Posts: 90
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Hey guys, I just got my result today and I passed !! I took CS during the last week of September and I wrote most of this post after I got back to my hotel room. This post is quite long.
Exam Day:
I have read almost every single thread on Step 2 CS, time to contribute. Do not expect much from my contribution, I have a PTSD – it started during the exam.
My exam experience, hmm… I don’t know where to start, should I start out by saying how hard the cases were or should I comment on my bad choice of study material.
Cases are not easy. They are complex cases that start out with a single complaint then branch off to several other complaints that have the potential to become other cases. The question is which case should you ask about ? The original one or the new symptom you discovered by coincidence ? That is a rhetorical question, there is no time for both, you’ll have to stick to the first one. There’s too little time, I’m not sure how they expect us to ask all the questions you usually would with a real patient. I’ve been on an observership before in the USA and believe me, they spend 30min-1hr asking them questions, counseling and answering questions. When I told my supervising attending they only allow 15min to do EVERYTHING he replied using a very unprofessional word; it starts with an F ends with a K and has 2 letters in between. I kid you not, he said that and he’s credentials are amazing.
Well anyway back to the original story, FA is a great source to orient you with the way you should approach patients. It will teach you proper bed side manners and catchy phrases, and the way to answer challenging questions. I would recommend the book to teach you these things however I am disappointed that my cases were NOT related to the book. It was like I hadn’t prepared for the exam at all, my approach was obviously flawed. FA is not enough, it does NOT contain all the cases. I know people that studied 3 days using that book and passed, it must have been a miracle. I honestly don’t know how they did it but it worked for them. I regret not subscribing to UW. Some people attending the 3 day Schwartz course seemed to enjoy the exam, I’m not sure what that course teaches but obviously they learned something I didn’t. I am a perfectionist and I like to do things ideally, that might have been my problem. I like to ask ALL the questions and perform all the physical exams.
The USMLE said that they have increased the pass grade for the CIS and SEP, I’m not sure if they made the cases harder or not but I can guarantee you that there were at least 2 cases with the strangest combination of symptoms ever or even without any positive symptoms ! The SP’s are amazing ! Honestly, there was this particular SP I swear the moment I got in there I forgot he was an SP, I thought he was a real patient.
Right before the exam I had memorized every single differential and every single case, I was worried about forgetting questions relevant to the case. During the exam that fear shifted towards “are these questions relevant ? what the hell am I supposed to do next ?” The only comfort I got was that I was not the only one complaining about the difficulty of the cases and I wasn’t the only one who forgot to do some counseling or ask questions.
This is how I prepared for the exam:
*I started about 3 months ago reading on and off
*I memorized all the Differentials in the book. All of them.
*I memorized all the questions in the practice cases.
*I practiced with a friend that had his exam on the same day, I was the SP in 15+ cases and the physician in around 20 patients. I also practiced with a non medical friend of mine. Total time practiced : 5 whole days.
*I was on an observership prior to the exam so I got to observe how different doctors approached different patients.
*I practiced 10 Patient notes on the simulated program provided by USMLE.
*I read digitaldoc’s CS blog, I would suggest you guys do it, it’s quite easy.
This is what I did in the exam:
*Read the complaint on the door, wrote down the name of the patient, age and sex. I wrote down the differentials, socrates and pamhugsfoss.
*Knocked on door
*Address patient by name
*Introduced myself, shook hands, stated role, smiled and established eye contact
*Draped patient
*Asked about the history while maintaining as much eye contact as possible, you can not remember all the data, you must take notes. It would be wise to train to write without looking for maximum eye contact.
*Asked permission to start exam, washed hands with hot water to warm hands, I suggest everyone do this, most of us will have frozen hands. Told the patient what I was going to do “I’m going to examine your eyes, can I listen to your chest ?” I didn’t explain my exam like “Now I’m going to listen to your neck and specifically your carotids to check and see if there is an audible sound that might be caused by this or that” there is simply no time and it seemed unreasonable and time consuming to do that with every single exam.
*Standard exam: HEENT, Chest, Heart, Abdomen , did more specific exams if they were required.
*Counseled, gave clinical impression and diagnostic workup, I did not summarize because I don’t think it’s that important to read out every single detail and because of course there is no time, I simply said “based on the information I was able to gather from you and the physical exam I performed I am inclined to think that your problem could be caused by ……… however there are other causes such as …….. and for that I will order ……….. tests along with ……… just to make sure and to exclude………”
*I addressed questions asked, asked if there were any other questions, scheduled an appointment for next week after we get the results, asked if that sounded good, shook hands, said “It was a pleasure meeting you” or something similar.
I finished as they announced that the encounter was over and in one case the proctor knocked on the door.
PN is the easiest part of the exam, I ran out of space in half of my History blocks. I had to go back and rephrase sentences and I still had time to finish all of my PN’s. Typing skills are essential but frozen/shaking fingers will slow you down, I got that on my first few cases because they were really difficult.
So what went wrong ? The patients didn’t have any symptoms that were consistent with FA differentials and some differentials weren’t even listed in FA.
I forgot to counsel a couple of patients, I definitely listed most of my differentials in the wrong order. When you have no symptoms it’s down to guessing what the patient has. I wonder if the patients with no symptoms were psychiatric cases and were not telling the truth. I told one patient that she had loss of DTRs, I was probably wrong. Forgot to do sensory exam on a patient.
If you expect the patient to tell you extra information you have forgotten then you are going to be disappointed. “Is there anything else you’d like to tell me?” They will not tell you anything you missed, they will simply say “Ummm, nothing comes to mind doctor” I was surprised that ALL of my patients never had anything they wanted to tell me, that’s why it’s wiser to save time asking the question for your physical exam.
So which part am I going to fail ? SEP? definitely not, my English is top notch. ICE? probably. CIS? maybe.
I will have to wait 10 weeks to find out.
Guys I was fasting because of Ramadan, it was no biggie. I would like to salute those that took/will take this exam during Ramadan, if I pass it will because of this blessed month.
12/5/07
Today I got my results and I passed, it is such a relief I can’t even begin to express how relaxed I feel. I wish the rest of the members waiting for their exam results patience because the final hours are very stressful, best of luck everyone.
I can conclude that you are allowed to make mistakes, how many I do not know but rest assure that you can make more mistakes than you think. I thought I would fail this exam but obviously I was mistaken, my study partner passed to so I guess we did something right. By the way this is my first step, it would have been easier if I had step 2 ck under my belt.
If anyone has any questions I will be more than happy to answer them for you.
I would also like to take this opportunity to thank everyone on this forum, keep up the good work people.
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,234
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Congrats and thanks for sharing!
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When men make the rules, God decides the exceptions.
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| mildanemia
Forum Newbie
Topics: 3
Posts: 90
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thx 
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| sachida
Forum Guru
Topics: 54
Posts: 438
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thx for sharing mildanemia
my experience was similar to yours but I dont think people need to panic and read from three different sources. I think FA is good start and may be some extra cases. Case difficulty was increased for no doubt. I had few cases that were very different from FA. But if you prepare for the first part of FA when you have complains and possible differential, majority of cases were covered. I do not think one should go to exam expecting to know everything and able to do every thing. I had hard time finished first three cases out of 5 due to same reason. I went in to break and told myself, there is no way I can do EVERYTHING. So I will just focus on primary complain and relevent exam. And then on, I always had enough time. I did explain all the procedure/exam I was going to perform.
Only thing I used was FA. I did do some other cases that friend shared with me. And I think that material was great. that included doing physical for insurance company, AIDS drug refill and things that are not covered in FA.
I practiced only 3 days. I do have observership/externship experience over 1 year and I think I was more natural through out the exam.
I dont want to steal your thread but I also dont want future exam takers to overthink/over do the exam. I think if you have some experience in US, preparation of 2 week should be enough. Again, provided you are fluent in English and know american ways.
good luck to all
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Doubt is a luxury we cant afford. Future is predetermined by the character of the people who shape it
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| supra
Forum Elite
Topics: 16
Posts: 360
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congrats mildanemia
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| shpp
Forum Newbie
Topics: 2
Posts: 34
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Congrats mildanemia, hope we all pass too
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| layla
Forum Senior
Topics: 16
Posts: 84
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congratualtions, thanks for sharing your experiance.
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