sachagro
Forum Newbie
Topics: 4
Posts: 9
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First of all, I’m very thankful to all friends, family, and my study partner for the valuable help they provided and made it possible for me to pass this exam . First attempt, very old IMG, took it in Philly in the beginning of March.
I prepared for about a month and a half, off and on. People say it is very easy and lots of them prepare for it in just one week or ten days, but I think that is not enough. There are about 40 short cases and 40 long cases in the First Aid and additional about 15 different cases in the UW so to cover all this in just 10 days would leave one with just too much to do in too little time. Giving adequate time for the preparation would bring confidence and also alleviate the extreme stress and anxiety that occurs during the loooong wait for the result of this exam. However, it is just my personal opinion.
I think the preparation should be started by reading the history taking and physical exam portions of the UW (they are very good). Then one should do the long cases of FA. The cases are given better in the FA. I used to practice about 4-5 cases with my study partner everyday. I was very lucky to have found him as he lived very close to my place and his exam was 15 days before mine so my preparation was almost complete with him. I made the mistake of starting the mini-cases of FA first in spite of a very dear friend of mine (who had taken the exam already) advising me to start with the long cases first. I have not taken step 2 yet so I was worried about getting familiar with the D/Ds and that’s why I did that. But that is not a good strategy.
This exam is all about time management. History taking should not take more than 8 min, no matter what. The SPs are trained to give you most of the information as soon as you ask them, “What caused you come in today?” Only relevant history should be taken as time is limited (8 min). There is no need to ask irrelevant questions just because they are in the proforma of the history but common sense tells us after listening to the chief complaint that they are irrelevant to the case. You always have to remember that even if you waste 20 seconds in those irrelevant questions, you might miss the closure in the end. Now what would you prefer – to cut short some irrelevant questions from the history or losing the whole closure? LoL. I hope you get the point. Also, there is no need to summarize at the end of history and then asking if they forgot anything because the SPs are very well trained and they give you all the information quickly in the beginning itself and nothing is missed. So no point in wasting time in that.
All SPs ask a challenging question as soon as you are done washing hands WITHOUT prompting. So don’t waste your precious 5 seconds by asking if they have any questions. They will ask as soon as you turn around after washing the hands lol. In my exam, one SP asked me the question before I could fully turn around and he said it very quickly so I couldn’t hear what he said. I asked him to repeat it saying I couldn’t hear him properly and he repeated it. I have been in the states for 6 yrs now and my English is very good but guys I don’t know what it was that he said. I was baffled. I thought that if I ask him to repeat again, that would come as a negative on his checklist in the SEP section, so I took a risk and used one of the standard responses in the FA and said, “Don’t worry, you are in good hands and we will take very good care of you.” And then I trapped him saying “Does that answer your question?” and he said yes. “Do you have any more questions?” and he said no. LOL. Getting a negative on the SEP would have been a shame for me.
I made quite a few mistakes in almost every case. For example, I did not use any instrument other than my stethoscope in any case! Didn’t even touch the ophthalmoscope/otoscope/tongue depressor. Though I didn’t have any diabetic or hearing loss case, but there were a few with hypertension and I should have checked the fundus.
In the first case, I stuttered lol. But from the second case I calmed down.
Also, in the first case I put the gown back on the female SP after the chest exam, but forgot to tie it.
Didn’t show empathy when the SP held the side of her chest and moaned in pain while looking directly at me. She did that atleast 5 times! I can say she was trying to elicit empathy but she got negative results HAHA. The reason was that I was trying to quickly think what was wrong with her coz she didn’t have any other symptoms AT ALL. History was totally blank. And when I was outside writing the PN, I wanted to kill myself for not suspecting or asking about physical abuse in that case coz she didn’t have any other symptoms. And after I was out of the center, I was remembering that case again and wanted to kill myself for not writing pulmonary embolism in the D/D.
In a case of bleeding, I didn’t ask about bleeding tendencies in history and didn’t order any LFTs in the PN.
Asked questions haphazardly in history and didn’t follow SIGEMCAPS in a case I suspected of depression. Same case, SP was pretending to be very sleepy and appeared as if he would fall any moment. I didn’t say or do anything about it.
Didn’t do straight leg test or the paraspinal percussion in lower back pain.
In a case of stroke, I wrote in the PN, deep tendon reflexes exaggerated on the NON-affected side instead of the affected side.
In the pediatric case, I didn’t order the first morning specific gravity of urine or any imaging studies for congenital malformations and I also didn’t write about congenital anomalies in the D/D.
In spite of cutting the physical exam very short (checking sensation in only 2 points per limb, checking muscle power in only 2 muscle groups, etc etc), I could barely reach the closure in the 3 neuro cases I got and had said only 2-3 sentences before the time was up but I’m glad I was able to atleast start the closure and earn the checkmark for it in the SP checklist. So I again emphasize, pls be fast, and do not miss the closure even if you have to cut the physical exam short because much of it is just pretending anyway, there are no findings.
Now comes the absolute shocker. The first PN I wrote was directly in the exam! I never practiced writing the PN. Just kept procrastinating, thinking there’s nothing to practice in it, and looked at 3-4 PNs in the FA while my brother was driving me to the exam center in the morning. As a result, I got paranoid and almost fell short of time in the first 2 PN (was fine after that), and wrote very bad PNs for all cases with horrible handwriting and there was no fluency in the information being transmitted.
Struggled to write more than 2 D/Ds in all cases when no case was outside of those given in the FA.
All systems were represented in the cases as they tell you on USMLE CD. There were about 3 Cardiorespiratory cases, 3 GIT, 2 GenitoUrinary, 3 Neurological, and 1 Pediatric case. No phone case.
Now I would like to tell abut the things I did right.
I knocked, introduced, called SP by last name, shook hands, draped, smiled, showed empathy by saying “I’m sorry to hear that” or “I understand it must be very difficult for you” from time to time, took permission to take notes while talking, knew exactly where I had to use open ended questions and transition sentences (given in UW), used pam hugs foss & liquor aaa soda, washed hands, answered the challenging questions properly, didn’t over-expose pt. body parts, pulled the footrest out on the table every time pt. had to lie down, took permission for everything and informed what I was about to do, counseled in the end, gave my clinical impression with a couple D/D and told what I’m going to do next in closure, and because of excellent time management, didn’t fall short of time, and wrote all my findings in the PN.
I did all those things perfectly in every case so I think that counted and earned me a lot of checkmarks.
While taking history, I preferred to stand as it makes better eye contact, and MOST IMPORTANTLY, sometimes we just don’t know what to do or ask next, so in those moments while standing, I pretended to scribble in my pad and the patient was not able to see that I am not writing anything and my mind was busy in thinking. While sitting that would not have been possible.
When washing hands, I didn’t turn my back towards the SP completely, I stood on an angle so they can see that I am scrubbing properly and also talk if they want to, but we didn’t. They just wait to ask their question until you are done. Instead of making irrelevant small talk, I used the silence of those few moments to quickly evaluate inside my head that I covered everything in the history and plan what to do next according to whatever the D/D might be.
In one case, as soon as I turned around after washing hands, the SP started telling me about one of his symptoms and I thought he forgot to tell me something during the history and telling me now so I quickly picked up my pad again, but then realized that it was his challenging question so I answered that and then I said oh I will have to wash my hands again………and the SP was sooo apologetic lol he said it’s fine you don’t have to do that again but I couldn’t take the chance so I said we take good care of our patients and it’s important that we make sure that our hands are clean before we touch them, and then washed again. I could see the concern on his face for my lost time .
That said, I don’t think that any center is better than the other or that SPs are more friendly in one than the other. My friends we have to keep in mind that these are very standardized exams and ECFMG makes sure that the difficulty of cases and SP behavior is same in all places. Anything the SP does, or any single word the SP says has some meaning, it’s a clue to something that they want you to say or do something about. So NEVER ignore those. The SPs are actors, they do same things for everybody, whatever they have been told to, and they don’t make things easier for one person or difficult for the other. If they are acting bad, it is a part of the test, it doesn’t mean that the center is bad LOL.
In another case, during closure when I was telling the D/Ds, I obviously mentioned the most probable condition first and before I could name the other condition, the SP shook his head in dejection and anger and says I was told it was so and so and he took the name of the second condition I was about to tell him. I have to say he was a very good actor coz he scared me. I really thought that I have made him angry and he is not happy…….but I calmed myself and said, “Yes, that may be a possibility as well, but pls tell me what makes you so concerned about that condition?”. He said, “My friends told me that is the most probable condition”. I said, “Don’t worry, we are going to rule out every possible condition and I am going to order some tests for that as well. Does that answer your concern?” And he said yes. Do you have any more concerns? LOL. No. But he still kept shaking his head. Anyway, guess what? When I came out and talked to a fellow examinee who came out with me after the exam was over, she told me he did the exact same thing with her too and she was scared that she made him unhappy as well. Then we both laughed coz now we knew he was acting .
You should take something with you to clean your teeth and the breath after the lunch lol. I didn’t, and I saw that some people DID!
One last thing………I have read many posts where people say, “I did everything right yet I don’t know why I failed”. I have something to say to them – YOU ARE IN TROUBLE BUDDY. You need to identify your mistakes and correct them because obviously you made many. Otherwise how will you pass the next time? Right?
There is so much to do, and time is only 15 min. so if you are not able to finish in that time, you need to practice more and be fast. But, if you are coming out before the time finishes, I can guarantee that you missed some things, no matter how fast you were. Trust me on that. Everything is given in FA and UW and most of the time all cases are from there too so don’t waste your time and energy in browsing through forums and websites too much. I did that.
Just finish and become thorough at what is given in FA and UW first.
I had prepared for this exam very well and while practicing at home, I didn’t make many mistakes, but during the real exam, I made so many………I’m sure there were more than the ones I have already mentioned, I just don’t remember them right now. Also, the PN was sloppy and D/Ds were not enough or to the point……..so I was very scared that I might fail. But my friends kept telling me that there were also many things I did right, and that everybody makes mistakes and I will pass. I want to thank everybody again who had confidence in me. I am a very old IMG and I knew that if I fail, it will hurt my interview chances a lot later on. I’m very happy and thankful to God that I passed
I have benefited a lot from reading other people’s experiences on this forum that’s why wrote such a long experience, but I think these are things that might help other people. I thank you all who take out the time to read this.
Practice, Practice, Practice, and manage your time.
Any questions are welcome.
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| arlete
Intern in 2009!!!!!
Topics: 25
Posts: 1,788
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Wow! What a long and helpful post!
Congratulations and thanks for sharing!
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| nyimalay
Forum Elite
Topics: 9
Posts: 277
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Thank you very much for taking your time to share such a precious strategy and experience.
My exam is going to be at the same center and I had lots of concerns because of rumors.
Thanks again for building my confidence.
All the best,
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| ra7man
Forum Junior
Topics: 9
Posts: 89
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thanks a lot for this nice advices
wish you good luck
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| ing
Forum Guru
Topics: 45
Posts: 432
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Your experience is very helpful. Thanks!! Wish you good luck!
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