beiwen
Forum Elite
Topics: 21
Posts: 212
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I took the Step 2CS in Houston on Feb 1st. Got the results on April 9th... All in all it was a very stressful but very easy and doable exam.
Proctors are very informative, easygoing and understanding. Everything was perfectly scheduled and all encounters flowed smoothly, with all examinees being placed in front of the room doors and being taken succesively to the next one after each encounter in a mechanical production-line based manner.
Try to focus on main complaint. Do HPI and PE focused on that. Don't spend more than a minute in ROS, FH and so forth. During PE it is a must: heart, lungs, abdomen, check for CVA, and peripheral pulses. After that, perform focused exam if not included in the mentioned ones. Also: always drape and offer a glass of water if patient is coughing repeatedly (which I forgot to do and realized while being outside writing the PN).
All encounters are straight forward. Diagnosis is very easily attained. But this is not the point of the exam. The point is to make appropiate questions in your histoy taking, focused proper physical examination and neat, well structured, logical, coherent, somehow well oriented PN (none of this components have to be 100% perfect, but acceptable)
YOU MUST BE COURTEOS, SINCERE, SMILING, EMPATHIC. If you don't know the answer to a question respond with the 2-3 most likely explanations to that or just say you can't answer that question at moment for you'll need some more testing.
If it is an emergency case, like pyelonephritis and the patients asks you if s/he can go home, tell them that they can't for the moment, and assure them you'll get the tests done immediatly and that you'll see him/her immediately once the tests results are done. Also assure them they'll be receiving proper care for pain in the meantime (they're gonna ask you for that). Remember however that you cannot pescribe a drug. But you can, still, assure them that they will receive the proper care and that you'll do everything you can to make them feel better while workup plan is being carried out.
Patients are very compliant. Most of them are very friendly. Except for 1 or 2 out of the 12 who you can tell they are acting to present a hard-to-deal kind of patient. Don't panic. They are acting... you can tell. It's is pretty obvious.
So... don't forget to initiate the ecounter properly: "hello mr X [shake hands] I am dr Y, I am here to help you... what seems to be the problem today? show compassion and ask permission to drape them properly.
Then... history and PE....
Finally: It is extremely important that you close the encounter properly by telling the patient what your dif dx are and which tests you're gonna run to come to a diagnosis. Tell them you're gonna call them as soon as you've got the results, to discuss about the diagnosis and the treatment plan. Show empathy and tell them: thank you for your cooperation, it was a pleasure working with you today. Have a great day (well... if it is an emergency case, you're supposed to tell them you'll take all measures to make them feel better and come to a diagnosis and treatment as soon as possible). Tell them you'll be right back, as well. Act with empathy.
The Patient Note: 10 minutes are not enough. Please practice with the software on usmle.org in a timed mode since you'll likely use the computers to write your PNs. I decided to do hand-writting in the first case. It was a mess, had to cross out many words. then come back to the HPI... it was very bad. So i decided to continue with computer notes. But you have to go fast. So, do systematic practice at home several times and plan how you'd like to organize the PN and stick to it.
I was extremely nervous during the whole day. Always final-counting on how many cases i had left. Felt horrible in the first case. All my mnemonics were flushed away from my mind in a split of a second/
After the exam I was very happy I dared to take it. I felt it was extremely easy but I also was aware that I ommited thousands of questions in history taking and maneuvres in PE. And the so many things I didn't write on the PNs pertinent to the cases...
As weeks went by after the exam I had continuos flash backs of these things I failed to write or perform. That was a torture.
But 8 weeks later I got the result: PASS!!! couldn't believe it... after this day and still today I have flashbacks of my mistakes in that CS exam, but feel so relieved when I realise I've already passed it.
Time of study: 3 weeks. More than enough. Material: FA (excellent) and UW (second best).
Strategy: try to group diagnosis in lists of differentials connected to groups of work up tests. These are always the same to each list of differentials. When writing the PNs I always started at the bottom of the screen by filling the blanks for differentials and workups, that's the easiest thing to do. You complete a very important part of the exam in 30 seconds and then you have 9 minutes and a half to develop History and PE.
If you're not a native English-speaker and have difficulties in fluency, read the questions suggested by FA and UW, read them out loud over and over. Those are the ones you'll use in your encounters. Rembember that you won't have time to spend in looking for words in your brain in order to state a question or comment. You'd rather have the questions already pre-packed by reading them out loud over and over in FA and UW. You;ll see how easy they come out during the encounter.
Bottom line: cases are straight forward; you should not try to focus on zebras but horses. The exam is about how you perform in the clinical encounter, how empathetic you are and how humanly you behave as a doctor taking care of another human being.
Good luck to all you all.
Edited by beiwen on 05/09/08 - 05:26 PM
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| bioguy
Forum Guru
Topics: 36
Posts: 678
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excellent review, beiwen!! and congratulations on passing!
thats the frustrating thing about this exam, you know everything, every question to be asked, but once you see the SP's face your mind goes blank. 
ultimately, it comes down to how much you practiced. how much of it is in your reflex!!!! of course, when the higher intelligence decides to go on a vacation on the spot, only the spinal cord will save the day! Ha Haaaaaaaa!
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| ing
Forum Guru
Topics: 45
Posts: 432
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Very helpfull! Thanks beiwen. Congratulations!!
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| cartman
Forum Junior
Topics: 6
Posts: 51
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Congratulations on passing your test!
I've yet to take the CS but from reading some of the recent posts it sounds a lot like a driving test. You know what to do..........you know HOW to do it........its just that you need to remember to actually do it. Like coming to a complete halt at a STOP sign or stopping before making a right turn on a red light. I remember I failed my first driving test becasue of that mistake.
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| nyimalay
Forum Elite
Topics: 9
Posts: 277
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Thank you very much, Beiwen for sharing your experience and your tips.
All the best,
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| dr_vvv
Forum Newbie
Topics: 0
Posts: 1
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thanks for this review ... it helps a lot .
Hussam
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