target
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| | 06/01/08 - 05:55 PM
3 of 3 forum leaders found this post helpful
| #1 |
Hi all,
This is a dream day come true! I never thought I would be writing my exam experience one day..because I have put off USMLE for so long in my life (would you say 8 years long?)..always thought of taking Step1 first and was on my first read (every year I have been having first reads and then some turmoil comes and I quit completely). I took exam late May 08, hence results are still not known - thought I would wait for the result before I post this - but I didnt want to hold a few things to myself while it could help so many CS takers - So take what will help you from this experience retrospectively.
There are 2 main people who stimulated me to take this exam - CS first - my longtime friend Mytime and Arlete. I had not even scheduled the exam or decided my date when I read Arlete's thread and met her on skype. Our first practice started on our first chat when I didnt know what the exam was. She was so cool and gave me one comment which made me go for the exam " You are good already". So I went I ahead (Someone believing in you makes a big difference) and booked the exam date. Enough about background ......Now about the exam!
STUDY MATERIAL: First aid and UWorld (just skimmed through what cases not in first aid) - signed up only one week ahead of the exam. Digital doc's csprotocol site (very informative) and Neeraj's CS notes (like his exam note template a lot -http://www.prep4usmle.com/forum/thread/70916/ )
WHERE TO START: I was confused where to get all information in one place but found it in different places
0) BELIEVE IN YOURSELF! - You are doctor already- as Arlete says this exam is like asking a doctor to act like a doctor .
1) Read First Aid introduction pages to know what the exam is about and how you are graded
You dont have to go on to Mini cases at this time - I got stuck here trying to read those differentials - but didnt make any sense as to where they actually fit in actually in the exam.
2) Formulate a template for history taking - YOUR OWN - easy to remember if you work in your style right? Inputs can be obtained from Neeraj's notes, digital doc's site , and Grazie's thread http://www.prep4usmle.com/forum/thread/71110/.
3)NBME for CS = Practice with someone who already took the exam even before you study actually- they will tell your weak areas and you will know where you stand - Video conferencing is better than just phone.
4) Practice Cases from First Aid - do one per day initially and then you can gradually increase.
Say for eg. it is an abdominal pain case - practice with your phone partner after he/she reads ONLY the doorway information (DONT GO THROUGH the case before hand- You sure will remember most history if you just read through it , duh -believe me this is not the case in the exam).
Buy a timer and start it when the information is read. - Next have a clip board with a sheet of paper and write down
NAME : BOLD AGE: SEX : VITALS: Chief Complaint:
(Vitals even if they are normal- you dont want to have second thoughts inside whether this patient has HTN or if he gives a history once you are in. ALso it helped not to get up and look at the vitals when you are writing patient notes)
OPDSFC, PAMHUGSFOSS - WADES vertically down the sheet LIQORAAA if patient complains of any pain (need not be on the doorway information) WADES is something I included - Weight, Apetite, Diet (any spl. diet), Exercise, Stress - I also had Travel and Whom do you live with in mind
More important : I allotted a space TOP RIGHT CORNER - SYSTEMS TO EXAMINE even before I entered - looks very obvious but say for chronic cough you need to examine RS (which the only one you may think of once you are cluttered with all the history taking) but you need to examine Heart , HEENT, and Extremities for pedal edema in case of COPD with Rt. heart failure.
BOTTOM RIGHT CORNER: COUNSEL - as you take history if he says smoking put that in the counsel column, helps you save time when time is running out to trace your crazy handwriting to see if THIS patient was a smoker. Believe me when you have 5 in a row it gets confusing if this one said or the previous patient said it ! Sometimes there is no bad habits to counsel on and when I knew my box was empty I asked them to keep up their exercise habit and told I am glad they are not into smoking and to keep it up.
I know some of you are thinking this takes some time - i sometimes took even more than a minute to do this thing but it helped - first to calm me down before every encounter and set a stage to ask the right questions and examine relevant systems.
Tell your partner to inform you when it is 5 min. Once the case is over ask your partner what you missed while you then open up first aid too and follow along. This includes noting what you missed in counseling. Usually you dont want to waste your partner's time while you write patient notes. So hang up and write patient notes in xeroxed first aid sheets in 10 min. Important while writing patient notes:
a) Use your rough sheet (which is equivalent to the blue sheet they give you at the exam) as your template to transfer information to your PN - dont rely on memory - in the real exam you are a Robot . I did not do this while practising - I had written down from mind but doing it in the exam for the first time - the flow was not smooth- I felt I should have practised this way!
In the real exam you will submit this rough sheet (blue sheet ) and patient notes (white) paper to the proctor after every case. The blue sheets are given together 12 sheets on the clip board and one white sheet at every desk after you come out of the room.
b) Start from bottom - Diagnosis and Investigations first , Then P/E and then history - if you run out of time you can afford to lose on history which is usually the elaborate one. You can include more negative history if you have time. This way you also have time to comment on how you ruled out your DD in P/E and history
c) Compare PN with first aid and correct and see what you missed.
d) File your rough sheet & patient notes, so before exam you can see what you actually miss every time
5) Now read Minicases relevant to the symptom you practised with you partner - say abdominal pain - read everything under abdominal pain. This makes you not only find out what could have been the Differential diagnosis but also the relevant questions you must have asked.
6) Videos: UWorld examination videos Try this link too:http://www.med-ed.virginia.edu/courses/pom1/video .....
Thanks Justice for this link.
Now the video will tell you how you should have performed your examination.
THEN WHAT? Follow these 6 steps for every practice case in First aid and then you can practise cases in Uworld - the ones that are not there in first aid , like menopause, sickle cell crisis, insominia, pregnancy (may be more pl. check). I didnt do all cases in USMLEWorld.
A WORD OF CAUTION ON PHONE PRACTICE: Please do practice in person because in reality it takes a lot more time. For example for washing hands -On the phone you say" Okay excuse me a minute to wash my hands" - 3 seconds in reality it takes 30 secs. Same case with reflexes, walk for me etc Practice on a friend at home - you will see the difference. I always finished my CNS case ahead of time on phone but found out it took 18 min in person. So final days I fine tuned it to under 15 min. Please remember the phone partner is helping you figure out your weaknesses - you should be happy when they criticize - I wanted more of it so I would be better for the exam.! Dont be defensive.
Okay people, following this outline will help you perfect each specific area of skill you need to prepare effectively for the exam. I did not follow this because I did not know then. But this is how I wish I had done for efficiency, reinforcement and consolidation in an organised manner. Hence I felt the need to write it retrospectively for all those who are new to CS prep. Please remember these are my personal views of how I would go about this exam and since I havent got my result yet .....take it with a pinch of salt. Good luck to you all out there!
P.S. I thank Justice's wife for her prompt phone calls at 9.30 p.m to practice 2 cases every day - without her I would have slept after a long tiring day at work. Then milee99 came to my rescue when even my 2 hour study was coming to a standstill in my 3 week prep period . Arabia practiced before his exams and gave me useful hints. Shwe passed her excellent tips with all her cold and all. Thanks to my 9 year old who practiced one cough case with me (giggling all the time!) and thereafter started running around the house when I asked him to be my patient. It was a wonderful experience to practice with people around the world - their accents - Egypt, Brazil, Russia, india and my little fake American hero for whom I embark on this journey! Please keep me in your prayers. Now to step1.......
Guys please scroll down for my 2nd post in this thread for more tips. Good luck and God bless!
Edited by target on 07/02/08 - 08:05 PM. Reason: more info
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| ing
Forum Guru
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Thanks for sharing. All the best to you!
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| milee99
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target!
this is a genuine exam experience ..
thanks a lot
and ofcourse we are praying for you. duh
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| new_n_lost
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So far teh best and most concise info i have read
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| paheli
It'sAllAboutGoodKarma
Topics: 197
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Extremely useful, target. You've done a good job!
Could you please tell which cases UW has that FA does not? [My exam is next week, and I'm using only FA] Thanks so much!
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Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows. Internship, Here I come!!
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| arlete
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I loved your post, target! I am your fan now that I know you!
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| target
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10 KICK STARTERS FOR THE CS ROBOT: I remember two at a time
BEFORE ANYTHING - TAKE A DEEP BREATH - dont undermine the value of its relaxing power!
1. KNOCK KNOCK (Recall patient name before knocking) ---- Enter SMILING
2. Mz/Mr......... - I am Dr............ (first patient name then your name)physician at this hospital.
3. Shake hands and Eye contact with patient (2 & 3 are done together)
4. When you hear the Chief complaints (after you have asked How can I help you) -------- I am so sorry to hear that (sympathy!)
5. DRAPE (as you say "Can I make you more comfortable") - SIT DOWN on the Stool (Do you mind if I sit down and take some notes)
(All 10 come with practice - in reality in the exam I hardly remembered to do these - it was natural while my mind was racing on the questions for history of present illness- without thinking after knock you should realize you are sitting - you know what I mean right?)
SHOULD I SIT OR STAND?- I preferred to sit though I didnt plan to - REASONS-
1) You cant sit on the stool till you take the drape off the stool - so you wont forget to drape!
2) Your handwriting in your blue sheet is better later on when you write PN and you can rest the pad on your laps - I tried holding it between thumb and fingers and by the last case my thumb was having some twisting involuntary movements!! I had to think of my pain rather than the patient's
3)It is a long exam - you are tired - stressed - drained by the number of cases and mental taxing. Take that 8 min to be kind to yourself - but dont get cozy and dwell on history (I actually did) and move on to physical.
4) When you get up - remember you make it to the SINK STRAIGHT to wash hands after you put your pad down and excuse yourself from the patient "I would like to examine you now . Could you excuse me for a minute while I wash my hands". When you come back "Can I begin examining your general health first" and start General examination - it is important! I found I would have missed some important findings if I had not done a thorough General exam- quickly though - Eyes (pallor, icterus), Neck (THYROID (ask to swallow), lymph nodes), hands (clubbing cyanosis and radial pulse) and feet (Pedal edema, dorsalis pedis, any ulcers) and SKIN (for scars, rash , bruise, icterus)
5) During 30 sec of washing hands - ask occupation (Arlete's suggestion) - I thought even that did not suffice since it takes a while to wash and dry your hands - I also asked How do you like your job? SP's seemed to like it instead of just staring at you (ofcourse secretly)!
6) You are tensed - YOU KNOW but the SP need not know. Sitting down makes you look professional and composed - my view again. I think I still had energy and my mind was clear because I sat down for a few minutes during this coninuous drill.
One case was a emergency situation and I did not sit for that case. A better reason would be - It was my last - You can tell I was ready to run out of the center! Hurray! It is over..........
Edited by target on 06/03/08 - 09:34 PM. Reason: typo
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| target
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Good to see some posts after mine from good old friends. Thank you all for the kind words....Paheli l answered yr questions as an edit to the post. Good luck! I will be busy with step1 preparation but I will try to clarify any issues with my post.
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| paheli
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Thanks a bunch, target. The second post is excellent stuff, as well.
Really sorry, but I don't spot the edit in your first post, about cases present in UW and not there in FA. Am I just not seeing it?
Also, what is Neeraj's notes? Are they available somewhere on this forum?
Thanks so much!
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Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows. Internship, Here I come!!
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| SORAN
Forum Newbie
Topics: 2
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paheli ..if you wish i can send you a copy of neerajs notes
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| study499
live@ur full potential
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Well done Target...
I am very happy for u...one step closer...
All the best with the rest
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| paheli
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SORAN wrote:
paheli ..if you wish i can send you a copy of neerajs notes
I'd appreciate that, Soran. Can you send to me via PM? Thanks!
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Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows. Internship, Here I come!!
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| target
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Topics: 5
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Hi Paheli,
There was trouble editing the link last time - so it probably disappeared. I have written some of the cases I can think of in the paragraph THEN WHAT? I also added the link to Neeraj's notes . Study499 good luck with your preparation. We are getting closer.....Cheers!
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| shwe
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GL in ur result & st 1 study  
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| paheli
It'sAllAboutGoodKarma
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Thanks a lot, tg! You're the best!
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Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows. Internship, Here I come!!
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| genbot
Easy...
Topics: 20
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Done with CS!
Congrats!!!
Good luck for the result.
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Finally got started with the interviews!
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| P4a99
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new_n_lost wrote:
So far, the best and most concise info i have read.
Yes, indeed.
One of only a couple threads that I have rated with 5 stars. 
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Congratulations Paheli! --- Congratulations Feyza! ..... Good Luck drnaik-faraym-Gogeta-Bioguy-arlete
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| hgheith
Forum Elite
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Wow! Target you really have written an excellent format for the "cs robot". Your post will definitely help me in my prep, I started late and kinda lost the direction in which I was studying! Your advice is structured, specific and to the point, there is no doubt that it has been the best I've read.
Thank you and good luck on your results, although being the author of this thread I am sure 99% u will pass (only God knows 100%)
Again thank you for taking the time to be so helpful to your colleagues!
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| target
Forum Guru
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I am honored by your comments -paheli, ing, genbot, nnl ,shwe, milee, arlete ( my guru!), p4a99 and hgheith - thank you for all the stars........makes me happy and instills confidence in me to go for step1 without fear.
I see that as of today 338 have read the post and hope it has benefitted them as well. I appreciate you guys who have taken the time to drop a line on this thread. Hgheith was even kind enough to write a personal note as pm.........schweeeeeeeeeeeeeet! Best wishes to all of you! Let us know how you did in your exams and add more to this thread so it helps all future test takers. Cheers!
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| skamran
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hi ,
do u think 10 days enough for cs prep??
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