cherryho
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After taking CK last weekend, I finally have time to sit down and write about my experience. My original plan was to take CS @ the end of Aug but several residents I contacted told me to move it to an earlier date. So I decided to just go for it with very little time left. I registered for the exam on 6/10 and got the permit in mid June. After monitoring the available dates crazily for 2-3 days, I got a spot in Philly on 7/1 and had only 2 weeks to prepare.
Study materials: I used FA plus UW. I went through the FA cases with my physician husband and my two study partners. For the UW cases, I only had time to do the ones that were not in FA in the last few days. The UW videos for PE were very good.
All the actual cases I got were either from FA or UW, not exactly the same diagnosis, but the same chief complaints. The weekend before my exam, I practiced with my partner in a different way: making up cases by ourselves based on the chief complaints in FA/UW. This strategy really helped us prepare for the unexpected in the real exam.
History taking:
As a start, introduce yourself properly. I think it's good to ask SPs how they are doing if they are not in acute distress.
For IMGs whose English is not very good or who have no USCE, better to memorize the questions in FA. Make sure the questions (and the English too) are understandable by general Americans.
History taking needs to be focused and efficient. Avoid asking unrelated questions and the "shotgun approach" (screening from head to toe). Do not continue taking history after the 5 min warning. Learn to close the cases in 12-13 min because in the real exam, it might take 1-2 more min. I used handwashing time to summarize the case and ask if the patient has questions. Be concise. If you can ask the question in one sentence, don't use two.
Mnemonics:
For chief complaints, I used FORDPAPP from FA. For pain, I used LIQR (liquor). For social history, I used my own mnemonics FAT DOTS (family hx, alcohol, tobacco, drugs, occupation, travel, sexual). digital doc's mnemonics were very helpful for D/D. I also made some mnemonics myself in case I freaked out in the actual exam, I still had something to hold on to. I hope to share them after I finish unpacking and find my FA from the pile of boxes (I just moved!).
Physical exams:
Practice is super important, esp for the neurological exam. Time management is a greater issue than discovering a positive sign. Make sure this part flows well w/o much pausing and thinking. Tell the patients loud what you are going to do even if you are only "inspecting/looking at the part". To have the patients follow the commands w/o a problem, use the language that they can understand easily. For example, tell the patient to do dorsiflexion of the feet by saying "point your toe towards the ceiling". It's also important to know what exams to do and "what NOT to do" in a case. Performing unnecessary exams is a waste of time.
Closure: I think it's the most difficult part of the whole exam, because it has to be organized and concise. It's easier to use the same template for every case. Make sure to give 2-3 D/D and tell SPs 2-3 tests you are going to do.
Counseling: It's not just limited to smoking/drinking/drug abuse/safe sex practice. Depending on the cases, it might be crucial to advise patients for bed rest, quarantine, fluid intake, etc. UW is a very good resource for counseling.
Notes:
The order in which I wrote my notes was: D/D, positive history, PE, negative history. So I'd have a relatively complete note even if time runs short.
Lodging:
I stayed in Windsor Suite in Center City, Philadelphia. I booked it on their Website. Only cost me < $110 a night. It's not very new, but the room was clean, neat, quiet and spacious. Staffs were extremely nice and helpful. Breakfast was complementary. They stored my luggage for me on the exam day even after I checked out.
The actual exam:
The first thing I noticed when I arrived @ the test center was that lots of examtakers (at least 2/3) were IMGs (including me). I actually felt a little bit relieved by that maybe because I am pretty confident about my English.
Overall my exam went pretty well: I finished every case in time. History taking was pretty complete. I was able to make a specific diagnosis in almost every case. Counseling was done in most cases except for one (condom use) and I think I did a very good job in closure. I tried to be more personable by chatting with the SPs a bit, and I felt that they liked my approach. However I still made a few mistakes:
- Completely missed PSH, FH, med, allergy, social history (got sexual though) in one case. felt kind of bad but decided to write "none" for everything in the notes. However history taking in this case was very detailed. I thought even if I missed 6-8 PMH/social Hx Qs, I might still have got 60-70% history in total.
- Thyroid exam: forgot to tell patients to swallow in 2 cases.
- NE: Only one case required a complete one. I found positive signs on the sensory exam so got a little bit nervous. I spent a little bit more time confirming the findings. Thus I missed Romberg and gait. I missed fundoscopy too and decided not to do Weber/Rinne due to time issue.
- Joint exam: I actually didn't know how to perform a complete joint exam. So after inspecting/palpating, I just told the SP to move the joint around. 
- Notes: pretty messy in style (mixed narrative and bullet style) but my handwriting was neat. misspelled "Puerto Rico" in one case and put down "hematemesis" for "hemoptysis" in another  Forgot the patient's age but remembered it was 40 something. Forgot to document the appearance/thought/speech.....in a psychiatric case.
Unlike most people, I actually felt pretty good after the exam. Because I realized that the key about this exam isn't to be perfect but "not to be the bottom". Hope my two cents help.
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99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| sackatdoc
Forum Guru
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great!pretty exhaustive description of your exam experience!, since i've been going thru several others, and you happen to have come to my notice, when i hve read alot, you become a victim of comparisons that are happening spontaneously, telling this is no way undermining the wealth of info i happened to gather thru this post.so dont take any thing personally, what i have infered is that one has to strike a balance, the once who are confident of their communication are cracking down at data gathering or PE,making this exam into a silly social meet with an American, the once who are getting too much involved with their being exhaustive with history and PE forgeting washing knocking smiling etc, so the crux can be told is to identify your weaknesses and dont get carried away with the strengths you possess.
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| AnneGermany
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Posts: 580
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Thanks Cherry for your thoughts on the exam day.
I´m glad and happy because it sounds a lot like mine but unlike you, I still have to wait another 2 months for the results
Well, I hope moving went well and I´m glad you´re soon ECFMG certified!
Good night and good luck!
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| cherryho
Forum Guru
Topics: 30
Posts: 573
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sackatdoc,
Before I took the exam, I went through the posts from people who failed the exam. Most of them failed the CIS, not the ICE component. The point I want to make is that CIS is not just about knocking on the door/greeting/draping/smiling. I asked a middle-aged woman about her kids and teenagers about their school. I don't consider it a silly social contact. That's actually my interpretation of a good doctor: one who cares not only for the illness of the patient but also his/her life in general. I might have wasted 10 sec on this conversation unrelated to the present illness of a patient, but I gained patients' trusts. To me this is much more important than asking one more question about the symptoms.
___________________
99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| cherryho
Forum Guru
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Posts: 573
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Hi Anne,
I am sure you'll pass so don't worry too much about it. Like I said, as long as you are not the bottom, you'll pass for sure. Your performance is no way near the bottom.
By the way I hope my CK was okay (please don't fail me because I need to be certified!).
___________________
99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| sackatdoc
Forum Guru
Topics: 8
Posts: 599
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 hey killer chill,be all the cherry as you called!!!! wat i told about silly social meet was other people too confident of their communication skills, i fear i could just be silly in front of SP,that is I may not ask him about his probs in detail, so girly get my perspective here,Also i'm new to this forum so i deserve little allowances, if in case i offended you ,forgive me,i never ever meant to do even the bit of it!!!But i had an inkling this could happen,so please forgive and forget
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| cherryho
Forum Guru
Topics: 30
Posts: 573
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sackatdoc,
I didn't feel offended. Just want to be sure that my message came across.
___________________
99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| sackatdoc
Forum Guru
Topics: 8
Posts: 599
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ok it was across already, after reading yours i could know there are two types like this, you are a good balancethat i figured out!!! thats y i said i learnt alot from the post
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| AnneGermany
Forum Guru
Topics: 36
Posts: 580
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Thanks Cherry,
and I´m sure you totally rocked CK! You sounded so confident in your email!
You deserve it, I think we all do
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| falcon
Forum Elite
Topics: 20
Posts: 426
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Hi, cherryho
Congratulation and Thanks for very elaborated and informative experience.
I actually failed in ICE. I did not practise at all because before I started prep for CS, I moved to a new city in Canada. I could not find a study partner here. My study sources are same as urs. I felt no problem in english and communication skills. Though I finished all cases in time but I think I missed so many questions in history and steps in physical exam. My patient notes were messy and could not write in that limited space what I wanted to write. I had 4 case of MSK and 3 CNS.
My question is that please tell me how u figured out that u have asked the required number of questions in history and u have done required number of steps especially CNS.
Did u use to write mneumonic before entering the exam room.
Yours suggestions will be appreciated
Good Luck for the match
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| cherryho
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Topics: 30
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Hi falcon,
I think practicing is very important, esp for a person like me, who's been away from clinical medicine for 5 years. I practiced w/ my husband (an AMG) for history taking and PE and 3 partners for history taking. For the last 5 days I did at least 10 cases in a day. FA has a checklist. I asked my husband/study partners to check it for me to know what I missed each time. I heard that if your history/PE is 60-70% complete you'll pass. To leave some margin for error, in practices it's better to hit 80%. I do have some nice mnemonics (almost for every symptom) to remind me of the questions to ask. They really helped. I hope to share them later when I find my FA.
NE is a package of exams. You can watch UW's videos to learn how to perform a complete one. If time runs short, I'd skip facial sensation, cranial n. VIII (if not hearing loss/vertigo), limb sensation (if no HTN/DM), and do only one test for cerebellar function.
Hope I answered your questions and wish you the best for the next exam.
___________________
99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| falcon
Forum Elite
Topics: 20
Posts: 426
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Thanks very much cherryho for this detailed reply. Thanks for giving me very valuable tips about Neuro exam, which is very time consuming.
Best of Luck for ur residency
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| dr_puma
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Topics: 35
Posts: 501
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great post thanks
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do whatever u want,but do it wholeheartedly...never hold back.
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| USMLEGladiator
2009 & still in race
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congrats
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Chance favors only the prepared mind. - Louis Pasteur.
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| cherryho
Forum Guru
Topics: 30
Posts: 573
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Thank you guys.
___________________
99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| drjits
Forum Newbie
Topics: 5
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can you tell me the cases if u remember. my e mail address is kajal313@gmail.com
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