dell1100
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This is the information I got from various sources about the exam after i lost in CIS. All this information may or may not help you but it helped me a lot and i passed the exam. Just wanted to share this because there is so much confussion for the IMG’s regarding the exam. Hope this information will help you guys out there. I think that all the information is correct as far as I know. I'm posting this information with the intention of helping others and I am not responsible if someone is misguided because of this information
1) Be confident and sleep well the night before the exam.
2)Get dressed neat and use moderate deodorant ( it's a must )
3) Knock the door; close the door (don't forget to do that) ; approach the SP slowly ( don't rush to him ); smile; introduce yourself and your role, greet him with a handshake and remember his last name only & don't forget to ask if you pronounced it right.
4) Ask if the SP is comfortable.
5) Now keep your pen and pad on the chair and say thay " I will cover you with this cloth to make you more comfortable " ( don't do all the draping and introducing at the same time. Do only one thing at a time.)
6) Now take both pen and pad and ask the SP " Do you mind if I sit down? " and wait for his permission. Please try to sit in the exam instead of standing. It makes you lot relaxed and focussed. Believe me. (Try it while you are practicing ). If you stand you will get exhausted for the last encounters and you may compromise your performance in them.
7) Now ask "What brings you to the hospital" and go into the history . Now after the chief complaint, say that " Well I can see that it must be bothering you.I am glad that you came here. I will do everything possible to help you. Just bare me for few minutes, I will ask few more questions " . This thing should be in a very sympathetic tone which makes sure that you are really caring for the patient. ( Don't ever say the word " Don't worry " any where in your history). False assurances are a fatal mistake in the exam.
8) Two important features of CIS are " Paraphrasing " and " Summarizing " and also showing sympathy when appropriate.
9) Paraphrasing : After asking the patient about the Chief complaint in detail repeat what he told to him; this shows that you are listening to the SP. Do this thing at least 2 times in your history. Paraphrasing concentrates on only a particular symptom unlike Summarizing which gives overview of the whole case.
10) Summarize after the history in brief . Do the counseling bit here if you had not done that before. Now proceed to the physical
11) Just ask " Now, I am going to do some physical on you. For this I have to wash my hands. Please excuse me for a moment "
12) While washing hands don't ask any questions. Think what you should do in the Physical. (after washing hands approach the SP with your hands high, not touching any thing just as a surgeon approaches to the operation after scrubbing). If you talk while washing the hands you can’t maintain eye contact. Make sure that while you turn the knob of the sink off; don't do it with your hand but use a tissue to turn the knob off after washing your hands.
13) Now before touching the Sp place your hand on him and ask if he feels your hand cold (if yes rub your hands and ask again )
14) If during any test he complaints of any pain say " I am sorry, I need to do this test to know what actually is the cause for your problem. Next time i will be gentle." ( never avoid any test fearing that it may cause pain to the SP. Just explain him the importance of the test)
15) After the physical; sit down and say " Let me share my impression with you and summarize him"
16) Before leaving ask " Have you understood everything we discussed today " & " Do you have any questions"
17) Say that " Have a good day. It was nice meeting you. Take care of your health. I will leave my no. with the nurse, you can call me at any time and i will be glad to help you.
18) Never worry about the time. 15 mins is enough . Believe me. I got out at 14 min on an average . If you leave early you loose points. If you finish the case soon sit down and say " Let me check if I have got all my facts right" (you might remember some points)
19) Never write anything while the SP is speaking. For that fact don't even use your pen in the room (if at all you use, just note 1 or 2 points; not more that). It's so important because you loose 2 points if you write while the Sp is speaking . You are not maintaining eye contact and you are not listening to him. Believe me you will remember everything the SP said after coming out ( Remember you have paraphrased; so you can't forget as the information is safe in the brail )
20)When after 10 min during the encounter ; when they do the announcement it may interrupt you. Don't show any frustration then. Just wait till the announcement is over and then carry on. Keep your smile and cool here. Don't ever show that you are tensed or frustrated at any point in the exam.
21)Also while doing the physical never ever touch the gown of the patient. Your duty is to just tie or untie the gown. Lowering the gown is done by the SP. Ask “Now I am going to examine your chest. For this I want you to lower your gown. Let me help you to untie your gown."
22)Never talk at the back of the SP. If at all you have to do that, say “ Now I am going to examine your back. I may give some instructions from the back. Please follow them.”
That's all I can remember about it. I will let you know if i know anything more.
Just be confident and carry on with the preparation. Don't get any negative thoughts. This exam is all about smart preparation.
Don't hear when anyone says, this exam is easy, I didn't do that, i didn't do this; but i passed the exam. These people should thank their lucky stars if it was so. Of course there is some room for error in the exam but that shouldn't make you complacent in the preparation. While practicing there should be zero room for error and I mean it.
Just do what all is needed to pass and you will pass it. So, practice from on and give the exam .(If you have passed the exam in ICE previously you can give the exam in a week or so. Fine tune your preparation and you will notice the change). Just introduce the above points into your preparation and you will come out with flying colors.
All the best for your exam.
Edited by dell1100 on 08/25/08 - 09:20 AM
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| dell1100
Forum Newbie
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Posts: 21
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History :-
Divide your History into 2 parts- (i)Present History (ii)PAMHUGSFOSS
(i)Present History:- It’s divided into 4 categories -
1)Symptom - a) Any symptom on the exam ask for ODPFAAA ( onset,duration,progression, frequency, alleviating , aggravating , associated factors ).
b) Ask the specific question related to that symptom ( ex :- For Pain, ask LIQORAAA; For cough with sputum ask quantity, color, odor, any blood )
2)System - Relate the CC to the system and then ask the relevant questions to that system. Ex :- If the CC is constipation then the system is GIT; so the questions are as follows- any abdominal pain, diarrhea, nausea, vomiting, jaundice( discoloration of sclera )
3)Differential Diagnosis - Make a note of D/D’s before you enter the room and make sure that you ask at least one question related to a particular DD so that you can rule in or rule out that particular DD. Ex - If you think of Primary Biliary Cirrhosis; then ask if she noticed any itching.
4)Review of Systems- Ask if the SP has fever, headache (make sure you ask this two things atleast ) . If you want to ask other questions ask atleast one from each system other than the chief complaint.
(ii)PAMHUGSFOSS - Everyone knows what to ask here. So, I will not detail it
-Physical Examination :-
Whatever you do here, first tell the SP what you want to do and then do the action. Don’t do both the things at one time.
Don’t ask permission everytime while you do the Physical. Just say “ Now I’m going to do so and so “ and do it. Don’t ask “ Let me examine your chest, is it ok”.
It irritates the patient. More over the physical is important for the SP. So, if the SP says that it is not ok with me you will get struck. So, just do it and if at all the SP resists, tell him the importance of the test and do it. Never avoid any thing that is to be done on that patient.
PE is Categorized into 3 parts -
1)General Examination -
-Look at the eyes for pallor
-Think if you have to use the ophthalmoscope at this point and use it if the SP has HTN, DM OR HEADACHE
-Look at the mouth for any ulcers.
-Palpate the neck for Thyroid asking SP to swallow
-Check the pulses in the arms and also look at the nails, skin and hair changes on the arm.
-Check the pulses in the legs ( maintain eye contact while doing this).
2)Examination of the System that is to be examined -
Do the focussed examination here.
3)Examination of the Heart and Lung -
If the CC is not realted to CVS or RESPIRATORY SYSTEM then only auscultate the heart and lungs. No need to do more than that
If the CC is related to heart or lung then the second and third parts merge. Here you do a detailed Chest examination.
Physical examination will take a maximum of 3 min 40 sec including the washing of your hands. Practice in such a way that you will not need more than 4 min for physical examination in any case.
{{{In any case not examining Heart and Lung is a crime. You will just need 15 sec for heart auscultation (3sec X 4 areas of the heart and 3sec for neck auscultation) and 20 sec for Lung auscultation (2 places in front & 2 places at the back for 5 sec each ( auscultate for one full respiration and then move to the other place. THAT'S IT}}}}
Remember there are only 4 types of examination basically (atleast 10 of 12 cases in your exam will fall into the below category)
1)Chest examination (both CVS & RS, they are so related that you do both the system examinations even if you are sure that the present CC is related only to one of the systems)
2)Abdomen examination
3)CNS examination
4)Pain case like Shoulder, Knee, Heel, ankle, Back pain (check movements, sensations, strength,reflexes below the level of pain; First check the normal joint and then the deceased one. Also check 1 or 2 normal joints )
So you have only 4 types of cases. It’s that easy. Now time your preparation and make sure that you get everything done with in 4 minutes.
Some case like tinnitus, hearing loss, Headache, Sore throat, need some extra examinations which you can practice. Don’t waste time doing unnecessary and unrelated tests(No need to use the BP apparatus in any case expect for HTN refill ).
So be confident. To be confident you need practice. Practice and you will do well.
All the Best. Rock the exam
Edited by dell1100 on 08/25/08 - 09:17 AM
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| kisna
Forum Senior
Topics: 26
Posts: 150
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thanx dell wonderful summary
it will really make things clear
i failed in CIS last time n have my exam next week ....so u posted at correct time
i wanna ask u can we do counselling there n then with social history?
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| dell1100
Forum Newbie
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yes Do it in which ever way you feel comfortable, What matters is whether you have done the counseling or not . Don't waste time doing lengthy counseling. There will be a check point on whether you have counseled or not BUT NO CHECK POINT in How you counseled the SP.
Remember that as you have given the exam, i think there is only 4 cases or so where we have to counsel. In the remaining cases you really don't find anything to counsel at all.
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| Whattodo123
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Thanks for the detailed post, a lot of original information that I have not read anywhere else. I am not happy about not being able to make notes though.
___________________
94/Nov/pass/3USlor/1pub/2USCE/CMS
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| dell1100
Forum Newbie
Topics: 3
Posts: 21
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Hi whattodo123
I detailed about writing during the encounter in the other post of yours. As long as you maintain eye contact and make the SP think that you are really listening to him, it's ok to write down. Now I think that you actually got the picture.
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| kisna
Forum Senior
Topics: 26
Posts: 150
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dell...
dont we have to lift up SPs gown for examning belly after taking permission from her?
or we hav to tell sp to do tht herself?
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| dell1100
Forum Newbie
Topics: 3
Posts: 21
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Don't touch the gown of the SP. Your duty is to tie or untie the knot of the gown only. Ask the Sp to " Can you lift your gown a bit. I am going to examine your belly"
I also didn't knew that until a guy who took coaching for the CSA told me. Surprised that even some Physician in Usa also didn't tell me that. That's why this exam is all about smart preparation.
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| kisna
Forum Senior
Topics: 26
Posts: 150
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thanks dell
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| azulita
Forum Newbie
Topics: 0
Posts: 2
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Dell: thank you so much for this info!!! I had no idea that I wasn't supossed to touch the gown!
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| altabban
Forum Newbie
Topics: 2
Posts: 29
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thank you s much for the information...
it's really helpful.
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| azirikani
Forum Elite
Topics: 61
Posts: 189
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hi guys
is it wise to say patients"I may refer you to specialist" ??
is it forbbiden ?
thanks
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| dell1100
Forum Newbie
Topics: 3
Posts: 21
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never ever refer your SP to a specialist. (It's always wrong for Step 2 CS and also for Step 1 questions).
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| sackatdoc
Forum Guru
Topics: 8
Posts: 610
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the cd from usmle as a test guide distinctly mentions this in donts.i just heard again yesterday,
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| FANTASTICUSA
Forum Newbie
Topics: 2
Posts: 5
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To dell,
do u have any idea how CIS is graded whether its a checklist like in ICE or its a scale,as noboby knows how it is scored,even i failed in CIS,that makes me think it cant be a checklist as i did most of the things.
if u know please write
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| drems
Forum Newbie
Topics: 1
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God bless you dell. Best wishes in your future endeavors
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| dell1100
Forum Newbie
Topics: 3
Posts: 21
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Hi FANTASTICUSA,
As far as I know everything is graded by the check list.( otherwise how can the evaluator or the ECFMG guys know your performance in the encounters ) But no one can ever know what is the official check list. If you come to know the official check list then the exam is not that hard. What we can do is that, be prepared to the best of our knowledge hope for the best. Also it's not whether you have done all the check list items but what matters is how well you have done them.
ECFMG guys do a lot of research and update the exam periodically and so the exam is no longer easy as it used to be.
So, we have to gather all the latest information by taking some coaching or discussing in the forums though I prefer the first one. This is all that I know. All the Best.
Edited by dell1100 on 09/25/08 - 03:50 PM
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