arivero
Forum Senior
Topics: 22
Posts: 87
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Guys let me start making my contribution to this fine web site that has helped me through Step1 and Step 2CK. I am an IMG Grad 2002 from the Dominican Republic. My English is crisp because I was born in the Bronx, NY and my early school years were here all the way through Highschool.
My exam was yesterday at Philly at 8am. I used First Aid,CS Protocol, and read some cases of UW that were not in FA. I practiced the cases with my wife, and I want to thank her for all the pain I put her through. The exam doesn't begin till about 9 because they have to check ID's and Confirmation letters, they give you the pads and a pen, show you to a locker where you put all of your personal belongings not allowed during the exam, and then they show you a video that looked pretty much the same as the one on the orientation material. I was really anxious for the test to begin to get it over with, and all that waiting was driving me crazy. The proctors are really nice, calm, and collective which helped me realize that they do this everyday so why should I be nervous if hundreds of Doctors and Med Students go through this ordeal everyday. So I'm just a number on an assembly line and it's time to go to work.
So the exam began and since I can't go through the cases in detail, because of privacy laws, I'll share some of the things i did right and some that I did wrong. Generally I went in thinking that I don't have to be perfect, and that the time restrains would not allow me to do a complete and accurate History or Physical Exam. So I stuck to the general rule of thumb. You know this already, the knocking, name calling, empathy, helping out with the draping, helping the SP's get off and on the table, smiling when it was appropriate, washing my hands before the PE, moving the leg extension on the exam table while holding the SP's leg when I would ask them to lie supine for the Abdominal exam, using transition sentences, trying to make eye contact when I would ask them a question and not just look at the blue sheet in front of me, standing if the SP was simulation pain or if the situation demanded that I should stand out of respect for the SP's concerns. I would try to counsel for what ever reason, but I know that I forgot to counsel in some cases, and my suggestion is to not wait to the end of the encounter because if you have not practiced enough you will forget. Also, if it's a pain case and you have to palpate the abdomen make sure you explain the importance of doing the test before you go in like a butcher to test the SP. Usually they will give you permission to do what ever test you want but you have to get their consent first, and you don't have to palpate hard or examine the SP like in a real clinical scenario.i.e. When your doing Murphy's Sign or rebound tenderness or sticking a tongue depressor in the SP's mouth you dont have to apply much pressure because it's a fake clinical encounter and they are making their complains up and can you imagine being an SP and having 12 people come and examine you and pinch you and press you everywhere. The proctors tell you this before you begin the exam, they say to be gentle to the sp's. So just be as gentle as you can while still getting the work done properly. Anyways, before each encounter I would write out the patients name, age, cheif complain, any vitals that were abnormal, and I would make sure to read the situation because they are mixing things up now so it's not the same as in FA. For example the settings are different in a way that the case might say that the patient is in an emergency room, outpatient clinic, or that a mother has her child in the pediatric triage and she wants to speak to you for what ever complain she has on the child. So reading the setting will help in the way you talk to the SP. I think they are trying to mix it up to see how you handle different situations. I wouls also write on the blue sheet my mnemonics. I always wrote ODPPSFC, LIQRAA( for pain), WADES, PAMHITSRUGSFOSS, LSODAWET. I would always ask CAGE questions if they drink too much. If it was a pediatric case I would write down ODPPSFC, ONCALLIDIOT, BINDERS,PAMHITSRUGSFOSS. ( for all of these mnemonics just go to first aid, and cs procol web site). Also I would make a mental note of DD and maybe one workup. I would take maybe about 1 minute to go in the room. I remember that some examinees would just knock and rush in the room, but I tried not to let this bother me. So I went in the room and hit them with a battery of questions and when I though I asked everything possible in my brain I always tried to recap the important history to the sp just in case I missed something, then I asked them to excuse me while I washed my hands, then I did the physical exam with all the respectful maneuvers, and then I gave them like 1 or 2 DD's and I would tell them why I was thinking this and some workup that I would send for like blood work or x ray. I always thanked them, shook their hands, and said that we will meet again. They always have a question for you and they don't wait to the end of the encounter to ask you, so just give them a nice political answer and ask them if they fell OK with the answer and if they have any more questions for you.
OK, so it might sound like I must have aced this test, but here are the things that I think I screwed up on. In one encounter it must have been the second because I was still getting used to everything, I forgot to knock on the door and I just barely cracked a door opening but then I remembered to knock first so I kind of closed the door and knocked before entering. I don't know if this is considered not knocking of partially knocking, but I remembered not to do it again and it didn't happen again. In one case I totally ran out of time while I was in the middle of the physical exam. In this case I had no idea what the hell the sp had so I think I was asking too much questions and when ever I thought i had a clear path to maybe some DD's she would deny the symptoms. I was totally perplexed with this case so I just wrote what ever I thought on the PN.
The last thing that I would like to write about for now is that I didn't get to do the Neuro exam in it's entirety. I didn't get any case that I thought I should do it in. Im thinking that it was on the case that had me confused. Also I forgot to do the eye exam on patients that told me they had HTN, or in cases that their vitals said they had HTN.
I think that's it for now. If I think of anything I'll write it. I'm open for any questions or comments, and i would like to thank the people that make this website work. Thanks!
Edited by arivero on 08/30/08 - 06:09 PM
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| arivero
Forum Senior
Topics: 22
Posts: 87
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The more I think about the test the more things I notice that I missed. I forgot to ask about suicide ideations in one case. 
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| USMLEGladiator
2009 & still in race
Topics: 135
Posts: 509
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in which hotel u stayed in phili? charges?what is medium of transport to phili frm new york?im IMG.knowing nothing abt transport in usa.thx
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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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USMLEGladiator,
Take train (AMTRAK). It's more flexible and it costs only $40-80 one way. The test center is very close to the 37th(?) St. train station in Philly.
There's another cheaper alternative called "China town bus", but it's not that safe w/ some sketchy people on it.
___________________
99/99/Pass; Certified; 2003; US PhD; 2M US clerkships; GC; Chance favors only the prepared mind. - Louis Pasteur
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| arivero
Forum Senior
Topics: 22
Posts: 87
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I drove down to Philly and I stayed at the Best Western in Central Philly. The cost for a room is 119 dollars plus tax, but you have to tell them that you are going to take the CS test so they can give you a discount. The rooms are nice and clean and there is a supermarket called whole foods like a block away where you can buy food and anything you need.
The test center is like a 10 minute drive. If you take a cab it will cost about 15 dollars. To get to philly you can take a bus,train, or a plane. Check this web site for more info.
www.usmle.org/Examinations/step2/cs/Phila.html
Good luck on your test
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| sackatdoc
Forum Guru
Topics: 8
Posts: 599
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arivero,as you already know this exam is not about doing all the things in lousy manner but doing all essential things in sound and safe way so by these standards you did ace the exam, for what its worth, the things that you didnt do are the set you forgot but it could have been anyother set of forgotten things on anyother day, cannot do and remember things like a computer,
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| arivero
Forum Senior
Topics: 22
Posts: 87
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What do you mean by that?
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| USMLEGladiator
2009 & still in race
Topics: 135
Posts: 509
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thanks cherryho, Thx arivero.
___________________
Chance favors only the prepared mind. - Louis Pasteur.
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| sackatdoc
Forum Guru
Topics: 8
Posts: 599
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i mean what all you forgot is acceptable, and anybody forgets such things on an exam like this, so randomly on anyother day there would be some other similar things that you'll forget, so doing everything by the text book is not possible
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| arivero
Forum Senior
Topics: 22
Posts: 87
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Ohh, now I get it. Thanks for everything.
How long do you think it takes for the results?
I'm kind of in a crossroad right now. I don't know what to do. I don't know if I should start my match application or wait for the results. Can someone help me?
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| sackatdoc
Forum Guru
Topics: 8
Posts: 599
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i am in a worse state than you, still to take exam on 11 this month, have been reading about people already applying and feeling happy, my plan is to apply by 15 sept to the programs which donot require passed CS at time of applying inorder to get saved from filtering process, hope its not late,
the schedule given by ECFMG website tells the time period during which results wiil be declared
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| arivero
Forum Senior
Topics: 22
Posts: 87
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I guess I have to apply soon. I'll start doing my research. I think I have to apply through ERAS right?
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| dr_puma
Forum Guru
Topics: 35
Posts: 503
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congrats ,thanks for this nice post
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do whatever u want,but do it wholeheartedly...never hold back.
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| arivero
Forum Senior
Topics: 22
Posts: 87
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ECFMG CERTIFIED ! I can't believe it. It's for real. After all these years it finally happened. Thanks you all for your help. You all made it feel more comfortable to go through all the Exams. Thanks for this great Forum. Good luck to all.
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