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 well...got my CS result  



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  #1

it's been a while since i did not post any topics.....since i took my CS exam in March, i kind of took off from studying.....

since today i received my CS result, it's time to give it back.....i wanna believe that my strategy will help others like me; i am an IMG who struggle on step 1(got 79/195); i knew that my only chance of improving my chances for a residency is by getting a good score on step 2 and by the first attempt: i already post my CK experience(got 99/230) and today, april 27th, i got my CS result: I PASS!!! i am extremealy happy cause in my opinion CS is by far the most stressful exam(and i mean it); the reason is very simple: for step 1 or CK, you study hard and the result will be positive; now, for CS is different: you are dealing with a real person, not a computer, you only have a certain ammount of time to deal with that patient, you have limited ammount to write the patient note, etc; the stress is so intense, it is really hard to explain in words(some of you may say is not that bad but for me it was)......

preparation time&books used: in january 21st i took CK and at that time i knew that my CS exam is on march 17th; so i had like 2 months of preparation; after taking CK exam, one week i took off; i study a lot of hours and i was kind of burned out; after this 'mini vacantion', i start to read kaplan CS book(i really don't know the exact name of it); in my opinion this book should be the very first and only book for the explanations given on how to proceed with the history taking, physical exam and patient note(they give a bunch of details and some mnemonics which i highly recommand to be used by people who are going to take this exam); i read this book 1 time during a 10 day period; in february 9th i got my CK result and i was so happy about it; here i made a mistake by taking off another week(i was just so happy and my mind would not with the CS books); after second 'mini vacantion', i realise that i have to study seriously from that point until exam day; so, by february 15th i start study really hard: i read one more time the kaplan book without reading the cases and then i start to read FA; since i already had a plan about how to go with history taking, i did not find this book so useful cause it has a different aproach that kaplan has(again, this is just my opinion); after reading the theory from FA, i start doing mini cases(excelent tool for CS....it gives you enough ideeas about what to think for on DD and labs); i read those mini cases twice and then i start doing the 41 cases from FA(i used as mnemonics from kaplan SIQOR PP C/I-FD AAA); this book regarding the cases is excelent and better than kaplan cases; after i read all the 41 cases once, i went one more time through them but second time writing the patient note with a clock(most of the time i need at least 1 or 2 minutes to complete all the details); after completing second reading+writing patient note, i read kaplan cases(i did them once); after this i start doing all of them with my wife(FA and kaplan cases)....what i did is i wrote on a paper the tasks which we were suposed to do and on the back of the paper i wrote in which book is the case and at what page; my wife took randomly 1 case, read it from the book and then pretend she is the patient; i got an otoscope, ophtalmoscope and a tunning fork from a good friend(big thank you L. and K.-i am not gona mention their name but they know how much they helped me and i am really thanksfull to them) and i had an stetospcope; we were pretty much all set just like in the real exam; we went through all the cases except 5 or 6 which we could not finish(i had to fly to chicago); the cases were done in the evening and during the day i was reading from Mastering the USMLE step 2 CS by Reteguiz(a so-so book and defitevly not a must or a single book for CS);

the day before flying to chicago i did not study at all....i took with me kaplan book and some notes which i made during my study; i read all the notes and one more time very briefly kaplan book; on march 16th i land in chicago, i took the van to the hotel(my budget is tight, so i was looking for something cheap but to be close to the center; i found this hotel which was not even 10 minutes of walk from the center and i payed arround 70$ for 2 nights....the hotel is called Chicago O'Hare and i booked it toghether with the plane ticket from expedia....at that time it was the cheapest site who offer a good deal for hotel and flight); i arrived at the hotel arround 5pm; after i checked in, i walked to the center.....by the time i was at the 6th level in the building, my heart rate was arround 200 smiling face .....i came back to the hotel, bought a sandwich and took a shower; i really did not want to read anything else cause it would most likely freak me out.....so i watched a basketball game and by 10 o clock i went to bed; woke up at 6.15, took a shower, dress properly and then i had a few donuts and a cup of tea from the continental buffet(the hotel did not offer anything else except those donuts+tea/coffee); i took my white coat in a bag and i walk to the center; i arrived there by 7-7.15....i was the second one....they told us until 7.30 they will not let us go upstairs; adrenaline was rising and rising; by 7.30 all 24 students we were there and we went to the 6th level; i was designated with number 23, then we all looked at the presentation(i recomand you all take a look at it before going to exam and it can be found at this link: http://www.usmle.org/Orientation/2011/menu.html); after that we all went to see the patients; by this time i was shaking and had so many butterflies; being so stressed, on my first patient i made some mistakes: by the time i had the 5 minutes announcement, i was just washing my hands; i did a very focused PE(he had an abdominal complaint) by doing an abd. PE and listen to his lungs and heart; by the time i was telling him my impresion, i got the anouncement that i have to leave the room....i apologise that i have to take this urgent call, shaked his hand and i left the room; of course i did not have time to finish the patient note but i finish most of it; for the rest of the patients i did everything which i thought is good to be done(i did not have any other time issues); on one of other patients on PE i only did neuro exam+lung and heart auscultation and i did not want to risk on doing abd exam and not be able to tell my impresion(this was a very good ideea cause by the time i was shaking her hand telling her bye-bye, the announcement was on and tell us that we have to leave the rooms); after 5 encounters, we had lunch; after another 4 encounters we had another break and after last 3 the day was over......when i got out i knew this was not a outstanding performance; i made some mistakes here and there and i am 100% i did more which i can't think of; i hoped that those mistakes will not influence a lot the final result

i am attaching to this post my performance profile.....this is not a excelent one but might give an ideea about how i prepare and how this can be corelated to a real exam performance. i am not an A student but i strongly belive that with hard work and help, those USMLE exams can be passed with good scores; since i am one guy who needed a lot of help from different sources, i think kaplan books is the best choice for people like me; this is the reason why i will always recomand kaplan books and it's not because i wanna give a free publicity; it helped me a lot and it's 100% onesty.

at the end i wanna say thank you to my wife which had to 'suffer' through all my teaching maneuvers, big big thank you to my mother in law who was here for my entire CK and CS preparation and took care of our son, to my good friends L. and K. for helping me with the materials and advices and last but not least to my son who is always in my mind no matter how tough his life can be. thank you GOD for giving me strenght and power to achive this!

i wish all of you good luck and all the best. cheers!


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Edited by anatomie on Apr 27, 2011 - 3:12 PM



  #2

congrats!!! well done


On Apr 27, 2011 - 9:24 AM, anatomie responded:
thank you!


  #3

man many congratulations , really good inspring exam experience

best luck


On Apr 27, 2011 - 2:57 PM, anatomie responded:
thank you for your words.....all the best to you!


  #4

well done ........buddy .......
could u plz tell me how u practised patient note i mean what was ur aproach right frm the begining and if u hav to do it again what u would do .......
my exam is near so i wanna know if u can advise me on how to get practice of patient notes and what protocol should i follow ...... thankx a lot


On Apr 28, 2011 - 9:28 AM, anatomie responded:
thank for the kind words....there are so many advices regarding how to approach the patient note(PN) but i will tell you what i did and also i will tell you why i did in this specific way.....

since i took the exam in march, i still had the posibility to choose to type it or to hand write it; i know from july everybody will have to type it on the computer; i really don't know what are your preferances but if you follow the next steps, it will help you a lot

if you are using the hand writing version, i suggest you print at least 70 papers(40 for FA and 30 for kaplan cases) with the exact format(for sure i know the kaplan book has it inside the book and i also think FA book has it inside); if you will type it, use this link: www.usmle.org/Orientation/2...PatientNote/EntryFrame.htm ; everytime you do a case write the PN and make sure you have a watch with you; another point: LEARN all the allowed abreviations!!! this will save you a lot of time and space!
next: do a case from FA or kaplan book.....look at the tasks and in your mind think for a minutes which questions you might ask that patient....then write down all the questions you wanna ask(i did with every single case and every time i used mnemonics...in this way i did not have to write so much)....after you are done with the questions, look at the answers and write them next to your question; when you are done with them, open the computer/take that PN paper and start the clock; from this point i have some sugestions which i think are very good:

1. always start with the differential diagnosis(DD); everythink should be fresh in your mind and you should have at least 3 for every case(in my exam i had for every case at least 4 but most of them i had 5)
2. write the diag. workup; you might know this already but this workup should only be relevant to what you already wrote in your DD!!! an example: if you have a SP with a cough, you put 5 DD but none is TB; on workup you will ask for sputum acid fast coloration, PPD test, CXR, etc; trust me you will not get any kind of credit for this specific workup because your DD does not contain TB.
3. write the physical exam.....here always write the general appearance and vital signs(even if they are normal!!!! if everything looks good, just write VS: WNL, GA: NAD; look for the abreviation in FA or kaplan book)
4. write the patient history.....i used very short sentences and i was not elaborating anything; for example: 45 y/o M c/o abd pain: epigastrum, 7/10 intensity, sharp, started 2 hours ago, radiates to his back, no precipitated event, getting worse, constant pain, not alleviated or aggravated by anything; also pt c/o nausea, sweating, and vomit(acidic, no blood, 1 episode 30 minutes ago); he did not have other similar episodes in the past; ROS: none except as above; then go with PAM HITS FOSS;

why in this specific order? you might be short on your time.....if you write in this specific order, you might end up not writing few things from family history, sexual life or social life; even though those are important, they are not as important as not writing DD or workup if you decide to start with the history, then going to PE, then to DD and then to workup.

i hope this will help you....i wish you all the best and good luck!


  #5

congrats!!!


On Apr 28, 2011 - 9:00 AM, anatomie responded:
thank you!


  #6

Hi
congratulations !
I'm sure it feels great to be done with all the tests !
I have my cs exam next week,I feel that I'm doing fine in the patient encounter,but I have a problem finishing the patient note in time
did you write the notes like the ones in first aid? coz the first aid patient notes are quite long for the 10 minutes,I always forget or don't have enough time to finish all the history,however DDx,work up & PE are usually fine
did u feel that 10 minutes are enough to write everything?
I'll be grateful for any advice.
good luck in the match.


On Apr 29, 2011 - 5:18 AM, anatomie responded:
hi there...thanks for you kind words

don't worry about timing in real exam; like i said in my initial post, when i was practicing cases, i always need 1-2 minutes extra to finish the PN because i already knew the cases.....i already read the cases before and i knew what kind of questions to ask; on real exam it will not be the same; you will not get all the questions from the checklist(i can guarantee you that) and you will have enough time to write pretty much everything you wrote on your blue paper; somebody ask me how to approach the PN and i said to start with DD, then go to workup, then PE and last go with history; for my every single PN, by the time they announce the 2 minute mark, i was typing family history/social history; except my very first Pt which i did not have time to finish the PN(see my initial post), the rest of the notes were finish just on time(i mean seconds before the announcement that the encounter is done)

bottom line: if right now you need 1 or 2 minutes extra to finish the PN from FA or kaplan book, you should not have any problems in the real exam with this situations(this is my opinion)....hopefully this will help you; good luck and all the best!


  #7

thank you so much
I'm currently in the panic mood & your words were very helpful !


  #8

Congrats smiling facesmiling facesmiling facesmiling facesmiling face

I also got my results last Wednesday smiling face I feel like the happiest person on earth ! grin


On May 02, 2011 - 4:20 PM, anatomie responded:
congrats to you too....it is such a big relief isn't it? smiling face


  #9

congratulations callie and anatomie. I am gonna take CK on 1st week of June and my CS on July, so that gives me barely 35 days actually and Im kind of nervous about the whole thing. they said practice and practice. I am left with my 14 year old cousin to practice with, otherwise, i would be practicing with the mirror. any feedback about online courses like CSE? I want to check it out aside from FA and neeraj which i plan to use too. I hope Id see that PASS on my CS report too. I am taking it Philly. IMG 2009. smiling face


On May 03, 2011 - 5:18 AM, anatomie responded:
well....35 days for CS is not bad at all; to be onest with you i don't think i study more than that(real time studying);
first aid is a very good for the cases; for the theory i used kaplan CS lecture notes(i apologise but i don't know exactly the name of the book); in my opinion the kaplan lecture notes is much better than FA on the theory because gives so many details and explanations on how to do the history, PE and PN(for me this was hudge cause i really need guidance);
after you are done with reading the theory, you have to practice.....14 year old cousin is not bad as long as he/she wants to help you; he/she has to read the case(you will see on Fa book that there are some tasks for him/her on what they have to say and what they have to do when you go with the Hx and PE and also he/she should give you a chalenging question....everything is written on FA);
you should also practice all the cases with time; also practice PN with a clock and learn all the abreviations allowed; this will save you time and space on the PN.
as an advice.....practice with your cousin the PE.....it should be as a second nature or better said you should be like a robot; when you wash your hands think what PE you have to do; then do the PE without thinking of what you have to do next(if you practice a lot you will understand me);as an example: lets say you have a neuro case(this is the most chalenging PE).....you will have to do all 12 CN except smell, you will have to do motor and sensory sensation of upper and lower extremities, you will have to do the DTR's of arms and legs, you might have to see how the SP walks, might do the vibration sence, cerebellum function,etc; all toghether takes about 3 minutes if you don't think about the next step(aka....ok, i did CN 2 so i have to do CN 3, 4 and 6.....what do i have to do? i know....i have to move my finger in an H position and the SP has to follow it.....etc); all this steps should be mecanically in your head(somebody said that you should not think, just act)

i wish you gook luck and all the best!


  #10

thanks anatomie. i have been thinking about that neuro PE too. i will try to look for that kaplan book on CS, i know only of first aid. now back to CK mode. haha. thanks a lot.wink


  #11

Hi anatomie....

I followed your great method and did the same with my wife .....and

i passed with high performance in all components with star in Data gathering...

Thank you very much you helped me a lot..

This is my second attempt ..I had a very bad results in data gethering and PN in my first one ...I did have a plan(Despite i took Kaplan expensive course) ..My second time i followed your plan and .......

I DID IT>>>>>Thanks .

My best wishes to you and to your great family.


On Aug 18, 2011 - 9:45 AM, anatomie responded:
Congratulations!!! You should be pround of youself.....now CS exam is history; It's been a while since I post this topic but I am so happy is still helpful.....I wish all of you good luck and all the best in your future medical career


  #12

congratulations on pass the exam
i hope for pass as well


  #13

hi anatomie it's unfortunate i couldn't read your post b/4 my exam.i took mine in philly last month and i only draped 5 patients whom i did abd exam on,the rest had chest pain etc so i did a focused PE and history taking. in one of the PN i ran out of time so couldn't write dx work up.the rest of the PN i wrote atleast 4 ddx. do you think i stand a chance of passing? am so scared i mean how could i hav 4gotten to put the drape on even when the SP only needed to sit? am so scared


On Sep 15, 2011 - 11:56 AM, anatomie responded:
it very very hard for me to tell you if you will pass or not....I've seen so many post for CS exam with a lot of mistakes and still a passing result; I've also seen posts where people were so surprized that they failed because they thought they did almost everything.....

my advice: wait, pray and hope for the best.....

I don't wanna make you feel better but if you look at my CS profile(it is attached to my initial post), you will see that my data gathering was mediocre but I had a very good patient note(I had star on it)....per total I had a pretty decent ICE profile; from your post, it looks like the major problem was on Hx taking and PE; if your patient note is very good, you might have a very similar profile like mine and to get a passing score on your exam.....

please do not think about it anymore.....you will just suffer too much and unfortunatelly you can't change it; whatever you did on the exam, is good done.....until the result will come, don't think about it(I know is hard but try as much as posible to stay away from it)!

Good luck!


PS: I am so happy that my post is still helping you guys.....it's been quite a while since I post it but it looks like it's useful.....


  #14

thank you anatomie, i will try to stay cool.GOD will surely HELP me





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