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 Passed in Philly!  



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  #1

Phew! Passed CS with good performance in ICE.
Here's my story (will be happy if it can pep things up for even one person):- Up until early this year, I wasn't even serious about usmles. So I was a little skeptical about taking CS before other steps. But since I had heard a lot of stories about people flunking despite 99s, I didn't want to put in efforts in other steps (since they need more sincere reading), until I cleared CS.
It took me around 15 days of serious work in addition to 15-20 days of not so dedicated efforts to prepare for the exam. I was working fulltime while I prepared for this exam. So for the first 15-20 days, I was casually watching csevideo. This site gave an orientation as in what is the patient encounter like. I also watched usmle cs orientation video and read the cases whenever I found time. Once I completed watching all patient encounter videos on csevideo.com, i started practicing patient notes on the same site. Once that was done, I started with UW, watched all examination videos and read the sample cases. Didn't start practicing yet. Once I completed the reading, I felt like starting practicing. So I convinced my husband to do 1-2 timed cases with me. I gave him the case scenario and then we practiced. Now this was the 3rd day of my 15 serious days. Since my husband had a full time job too with long daily travel to and from NY, it was difficult for him to devote time for this so I found a skype study partner on prep4usmle. Thankfully, my sp was very flexible with his schedule to accommodate for my worktime needs. We targeted to practice all cases on UW in 1 week along with typing patient notes. I was off from work for this week. We also managed to read through the FA minicases once together and once by ourselves to get thorough with the DDs. Then we started testing each other with random cases from FA. I practiced with my sp sincerely for 10 days and then I preponed my exam because I had to resume work and I didn't want to forget things or get out of practice. He postponed his exam due to personal reasons but I am glad both of us passed!

Here are my 2 cents around CS preparation and it helped my sp as well.:
1. Get oriented to what CS is like
2. Should know the DDs. I was too scared because I was lacking the strong base that most candidates have , having given one or both steps. For this minicases were very helpful
3. once you know the DDs, you have a set of questions to ask. I made lots of mnemonics and also shared with my sps.
For example, for the CNS case along with NICOT GUST WADDEST (from csevideo), I made a mnemonic WOBBLES.(weakness, bowel/bladder incontinence, blurry vision,loss of balance, epilepsy-seizures tongue bite etc, swallowing difficulty)
N-neuro symptoms, headache, dizziness,
I- infection symptoms-fever, rash, Also immunization
C- Chest/Cardio symptoms- cough, chest pain, SOB, palpitation
O-Obs/Gyn
T-Thyroid symptoms

G-GI
U- urinary, GU
S- Sleep
T-Trauma

W- Wt
A-appetite
D- Diet
E- Exercise
S- Suicide/Depression
T- Travel

RAMPOFS
R- Review of Symptoms (which we just did)
A- Allergy
M- Married
P- Past medical/surgical/hospitalization history
O-Occupation
F- Family history
S- Smoking/Alcohol/Drugs/
S- Sexual history

And then focused exam. Make/learn as many mnemonics as you can because during the exam your sympathetic nervous system with take away your ability for critical strategic thinking and you'll be turned into a mere mechanical robot.

Things to remember-
Knock the door
Greet the patient
Address them by name
Drape the patient appropriately
Ask for permission at each step
Ask for potential abuse in case of females and elderly
Wash hands before exam
Conclude the case very well and explain the patients your DDs and what findings are you basing them on and what are the potential next steps in management
Counsel for smoking/alcohol/drugs/safe sex practices
Provide option for social support availability for abused women as well as debilitated and elderly
Ask 2-3 open ended questions


If you do these things, in addition to knowing the DDs and working towards a relevant history + focused exam, you'll pass. If it is hard to remember relevant history points for tons of possible diagnosis, try system wise approach and make mnemonics. For example something like WOBBLES for CNS, If I find time, I'll post more that I made.
Make one for Cardio and pulm; one for pregnancy, one for GU, one for rheumatology, and so on and so forth


A few words on Philadelphia test center. People scared me that it is IMG unfriendly but the staff was very nice and the patients were very generous in behavior. I got good score on ICE. However, per my expectation, I was hoping to get a good score on SEP (since I am a high scorer on TOEFL and IELTS both and I studied for and worked in the US for 3 yrs) and CIS (just because I am aware of the usual US culture and behavior pattern) but I received a little above borderline or borderline. So wouldn't say that it is a lenient center. However, they are not totally unreasonable coz i and my partner, both passed!

The mistakes I made during my exam-
forgot counselling for smoking cessation in my first case.
forgot to write age and sex in patient notes for first 3 cases, but did all the other things pretty comprehensively
ran out of time in a forgetfulness case , hence i just mentioned the name MME and explained the need for it but couldn't actually perform one because I spent ton of time in history taking as the patient was responding slowly. Did rest of the neuro exam though as well as general systemic exam. also couldn't counsel this patient in detail. barely touched on it.
took 1-2 sec extra for 33% of my cases. for 3 of my cases, I moved out of the room immediately after the proctor knocked the door.

The key is know the DDs and basic etiquette and practice and practice and practice and timed practice! Hope you find this note helpful.





Edited by drjs on Apr 25, 2012 - 8:50 PM



  #2

Thanks a bunch for the experience. I have my Step 2 CS now in 10 days in Phili too. All I have time to do is First Aid CS. There are 44 Cases in them. Did you do all of them ? If so do they cover most of the cases you experienced in Phili ?

Do reply at your earliest ! Little nervous about the test. Any Mnemonics too would help. Thanks in advance !

Nik.


On May 05, 2012 - 5:50 PM, drjs responded:

Hi Nik,
FA is awesome. If combined with UW, nobody can stop you from passing with a good margin.I would say that 85% of cases will be from FA, you may get all 100% from FA though. For the remaining 0-15% , just practice history taking and examination protocol. Once you are done with FA,you'll be quite prepared to ask relevant questions even in newer cases. I practiced with UW followed by almost all cases from FA with my sp at random i.e we tested each other with random cases, not knowing which case are we working on and then comparing performance with the checklist. Also definitely go through the minicases. 10 days is more than enough to come out in flying colors.

Here are my 2 cents for your study plan:
Day 1 - complete all minicases with sp or on your own if no sp. have someone to test you by asking a few randomly
Day 2 - 2-4 hours- DD revision, minimum 10 cases timed practice cases with patient notes
Day 3-7- Practice 12-15 cases with patient notes . (Try practicing with different people to get a flavor of 12 different patients on the exam day) Revise DDs and mnemonics.
Day 8- Live practice with sp or friend/spouse/relative. Revise DDs and mnemonics. Read additional interesting material each day like post op complications and go through checklist for counselling and checking for domestic violence, elderly abuse, smoking / alcohol /drug cessation., use of seat belt etc
Day9 - Relax, have a good fiber rich diet at 7pm. Go to bed at 8 pm. Sleep tight. Breathe deep and think good and be confident
Day 10 - exam day!

Wish you all the best for your exams.

Regarding your question on timing. There is one alarm at 10 minutes, then another one when the encounter is over. You are supposed to come at at that alarm but it is okay to conclude your sentence and say good bye before coming out. If you do not go out immediately, the proctor knocks at the door in 2-3 sec when you are supposed to move out. Even then, they allow you time to complete your sentence if you were in the middle of one. Ofcourse, your patient note typing time may decrease a little as the patient note typing time starts as soon as the patient encounter gets over. I felt that even though I was able to finish typing patient notes 1-2 minutes earlier while practicing, I was finishing them just in time on the exam day. so practice typing !


Here are a few more mnemonic that I made-
BLOSCIM for pregnancy-
Blood Transfusion/breathing/breast changes, leg swelling,OBGYN,STDs, Contraception,Immunization, Morning sickness,Menstrual

MUG for NPH(Normal pressure hydrocephalus)
memory loss/confusion; Urinary/fecal incontinence; Gait disturbances

Investigations for pt notes: BURII
bld, urine, Rheumatic, Immunology and Imaging'

FUNDS BHP for UTI (urology history)
frequency, urgency, nocturia, dribbling and incomplete evacuation, burning and blood, hesitancy, pain

For musculoskelatal: SOW FORM JT

S- swelling/redness/warmth bruise scrap,
O- other jt involvement
W-Weakness, numbnes

F- fever
O- oral ulcers/ genital ulcers
R- rash, Restricrtion of movement, redness
M- morning stiffness

J- JT-joint
T- trauma

I made more but unfortunately didn't save them anywhere. I'll post more as and when I remember.

There are a few common mnemonics which you probably must be knowing
LIQORAAA for pain (Location; Intensity; Quality; O for OPD Onset/progression/Duration/constant or intermittent, frequency,;Radiation; aggravating factor; alleviating factor; associated symptoms)
DEATH SHAFT for ADLs CNS patients (forgetfulness, stroke , debilitated patients). Also if the patient is debilitated ,counsel for social support services
DEATH- Dressing, Eating, Ambulating, Toilet, Hygiene
SHAFT- Shopping, Housekeeping, Accounting, Food preparation, Transportation

Hope that helps. ALL THE BEST!!!


  #3

Hi Nik,
FA is awesome. If combined with UW, nobody can stop you from passing with a good margin.I would say that 85% of cases will be from FA, you may get all 100% from FA though. For the remaining 0-15% , just practice history taking and examination protocol. Once you are done with FA,you'll be quite prepared to ask relevant questions even in newer cases. I practiced with UW followed by almost all cases from FA with my sp at random i.e we tested each other with random cases, not knowing which case are we working on and then comparing performance with the checklist. Also definitely go through the minicases. 10 days is more than enough to come out in flying colors.

Here are my 2 cents for your study plan:
Day 1 - complete all minicases with sp or on your own if no sp. have someone to test you by asking a few randomly
Day 2 - 2-4 hours- DD revision, minimum 10 cases timed practice cases with patient notes
Day 3-7- Practice 12-15 cases with patient notes . (Try practicing with different people to get a flavor of 12 different patients on the exam day) Revise DDs and mnemonics.
Day 8- Live practice with sp or friend/spouse/relative. Revise DDs and mnemonics. Read additional interesting material each day like post op complications and go through checklist for counselling and checking for domestic violence, elderly abuse, smoking / alcohol /drug cessation., use of seat belt etc
Day9 - Relax, have a good fiber rich diet at 7pm. Go to bed at 8 pm. Sleep tight. Breathe deep and think good and be confident
Day 10 - exam day!

Wish you all the best for your exams.

Regarding your question on timing. There is one alarm at 10 minutes, then another one when the encounter is over. You are supposed to come at at that alarm but it is okay to conclude your sentence and say good bye before coming out. If you do not go out immediately, the proctor knocks at the door in 2-3 sec when you are supposed to move out. Even then, they allow you time to complete your sentence if you were in the middle of one. Ofcourse, your patient note typing time may decrease a little as the patient note typing time starts as soon as the patient encounter gets over. I felt that even though I was able to finish typing patient notes 1-2 minutes earlier while practicing, I was finishing them just in time on the exam day. so practice typing !


Here are a few more mnemonic that I made-
BLOSCIM for pregnancy-
Blood Transfusion/breathing/breast changes, leg swelling,OBGYN,STDs, Contraception,Immunization, Morning sickness,Menstrual

MUG for NPH(Normal pressure hydrocephalus)
memory loss/confusion; Urinary/fecal incontinence; Gait disturbances

Investigations for pt notes: BURII
bld, urine, Rheumatic, Immunology and Imaging'

FUNDS BHP for UTI (urology history)
frequency, urgency, nocturia, dribbling and incomplete evacuation, burning and blood, hesitancy, pain

For musculoskelatal: SOW FORM JT

S- swelling/redness/warmth bruise scrap,
O- other jt involvement
W-Weakness, numbnes

F- fever
O- oral ulcers/ genital ulcers
R- rash, Restricrtion of movement, redness
M- morning stiffness

J- JT-joint
T- trauma

I made more but unfortunately didn't save them anywhere. I'll post more as and when I remember.

There are a few common mnemonics which you probably must be knowing
LIQORAAA for pain (Location; Intensity; Quality; O for OPD Onset/progression/Duration/constant or intermittent, frequency,;Radiation; aggravating factor; alleviating factor; associated symptoms)
DEATH SHAFT for ADLs CNS patients (forgetfulness, stroke , debilitated patients). Also if the patient is debilitated ,counsel for social support services
DEATH- Dressing, Eating, Ambulating, Toilet, Hygiene
SHAFT- Shopping, Housekeeping, Accounting, Food preparation, Transportation

Hope that helps. ALL THE BEST!!!


Edited by drjs on May 04, 2012 - 3:50 PM

  #4

I know you don't really have to reply since your done with your exam but I really do appreciate it ! The musculoskeletal mnemonic really helped ! Always messed up those questioning. If you could find a mnemonic for a Neuro case history and for the OBGYN history I'd me much obliged.

I'm following a simar schedule like how you have suggested. Just had one more query. When you meant that 80% of the cases come from first aid (if im lucky) you mean including the mini cases ? Or just out of the 44 long cases ill be tested.

I know it won't be exact. But as Long as I have a flow that I'm following in the exam room I'm cool. Additionally the 20% that are out of syllabus per say, how challenging are they ? Are they covered somewhere at least in FA or will they bet totally out of the blue ?

Thanks again for your time !





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