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 Passed- my experience  

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Did Oasis trick today and learnt that I have passed. Thank God. The painful wait is over. Let me share some of my experience for the benefit future exam takers and also those who have taken it and anxiously awaiting for the results.
Let me give a profile of myself so that people can compare themselves. It is no point saying that I read in just 7 days without mentioning what I am made of! I am a post- graduate in Pediatrics and am ‘considered’ generally as a “bright” student by many. Working in India with no US exposure. Speaks normal Indian English and can usually understand 50% of dialogues in the English movies! I got 99 in both steps.

I prepared for CS for one full month; mostly in the evening after the hospital hours except on holidays when I use to sit the whole day. I read through the USMLE world notes at least 3 times and first aid twice. A week before the exam I practiced nearly 90% of cases with my wife. I had not practiced the telephone case (which was a mistake as the telephone case is not as easy especially for understanding the accent through phone). I was in US for 4 days before the exam so that I can learn the usual way people in US interact and communicate. It is important I guess!

Irrespective of how may cases we practice, I think the most important practice case unfortunately will be the first case we face in CS exam. I messed it up for one very important reason. I got distracted by a wrist joint swelling and wasting of thenar muscles (probably wrist arthritis and carpal tunnel syndrome). I wasted nearly 2 long minutes enquiring about-obviously he has been instructed to say “no’ for all the questions outside his ‘syllabus’. His basic problem was “something else” (not supposed to divulge cases) and is an easy case to crack by any measure. He was a standardized patient of that “something else” but a real case of wrist arthritis and carpal tunnel syndrome. But one doesn’t get credit for diagnosing his real problems. So important rule no is don’t spend time on findings or history not relevant to chief complaint. One simply doesn’t have the time for it. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

As I wasted time, I couldn’t summarize the findings and couldn’t counsel regarding the investigations and treatment. When one is absorbed into the case, we will not hear the announcements made 5 minutes before the exam is over. So don’t rely on that. Watch your wrist watch. I use to set my watch as showing as 10:00 before starting each case. It is easy to deduce the time left after you enter the room. I use to switch ‘on’ the watch (press the key) as soon as the announcement says “SPs you may please get ready for the exam” Generally it takes 20 to 30 seconds after this announcement, the examinees are allowed to enter the room or open the box. So you have additional of 20-30 seconds (after the watch shows 10:15) still at your disposal. I found this very effective. I had kept the dial of the watch over the front of the wrist rather than the usual back of the wrist. I use to look at the watch –when washing the hands and when auscultating or examining the back. Never mind….. you can look at your watch at any time, even it is obvious for the SP. It is important to keep the time. In fact it is the most testing aspect of the exam.

After the first case, I had realized my mistake and could finish at least all the rest of the cases in 14 minutes. Came across a h/o fracture in the past and few surgeries in the past in few cases (didn’t waste time on the details) and also found varicose veins on a patient-just noted it-didn’t go into the details of it. Please do not think that SPs don’t have findings. Some have lymphadenopathy, tonsillar enlargement, goiter, wheeze, etc. So be sure to look out for these.

Do not spend time in writing the PAMHUGS FOSS while you are outside the room. It takes some time; more than that it increases your anxiety. So get into the room as you make some differentials. No point in spending more than 30-45 seconds. When you start taking the past h/o start writing




And take note of the details then and there. If you have rehearsed enough during your practise, then this should do. If you think that you are liable to forget PamhugsfosS, then this means you have not adequately practiced.

The same thing can be practiced for other mnemonics. Write them vertically down the order-that is user friendly! Remember that you have the back of the page as well! I didn’t use it-anyway.

If you are running short of time towards the end of the examination, then skip less relevant examination and proceed for counseling. It is very important to follow this as you lose lots of points if you don’t counsel and you may lose only a point or two if you don’t complete the examination in detail.

Regarding language, most Indians wouldn’t find it difficult. Be ready to greet them. When you introduce your self many would say “nice to meet you”- acknowledge that by saying ‘you too”. I couldn’t understand few of the SP’s responses while doing the telephone case. I had to give up. Also she couldn’t understand a few questions put across by me. But I said that I have adequate information and would verify the ones we left out when she brings the baby to the hospital!

When you write the patient note, practice writing only the relevant ones for the case. You don’t have to write all about PAMHUGSFOSS in the patient note. In the scrape paper provided to you (a blue one) you can underline or CIRCLE the ones that are important i.e., to be written in the patient note. This should come handy. Note down the positive ones first. Not necessary to write down all the negative ones. Use accepted abbreviations whenever possible- it really gives you lot of time to spare and the note would appear neat as well. Invariably your patient note would look unsatisfactory for most of you, I guess. If your handwriting is awful, better to practice typing if you are good enough.

After the exam, I felt good for few hours… I knew that I hadn’t done well in the first case (in the sense couldn’t counsel) and had some problem with the telephone case. Rest I thought was decent. However as day progresses, one starts doubting about lot of cases- I was wondering whether I missed some DD aor didn’t priorities the DD well and so on and so forth. I don’t know whether my fears were unwarranted or real. Finally I came to a conclusion that I have done 6 cases undoubtedly well and four-definitely average and 2 less than satisfactory (in patches). I was extremely worried about my handwriting (was very tremulous after I ran out of time with the first case) and the writing improved after that. Nevertheless I was a bit concerned about the handwriting aspect. After few days you might think that you wont be surprised if you fail. However after 6 weeks I again felt that I had a good chance to pass! So if you find dip in your spirits, I have reason to think (I have passed!) that it may be normal. Relax until the result is out and Enjoy after it is out.

Be systematic…

Never forget greeting the patient, introducing you, hand washing, and transition statements… Include all when you practice…

You can always ask more information about the symptoms when you are examining also…

Use all mnemonics- it gives a lot of confidence…

Anticipate disappointment in the first one or two cases… You will regain your composure soon… don’t lose heart… It happens to all….

Ask Pamhugsfoss for all….

Don’t overspend your time in details (both history and examination) that are less relevant to chief complaint….

Practice writing patient note for at least 30-40 cases….

Use abbreviations as needed…

Never be complacent. Work hard….

Practice, Practice, and lots of Practice. …Practice is the key.

GOOD luck. I am ready to answer your queries if any.



Thanks , for such a detailed and valueable information.
i wanted to know that while u were reading Usmle world for the first time, did u practiced on anyone
what should I do I dont have anybody to practice on?
r these cases simple? or do they have surgical and all kind of stuff?
please reply
thanks again


Thank you HP and congratulations....


Nice post! Thanks! I guess my question is if the 40 cases from USMILE are representative of the complexity of the real exam. And also, how do I practice by myself?


Thanks for the replies.

Initially I read UW notes twice. During the third one my wife would pick any of the cases from the 40 and would read the patient information sheet and would act as the patient. After we completed it, we sit together and mark on the notes-regarding how many missed. This process has to be repeated for all cases preferably. if you are alone your practice may not be perfect and timed. Ask your friend or relative to help. A medical person is better... but others can do as well. Practice telpehone case also through phone. It may be useful. UW covers the entire spectrum. I had one case outside the "UW syllabus"! But I could do it well.


thank you very much. Very useful topic.


Hi friends,

I took this test at Chicago center on August 24th and Oasis was updated one week ago. The paper results arrived the last Friday and you can imagine how incredibly happy I felt when I read the result: PASS.

I'm a general physician and Spanish is my native language but I was learning English in my country in the freetime of the med school. Thanks God, I obtained an observeship in USA for 3 months and I travelled to US 3 days after taking my step1. So, I have the 3 months for the observership and to training for the exam.

The first month was so hard because it was my first time in a USA hospital but it help me too much because I could learn common medical phrases and each time that I have the opportunity to speak with the residents or any Spanish speaking patient I offered myself to help the residents, and it helped in the Spoken English proficiency. At least, I guess so.

Well, I follow the advices of my friends and people of this forum and I also took the USMLE world course, it´s really great and useful. At the same time, I read and practice the first aid for step2CS and I also practice the 40 cases available in this webpage. It was so helpful with the telephone encounter. In fact, I had a similar telephone case during my exam. It was so hard at the beginning because of the English accent by phone but finally I did it.

I was living alone in USA; so I practice the cases of the USMLE world with the people working in the guest house. They were normal people, I mean adult people around their 40's, they could be any patient of the hospital- and they corrected my pronunciation and suggested me non technical words for the interviews. So, it was a play-role, they act as a patients and me as a physician. I learn how to be understandable with my language. Although, they didn´t have enough time to practice with me but I try to approve any time available during the weekends.

I´m totally agree with the people who suggest that practice is the key. That´s right, mainly if the English is not your native language and when you feel anxious you can forget some words but if you practice, you have more options to replace the most common words with others available in your mind. I practice the cases as soon as I returned from the hospital, and I did it almost everyday. I also see news to improve my English listening, make phone calls to information offices to try to practice indirectly my English listening by phone.

I think that it´s a gift of God and I want to say THANK YOU VERY MUCH to all the people who provide advices and their experience by this forum. It help me too much.

My best wishes for everybody until the next time.

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