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Old 10-10-2014
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Default My Step 2 CS experience: first attempt, high performance in all 3 components

(This is a bit of a lengthy post)

This is an attempt to help others preparing for their CS exam. I will explain the process I went through, the materials I used and my thoughts on the Kaplan prep course I took.
First of all, the exam is not difficult. It involves much less preparation and study than either Step 1 or CK. Also, it is nowhere near as stressful as the other two. The intimidation of the exam really comes from the surrounding logistics, like the long process of applying for and getting approved for a US visa, and the lengthy process of travel, hotels and money spent. The exam itself though is not that hard.
1) First Aid is more than enough. It will prepare you for all the cases you are likely to encounter and the difficult situations you may end up in. Read it cover to cover, and read it carefully. I personally read it about one and a half times (I didnít finish it the 2nd time). I used the fourth edition, but the 5th is updated to reflect the new exam format, so it is better to use the 5th (in the new format, you list a maximum of 3 DDx and explain what history and PE findings you found that suggest this diagnosis).
2) A good study partner is essential. Ideally, it should be live and with someone preparing for the exam as you. If you canít find a live study partner in your country, start by doing Skype practice and then network with other people on USMLE forums who will be in the same city as you when you get there. Meet at hotels and practice live. I suggest arriving in the US about 10 days to 2 weeks before arriving to have time to get over the jet lag, get oriented with transportation to the exam center and its location and to practice.

When practicing, the idea is not to finish all the cases with your partner. I personally did half of the cases twice with my partner and read the others carefully. The idea is to develop a pattern that you know so well that you can do almost subconsciously and appear smooth. Youíll suck at this at first, but that is what practice is for. After about half of the cases, youíll find that youíve developed a pattern.

Be sure to time yourself when practicing. Rather than use a stopwatch, there is an application on Android and iOS markets called USMLE CS Timer that give the announcements and everything. In the beginning you will go overtime, but that is what practice is for. With practice, youíll develop a sense of the time and be able to manage it relatively well.

3) YouTube videos. I did not use a lot of these, but there is a channel called MDforAll that has lots of short videos that I used to revise some maneuvers, like psoas or obturator or Rovsing sign. I did not use the CSE videos.

4) The patient note entry form on the USMLE website ( When practicing, you must also practice writing the PN. Some people make the mistake of concentrating too much on communication skills and physical exam and donít give the PN the importance it is due. The PN needs practice to finish in 10 minutes, and to get used to the abbreviations you will use in the exam, as well as the number of characters so that you donít run out of space. I personally practiced typing only about half the cases and got a good feel for it. I would personally start the PN from the bottom up, starting with the DDx and investigations. I felt this consolidated my thinking and also made sure I did not forget to write what is essentially the most important part of the note (the diagnosis!).

5) Kaplan course. This last item is really plus or minus. This course is not necessary to pass the exam. I found it helped mainly with communication skills. They will certainly not improve your medical knowledge or your English in five days. What they can do best is help you improve your communication and empathy skills. This course on its own will now make you pass, as you yourself must arrive reasonably prepared and with some practice under your belt in order to gain maximum benefit. It is very expensive too. They offer a course book as well, but if you get your hands on it donít bother using it. I paid for it and it is still untouched. Bottom line, if you can afford it and really need something to boost your confidence and communication skills, take the course. HOWEVER, it is not a must to pass. Many IMGs have passed without it.

These are just some random tips that I think are helpful, in no particular order

1) 1) There is no need and no time to take a comprehensive/complete history and physical. If you try to do that, youíll run out of time. Keep the history and physical exam FOCUSED. For example:
- if there is a case of abdominal pain, you certainly want to do the abdominal exam first and not get lost in an unnecessary chest or cardiac exam.
- If there is a case of COPD you will certainly prioritize the heart and lung exams and take a look at the extremities for edema/capillary refill/clubbing.
- If thereís a case of knee pain, you should start with the knees in your exam. When taking a history, keep the history pertinent e.g. joint pain, history of infection, fever, rash, STD.
The point I am trying to make here is that you should be focused and concise.
2) 2) Use mnemonics! It may take an extra minute at the door to write the mnemonic, but they will save a lot of time when you are with the SP. It is not only about saving time, but it will help you appear smooth and systematic, always asking something because you have a mnemonic in front of you to remind you of it. Without mnemonics, you may find yourself pausing to think about something in front of the SP, which affects your CIS score and makes you look less confident. I found mnemonics to be especially helpful when I did not know what I was looking for, as it made me appear systematic rather than shooting in the dark. The mnemonics I used were OPDFCAAA (onset, progression, duration, frequency, constant/intermittent, aggravating factors, alleviating factors, associated symptoms), PAMHUGSFOSS for past history and SWADE for constitutional symptoms (sleep, weight, appetite, diet, exercise)

3) 3) Do not try to be perfect or to get everything right. You will make mistakes! In one of my cases, because of the stress I was under I frankly told the patient I didnít know what he had, and when I cooled down and started to write the PN I found out the diagnosis. In other cases, I ran out of time before I could finish my closure and counseling. I even ran out of time before counseling on alcohol and smoking in one case. A mistake here and there will not fail you if your overall performance is OK (which it will be with practice).

4) 4) Always ask the SP if he/she has any other concerns or if thereís anything else he/she wants to talk about. There will almost certainly be a clue to something youíve missed.

5) 5) Donít try to get creative in the exam. You may feel tempted to do something new in the exam. Donít. Develop your pattern with practice and stick to it.

6) 6) Thereís no need to bring any food unless youíre on a special diet or something. Everything is available, from food to coffee to sanitary pads and tampons. You might want to bring along some Red Bull or whatever keeps you up because it is a long, exhausting day.

7) 7) A lot of stuff is said about how Houston is the best center for IMGs. I took my exam in Chicago, and it was actually my first time in the US. I also know people who have passed in LA and Philadelphia.

8) 8) Time needed for preparation: I took longer than usual (several months) because I was moving very slowly at first. My visa was not issued immediately so I was not in a rush. My prep time, condensed, was about 2 months (which is usually what people say they needed to prepare for the exam).

9) 9) You donít need to have prior US clinical experience, or any clinical experience for that matter, to pass the exam. I havenít seen a real patient in over a year.

Thatís about it. Remember that youíve already come this far in your USMLE preparation and that whatever the future has in store for you is almost certainly better than what youíve left behind. Good luck!!
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Old 10-12-2014
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Very good.thanks a lot for sharing.good luck to u
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