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  #1  
Old 08-21-2011
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Arrow How I passed Step 2 CS in 17 days - lesson & tips

Some of you may have read my original thread dated 17th August 2011, which has since been taken down by the site. After much consideration, particularly taking into account the many positive comments I have received from forum readers, I have decided that on balance, it's worth re-posting the same thread. Regrettably, I have had to heavily edit and truncate one section of my original post, as my criticism and review of one of the study resources did not go down well with some readers.
-----------------------------------

Hello everyone,

I'd like to share my experience of passing Step 2 CS in the first attempt (got results today) after 17 days of revision, despite multiple mistakes during the exam which I will also highlight below. Forums have been very useful to me during my preparations for all the USMLE exams, and I hope to add something in return.

MY BACKGROUND

I am a board certified ophthalmologist in the U.K. I went to medical school in the UK, and graduated 11 years ago. I am of Asian origin and grew up in Asia. I have not done any general medicine or surgery for 10 years - only ophthalmology. I am taking the USMLEs, because I plan to do a clinical fellowship in the USA in a very specific area of ophthalmology

WHAT USMLE STEPS HAD I TAKEN BEFORE STEP 2 CS?

None. Step 2 CS was the first exam I took, purely because I need to get my USMLEs as soon as possible and the results of Step 2 CS take the longest to be published. Whilst waiting for these results, I have since taken Step 1, and will be taking Step 2 CK in a month. Thus, I had no recent clinically relevant knowledge from Step 1 or Step 2 CK to help me in Step 2 CS (such as remembering all the different diseases, taking a relevant history, etc).

HOW DID I PREPARE?

I only had 17 days to prepare for the exam (had other major work commitments beforehand. Thus I had to be do a super targeted revision. These were the ONLY resources I used:

1. Kaplan - history taking / examination section only. The physical examination section particularly is more thorough (and necessary in some cases) than First Aid.

2. First Aid - just a fantastic book. Long cases and mini cases. Even the handling difficult questions during counselling section was a useful read.

3. Youtube videos for concise physical exam, particularly by this author (there are others too - just look in Youtube): http://www.youtube.com/user/mdofola#g/u

4. Medscape online for basic clinically relevant information for almost all diseases (presentation, differential, diagnostic investigations) - this was extremely helpful.

5. I did not go to any general medical clinics or wards to see any patients. I just did not have enough time. I am currently doing some ophthalmology research.

6. CSE video – it did not help me.


THIS WAS MY PREPARATION TIMELINE:

1. Day 1-2: read the clinical examination section of Kaplan and First Aid. Combined the two sets of information. Learnt that.

2. Day 3-17: After that, I practised all the systems examinations thoroughly with my wife, daily for the first week, then alternate days or less for the 2nd week (because I was getting a little tired at the end of all that studying). The real difficulty I found with the physical exams, is that I had forgotten everything from medical school, including where to auscultate for various types of murmurs (yup, that basic), the order to do an abdominal examination, etc etc etc. The only ones which are currently relevant to my clinical practice and over the past last 10 years are ophthalmic and cranial nerve examinations! Surprisingly, Youtube videos have been extremely helpful in reminding me about the different examination techniques, particular the ones from the author shown above.

3. Days 3-7: Started reading through mini-cases in FA to learn all the different differential diagnoses. To be honest, this was a mistake. I should've started immediately with the long cases in the second half of the FA book. I got too bogged down by the fear of not remembering enough differential diagnoses relevant to each patient / presenting symptom.

4. Days 8-16: Simulated history taking using FA long cases. My sisters who are doctors, helped me by being the patient. As they are in a different country as I am at present, we did this all over Skype. I think it's better to ask fellow doctors to be mock patients, as they can better understand the relevance of the history/disease and thus simulate more accurately. So they would read through the relevant long case, and I'd simulate the whole thing via online video, including knocking on the door, introducing myself and taking a history. I simulated a physical exam relevant to each case (via Skype video!), in the sense that I simply used it as a tool to go through the motions of the physical exam so it would force me to think through what relevant examination I would do in the time constraints. The only time I practiced generic general systemic examination on a real person is as indicated in "Day 3-17" above (i.e. not in the context of these long cases practices).

I then counselled the "patient", closed, and typed up the patient note.. At the end of each long case, we would go through which questions I did not ask in the history taking based on the checklist in FA. Please note that I feel it is IMPOSSIBLE to ask ALL the questions on the checklist in the FA long case. There is just not enough time. Never did I ask all questions - there were always a few that I missed out on. Felt bad at the time of practise, but I just moved on to the next practice case.

5. Days: 15-17. FA mini-cases. Read through all of this again. Very important.

6. Day 18. Exam day.

EXAM DAY EXPERIENCE:

I made a LOT of MISTAKES on the day:

1. Forgot to pull out leg rest during supine exam – first case
2. Forgot sex history 1 case (16 yo with depression)
3. Time ran out when only just started closing statement “I’d like to share with you what I think…” – 1 case. I didn't explain diagnosis, etc.
4. Forgot to document ophthalmoscopy exam 1 case in PN (even though I performed the examination).
5. Forgot to ask PPD in COPD exacerbation case
6. Forgot to ask Pap smear in amenorrhea case
7. Forgot to ask menarche age in amenorrhea case (did ask about when periods became regular)

SOME FINAL TIPS:

1. Ask patient anything else they’d like to mention before moving on to physical exam – x2 cases brought up useful things in history I forgot to ask.
2. Ask patient for generic name of drug – they usually know and will help - I asked x2 patients. I'm not familiar with the brand name of drugs in the USA.
3. Use this blog for some useful tips: http://csprotocol.blogspot.com/2006/...-for-your.html
4. Atlanta great place to take exams if if you don’t live in one of the CS2 site cities – hotel 5 minutes from airport by complimentary shuttle to Country Inn & Suites By Carlson - Atlanta Airport South – EXAM CENTRE only 5-7 minutes WALK away
5. Revision:
a. Use Kaplan for examination detail
b. Use First Aid, and in retrospect, this is what I should've done:
i. Firstly, read through practice cases – explanation needed for diseases there, so I could've spent a lot LESS time trying to look up what Plummer Vinson disease is, etc etc. The relevant explanation for each diagnosis and test is all listed at the end of each long case.
ii. Secondly, read through mini cases
iii. Finally, go through (i) and (ii) again

SUMMARY AND CONCLUSION:

It is actually possible to pass Step 2 CS in just over 2 weeks. Remember, I had been out of general clinical medicine for 10 years, and did not have the benefit of clinically relevant knowledge from a recent Step 2 CK exam (taking this in a month's time!). During my revision, I never saw or practised on any real patients on the wards or clinics, because I felt I could use my very limited time (17 days) more efficiently by practising with family/friends. It was actually very odd when I examined the first patient on the actual Step 2 CS exam day, because that was the first time in 10 years that I did a systemic / physical examination on someone who's not my wife (whom I had been practising on)!

Just be very focused with your revision, and you'll pass. Just don't neglect any of the 3 main sections of Step 2 CS (e.g. don't leave your introduction or counselling as an after thought - leave nothing to chance). First Aid book is the key.

Good luck to all of you. Hopefully my entry can help you as much as others on forums have helped me.
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  #2  
Old 08-22-2011
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hey,
can you email me tiem7@hotmail.com, my exam is in 2 weeks and i work almost full time
hope to hear from you soon
Good luck with other steps
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  #3  
Old 09-06-2011
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Hi Redreflex,
Your post is heart-warming and encouraging. I am currently studying for my Step1 exam; I take the exam in Dec2011. I had earlier in July applied for CS and have till July2012 to take it. However, you sparked my interest to take the CS before CK.
Do send the links you mentioned to: b4amee@yahoo.com. I can't copy and paste the links from your post since I'm using my iPod for the forum.
Again, Thanks and Goodluck!!
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  #4  
Old 09-13-2011
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b4amee

thank you. Good luck with your exams. I think if you have the time to take step 2 CK before CS, you probably should. I needed to get all my exams as quickly as possible, and thus did CS first, because it takes about 2 months for the Step 2 CS results to be announced, whilst it only takes 3 weeks with step 2 CK.. I have since taken step 1, and just found out I passed last week (will write a post shortly about my experience of passing it in 50+ days of revision).

Good luck to you
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  #5  
Old 09-14-2011
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Congratulations again Redreflex, you sure make the Step Exams seem easy the way you've taken them. Can't wait to hear the preparations leading to Step1. Do post soon.
Again, Congrats.


---
I am here: http://maps.google.com/maps?ll=39.402056,-76.494057
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  #6  
Old 09-14-2011
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Quote:
Originally Posted by b4amee View Post
Congratulations again Redreflex, you sure make the Step Exams seem easy the way you've taken them. Can't wait to hear the preparations leading to Step1. Do post soon.
Again, Congrats.
Thank you and good luck to you! I can assure you none of this has been easy!

I have just submitted a post on my Step 1 experience - hope you find it useful! How I passed Step 1 in 54 days, tips
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  #7  
Old 09-24-2011
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thanx ,ur post z so much encourging ,God bless u.
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  #8  
Old 09-25-2011
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roseMD - thank you. Good luck to you.
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  #9  
Old 11-01-2011
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Thanks!...and again thanks for the youtube tip!
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  #10  
Old 11-01-2011
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Thanks Redreflex. Just read ur tips on how u took Step1 in 52days.
Very encouraging.
Looking forward to your tips on CK.
Taking Step1 in late December.


---
I am here: http://maps.google.com/maps?ll=39.393689,-76.525133
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  #11  
Old 11-01-2011
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Quote:
Originally Posted by b4amee View Post
Thanks Redreflex. Just read ur tips on how u took Step1 in 52days.
Very encouraging.
Looking forward to your tips on CK.
Taking Step1 in late December.
---
I am here: http://maps.google.com/maps?ll=39.393689,-76.525133
Thanks B4amee. I have also posted a thread on passing 2 CK - similar thread title. Posted it about 1 week ago.

Good luck!
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  #12  
Old 01-18-2012
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Default Hey thanks

hey redreflex thank you very much for such helpful post,,,,,,,,,,,,awesome good work
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Old 01-18-2012
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Quote:
Originally Posted by hardik221186 View Post
hey redreflex thank you very much for such helpful post,,,,,,,,,,,,awesome good work
Thanks! Good luck!
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  #14  
Old 01-18-2012
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Quote:
Originally Posted by Redreflex View Post
Thanks! Good luck!
Thank you
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  #15  
Old 11-25-2014
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Congrats! Very informative
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  #16  
Old 4 Weeks Ago
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thanks for the advice
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  #17  
Old 3 Weeks Ago
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Thanks a lot!
Your post was well summarized and motivating for people like me who want to take CS first.

Thanks again & good luck.
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