Some of my Step 2 CS Gems (useful stuff) - USMLE Forums
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Old 05-02-2015
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Default Some of my Step 2 CS Gems (useful stuff)

This forum was quite useful for me in preparing for Step 2 CS and I would like to express my gratitude by giving a little back.

I am an IMG and passed my step 2 CS with high performance in ICE and above borderline performance in CIS (only 3 stars were borderline, and the remaining stars were above), even though I was late on 3 of my closures and didn't have time to ask these patients if they had any more questions for me. In addition, on a 4th case I had 20 seconds to answer a patient's challenging question at the end and I answered completely wrong.

Still I safely passed all 3 components, so I must have done some things right. And I have a pretty good idea what these things are.

1) For all my cases, I would say something similar to this (usually after summarizing): "Is there anything else you'd like to add to what you've told me? Even if you feel it may not be relevant sometimes it might be related. Feel free to add anything that comes to mind."
Many times I would get one or two additional things. Once a patient gave me additional family history when I said this.

2) Don't allow awkward silences! I needed some time to think for some cases and I would always say "I hope you don't mind I just need a minute\moment to collect my thoughts".
Nice trick: I always asked permission to write a few things down. Sometimes I would ask permission at the beginning ("I'll be writing some notes as we go along, is that okay?"), but most times I would start taking history after the intro, and then when I need a break to write the answers and think of more questions to ask, that's when I would say with a smile "I hope you don't mind me writing a few things down as we go along". And this would give me 10-15 seconds of my own time.

3) When washing my hands with the alcohol solution (~20 seconds), I always asked patients if there's anything they were concerned about or anything on their mind they would like to ask. I tried to get the challenging question here but almost all my SP's wanted to save it to the end. So in order to avoid awkward silence, I tried to fill in some small talk here like "lovely weather today, isn't it?" or "long day, isn't it?" or "before i examine you, are you comfortable in this room? can I get you anything like a cup of water?". This is also where I double checked that the patient had the drape on their lap.
Oh and of course, SMILE if patient is not being difficult. And if patient is being difficult and you can't smile (i.e. patient in too much pain) you can use this time to say "I can see that you're in a lot of pain I will do my best to figure out what's causing this quickly and relieve your pain."
Pro Tip: Pain is ALWAYS an EASY complaint because the PROGNOSIS IS KNOWN. You will ALWAYS figure out the CAUSE of the pain and FIX it and alleviate the pain. Therefore you can be ASSERTIVE\REASSURING when it comes to the pain. Other prognoses (will I regain function of my hand? will I need surgery? will my memory\vision\hearing improve? etc...) you may not be assertive about (you can only promise to do your best) but for pain you always know that I WILL HELP WITH YOUR PAIN BY FIGURING OUT THE CAUSE AND TREATING IT PROPERLY.

4) For people who are wordy like me, especially those who like to counsel about smoking, drugs, alcohol, lifestyle etc... on the spot, you may struggle with the amount of time you are given (15 minutes is just not enough).
The solution for this is to do a very targeted physical exam. Only do the most important physical exam maneuvers. You will not have time to do all the physical exam maneuvers in the first aid book.
If there are no heart\lung symptoms, and vitals are stable, then you don't need to do heart or lung exam for most patients, even if elderly.
Always do the maneuvers most specific for your DDx. Find something positive to document, and it shouldn't be so hard because from the history you should know what you are expecting to be positive.
E.g. fatigue: check conjuctiva, do thyroid exam (remember to offer water!) much more important than heart\lung\abdomen
Confusion\memory loss in elderly: Do some mental status exam components and do cranial nerves. If there is no numbness, tingling sensation, difficulty ambulating, muscle weakness, or tremor in history, then you don't have to check for focal neurologic signs and assess muscle power etc... It's more important to find the positive findings first.
Another gem: For patients who seem depressed, if they were talking slowly throughout the interview, document flat or blunted affect and slow speech in the physical exam! This is a positive finding that can support many Dx.

Good luck guys I hope some of you find this post useful!

This forum has many great shared experiences to learn from and I think it is a very valuable resource to learn from others who have taken the test.

The only warning I give you is to stay away from posts claiming this exam is a scam\conspiracy\bias in scoring\anti-IMG. At the end of the day it is a requirement for ECFMG certification and you don't have a choice except to take it and pass it. Protesting the exam is not constructive because it is a wasted effort. This is their game and you have to play by their rules.

Last note for IMGs:
SPs might realize you are not american from your accent or from your looks, and they may decide to "test you more" (i.e. complain more about something, "act" harder to elicit more empathy\understanding, pay more attention to your manners). The way I see it, these things should give an IMG an EASIER time than an AMG, because they are really focused on your interpersonal skills and will pay more attention to the things you do right (i.e. if you are friendly, calm, smile, and show empathy\understanding, they will notice it better). Only tough thing is if you don't do these things they will also notice pretty quickly and make you pay the price.

Last edited by LebMed; 05-02-2015 at 03:03 AM.
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The above post was thanked by:
ari2003 (05-03-2015), Cubandoc (05-17-2015), drpisho (05-02-2015), maymed (11-30-2015), menatallah Elgohary (05-02-2015), npktun (05-02-2015), reham (05-05-2015), theroyalrook (05-06-2015)


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