My exam experience
It was yesterday June 20th when I was expecting my CS result of the exam taken in Philly on April 28th Saturday. It was indeed a very long wait but I had totally forgotten about it and was focusing more on my elective, and in my opinion that’s the right way to go about it. No need worrying on something which is beyond your control because it will do you no good. But the morning of 20th June was full of suspense and no matter how much I tried to control my emotions I just couldn’t calm my nerves. The first thing I did after reaching the hospital was check my email and then oasis and there was no sign of any info. I checked again after an hour and there it was the dreaded email! Went straight to the Oasis and to add to all the drama oasis was taking forever! Each link would take 10 minutes to load! Finally after much of waiting the report was there and the golden word “PASS” captured my attention straight away. By the grace of god it was a high pass in all the sections!
My prep experience might be a bit different from most because I had to take the exam while I was doing my electives. I had given a total of 4 weeks with around 3hrs every day when I returned from the hospital. I was fortunate in the sense that I got an amazing practice partner living in the same apartment building. The essential tools in the CS prep kit include:
First Aid + Practice partner also taking the exam preferably + Neeraj Notes
There are other resources which I used which are complimentary and I will be talking about them briefly.
My Approach to the exam:
1. Read section 2 of first aid thoroughly for 2 days, learned all the counseling, transition sentences, commands for physical exam, SP questions and get oriented to the exam format and most importantly learned all the mnemonics.
2. Jumped directly to Practice cases. The way I did was to read 3-5 cases together each day and practice them with my partner every day and he used to do his 3-5 cases (different ones). We used to sit and discuss our mistakes, read out the patient note and highlight our errors.
3. Once we were done, we started to do all the cases again but this time without reading them first. We would repeat the rest as above except for this time typing the patient notes on the software given at the ECFMG website.
4. The third time we used to given random cases sometime combining 2 different cases together which just to make things tougher.
5. Just 10 days before our exams we skimmed through mini cases, discussing them, making practice cases form mini cases and testing ourselves. Skimmed through Neeraj notes, our mistakes in FA, challenging questions and DDs of all the cases. Watched you tube videos on showing empathy towards patients and doing the physical exam, watched USMLE orientation videos.
6. 5 days before the exam I practiced with 4 different Skype partners to ensure there wasn’t amy bias as far as I being used to just one practice partner.
7. 2 days before the exam went to times square to relax
8. A day before the exam I reached Philly and spent my time playing table tennis.
9. On the day of the exam I had good breakfast, offered my Fajr(morning) prayer and reached the exam center earlier than the reporting time which really helped me calm my nerves.
Once at the center I was allotted a number, given an introduction by the Procter, guided into another hall where we were made to watch the orientation video, got a chance to play around with the instruments, had some coffee and made sure I emptied my bladder . So the exam was 5 cases then 30 mins break followed my 4 cases then 15 mins break and finally 3 cases. The exam will be over before you know it. Your time will race so make sure you gather your thoughts during the break and eat well but don’t over eat. You WILL MAKE MISTAKES SO DON’T FREAK OUT and LEARN FROM EACH ENCOUNTER MAKING SURE THE NEXT ONE GOES BETTER. Its extremely important to have a presence of mind and to calm down your nerves during the exam. I used to leave each encounter at 12-13 minute, only one encounter I left at 14 minutes, so time was never a problem and I got that additional time to formulate the DDs in order of likelihood and write well organized notes!
The mistakes I made:
1. Forgot to wipe my hands after washing the hands during the first encounter, remembered when I started palpating. So I stopped in the middle and asked “Do my hands feel cold or wet?” she replied no. So I proceeded.
2. Forgot to drape the patient, realized it when I was closing. So I draped the patient there and then apologizing for not doing so earlier.
3. Did not look at the eyes of a patient with knee pain while palpating as it was tough to maintain eye contact while myself kneeling down. Realized a second later and immediately looked up only to find the patient in distress and making faces without any noise! Apologized immediately, making sure I did not repeat it.
4. Found a look of dissatisfaction on one of the fatigue cases. While I was about to leave and saying good bye a realized and stopped to ask “You seem to be bothered about something; can I help?” he replied “Only this fatigue is bothering me” Counseled him and got a smile In return! J
***Remember its all about having presence of mind during the encounter***
Throughout my prep I reminded my partners to go hard on me and ask challenging questions even beyond the book, be rude to me, waste my time in some way or the other. We simulated the practice sessions as much as we could. e.g. Diming lights in a patient with headache, pretending in severe distress in ER cases, constantly coughing in respo cases with a tissue in hand, pretending to wash hands, taking time to untie and tie the gown as it would take some time in the actual exam too and being rude SPs. Trust me it all paid off.
Some people have also practiced on Skype throughout and managed to pass. That’s not a bad idea eighter as not everyone is fortunate enough to have a live practice partner. The way my skype sessions worked out were. We used to simulate the exam. Knocking, then entering, sitting, draping ourselves, examining ourselves and timing as usual. The I know I few who have practiced on a mirror although not very advisable but only good for people who have no other option.
There was a post somewhere, I think I came across it in Neeraj notes, which commented on the CIS section. Every year they are raising the bar and margin of error is minimum on that section. It used to 75%-80% of their check list to now being 94%. It includes questioning skills, information sharing skills, Professional manner and rapport. Make sure you done miss anything from knocking the door, smiling rather than grinning, identifying patient, using his/her last name, introducing yourself, warm hand shake, draping respectfully, washing hands, supporting the patient in sitting up/lying down, offering a hand and pulling out the stool prior to making them walk, explaining each and every exam maneuver, keeping then engaged in conversation and at no point leaving them unattended, counseling on smoking, alcohol, sexual, suicidal thoughts, just to name a few there and then, closing well, asking for any questions or concerns, asking open ended questions like “what brings you here” or “how may I help you” or “anything else?”, celebrating their joys, complementing them, maintaining a balanced casual yet professional tone, empathizing where needed, identifying support and offering it where needed.
These are around 18-20 points which I consider freebees and a matter of pass/fail at the same time. Sometime we focus too much on DDs and questions that we deviate from such minor yet result changing stuff! I used to leave the Occupation part while washing hands so I could keep them engaged in a conversation and used to have a thing or two pleasant to say about their conversation.
So I conclude my exam experience here, I haven’t gone much over the mnemonics as they can be found everywhere I thought it was more important to focus on the approach and CIS component. Having said all this, this exam is quiet doable. 10-14 days of only CS or 4 weeks of CS + elective is quiet enough. Its very tough to handle it with electives but again not impossible particularly if you have a live partner to keep you motivated. I hope this post helps, I am willing to provide more info should you need any. Also I am willing to mentor one student at a time every day with Skype sessions. You guys can add me as arsalsidd with a message stating “CS help USMLE-forums” I hope this post was helpful please remember me in your prayers for Step 1, CK, Step 3 and most importantly the MATCH! Still a long way to go!
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