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USMLE Step 2 CS Forum USMLE Step 2 CS Discussion Forum: Let's talk about anything related to USMLE Step 2 CS exam


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  #1  
Old 02-21-2013
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Default CS experience

I finished my CS exam recently and wanted to jot down a quick few things before I forgot the experience completely.

How I prepared: I only did CSE videos and First Aid. I practiced with a non-medical friend (thank God for his patience!). Was uncomfortable with Skype and could not find a study partner who was giving the exam at the same time so my study schedule did not match anyone elseís.

Some nuggets:
1. You must have heard from everyone that TIME is the key. I can tell you that itís 100% true. Just want to reinforce the fact that there will be barely any time in some cases to do a full physical at the end. The patient can have more than one (sometimes 4!) complaint that you need to explore.
2. Another comment on Ďtimeí: The key to finishing on time is to be robotic. By that I donít mean be non-empathetic. I mean you should have the questions that you need to ask on the tip of your tongue. Symptomatology is thus very important (FA mini-cases).
3. CSE videos are great in helping you come up with these questions. The doc in the videos does this and by the end of watching 10-15 videos you would have subconsciously imbibed this info.
4. CSE videos are great but there are times when she doesnít ask all relevant questions and also comes up with inaccurate D/D and investigation plan. So, watch out.
5. I donít like mnemonics. I always took me forever to remember the mnemonic and then what each letter stood for and more often than not I confused the letters. But thatís just me. Use mnemonics if you like them.
6. Hereís a spoiler - you will encounter some weird cases and you will miss stuff! Donít beat yourself over it. Attack each new patient encounter as a new one Ė donít get bothered by what you did. Focus on whatís next.
7. Make casual conversation with fellow examinees during the breaks (of course not about the cases). It calms you down. Sitting there alone will only sap your confidence as you will keep thinking about the things you missed/did wrong.
8. Data gathering may be the thing most of us have problems with, but do remember that ICE (history + PE) is only one third of what you are graded on. 9. Your English proficiency and interpersonal skills are equally important.
10. Say youíre welcome every time the patient says thanks.
11. I used gloves in all cases Ė faster, easier to wear, you can face and talk to the patient while wearing gloves.
12. For PE, do the relevant system first. Then one or two quick tests from the major systems.
13. Practice writing abbreviations in the PN Ė that can really speed up things. E.g. in a case where CVS is not the C/C, you can listen to the heart beat in 4 areas (takes only 5 seconds) and later in the PN can write: RRR, S1S2 NL, no RMG. Thatís it!
14. After asking questions about C/C and D/D, make sure you practice asking the same questions for PMH, ROS, etc like Asso. Symptoms, LIQORAA, ROS, SODA, PAM HUGS FOSS - write these on the doorway and it makes asking these questions much easier.

Feel free to ask questions and give comments! Hope I have helped some of you out there.
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The above post was thanked by:
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  #2  
Old 02-21-2013
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Congratulations ! Hope we all pass
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  #3  
Old 02-21-2013
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Quote:
Originally Posted by abeworld View Post
I finished my CS exam recently and wanted to jot down a quick few things before I forgot the experience completely.

How I prepared: I only did CSE videos and First Aid. I practiced with a non-medical friend (thank God for his patience!). Was uncomfortable with Skype and could not find a study partner who was giving the exam at the same time so my study schedule did not match anyone elseís.

Some nuggets:
1. You must have heard from everyone that TIME is the key. I can tell you that itís 100% true. Just want to reinforce the fact that there will be barely any time in some cases to do a full physical at the end. The patient can have more than one (sometimes 4!) complaint that you need to explore.
2. Another comment on Ďtimeí: The key to finishing on time is to be robotic. By that I donít mean be non-empathetic. I mean you should have the questions that you need to ask on the tip of your tongue. Symptomatology is thus very important (FA mini-cases).
3. CSE videos are great in helping you come up with these questions. The doc in the videos does this and by the end of watching 10-15 videos you would have subconsciously imbibed this info.
4. CSE videos are great but there are times when she doesnít ask all relevant questions and also comes up with inaccurate D/D and investigation plan. So, watch out.
5. I donít like mnemonics. I always took me forever to remember the mnemonic and then what each letter stood for and more often than not I confused the letters. But thatís just me. Use mnemonics if you like them.
6. Hereís a spoiler - you will encounter some weird cases and you will miss stuff! Donít beat yourself over it. Attack each new patient encounter as a new one Ė donít get bothered by what you did. Focus on whatís next.
7. Make casual conversation with fellow examinees during the breaks (of course not about the cases). It calms you down. Sitting there alone will only sap your confidence as you will keep thinking about the things you missed/did wrong.
8. Data gathering may be the thing most of us have problems with, but do remember that ICE (history + PE) is only one third of what you are graded on. 9. Your English proficiency and interpersonal skills are equally important.
10. Say youíre welcome every time the patient says thanks.
11. I used gloves in all cases Ė faster, easier to wear, you can face and talk to the patient while wearing gloves.
12. For PE, do the relevant system first. Then one or two quick tests from the major systems.
13. Practice writing abbreviations in the PN Ė that can really speed up things. E.g. in a case where CVS is not the C/C, you can listen to the heart beat in 4 areas (takes only 5 seconds) and later in the PN can write: RRR, S1S2 NL, no RMG. Thatís it!
14. After asking questions about C/C and D/D, make sure you practice asking the same questions for PMH, ROS, etc like Asso. Symptoms, LIQORAA, ROS, SODA, PAM HUGS FOSS - write these on the doorway and it makes asking these questions much easier.

Feel free to ask questions and give comments! Hope I have helped some of you out there.
So you think by covering 44 cases from FA + minicases DD + CSE videos is enough? Did you get cases out of these resources? One more question: by the 10 min. mark were you already doing PE in all cases? Did you follow CSE videos by summarizing before doing PE? Thanks!
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  #4  
Old 02-21-2013
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Quote:
Originally Posted by stepdoc1 View Post
So you think by covering 44 cases from FA + minicases DD + CSE videos is enough? Did you get cases out of these resources? One more question: by the 10 min. mark were you already doing PE in all cases? Did you follow CSE videos by summarizing before doing PE? Thanks!

I think 44 FA cases + FA minicases + CSE videos is more than enough.

The symptoms, as you can imagine, were all covered by FA + CSE. But the D/D were not all the same.

By the 10 min mark I had almost always started my PE. If not, I would start wearing gloves and keep asking questions.

I summarized at the end of history + PE. Summarizing history right after taking history feels redundant. Its like repeating what the patient just told you a minute ago. It's awkward.
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  #5  
Old 02-21-2013
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Quote:
Originally Posted by abeworld View Post
I think 44 FA cases + FA minicases + CSE videos is more than enough.

The symptoms, as you can imagine, were all covered by FA + CSE. But the D/D were not all the same.

By the 10 min mark I had almost always started my PE. If not, I would start wearing gloves and keep asking questions.

I summarized at the end of history + PE. Summarizing history right after taking history feels redundant. Its like repeating what the patient just told you a minute ago. It's awkward.
It depends on personal preference. Both are correct ways of doing it. For example in my case i felt it was better to summarize + counsel + use PEARLS right after history / before PE while wearing gloves so that you dont miss any information or dont forget it later on (in case your memory sucks).

I think people that have yet to take the exam must practice and see which way they feel more comfortable with.
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  #6  
Old 02-21-2013
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Quote:
Originally Posted by XpaezX View Post
It depends on personal preference. Both are correct ways of doing it. For example in my case i felt it was better to summarize + counsel + use PEARLS right after history / before PE while wearing gloves so that you dont miss any information or dont forget it later on (in case your memory sucks).

I think people that have yet to take the exam must practice and see which way they feel more comfortable with.

Yes, I think you are right. I just think it gets awkward and weird to do that. But not a deal breaker...as it is more important to ask rather than to ask at the right time.

I used PEARLS all through the encounter whenever I had a chance (like CSE doc)
I counseled right after the patient confessed that he was a smoker or an alcoholic, etc. - I believe these are things you can forget if you leave them to the end (like CSE doc)
But to me it seems natural to summarize the history at the end of history + PE, and then say - "based on this and the physical exam, I think you might have ____ or _____. I would like to do _____ or ______ tests. Is there anything else you would like to ask me at this time? No? I will see you with the test results, Mr. _____. Thanks"

Just my two cents.
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  #7  
Old 02-21-2013
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Quote:
Originally Posted by abeworld View Post
Yes, I think you are right. I just think it gets awkward and weird to do that. But not a deal breaker...as it is more important to ask rather than to ask at the right time.

I used PEARLS all through the encounter whenever I had a chance.
I counseled right after the patient confessed that he was a smoker or an alcoholic, etc. - I believe these are thing you can forget if you leave them to the end.
But to me it seems natural to summarize the history at the end of history + PE, and then say - "based on this and the physical exam, I think you might have ____ or _____. I would like to do _____ or ______ tests. Is there anything else you would like to ask meat this time? No? I will see you with the test results, Mr. _____. Thanks"

Just my two cents.
yeah, thats true, I summarized quickly the important symptoms + past medical hx relevant to the case right after history.. and thats right, PEARLS has to be used whenever is possible, i tried to do it at least twice.

For the looks of it you had a good prep and prob you did pretty good... now we have to wait for april the 24th haha
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  #8  
Old 02-21-2013
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Quote:
Originally Posted by XpaezX View Post
It depends on personal preference. Both are correct ways of doing it. For example in my case i felt it was better to summarize + counsel + use PEARLS right after history / before PE while wearing gloves so that you dont miss any information or dont forget it later on (in case your memory sucks).

I think people that have yet to take the exam must practice and see which way they feel more comfortable with.
I have to agree with you...my memory sucks especially when I get nervous so I'm practicing by doing a summary + using PEARLS before PE (just like in CSE videos) so I won't miss out on anything. I want to believe this won't affect my overall performance...
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  #9  
Old 02-25-2013
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Originally Posted by stepdoc1 View Post
I have to agree with you...my memory sucks especially when I get nervous so I'm practicing by doing a summary + using PEARLS before PE (just like in CSE videos) so I won't miss out on anything. I want to believe this won't affect my overall performance...
stepdoc1,

I don't believe summarizing the history before or after the PE will make ANY difference in your performance evaluation. You should do what ever you feel comfortable with. If you are already practicing with summary before PE, don't change anything.

Good luck! Keep your spirits up.
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  #10  
Old 02-25-2013
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Originally Posted by abeworld View Post
stepdoc1,

I don't believe summarizing the history before or after the PE will make ANY difference in your performance evaluation. You should do what ever you feel comfortable with. If you are already practicing with summary before PE, don't change anything.

Good luck! Keep your spirits up.
Thank you abeworld! Wish you good luck too!
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