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Old 03-09-2013
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Smile Philadelphia CS Experience

I took CS this past week in Philly and I thought you guys might be interested to know about my experience. We all have different backgrounds so I won't go too much into details of how I prepared for the exam. In my case, I am an IMG, graduated 5 years ago and I've been out of practice since then. I've taken Step 1 (99%) but not CK. I have to work at my daily job about 8 hours a day but I could find few hours each day to study for about 3 weeks.

- I mostly relied on FA (third edition), but I went through usmleworld once and also watched the first set of CSEvideos (12 videos). I recommend FA. Should you use other material, it really depends on you.
- I practiced with a non-medical person about 15 cases. This proved to be really helpful as I left the room before the final announcement in all cases.
- Most examinees were AMG's. I think only 2-3 were IMG's out of 24 examinees that day.
- I spent a minute outside of the room in the beginning to think about DDx and what PE is needed.
- I don't use mnemonics but I asked about the routine parts of the history and performed thyroid/CV/lungs/abdomen in most cases.
- I put on gloves in 11 cases. For 1 case I forgot to use gloves or wash my hand.
- The SP's were better than I expected in acting. One case who was in severe pain was really good and kind of threw me off.

Here are some mistakes that I made and I remembered after exam:

- Ask the patient if they are comfortable in the room and if you can do anything to make them so. Especially in SP's with pain.
- In traumatic cases, there might not be any bruises or cuts. Document it.
- If there is anything important in the history (pos or neg), take a note of it. The time for the PN is really short and you might forget to write down stuff that you asked.
- In PE, some patient might have real scars (eg. previous surgeries). Document it.
- For the physical findings in the differential diagnosis, I left most of them blank as I didn't find anything in the PE. Now I think I should have put some relevant vital signs there. .
- When ordering CT, I forgot to write what part e.g. CT-head, as I was trying to type fast and finish the PN.
- I Could have ordered more than 3 tests just in case.

Looking back, I think I should have been more relaxed and more confident. I don't feel good about my performance and I have some misdiagnoses (at least 2). If I had taken CK first or had recent clinical experience, it probably could have helped me to write better DDx and tests. Also I hope the SP's don't compare my English to the native speakers.

As an advice, I highly suggest timed-practice for both encounter and typing. Don't panic. Stress will impact your normal performance. Think of SP's as ordinary patients and react as you would in a similar situation at ER or clinic: Be nice, introduce yourself, show that you care about their problem, ask relevant questions, do the relevant PE, let them know what you think and what should be done to confirm the diagnosis and finally ask if they have any questions.

Good luck everyone.

Last edited by kp1132; 03-09-2013 at 09:33 AM.
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Old 03-09-2013
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Thanks for your post was very useful, can I ask how fast you were typing cos am kind of slow, and between CSE videos and U world which is better.
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Old 03-09-2013
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Originally Posted by ritemu View Post
Thanks for your post was very useful, can I ask how fast you were typing cos am kind of slow, and between CSE videos and U world which is better.
Glad to hear it was useful.

1) My typing speed is OK. Not fast.
2) Well, it really depends on your background and how fresh your clinical knowledge is. I think FA+timed-practice would be very helpful. Also there are many freely available notes that can cover some cases that FA doesn't have.

If you read FA + know how to handle common complaints + do timed practices + feel relaxed and confident on the exam date, I think you should be fine. Check other online notes for some complaints that FA might not have. Other resources such as CSEvideos and UW come next. If you watch CSEvideos, remember that the doctor there appears rather robotic and you should be nicer and more connected to the patient. I've heard that Kaplan videos are good but I couldn't afford them.

I think my biggest mistakes were I wasn't confident and professional enough and kind of got carried away which I attribute to being out of practice for a long time (my daily job is not related to medicine). I am mainly worried about the communication skills, the cases that I misdiagnosed and many little details that I missed in PN. I hope I pass but Philly has kind of bad reputation of not being IMG-friendly. We'll see.

ps. the icon for this thread shouldn't be smiley face. I'm dying of stress over here!

Last edited by kp1132; 03-09-2013 at 01:57 PM.
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Old 03-11-2013
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Hi kp1132,

Thank you so much for sharing your prep & exam experience!!!

I really understand you .... because I took CS in Philly as well, so I have exactly the same feeling!!!!
I guess, it is normal response for all med students .... took exam and then think what you did and what did not ....

You are not alone

May God help us with our result in April 24 :sorry:
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Old 03-15-2013
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Default Me too

I also took in philly and waiting for april 24th.I totally had similar experience.The sps are really good, so We just have to be confident . Dont panic because it will affect your thinking ddx .So buddies be cool.

Good luck all of you.
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