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Old 06-14-2013
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Cool Did CS this week - my 2 week prep

I am an IMG living in Toronto. I just did the CS this week in Chicago.
I knew beforehand that Chicago was the cheapest flight from Toronto, so I hoped to get a spot there... and the spot I snagged with C4C was Chicago anyways (originally had sept date). Here is my prep experience.

Started reading First Aid when I got the spot 2 weeks ago. Read through the forum to get a sense of the exam experience. Looked on YouTube for some CS videos and physical exam videos. Taught myself how to write the PN based on FA. I should mention that neither my med school nor my patient care was in English, and I am used to a different PN format. I haven't done step 2 ck either, but I have read IM and at least I did step 1 last month.
After 1 week of prep, I started the cases in FA. Since I had no partner, I used a stuffed bear as my SP! At first it was so comical and ridiculous I couldn't focus. But I found it helped to practice my demeanour, introducing myself and shaking hands, remembering to drape and make eye contact. Also mannerisms in doing the PE, such as asking if I could untie the gown (a make-shift one from an old T-shirt), only exposing small areas of skin at a time, and telling the SP what I was doing/asking permission to do things. I think CS prep entails mainly practicing a lot so that in the real thing it comes automatically. I did several cases per day (short prep time), but found that i really had to force myself sometimes to do the next one, they weren't hard, just tedious when they were so many.
I would time my encounters, 7.5 min for intro, history taking and summarizing, then 7.5 min for washing hands, PE and closure/counselling/answering qs. After reading the door info, I would use the CC and ask everything that could give a clue to the ddx (the bear wouldn't tell me), then ROS and the rest. I got into a rhythm of how to ask my questions and in what order. When I finished, I would pause and read the Hx checklist of the case in FA, q-s and a-s, take a mental note of what I hadn't asked, also wrote down on my clipboard what i would have written if i had been told the answers.

At first it was hard, but it actually became fairly easy to ask almost all the necessary qs just based on the CC. Then i would start the timer again, summarize the info, wash my hands and do the PE. Again, after that i would pause and read the sp notes and question to know what i was supposed to find in the case, and whether i had done all the relevant exams on the checklist, then start the timer, and do the closure and answer the question.
I used the PN simulation program on the usmle website practice materials and a youtube CS timer to practice writing up the PN after each encounter. It is difficult (at least for me) to fill in everything in 10 min, in the actual exam I found I would leave the exam room a few minutes before the announcement, which was a big help.

I couldn't sleep the night before, arrived at the test center at 7:30, most people were already there. I think there were several IMGs. After all the preamble, we finally were standing in front of our 1st SP door. I started to shake then stopped myself. For the 1st case I left the exam room only with the announcement and forgot to write 2 things in the PN, remembered when I was standing in front of door 2 (mentally kicking myself). They were sort of minor, so I think that was ok. After that, I found I did ok with timing, like I said, leaving most rooms +/- 2 min before the announcement. I forgot things and would remember them when it was too late, like telling an sp about a dx test, or examining a system that was secondary in importance, or putting something in the pn, but felt that most encounters were ok. We had 5 encounters lunch at 11:15 4 encounters break at 1 something then 3 encounters. I started spacing out on the last few, probably due to lack of sleep.

My torment is 2 encounters that i messed up, one forgetting to counsel and not putting in a positive finding in the PN, the other blanking out in the ddx. For the second, I would say even if you're not sure of the ddx, keep going, sometimes when writing up the PN you realize what the ddx is. If you stop and think during the exam, you're dead. Not enough time to step back and reflect. For that case, i couldn't think of what the sp had and began asking more qs after the pe, didn't finish the closure. I did notice that the person in front of me and the person after me didn't leave the room until the announcement either, so maybe it was a tricky case, not sure. Of course, when I was leaving the center, I realized what the ddx was for that case.

What I did good (I think): timing on most cases, empathy and manner, developing rapport with sp, most pn. I felt ok about most of the cases, I was pretty sure that I was in the right ballpark at least with the overall encounter and ddx. Exam finished around 3:15.

The SPs themselves were fine, some were helpful, others less so. I think most were Chicago natives. The proctors were also fine, they looked friendly enough anyways. The lunch was sandwich buffet, decent also.

Since I got stuck in Chicago due to extreme weather conditions (500 flights cancelled that afternoon), had to scramble to get a flight back, at first was told no flights for 3 days. After a lot of insistence, managed to get on the first flight out the next day; slept in the airport. Whenever I have bad luck, I always think it balances out good luck, so I'm hoping that that means I passed the CS! I've been going over and over and over all the mistakes in my head for the past few days, gonna get back to studying for CK to take my mind off of it! Won't know for a few months anyways....
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The above post was thanked by:
aknz (06-14-2013), anila (06-15-2013), DR HB (06-16-2013), hepevirus (06-14-2013), rg99 (01-23-2014), tsttm (08-22-2013)



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