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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 06-17-2013
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Smile IMG, 1st attempt, PASS at LA

Heey all, i've been a silent member of this forum, but i admit it helped me alot during my all steps, i'm now finally ECFMG certified, it's time to give something back, here's my step 2 CS experience.

Preparation:-
2 months, first aid, cover to cover, did all cases and practiced typing all patient notes twice. I'm an IMG working as a GP in a city by the beach were most of the patients are divers/tourists, all english speaking, so applied the CS cases on them as much as possible, sometimes was funny cause they were like " Why the hell is he asking all these questions and then typing them on a laptop ?!" (-: . Did not do any online course or anything but watched a few youtube vedios, for ex. Neuro exam, obturator sign, kernig's, brudzinki's, etc..

Before exam:-
Arrived 5 days before the exam, stayed at a hotel 10 minutes from test center, very important for all IMGs to arrive early, specially if you have to take a 15 hour flight like me, jet lag, weather difference, fatigue ..all these must be put into consideration , this exam already carries alot of stress, and you want to be as fit as possible on exam day, so book somewere nice even if it is expensive, get good rest, go for a walk/jog daily in the last few days before exam, and most importantly keep in mind that occsionally flights get delayed and this can ruin the whole trip if you are transiting, so always arriving sooner is safer.

Exam:-
Was a little stressed out in the beginning, but i realised its very normal as long as you keep it under control, a little boost in adrenaline can make you sharp and concentrated, but too much would definitely be paradoxical.
ALL cases were from First Aid, staff and patients were friendly except 1-2 patients, which is very normal, break was short but food was good, time in PN was very challenging to me cause i'm a slow typer.

Mistakes:-
- I wrote everything in PN in descending order from history downwards, but left the positive findings the support each diagnosis to the end, didn't have time to write them in at least half of the exam cases, left them totally blank
- Forgot to counsel a patient having unprotected sex against STDs and didn't ask permission to test for HIV and didn't write it in PN
- My 1st encounter i was a bit stressed so forgot to drape, she was also tricky cause she had the drape next to her ( not on her legs like other patients) and it was blue ( not white like the others ) so was totally camouflaged and i didn't see it!
- You're supposed to go out from the same door you walked in at the patient encounter, but my 1st one i have no idea why i walked to a different door in the room! ( i think it was the emergency exit haha ) , but the patient was nice, she smiled and told me take the other door.
- Ran out of time in only one patient encounter, the announcement was made and the proctor opened the door while i was in the middle of closure.

Things i think i did right:-
- Washed my hands before each patient, its good to think of what organ systems you need to examine during these few seconds, 1st called each patient by his surname, then introduced my self, then after the patient mentions his complain i always responded by saying "Can you tell me more about this ?' ..patients like open-ended questions
- Before each sexual history i asked the patients " Do you mind if i ask you some private questions ? Did closure in all cases except one, summarizing +ve findings and management plan without giving one specific diagnosis to the patient (as mentioned in FA), and always closed by saying "Do you have any questions or concerns ? ..Thank you sir/mam ..have a good day (-: "
- Offered tissue to a coughing patient, although he was surprised cause it was dry cough but still i felt right
- Saying "i'm sorry about that" to any patient that told me that a family member passed away
- Finished the history taking by asking " We talked about this .& this ..& this.. anything else you haven't told me ?" ..in a couple of cases i missed important stuff to ask about, and this question made the pateint himself remind be by saying "ohh..didn't i tell you about this & that as well ?..etc"
- Counseled a smoker about the risks of cigarette smoking and the benefits of quitting
- Whenever a patient asked me why do we need this imaging study / blood test / colonoscopy ..etc ..i always replied " because your safety is my concern ...it might not diagnose the problem but will definitely rule out more serious underlying disease"
- Mentioned i need to do pelvic/rectal exam in patients with abdominal pain , vaginal bleeding and lower back pain
- Asked and typed CAGE questinos whenever applicable
- Always explained what a CT / MRI / Ultrasound / colonoscopy is to patients without waiting for them to ask what do you mean by that.

After-test:-
I admit waiting is the hardest part, i got my results exactly a month after my exam, i was afraid i'm not going to pass because of my unfinished patient notes / + history and physical findings supporting each diagnosis that i skipped in more than half of the notes, but woho! i passed with highest permormace with an asterisk in SEP, high in CIS and borderline in ICE ( as expected ) thank goodness.

Conclusion:-
Step 2 CS is NOT difficult and doable, it's an exam of time and nerves, not knowledge, any medical student can pass it if he trained well. I think the key is feeling in the exam day like any other regular day in your practice, nothing more, and this needs alot of daily PRACTICE PRACTICE PRACTICE to build that kind of confidence and the speed required in PN. See as much actors/patients as possible, talk to them exactly like you'd like to talk on the exam day, train examining ALL organ systems, specially fundus, neuro ..and NEVER do anything on the exam day for the 1st time, this day should be like regular practice / clinical clerkship, and your skills should be like a knee jerk reflex without thinking.

First Aid is awesome, it's all i needed beside working as a family physician and taking timed history from patients and typing them in PN. I have no idea if there is other course / vedios that can be useful cause i haven't tried any.

Finally most importantly is to love what you do, stay physically fit, work out, pray or meditate or dance, whatever gives you inner peace, and don't let this test make you home sick or book sick, study then go out, do new things, meet new people, travel, do not underestimate the importance of having fun .. life is a great balancing act.
Know that all these countless hours we spend in our career reading, studying, working, will pay off , when you save a life or at least alleviate the suffering of a patient that can very much be a loved one, and this what i think USMLE should be all about.

At last, i recommend boosting up your positivity during study by reading Conrad Fisher's book "Routine Miracles" , very inspirational and uplifting and also watch this little amazing poem/vedio about life by Dr.Seuss called "Ohh the place's you'll go" based on his book, i watched it over and over, specially the morning of the exam and it made me feel good. Links down

http://www.amazon.com/Routine-Miracl...utine+miracles



I'm happy to answer any questions from anyone..Good luck to all..YOU WILL ACE! (-:
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The above post was thanked by:
aaru20 (06-18-2013), cearamor (06-18-2013), Dr. Mexito (06-18-2013), emmax2alfa (06-21-2013), hepevirus (06-17-2013), ifss (06-17-2013), mdzehra (06-17-2013), MedicalExaminer (06-19-2013), nastasya (06-18-2013), starbucks2009 (06-23-2013), usramt (06-18-2013), Vurtil (06-19-2013), water (06-17-2013)




  #2  
Old 06-17-2013
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Many congrats for passing the test & sharing your amazing experience. It was in fact very interesting to go though the entire thing you wrote. Im also waiting for my results hope to get it by this Wed. Thanx for telling abt Conrad Fischer's book I would have never know otherwise, sounds pretty interesting to me!!Good luck for your next step
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  #3  
Old 06-18-2013
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Thanks alot of sharing your exam experience.
can you tell me do you fine any + ve finding during your pe like murmer which is sound made by patient or any breath sound abnormality,tactile fremitus...etc
and do you recommend practice on ophthalmoscope,otoscope, deep tendon reflexes or just do them correctly.
thanks and good luck.
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  #4  
Old 06-18-2013
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I recommend both, doing these maneuvers correctly and practicing them before the exam, don't do them on the exam day for the 1st time, patients feel who is confident and who is hesitant.

Regarding findings; + ve straight leg raise test, hyperreflexia 3+ in one limb, +ve rovsing, psoas & obturator signs. Tenderness & rebound RLQ, tenderness without rebound in LLQ
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  #5  
Old 06-19-2013
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Quote:
Originally Posted by TeeBee View Post
I recommend both, doing these maneuvers correctly and practicing them before the exam, don't do them on the exam day for the 1st time, patients feel who is confident and who is hesitant.

Regarding findings; + ve straight leg raise test, hyperreflexia 3+ in one limb, +ve rovsing, psoas & obturator signs. Tenderness & rebound RLQ, tenderness without rebound in LLQ


thanks for answering can you please tell me if patient with RLQ pain and tenderness and find +ve psoas and rebound tenderness do i need to do obturator sign or no?
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  #6  
Old 06-21-2013
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Yes, you need to test all signs in any patient with RLQ pain xx
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