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  #1  
Old 07-10-2013
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Smile Cearamor Step 2 CS Experience

Hi guys,

It's a great pleasure to recount my experience here and try to help you guys that are either awaiting for the results or preparing for the test.

My Background

Firstly, I'm an IMG and english is not my first language. I finished med school in June, 2010 in Brazil and got into directly the PhD program in pharmacology that I'm about to finish. I have to say that my medical english was a little bit rusty because the last time I did a Hx and Physical in english was back in 2009 when I spent 6 months in US doing electives/subIs in IM specialties.

Set up before going through First aid

The very first thing I did 2 months before my CS was to work on the phrasing of the questions, this is very important if you're not a native speaker and is some time away from english-speaking patients. At this very specific point, csevideos was important, also to start to develop a structure for the encounter, but use it carefully and knowing their CIS skills are dismal and you'll most likely fail if you rely on them!!! I took me less than a week studying on and off, dedicating about 1 hour to develop my way of asking the most important questions and the other parts like introduction, transitional statements, PE and closing. Concomitantly, I went through the Mini-cases and learnt the main DDx and rational, which was quite easy because I had more than 2 months of CK studying and some clinical experience working as a general practitioner in my home country.

Preparation

After that, I got a fantastic live study partner, who will be applying to Psych this year and is a genius.. We went through all the 1st aid cases twice, but to have some peace of mind, we decided to take a LIVE course so we can have some feedback and see whether we were set to go. We were between the 3-day courses of c3ny and Ximedus that looked alike and had similar prices and people who we knew and took those courses thought very highly on them, but ultimately we decided to take Ximedus because of logistics (Florida seemed a calmer environment for us and also would be cheaper in terms of costs of transportation). Well, the live course is very good, but I think I could totally made it without it, just focusing on first aid. But for me, a very anxious and perfectionist guy, I needed the reassurance and the live course served me just like the NBMEs served to assess my preparedness for the CK or Step1. So, don't think that in 3-days they're going to do a miracle and make you pass, that's not the point!! But the 12 cases simulation exam is very accurate (they use retired cases from the LA center) and after each encounter you know what you did wrong in a 10min encounter with the Standardized Patient. Also, they give you a very detailed evaluation report and compare to other students they had that took the exam and say if you're good to go or not, and if not, what do you need to improve (in my case, my note was not that good, because I'm a slow typer and also didn't manage to write a good blue sheet, so I ended up forgetting to put a lot of things I did in the actual encounter on the note).. But even so I decided to take the risk and take the exam that was 5 days after the end of the course, and that was my biggest mistake!! If you end up deciding to take a course to evaluate yourself, make it at least 2 weeks apart from your exam, so you have some time to work on your weaknessess!!!

Real deal

I took my CS on the Atlanta center. I stayed in the Country Inn hotel because it was in a walking distance from the center (about 5 min). Had a good night of sleep with my study partner and arrived at the test center. The proctors were very courteus and the IMG/AMG ratio was like 50/50, which I didn't care much since I was with my Study partner and it was very reassuring to have a friend around to share your anxiety!!

Well, my major problem was with TIME MANAGEMENT, since I didn't manage to close 4 cases properly! I was either in the middle of the counseling or in the middle of the explanation of the plan to the patient, but I've followed all the rituals and used PEARLS for empathy!! Always remember the ACKNOWLEDGE is the single most important think if you are trying to be empathetic!! So instead of saying like the robot in CSEVIDEOS "I'm sorry blah blah blah".. ACKNOWLEDGE like "I SEE you are upset/mad/sad/embarassed" or "I UNDERSTAND you are upset/mad/sad/embarassed".. Or simply, stop writting, put your clipboard at your side and repeat slowly "I UN-DERS-TAND." This works way better than an empty "I'm sorry this or that".. AVOID "I'm SORRY".. Stress that you'll be on the patients side all of the time!!! Like "I see you are worried, but I'll be at your side whatever happens".. These statements and a sincere feeling of being concerned for another human being made me pass with flying colors in CIS despite not been able to close 4 of those..

So, here is my main message:
- Start preparing early!!
- Get a live partner, if you can't a skype partner is ok, but consider getting some input from someone who took CS recently to see if you are good to go!
- If can afford, a Live course is a good option to assess if you are good to go or not, think it as a NBME that you pay
- First Aid is enough if used properly another good book is Kaplan Complex Cases for the phrasing and abbreviations and their cases are good too, although very challenging..
- Don't rely too much on mnemonics, the sp's don't grade you on the questions you ask anymore, focus more on the Physical Examination and try to be as complete as possible (Dr Swartz has a good amount of videos on the internet!)
- Try not to freak out in the period of the release of the results. It's very stressful, but if you followed those advices and didn't freaked out during the exam you have safely >95% chance to pass comfortably..
- Thanks for your support guys!!! You're very important to keep me sane during the awaiting period!!
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hope2015 (01-12-2014), MedicalExaminer (07-11-2013), Monkey Jones (07-11-2013), nastasya (07-11-2013), npktun (07-11-2013), nsesereso (09-25-2013), skyline24 (07-11-2013), vita86 (03-11-2014)




  #2  
Old 07-11-2013
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Thanks so much for your experience cearamor!

If you don't mind me asking, could you tell us about some of your errors on ICE? I think your experience might be a good estimate for some of us, since you mentioned you scored low borderline on ICE.

Congrats on passing!!!
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  #3  
Old 07-11-2013
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Quote:
Originally Posted by Monkey Jones View Post
Thanks so much for your experience cearamor!

If you don't mind me asking, could you tell us about some of your errors on ICE? I think your experience might be a good estimate for some of us, since you mentioned you scored low borderline on ICE.

Congrats on passing!!!
Well, I think what saved me on ICE was the PE, I trained a lot all the sequences and was very focused, but I missed some points because I forgot some stuff I thought it was important to the completeness of the examination of the system like CVA tenderness, PMI, Neck stiffness or Brudzinski or kernig and straight leg raise. So PE was not a big deal..

But what was worst was my note, because:
1) I barely practice it, and during my practices was being too relaxed with the time, so I missed a lot of important things I did during the encounter, specially in the PE, but also in the HPI like forgetting some important from the LIQORAAA, I mean, I asked the patient, but because of the rush in writing the note I overlooked those details and forgot to write, that happened on and off in most of the cases.
2) I had some trouble with the DDx in 2 cases, although it could made sense, the DDx were not the most likely and the support was lacking..
3) Didn't write pertinent negatives and had a lot of unfilled spaces on the DDx part, barely wrote on the PE part.. That was due to my lack of preparation on the note, that is extremely important..

So, basically, my main problem was time management, even with the note, and focusing too much on CIS that was my weakness, but ended up being ok..
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  #4  
Old 07-11-2013
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Default congrats bro!

congrats bro! good job staying strong through a long and tough wait for your result u surely deserve it! don't want to steal your thunder but Ximedus helped me also rock the test too!
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  #5  
Old 07-11-2013
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Good job man!! Knew you'd pass, congrats!
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  #6  
Old 07-11-2013
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congrats on your score! and obrigado for sharing your experience! jaja
very useful advice, for people like me wondering if we should take a live course. once again, thank you.
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