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Old 08-15-2013
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Show Teeth hamzarayes CS experience


I started on and off ie. Couple of hours every other day for 1.5 month before I enter USA, mainly on skype although I think It did not help much but it did help to develop a good sense of what to focus on during live practice in addition to get familiar with the FA and how to go through it specially that most of the peers I had in skype were a few days ahead of me in their preparation.
So what I did was that I wrote an announcement in USMLEFORUM.COM and USMLE-FORUMS.COM stating my study goal and timing at which I would be available with my skype account and asked who was interested to add me and write down CS in the invitation letter so you get an idea of what is happening in your account. Eventually I had 2 to 3 people getting added every day to my account what I did is I added every body in one conference group this way when ever you think of practicing CS you have a very high chance to find one of the almost 50 people added to this group to practice with, so this was a very useful think specially in term of let you get a diversity of SP exposure that is essential for this exam. Don’t stick to only one SP for the whole prep because you will be predicting all his/her next moves and your practice will not be a fair game believe me.
After I arrived USA I did everything to find a SP but could not find any so I heard about a course in NY that exposes you to many trained SPs. The course was useful but nothing that you can not do on your own by studying but the practice with SPs was of grate value.

The way we carried out the life practice was amazingly difficult at the beginning but once we got a specific pattern it became much more easier. We started by doing FA cases as such the SP would read the history and give the same history findings written in the FA with out changing in this way we could assess our selves using the check list of questions. The physical exam was some thing we did not focus much into at the beginning. Anyway back to the history taking after that first round we did the FA cases all over again but this time the SP can change the diagnosis and the differential giving different history and physical finding so was more unpredictable and more like an exam specially when more people came to practice with us forming a 5 people group insured diversity and variety of patients which is what we expected and actually found in the real exam. As the exam date approached we started practicing the FA minicases and UW cases plus physical exam.
In regard to physical exam we noted that just like in history a you need to develop a certain pattern and follow it in every case. You need to memorize certain sentences that you will say in every case. For instance, now I am going to press over you belly and let go please let me know if it painful ( to asses for rebound tenderness in abdominal examination ) it is unadvisable to change sentences if you are not a native English speaker or have not been practicing for a while in an English setting with English speaking patients, because with exam stress it is hard to make things up or to look for alternative sentences specially if something unexpected happened just before doing this maneuver like for instances you forgot to wash your hands or to tie patient drape and you just realized it you might get so stressed and your thinking gets so absorbed by what happened, at that time if you don’t have an exact sentence that you have said 100s of times during practice you are likely to get more mistakes under that pressure.

Confidence is another issue, that only you can get rid of by practice and practice, but just like I said before practice with only one partner is good for developing a pattern for history taking and physical exam but does not however brake the ice between you and people who are strangers for you. Every time I did a very familiar case with a new person especially people you havenot before you feel very different and you get more mistakes and you learn from them so you don’t do them in the real thing. Eventually approaching the exam you are used to start an encounter with anybody and confidently.
With this been said the most important thing is confidence in god’s help and do not sit for the exam until you feel really comfortable making an encounter with anybody any symptom at any place.
Exam day: sleep early and wake up early be there at 7 to 730. Bring you passport non expired, white coat and stethoscope. You don’t need to bring food nor water, you have every thing available in the center for your convenience. The staff are really friendly you can go the toilet in brakes and can even pray just bring alsajada to pray over it. The first 2 cases are the most challenging for you but in fact they are just random cases, the issue is you just starting the day and you have not got the pace yet so many people don’t finish the first or second case in time, but this is not a role as all of our group finished the first cases in time guess because of intense daily practice.
When the exam starts they will get you in a big room so you can check the instruments that you will see in the office like : bed, ophthalmoscope, otoscope, tap, gloves etc.. you will be to test them use them and abuse them loool enough time.
Then they will give you numbers and put you in lines to enter the exam hall. Then every candidate will stand in front of the door waiting for the start annoouncment of the first case. The first announcement is actually for the SPs to get prepared then is your announcement to open a small box in the door at which the door way information is written. One you hear it the 15 min time starts. Some people stay out writing mneumonics and notes then they enter, personally I wrote pt name age sex and 2 differential and got inside. I don’t think there is a difference as long as you are used to it before hands.
SPs all of them are friendly and really good actors; I had a case in which her son died a few days ago… she made tears yes she did hhhhh. When you to the inside of the room you will be behind the patient’s back the patient will turn to you in the beginning but becareful of not staying there as some candidates have done it before. Go infront of the patient greet and hand shake him. All patients were draped already except for one case she was wearing the gown but in a chair not in the bed I toke the history and then asked here gently to go to the bed for the sake of the physical exam and draped her. And after finishing I forgot and sat on her chair so I aploagised and asked if she wants to go back to her seat but she said it is ok I will stay over the bed.

Counseling: although I did not have time to answer questions at the end of the case I had a challenging question in all cases as I asked between history and physical exam whether the patient has anything he wants to add or anything he wants to ask. Most patients did not add any information at that moment if not relevant but they did ask. In closure and before asking the patient whether he has any questions I talked too much about many differnet things and answers to possible questions the patient might have although it looks good but in this way I lost precious time for the patient to show his concerns and me to answer them. So even if in my closure I told the answers to future question in this case I still did not get points for the explanation and assessment of patient specific complaints; which can cost you some communication skills stars.

When the last announcement rings if you stay in the room you not only lose time from your patient note ( as the other 10 min timer for the patient note starts at that time) but you will also have risk of being assigned an irregular behavior form and in the mean time you will not get any additional points for anything you say. However, don’t leave the SP with saying bye bye you can interrupt the subject you were discussing but you cannot interrupt the encounter as a whole with giving an excuse saying sorry you have to leave because of (for instance an emergency) and you will be back to finish anything undone or to address any additional concerns the patient might have. I personally used sorry I have an emergency I will be back as soon as I can shaked hands and left., though that did not happen in all cases as it is difficult to fight the temptation of saying something important in the closure when the alarm rings.

Patient Note: the time is not enough to write it you have to be very focused even in the patient note write the relevant info first, which is basically info that suppots the diagnosis. Avoid writing for instance no chest pain in a case highly suspected of appendicitis it is a waste of time and concentration. To give you an idea the day bofore exam I was writing the PN in 7 minutes only. In the real exam I finished it but still had some things to add and to delete. Probably this is because of the fact that the differential is not as clear I mean the the 3 causes of the Sx are always clear but what is not always clear is which goes first and which follows and what are the things that patient says and you have to remember which is almost always the case. When the finished you leave the keyboard. You don’t need to click the submit button before the time finished you can do it after the time finishes it is ok . actually even if you don’t do it they will remind you of doing it and even if they forget to all computers are checked and form submitted after you leave the table so if you forgot to submit for some reason just move on or give them a notice.
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abeer (08-15-2013), Amna Aziz (10-22-2013), billy (08-15-2013), ifss (08-15-2013), MedicalExaminer (08-15-2013), swwal (08-19-2013), water (08-15-2013)

Old 08-15-2013
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Default can u help me in this regard

hey friends i m also waiting for my results...can anyone please guide me about my mistakes i mean to say are they just minor mistakes ,blunders or big blunders
1..i forget to do leg rest in my 4 abdominal examination cases
2..after doing my counselling at the closure of my all cases i forget to remove my gloves i all 12 cases and hand shake with all sp e my gloves
3....in 2 cases i found the name of my sp a bit difficult and just during the knock i used to kall my sp e name and after that i used to kall him e YOU or MR

can u people give ur valuable feedbacks..can i pass my cs exam e these mistakes??everything else was ok i think but these mistakes bother me a lot.plx need ur advise,its a real torture for me,,thanks
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Old 08-15-2013
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thanks for that great writeup. was FA enough for are 12 cases?
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Old 08-15-2013
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Originally Posted by ifss View Post
thanks for that great writeup. was FA enough for are 12 cases?
FA was enough for me (also check out my thread here: val7 Step 2 CS experience: Philly, May 2013).
Also, I honestly don't think it makes sense to practice the FA cases more than once. They are not the same as the cases in the real exam, they are really just one thing - practice. Once you are done and you want to do more, get a different book and do different cases so you will be ready for anything they throw at you. I have met a lot of people trying to memorize the FA cases but I honestly do not see the point. it will make you narrow minded.
I personally was fine with just FA (did every case once).
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Old 08-17-2013
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plx comment on my mistakes..i have posted on ur thread and guide me can i still pass with these mistakes ?? waiting for ur rpl,,thanku
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