Smashingdude experience for CS: An honest review! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CS Forum

USMLE Step 2 CS Forum USMLE Step 2 CS Discussion Forum: Let's talk about anything related to USMLE Step 2 CS exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-25-2013
Smashingdude's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 268
Threads: 73
Thanked 512 Times in 109 Posts
Reputation: 522
Show Teeth Smashingdude experience for CS: An honest review!

Intro

Well, well, well. My second exam is done and I passed it. Couldn't be happier. I've been procrastinating for 2 months to write the review for this rather 'iffy' exam. I took it in Houston, and got high performance in all the components.

I chose the word 'iffy'for a reason. CS is an exam that is the most unpredictable of all the exams. And NO, its not difficult at all! The fear of CS lies in its unpredictability. That is the most daunting aspect. Its not the material or the exam itself. Frankly speaking, the exam is way easier than any other step in terms of knowledge base. Its uncertainty is the one that gives me the reason to list it as the most difficult step for IMG's.

That being said, rest assured. Even the uncertainty can be managed to a good probability, if a proper plan is laid out and executed. As one of my good friends said, 'CS is like a scorpion. You can easily step on it. But you shouldn't take it lightly, because it may bite you'

Materials
Frankly, you don't need anything beyond FA. I did get UW, but ITS NOT IMPORTANT. I only went through the physical exam videos and the physical exam normal findings, and didn’t even read the cases. So, you wouldn’t really miss out on anything, trust me!!!! I am that kind of guy that usually have a paranoia of missing some details if I didn't attend one lecture or read a topic! So take it from me. You won't miss out on anything. There is 1 good thing about UW though. The physical exam note writing format. That is just great. Ill talk about it in detail later. Oh, and the videos are good to, in case you need brushing on your clinical skills. But, I know you can find tons on YouTube for free.

Time
You can easily do it in around 3 weeks. This is actually more. My friend gave it in 10 days, and he didn't even have any proper idea of the exam. The ideal range is around 10 days to 21 days. More than 21 days, you are just being lazy! Oh, and don't worry if you aren't in practice now or out of it. All my friends including me hadn't touched a patient in over a year, some over 3 years. And all are IMG'S.

You see what i mean? CS is NOT about hour much experience you have in the field. Its about how great of an ACTOR you are, how well you can improvise given a particular scene, how well you can make that ACTOR real!

Myths
-Due to the recent changes in the CS passing standards, the exam is much harder?

Not quite. In fact, I trained many of friends from all ends of the normal curve. The exam appeared tough, but in the end they all managed to drift pass it. So, no, I don't think it has made that much of a difference.

-Philly or this 'x' state has scary actors, and much harder to pass?

Nope. 2 of my friends gave in Philly, and they followed the techniques that we all used in Houston. And they had almost similar experiences. So no! The actors are very professional, and are pretty much standardized. Don't get too worried on whatever people say.

-The exam will be harder if you give it before CK? And, you should always get the first diagnosis right?

Nope. I gave it after step 1. I did have some problem in getting my differentials/workup right, but with a bit of practice from FA, it becomes easy. In fact, most of the cases are classic, with the same differentials/workup. That being said, CK does give you an edge in getting them right, nonetheless. However, the exam is not about getting the differentials/workup right. Like so many of my differentials/workup were so wide, so broad. So many times I didn’t know which one was the first diagnosis. Like literally, I put so many bogus diagnosis like 'Bronchitis' or 'Caffeine-induced insomnia' , it seemed as if a first year med student is writing the differentials! But, I got high performance in my ICE, to my surprise. I realized that as long as you can support your diagnosis, and stay within the frame of the case with the appropriate workup, you will be fine! Also, I tried my best to get the first one as close as possible, but I couldn't get all of them right.

If you leave any of your patient note blank, you may fail the exam?
Partially this seems true. I know a few people who didn’t have time to fill the PN completely. Of those, I found the ones who left the differentials/workup made it alright, and had good performances. Those who left the P/E blank in 2 cases failed the exam. They may have failed it because of some other cause, I am not sure. But a general word of advise, don’t ever leave any of the P/E blank, or the case details for that part.

-You got to mention pertinent negatives, or else you fail?

Ah, pertinent negatives. My nightmare. If you are reading this, and are an avid follower of the threads at this forum, you know what I mean. I had a few threads previously so check them out to get oriented.

Explaining once and for all the pertinent negative crap!

So whats the verdict on these negatives? In the exam, I only wrote the pertinent negatives in the P/E, and didn’t have time to write in the rows for supporting the diagnosis (except a few cases, 1 or 2 negatives) Therefore, you will be alright if you do not mention them in the supporting rows, as long as u mentioned negatives in the P/E. Therefore, you can safely discard this pertinent negative crap, and forget about it for good in the supporting evidence (as long as you mentioned in P/E)

Oh, and my negatives were SO WIDE. Like, my PN was a literal copy of the UW note. So for example, a case of chest pain, in which I also examined abdomen, I wrote all the negatives that are not even related to the case. (like BS+ in all 4 quads, soft, ND/NT, no peritoenal signs, Murphy -ve, no HSM etc) So, its not necessary for your negatives to be related to the case. You can safely write all of the negatives, and hopefully 1-2 of them will be related to the case This is a neat trick you all can do!

-Some actors were very rude, and won't give you that much information unless you ask specific question down to the dot?

Nope. Nope. Nope! The patients in my experience were very professional, and they were quite nice to talk to. Some were a bit stubborn or a bit angry, but all of them gave you information without much trouble. For instance, in one of them I didn’t ask one question, and when I asked later "Is there anything else you would like to tell me", she told it all out!

Therefore, DON’T FORGET TO ASK AGAIN AND AGAIN "Is there anything else you would like to tell me" or "Is there any other concern you might have" So many times they would be just waiting to help you out if you just ask this straight question. Don’t worry if you don’t remember the specific question to ask. They will help you out!!!

-Do you need to attend any course? Or watch the videos of CSE?

CSE is a definite no! The videos are old, and they lack the heavily in the CS component. Besides, the doctor is robotic! There are so many threads describing it, I don’t even wanna start there!

As for courses, frankly you don’t need them if you have a good partner. One of my friend did benefit a lot from the Kaplan course he took in Chicago. They broke his barrier of fear in speaking. So if you have this kind of phobia or fear of interacting with the patient, then yeah, you may take one. Otherwise, its not crucial for passing. Whatever tips and tricks they tell you are already out there, written as CS guides by so many different people. And they all have the same bottom line : SMILE AS MUCH AS YOU CAN, BE CONFIDENT, COURTEOUS AND RESPECTFUL! That’s the core of the exam!

My Mistakes
You can see my earlier post regarding it.
My CS mistakes
In retrospective, I was just being overly scared! And they are so funny!!!

Method
I did a lot of research on forums, gathered what I had to do and don't. They truly helped me a lot.

-First, I gathered what mnemonics I'll be using. I made a simple list, of the most important ones to remember. Don't get stuck up in learning like a 100 mnemonics for each case! No, you will mix them up terribly. I used as few as I could, and this was the best decision I made.

-I read through FA, only the minicases. What I used to do was to cover one side of the book and come up with the differential/workup. They help you in orienting in case, but its not important to do all of them practically since many of them are quite vague and similar, and you will be just wasting your time. That being said, some of them are a must to do (like the pediatric ones)

-Then I practiced all the cases on my brother (poor him, he suffered a lot!) under time mode, with PN writing. I practiced under the 13 min condition. This helped me a lot, since during the real exam, time is on a different dimension. You won't be able to catch it, trust me! The more you can tame it now, and practice in the strictest condition, the better!!!

-Then I went through all the cases again with my friends, around 8 cases a day complete with PN typing.

-Then we did speed rounds. Like 5 cases straight in a row, without a break. This is crucial to practice, since in this mode, all your weaknesses come out!

-Also we did rounds of counseling/challenging questions. This also helped a lot.

Experience
It was nothing like the practice we did. It was SO FAST! Like in the blink of an eye. In fact, I asked the proctor if I truly just did 5 cases, and she said 'I know, right?'.

-The proctors at the Houston center are so nice, and courteous. They are there to take some of the exam anxiety away. They surely took mine away! They are polite, and very professional.

-The actors were all very professional, and courteous. I didn't have a problem in understanding in any of their accents. One of them, though, had a very low tone and I had to come really close to understand what he was saying. And he also had a think southern accent. But not much of a problem.

-The cases. They are ALL from FA! IF not the long case, but they are present in minicases. So if you have done FA nicely, you are all set! Don't be alarmed when you get a very vague case, since you can always come up with 1-2 differentials based on FA, and most of the time it will be ok.

-Time. The only thing that is against you in the exam! Its like a raging bull, running after you, and the problem is that its going to hit you sooner than you predicted. All you can do is to fool it by running around, utilizing all the time you have to your advantage.

That being said, I have good news for you. Even this raging bull can be put to the ground in 10 out of 12 rounds, if you have practiced under the time constraints of 13 minutes. Also, you will have to adjust and improvise. Like for instance, you will have to JUMP the mnemonics, don’t stick to it, and don’t be robotic. Like for instance if you think the case is related to some STD, ask the OBGYN questions while you are taking the HPI, don’t wait for the mnemonic to bring you there. Or if you think its related to smoking, don't wait till you reach the mnemonic of 'Social'. PLEASE DON’T! This was by far the most common problem that all my friends faced.

YOU NEED TO JUMP MNEMONICS! If you go step by step, you are done! The was the best strategy that I did. I used to look at the CC, write of 3-4 diagnosis, and then walk in. While I talk and introduce myself to the patient, I write the LIQOPRAA or PAMHUGS really quick (ofcourse not breaking the Eye contact for long. ONE MORE IMPORTANT THING. Don’t let the patient talk to your scalp, please!) Then, I ignore some components of it, and jump some and just ask all the questions related to the diagnosis. Once I have done the P/E, counselled, and closed the case, then I used to say "Oh, let me see if I have everything. Yes, I forgot to ask you, what do you work? or "how is your sexual life etc".

You see what I mean? Ask the important things now. In the end when you have time, you can look over the mnemonic and ask what thing is remaining. This will save your ass from that bull, trust me!!!

Oh, and one more bitter fact. YOU WILL NEVER HAVE ENOUGH TIME TO GET ALL THE INFO OR COMPLETE THE MNEMONIC. Gulp this truth now, otherwise it will be demotivating to you in the exam. But, its alright. Completely alright, trust me! Its not at all important to ask all the questions of the mnemonic. As long as you ask the ones related very close to the case, you will be fine. Like so many cases, I completely ignored the sexual history or OBGYN on purpose, since it wasnt necessary. I did do some screening questions. Like "Any problem with your periods", if she said no, thats it, I skipped. But, even these screening questions I didnt have time to ask to them in all the cases. So, again, its alright to miss the HPI and some details. Stick to the most important questions related to the case. You can complete the history in the end as I mentioned, just to polish your PN. A full PN looks much nicer, and professional, but its not crucial!

-Counselling. Is really important, we all know that. Some people counsel at that spot, some at the end. I prefer to do it at the end. That way, you close of the case on a nice note, and have a solid rapport with the patient. I couldn't counsel on all the aspects, so its alright if you miss a few. They don't look at how many things you council. If you counselled on 1 or 2 aspects, you will be fine. However, I have seen so many people do council but forget the other important aspect. They forget to list some tests, or 1 or 2 diagnosis. Make sure to list in this order, Diagnosis, tests, councils, concerns. (DTCC)

-Concerns. Ask at least 2 or 3 times. I asked once during I washed hands. Once at the end of the counselling. Once just before I shook hands and left. Patients usually have 2 challenging questions or more. So give them opportunity to ask you. They are good points! And all their questions can be answered based on the concepts of FA. But, be sure to always be diplomatic. Don’t say a yes or a no. So many times even I felt what I said was confusing, and I didn’t know what I was saying. I was being too diplomatic "Maybe this, maybe that" or "Could be this or that" or "Yes, that may cause it" or "Yes, maybe you can, after the test, but later you might...blah blah blah". I guess, that was my strong point. I was able to convince them with my diplomacy So, don’t be afraid to practice it.

-PN. I practiced writing under 8 minutes, so I didn’t have much problem and was on time in all the cases. Besides, my programming skills really helped since I have a pretty good typing speed. You can increase it by practicing daily (sites like http://play.typeracer.com/ help you a lot, and are so fun). I first wrote the diagnosis, workup, and then the HPI, and P/E. For P/E, I strongly advise you to learn by heart the P/E note of UW. Its only a page, and you can practice it writing again and again till its at the back of your. You can just type it all out without thinking even for a second. It saves a lot of time. Many a times my third diagnosis was so vague. I tried my best to narrow all of them down to the CC. I even didn’t have many things to put for the supporting rows. My workup was the same, with so many different tests for a simple case.!

-P/E. I completely forgot about that. HAHA. You see, I didn’t even give it that much importance, and neither should you. I did a very focused P/E since you won't have time to do any of it. I did follow the respectful draping procedure, asked permission, helped the patient get up/ get down etc. Only do the common clinical PE. You don’t need to do specific maneuvers performed in 1000 BC, or all those sophisticated crap related to sports medicine!!!

Final thoughts

Well, that was longer than the step1 experience. Hope it helps all of you. In the end, CS is completely doable. Focus on your Communication skills, since they are the best weapon you have against the bull. And be wary of your time! And be confident. You are in control, not the actor! Put this in your hand, and stride in that room without ever thinking of the previous case. When you leave that room, that’s it! NEVER ponder on what you did, or what you could have done. Its okay to screw up 2-3 cases. You have plenty of room to make mistakes. But don't make any major mistake relating to CIS, or leave PN blank. Always smile, be courteous, and always ask concern.

Best of luck!
__________________
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Last edited by Smashingdude; 10-25-2013 at 12:28 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
abeer (10-25-2013), AkshayKhatri (03-02-2014), amen (04-26-2014), Amit72020 (05-16-2015), anukrati7 (06-01-2014), asmz34 (03-01-2014), Asoka (05-21-2014), Ayman Qasrawi (02-18-2014), Bird (03-18-2015), bpjavi (04-24-2014), citadel08 (02-13-2015), datar (06-16-2014), Divyajot (06-30-2014), Doctor Ali (10-30-2013), dr rookie (05-16-2014), Dr.MGM (10-25-2013), DR.PRO (10-25-2013), Dr.Tiger (10-26-2013), drglo (02-13-2014), drmalany (04-29-2014), DrNewB (02-18-2015), Eshed (11-07-2015), geesa (03-14-2015), ginseng plus (01-25-2015), GrumpyPants (02-17-2014), HafDoc (11-13-2013), Helena (01-25-2015), IMlover (02-05-2014), insa_ny (02-10-2014), Insomniac (05-04-2015), IrakliTodua (05-23-2014), Jeesan (10-28-2013), kagman (11-21-2013), KovachMarina (12-11-2013), Linc (08-10-2016), med_ziva (10-25-2013), MedicalExaminer (10-26-2013), MEDICINE DOC (04-24-2014), MishkaMD (05-27-2014), Mulan (01-25-2016), Neutrino (10-25-2013), Ojbin (05-26-2015), pd10 (12-19-2014), PneuX (02-13-2014), prat22 (03-24-2014), prtysha (02-28-2014), Ramon Santos (04-25-2014), rapiddo (10-30-2013), rg99 (10-25-2013), s_patel (02-10-2015), samren17 (02-17-2014), seemaCMC (05-21-2014), shooby-doo (10-26-2013), siddhuv (10-25-2013), sivasubaiah (01-26-2015), spaduri (10-28-2013), srssp (11-04-2013), Subuhi (11-03-2013), think big (02-13-2014), ttdnassri (11-08-2014), umernisar (10-27-2013), usbound (11-01-2013), usmlegusmle (10-26-2013), vita86 (04-24-2014), vnagubandi (10-25-2013), Volkmann (05-01-2015)




  #2  
Old 10-25-2013
abeer's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 369
Threads: 3
Thanked 193 Times in 81 Posts
Reputation: 203
Default

you are one of my favorite on this forum when it comes on writing reviews !! goodluck for CK !!
Reply With Quote Quick reply to this message
The above post was thanked by:
ginseng plus (01-25-2015), Smashingdude (10-26-2013)
  #3  
Old 10-26-2013
Smashingdude's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 268
Threads: 73
Thanked 512 Times in 109 Posts
Reputation: 522
Default

Thanks abeer for the kind words. Hope you are doing well!

PS: To the readers, sorry for the grammatical and spelling errors in my above post. I guess yesterday night I was quite sleepy when I posted it I am trying to edit and add some more details, but the thread appears locked.
__________________
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
abeer (10-26-2013), ginseng plus (01-25-2015)
  #4  
Old 10-26-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 25
Threads: 2
Thanked 4 Times in 4 Posts
Reputation: 14
Default

That was very informative and I am planning to take the CS after the Step 1 , so you gave me a lot of confidence
Thanks
Reply With Quote Quick reply to this message
The above post was thanked by:
Smashingdude (04-24-2014)
  #5  
Old 10-26-2013
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 13
Threads: 0
Thanked 2 Times in 2 Posts
Reputation: 12
Default

Thank you for the detailed post. Much appreciated.
Reply With Quote Quick reply to this message
The above post was thanked by:
Smashingdude (04-24-2014)
  #6  
Old 11-03-2013
Subuhi's Avatar
USMLE Forums Scout
 
Steps History: CS Only
Posts: 36
Threads: 2
Thanked 5 Times in 4 Posts
Send a message via Skype™ to Subuhi
Thumbs Up Wow..

Thank you so much for sharing your experience!
Reply With Quote Quick reply to this message
The above post was thanked by:
Smashingdude (04-24-2014)
  #7  
Old 11-10-2013
Smashingdude's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 268
Threads: 73
Thanked 512 Times in 109 Posts
Reputation: 522
Smile Some tips

I messaged some tips to a fellow user, so I thought why not post it here as well!

Basically, the technique is the ordinary one. I didn't do nothing out of the ordinary. Let me list some tips:

1. First and foremost, get down the mnemonics you will be using. Choose only a few, and memorize them well. They should be at your fingertips.

2. Work on your intro. You should be so fast and so natural in your intro, that you do it subconsiously. Make sure to cover the following points:
-Knock
-Address the last name, just to confirm the correct patient.
-Greet with/without handshake
-Introduce yourself
-Explain what you are going to do
-Give reassurance that you will take care of all their problems
-Ask permission to sit down and take some notes

3. Work on your questioning skills. Only open ended questions. NO close ended. Ask only relevant stuff. Jump mnemonics and ask all the important stuff now (i.e if something related to sex, ask it now rather than waiting for the entire sexualy history to be taken)

4. Make a habit of asking concerns at least 2 times. And address the patient by his/her last name at least 5 times throughout the conversation.

5. Get accustomed to doing a fast and specific physical exam. You can watch Youtube videos or UWorld videos on how to do them. No need to do detailed specific maneuveurs. Only the most commonly used in clinical practice.

6. Practice challenging questions. Do speed rounds of the most common ones. You can find them all in FA

7. Practice entire full cases with PN typing, in all conditions, in series. Like 5 cases straight in a row. This builds your stamina

8. Practice the UW P/E note. Like type it out everyday. This will make you accustomed to writing the normal findings. You cant just type WNL. You have to specifiy what you found was normal! Like dont say CV: WNL, say CV: RRR, S1/S2 normal w/o murmurs/gallops/rubs, PMI not displaced.

9. Practice differentials/workups as well. Like do cases from minicases, and come up with 3 differentials/workups. Memorize key workups.

10. Finally work on your communication skills. This involves Eye contact, Body language, Tone of your voice, hand gestures, and most importantly, SMILE!!! Let your friends observe you, and tell you what you are not doing properly.

Well, thats about it. Hope it helps!

If I get other tips, I'll list them out here.
__________________
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
asmz34 (03-01-2014), Doctor Ali (11-10-2013), drmalany (04-29-2014), DrNewB (02-18-2015), kagman (11-21-2013), pooj (12-08-2013)
  #8  
Old 02-12-2014
USMLE Forums Scout
 
Steps History: Not yet
Posts: 11
Threads: 3
Thanked 0 Times in 0 Posts
Reputation: 10
Default

Thank you for the your post, it is very helpful.

You mentioned "P/E note of UW", where can I get this?
Reply With Quote Quick reply to this message
  #9  
Old 04-24-2014
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 253
Threads: 35
Thanked 51 Times in 45 Posts
Reputation: 61
Default

Thanks for such great review

Can u please tell me if it is absolutely necessary to join Kaplan for CS?
my exam is in july,i haven't been in practice since 4 years n m an IMG..have never seen a patient here in US..

Thanks
__________________
If God put a dream in your Heart, HE saw the potential in you to achieve that goal
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
Smashingdude (04-24-2014)
  #10  
Old 04-24-2014
Smashingdude's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 268
Threads: 73
Thanked 512 Times in 109 Posts
Reputation: 522
Default

Quote:
Originally Posted by MEDICINE DOC View Post
Thanks for such great review

Can u please tell me if it is absolutely necessary to join Kaplan for CS?
my exam is in july,i haven't been in practice since 4 years n m an IMG..have never seen a patient here in US..

Thanks
Nope. Not at all!

As I mentioned, most of my friends including I, havent touched a patient since over 1 and a half years or more, some like 3 years. So it doesn't really matter, since the exam is NOT about knowledge! Rather, your interpersonal skills, and how well of an actor you are!

And no, Kaplan course is NOT required. If you have fear of public speaking, or problem in communicating, then it may be helpful. Otherwise, its not required.
__________________
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #11  
Old 05-16-2014
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default Step 2 cs

I am a final year international medical student and I am preparing to give my step 2 cs with my clinical electives in US in August. Firstly, I don't have a study partner so I don't know if I am preparing well alone,secondly I would like to ask which subscription is better, CSE or UW?
Reply With Quote Quick reply to this message
  #12  
Old 05-16-2014
Smashingdude's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 268
Threads: 73
Thanked 512 Times in 109 Posts
Reputation: 522
Default

Quote:
Originally Posted by Noor View Post
I am a final year international medical student and I am preparing to give my step 2 cs with my clinical electives in US in August. Firstly, I don't have a study partner so I don't know if I am preparing well alone,secondly I would like to ask which subscription is better, CSE or UW?
You don't need to get CSE. You may watch 1/2 videos just to get orientation, and you can find them online by googling. Otherwise, they are not that good and have lots of errors.

As for UW, its also not that important. The videos are only for physical exam, and you can find tons on youtube for me. You may get it if you want to improve on PN writing.

Frankly, only FA is more than enough for CS, and lots of practice.
__________________
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #13  
Old 05-21-2014
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 44
Threads: 20
Thanked 1 Time in 1 Post
Reputation: 11
Default

i must thank you for a very helpful exam review. Can you tell me how many P/E findings did u write for each d/d?
Reply With Quote Quick reply to this message
  #14  
Old 06-29-2014
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 592
Threads: 92
Thanked 195 Times in 127 Posts
Reputation: 205
Send a message via Skype™ to drpisho
Default

Quote:
Originally Posted by Smashingdude View Post
Intro

Well, well, well. My second exam is done and I passed it. Couldn't be happier. I've been procrastinating for 2 months to write the review for this rather 'iffy' exam. I took it in Houston, and got high performance in all the components.

I chose the word 'iffy'for a reason. CS is an exam that is the most unpredictable of all the exams. And NO, its not difficult at all! The fear of CS lies in its unpredictability. That is the most daunting aspect. Its not the material or the exam itself. Frankly speaking, the exam is way easier than any other step in terms of knowledge base. Its uncertainty is the one that gives me the reason to list it as the most difficult step for IMG's.

That being said, rest assured. Even the uncertainty can be managed to a good probability, if a proper plan is laid out and executed. As one of my good friends said, 'CS is like a scorpion. You can easily step on it. But you shouldn't take it lightly, because it may bite you'

Materials
Frankly, you don't need anything beyond FA. I did get UW, but ITS NOT IMPORTANT. I only went through the physical exam videos and the physical exam normal findings, and didnít even read the cases. So, you wouldnít really miss out on anything, trust me!!!! I am that kind of guy that usually have a paranoia of missing some details if I didn't attend one lecture or read a topic! So take it from me. You won't miss out on anything. There is 1 good thing about UW though. The physical exam note writing format. That is just great. Ill talk about it in detail later. Oh, and the videos are good to, in case you need brushing on your clinical skills. But, I know you can find tons on YouTube for free.

Time
You can easily do it in around 3 weeks. This is actually more. My friend gave it in 10 days, and he didn't even have any proper idea of the exam. The ideal range is around 10 days to 21 days. More than 21 days, you are just being lazy! Oh, and don't worry if you aren't in practice now or out of it. All my friends including me hadn't touched a patient in over a year, some over 3 years. And all are IMG'S.

You see what i mean? CS is NOT about hour much experience you have in the field. Its about how great of an ACTOR you are, how well you can improvise given a particular scene, how well you can make that ACTOR real!

Myths
-Due to the recent changes in the CS passing standards, the exam is much harder?

Not quite. In fact, I trained many of friends from all ends of the normal curve. The exam appeared tough, but in the end they all managed to drift pass it. So, no, I don't think it has made that much of a difference.

-Philly or this 'x' state has scary actors, and much harder to pass?

Nope. 2 of my friends gave in Philly, and they followed the techniques that we all used in Houston. And they had almost similar experiences. So no! The actors are very professional, and are pretty much standardized. Don't get too worried on whatever people say.

-The exam will be harder if you give it before CK? And, you should always get the first diagnosis right?

Nope. I gave it after step 1. I did have some problem in getting my differentials/workup right, but with a bit of practice from FA, it becomes easy. In fact, most of the cases are classic, with the same differentials/workup. That being said, CK does give you an edge in getting them right, nonetheless. However, the exam is not about getting the differentials/workup right. Like so many of my differentials/workup were so wide, so broad. So many times I didnít know which one was the first diagnosis. Like literally, I put so many bogus diagnosis like 'Bronchitis' or 'Caffeine-induced insomnia' , it seemed as if a first year med student is writing the differentials! But, I got high performance in my ICE, to my surprise. I realized that as long as you can support your diagnosis, and stay within the frame of the case with the appropriate workup, you will be fine! Also, I tried my best to get the first one as close as possible, but I couldn't get all of them right.

If you leave any of your patient note blank, you may fail the exam?
Partially this seems true. I know a few people who didnít have time to fill the PN completely. Of those, I found the ones who left the differentials/workup made it alright, and had good performances. Those who left the P/E blank in 2 cases failed the exam. They may have failed it because of some other cause, I am not sure. But a general word of advise, donít ever leave any of the P/E blank, or the case details for that part.

-You got to mention pertinent negatives, or else you fail?

Ah, pertinent negatives. My nightmare. If you are reading this, and are an avid follower of the threads at this forum, you know what I mean. I had a few threads previously so check them out to get oriented.

Explaining once and for all the pertinent negative crap!

So whats the verdict on these negatives? In the exam, I only wrote the pertinent negatives in the P/E, and didnít have time to write in the rows for supporting the diagnosis (except a few cases, 1 or 2 negatives) Therefore, you will be alright if you do not mention them in the supporting rows, as long as u mentioned negatives in the P/E. Therefore, you can safely discard this pertinent negative crap, and forget about it for good in the supporting evidence (as long as you mentioned in P/E)

Oh, and my negatives were SO WIDE. Like, my PN was a literal copy of the UW note. So for example, a case of chest pain, in which I also examined abdomen, I wrote all the negatives that are not even related to the case. (like BS+ in all 4 quads, soft, ND/NT, no peritoenal signs, Murphy -ve, no HSM etc) So, its not necessary for your negatives to be related to the case. You can safely write all of the negatives, and hopefully 1-2 of them will be related to the case This is a neat trick you all can do!

-Some actors were very rude, and won't give you that much information unless you ask specific question down to the dot?

Nope. Nope. Nope! The patients in my experience were very professional, and they were quite nice to talk to. Some were a bit stubborn or a bit angry, but all of them gave you information without much trouble. For instance, in one of them I didnít ask one question, and when I asked later "Is there anything else you would like to tell me", she told it all out!

Therefore, DONíT FORGET TO ASK AGAIN AND AGAIN "Is there anything else you would like to tell me" or "Is there any other concern you might have" So many times they would be just waiting to help you out if you just ask this straight question. Donít worry if you donít remember the specific question to ask. They will help you out!!!

-Do you need to attend any course? Or watch the videos of CSE?

CSE is a definite no! The videos are old, and they lack the heavily in the CS component. Besides, the doctor is robotic! There are so many threads describing it, I donít even wanna start there!

As for courses, frankly you donít need them if you have a good partner. One of my friend did benefit a lot from the Kaplan course he took in Chicago. They broke his barrier of fear in speaking. So if you have this kind of phobia or fear of interacting with the patient, then yeah, you may take one. Otherwise, its not crucial for passing. Whatever tips and tricks they tell you are already out there, written as CS guides by so many different people. And they all have the same bottom line : SMILE AS MUCH AS YOU CAN, BE CONFIDENT, COURTEOUS AND RESPECTFUL! Thatís the core of the exam!

My Mistakes
You can see my earlier post regarding it.
My CS mistakes
In retrospective, I was just being overly scared! And they are so funny!!!

Method
I did a lot of research on forums, gathered what I had to do and don't. They truly helped me a lot.

-First, I gathered what mnemonics I'll be using. I made a simple list, of the most important ones to remember. Don't get stuck up in learning like a 100 mnemonics for each case! No, you will mix them up terribly. I used as few as I could, and this was the best decision I made.

-I read through FA, only the minicases. What I used to do was to cover one side of the book and come up with the differential/workup. They help you in orienting in case, but its not important to do all of them practically since many of them are quite vague and similar, and you will be just wasting your time. That being said, some of them are a must to do (like the pediatric ones)

-Then I practiced all the cases on my brother (poor him, he suffered a lot!) under time mode, with PN writing. I practiced under the 13 min condition. This helped me a lot, since during the real exam, time is on a different dimension. You won't be able to catch it, trust me! The more you can tame it now, and practice in the strictest condition, the better!!!

-Then I went through all the cases again with my friends, around 8 cases a day complete with PN typing.

-Then we did speed rounds. Like 5 cases straight in a row, without a break. This is crucial to practice, since in this mode, all your weaknesses come out!

-Also we did rounds of counseling/challenging questions. This also helped a lot.

Experience
It was nothing like the practice we did. It was SO FAST! Like in the blink of an eye. In fact, I asked the proctor if I truly just did 5 cases, and she said 'I know, right?'.

-The proctors at the Houston center are so nice, and courteous. They are there to take some of the exam anxiety away. They surely took mine away! They are polite, and very professional.

-The actors were all very professional, and courteous. I didn't have a problem in understanding in any of their accents. One of them, though, had a very low tone and I had to come really close to understand what he was saying. And he also had a think southern accent. But not much of a problem.

-The cases. They are ALL from FA! IF not the long case, but they are present in minicases. So if you have done FA nicely, you are all set! Don't be alarmed when you get a very vague case, since you can always come up with 1-2 differentials based on FA, and most of the time it will be ok.

-Time. The only thing that is against you in the exam! Its like a raging bull, running after you, and the problem is that its going to hit you sooner than you predicted. All you can do is to fool it by running around, utilizing all the time you have to your advantage.

That being said, I have good news for you. Even this raging bull can be put to the ground in 10 out of 12 rounds, if you have practiced under the time constraints of 13 minutes. Also, you will have to adjust and improvise. Like for instance, you will have to JUMP the mnemonics, donít stick to it, and donít be robotic. Like for instance if you think the case is related to some STD, ask the OBGYN questions while you are taking the HPI, donít wait for the mnemonic to bring you there. Or if you think its related to smoking, don't wait till you reach the mnemonic of 'Social'. PLEASE DONíT! This was by far the most common problem that all my friends faced.

YOU NEED TO JUMP MNEMONICS! If you go step by step, you are done! The was the best strategy that I did. I used to look at the CC, write of 3-4 diagnosis, and then walk in. While I talk and introduce myself to the patient, I write the LIQOPRAA or PAMHUGS really quick (ofcourse not breaking the Eye contact for long. ONE MORE IMPORTANT THING. Donít let the patient talk to your scalp, please!) Then, I ignore some components of it, and jump some and just ask all the questions related to the diagnosis. Once I have done the P/E, counselled, and closed the case, then I used to say "Oh, let me see if I have everything. Yes, I forgot to ask you, what do you work? or "how is your sexual life etc".

You see what I mean? Ask the important things now. In the end when you have time, you can look over the mnemonic and ask what thing is remaining. This will save your ass from that bull, trust me!!!

Oh, and one more bitter fact. YOU WILL NEVER HAVE ENOUGH TIME TO GET ALL THE INFO OR COMPLETE THE MNEMONIC. Gulp this truth now, otherwise it will be demotivating to you in the exam. But, its alright. Completely alright, trust me! Its not at all important to ask all the questions of the mnemonic. As long as you ask the ones related very close to the case, you will be fine. Like so many cases, I completely ignored the sexual history or OBGYN on purpose, since it wasnt necessary. I did do some screening questions. Like "Any problem with your periods", if she said no, thats it, I skipped. But, even these screening questions I didnt have time to ask to them in all the cases. So, again, its alright to miss the HPI and some details. Stick to the most important questions related to the case. You can complete the history in the end as I mentioned, just to polish your PN. A full PN looks much nicer, and professional, but its not crucial!

-Counselling. Is really important, we all know that. Some people counsel at that spot, some at the end. I prefer to do it at the end. That way, you close of the case on a nice note, and have a solid rapport with the patient. I couldn't counsel on all the aspects, so its alright if you miss a few. They don't look at how many things you council. If you counselled on 1 or 2 aspects, you will be fine. However, I have seen so many people do council but forget the other important aspect. They forget to list some tests, or 1 or 2 diagnosis. Make sure to list in this order, Diagnosis, tests, councils, concerns. (DTCC)

-Concerns. Ask at least 2 or 3 times. I asked once during I washed hands. Once at the end of the counselling. Once just before I shook hands and left. Patients usually have 2 challenging questions or more. So give them opportunity to ask you. They are good points! And all their questions can be answered based on the concepts of FA. But, be sure to always be diplomatic. Donít say a yes or a no. So many times even I felt what I said was confusing, and I didnít know what I was saying. I was being too diplomatic "Maybe this, maybe that" or "Could be this or that" or "Yes, that may cause it" or "Yes, maybe you can, after the test, but later you might...blah blah blah". I guess, that was my strong point. I was able to convince them with my diplomacy So, donít be afraid to practice it.

-PN. I practiced writing under 8 minutes, so I didnít have much problem and was on time in all the cases. Besides, my programming skills really helped since I have a pretty good typing speed. You can increase it by practicing daily (sites like http://play.typeracer.com/ help you a lot, and are so fun). I first wrote the diagnosis, workup, and then the HPI, and P/E. For P/E, I strongly advise you to learn by heart the P/E note of UW. Its only a page, and you can practice it writing again and again till its at the back of your. You can just type it all out without thinking even for a second. It saves a lot of time. Many a times my third diagnosis was so vague. I tried my best to narrow all of them down to the CC. I even didnít have many things to put for the supporting rows. My workup was the same, with so many different tests for a simple case.!

-P/E. I completely forgot about that. HAHA. You see, I didnít even give it that much importance, and neither should you. I did a very focused P/E since you won't have time to do any of it. I did follow the respectful draping procedure, asked permission, helped the patient get up/ get down etc. Only do the common clinical PE. You donít need to do specific maneuvers performed in 1000 BC, or all those sophisticated crap related to sports medicine!!!

Final thoughts

Well, that was longer than the step1 experience. Hope it helps all of you. In the end, CS is completely doable. Focus on your Communication skills, since they are the best weapon you have against the bull. And be wary of your time! And be confident. You are in control, not the actor! Put this in your hand, and stride in that room without ever thinking of the previous case. When you leave that room, thatís it! NEVER ponder on what you did, or what you could have done. Its okay to screw up 2-3 cases. You have plenty of room to make mistakes. But don't make any major mistake relating to CIS, or leave PN blank. Always smile, be courteous, and always ask concern.

Best of luck!
hey smashing dude! thanks for a truly great and helpful thread.
i want to ask that when you say you practice with friends speed rounds you did them online or live study partners?? that method sure sounds helpful. but live study partners are hard to find!!
thanks in advance
__________________
Will. Power. Faith. MATCHED IM 2016!
Reply With Quote Quick reply to this message
  #15  
Old 06-30-2014
USMLE Forums Newbie
 
Steps History: Step 1 Only
Posts: 4
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

hey smasher thanks for your post but its over a year old.
I have an opinion too. I saw uw videos I agree they are not that great right now I am using csevideo I purchased a month of csevideo and I am not seeing any mistakes its right from the the fa like you can follow each case with the fa. I am also using a sp live and that helps alot. We act out each case as we see them in the video. I like the robotic style because it clear and direct no frills just information I need to know. hope that helps someone. leave me a pm if want to study online. oh yeah I saw the free version of csevi online and its really old the ones on the website are newer so I dont recommend using the free ones
Reply With Quote Quick reply to this message



  #16  
Old 06-30-2014
Smashingdude's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 268
Threads: 73
Thanked 512 Times in 109 Posts
Reputation: 522
Default

Quote:
Originally Posted by bootsnpants View Post
hey smasher thanks for your post but its over a year old.
I have an opinion too. I saw uw videos I agree they are not that great right now I am using csevideo I purchased a month of csevideo and I am not seeing any mistakes its right from the the fa like you can follow each case with the fa. I am also using a sp live and that helps alot. We act out each case as we see them in the video. I like the robotic style because it clear and direct no frills just information I need to know. hope that helps someone. leave me a pm if want to study online. oh yeah I saw the free version of csevi online and its really old the ones on the website are newer so I dont recommend using the free ones
Thank you for the promotion of CSE Videos. I see where its going and coming from

I don't have anything personal against CSE Videos. The old ones I saw had bunch of mistakes. Maybe the new ones are better, so I really cant comment.

But my whole point was that CSE videos or other courses are not essential to pass the CS exams. I think practice and a good SP are far better then just being monotonous watching these videos.

Anyway, I've been known in the forums to give honest reviews, so this was my take on CS, and I am sure many people will relate to it.

Hope the videos help you out and you ace the exam! Best of luck!
__________________
Persistent and perseverance, and the flowing waterfall carves rivers along the lofty mountains
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
250/250/241/CS, 2012 European Grad, 9m USCE, Need visa, MATCHED to IM
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
MishkaMD (07-01-2014)
  #17  
Old 01-24-2015
mozg's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 10
Threads: 4
Thanked 3 Times in 3 Posts
Reputation: 13
Default Thanks!

Thanks for the review buddy, well written.
Reply With Quote Quick reply to this message



Reply

Tags
CS-Experience

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Your Experience with Gold USMLE Review? drsrb USMLE Step 2 CS Forum 9 02-28-2016 08:40 AM
Smashingdude experience for Step 1: an honest review! Smashingdude USMLE Step 1 Forum 75 07-16-2013 11:50 AM
Honest advice whatsupdoc86 IMG Residency Match Forum 6 05-19-2013 04:08 PM
Hypermedic Step 1 Experience - In depth Review hypermedic USMLE Step 1 Forum 9 10-11-2012 05:37 PM
What's up with premier review CK? Any experience besides from step 3? compal USMLE Step 2 CK Forum 0 10-18-2011 05:19 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)