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Old 12-06-2013
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Steps History: 1+CK+CS
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Experiences Passed in houston!

I recently found out that I passed. I'm really thankful because when I took the exam last October, I really felt like I failed BIGTIME.. Anyway, I thought I'd share my experience to help those who are about to take this exam.
Uworld and first aid cases helped me a lot. I must have practiced them 2-3 times to the point where I already memorized the cases. When i ran out of materials, I had my friend mix and match symptoms in the minicases in FA. Practice doing the interview within 13.5 minutes and the patient note in 9 minutes. That way, you'll never run out of time in the actual exam. Also, print out the patient notes you make, and staple it together with the scrap paper that you used during the interview. You then can review it and make notes of what you did wrong. You can also see your progress when you do that case again because you can compare them. It also gives you confidence seeing that big pile of paper and you know that you're giving this test your all.
I had my friend act as a difficult patient (like someone waiting for a long time, irritable px in pain). It's just so I won't get rattled if do encounter one in the test. When I took the exam, all the SPs were very nice (except for one african american who got irritated because I had difficultly understanding his accent).
Exposing yourself to the culture also helps a lot. The only way to hone your interpersonal/communication skills is by talking to people whose first language is english.
I did take a 3 day review class in Ximedus... It is expensive and exhausting. But I think it helped me with my time management. Also the practice cases there are EXTREMELY DIFFICULT. Looking back, it's a good thing because it made me take the exam more seriously. If you do decide to take a review class, schedule it at least a week before the test so you'll have time to work on your weak areas.
On the day of the exam....
First of all, know that when the announcement is made to begin the case, most of the people there (AMGs) will take like 10 secs before knocking and coming in the room. I felt really nervous about this because I usually take almost a minute (jotting down my mnemonics and writing down at least 2 dx and sometimes even writing down some pertinent questions that needs to be asked).
1) Right before going in: put your clipboard at your side, putting it in front of you makes the SP think you're shielding yourself from them. Knock like you're the boss in the office (sign of confidence). Take a deep breath.
2) Introduction: *big warm smile* Good morning Ms ABC! *shake hands* I'm Dr. XYZ, I'm a physician in this clinic. I would like to ask you some questions and do a physical exam, is that OK? Are you comfortable? May I take a seat? How may I help you? I can see you're very concerned about this. You did the right thing by coming in the office today and we will work on this together.
3) LISTEN! There should be good eye contact but at the same time, make sure you take note of the pertinent things that the SP is telling you. I found that when I was typing the PN, it's really easy to forget important things.
A good strategy to not spend too much time in HPI is to ask just 3 questions for your top 2 possible dxs first, get out of HPI then go through the rest of the questions. Do the review of systems LAST. You can get valuable clues from the PMH, FH, SH, then go back to the things that you want to ask in the review of systems. For an example, you have a 50 yo pt with irritability. There are a dozen of diff that could cause it. If you find out in the OBGYNE Hx that she's been having irregular menses, then you can start zeroing in on questions about menopause in the ROS. It would have taken longer to establish that diagnosis in HPI alone. But I guess it's really up to what strategy you're comfortable with.
4) PE: "Ms. ABC, I'm done with the questions, I would like to start the physical exam now if that's OK." If you were sitting during the interview, make sure to put the chair in a place where you won't stumble on it. Either wash your hands or put on gloves. I prefer hand washing because I have sweaty hands and it takes me forever and a day on put gloves on. I usually take this time to ask if the SP has any questions/concerns, which in my case, is where they threw in the challenging question 100% of the time.
Be respectful and expose only the parts that you're about to examine. Every time you move the patient to a different position, ask them if they are comfortable.
5) Counsel: I was told in the workshop not to counsel until closing but I always tend to forget thus, I counsel as soon as I can. I ask these 3 questions first: smoking, EtOH and Drug use. After I know which ones they do, I say, "I'm sorry but I want to stop here and address your smoking/drinking/drug use. Smoking can cause damage to your lungs and is a risk factor for CA. If you need help quiting, I'm here to help." Don't ask them if they are ready to quit because it's just gonna be a waste of time. If they are not using any, say, "I'm glad to hear that. I commend you for not using those." Counsel as needed for exercise and healthy diet. Then say, "Continuing with my questions..." to go back to the rest of the interview.
6) Closing: "Ms ABC, from the interview and the physical exam, I think what you have right now might be caused by a couple of possibilities. First is an infection in your liver which what we call Hepatitis or it can be from an obstruction from stones within the ducts in your liver, which is called cholelithiasis. To help us determine which one is causing your problem, I would like to have an imaging of your belly taken through a test called ultrasound and some blood tests as well. I will let you know as soon as the results come out, do you have any questions?"
After the exam, I guess it's normal to think that you failed. I started to realize all the mistakes I made after walking out of the building. I had nightmares about it and I even woke up thinking of the right diagnosis to a case I wasn't able to figure during the test. I was actually saving up for the re-take. I'm just really happy and thankful to God that it's over with.
I hope this helps! And the best of luck to everyone.
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The above post was thanked by:
dr rookie (12-06-2013), frunzaf (12-11-2013), IMlover (01-29-2014), psonis (12-08-2013), starstar (12-10-2013)

Old 12-10-2013
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Steps History: 1 + CK
Posts: 6
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Reputation: 11
Default you are advertiser for ximedus

why dont you get off this forum with your fake ads for ximedus, they are the worst review, they left me at airport for 2 hrs i failed after taking their pathetic review their sps gave very poor feedback definitely not worth going to florida mrs rowley has limited knowledge and did not make any effort to teach us please avoid this review and dont fall for the above ad
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Old 12-10-2013
USMLE Forums Newbie
Steps History: 1+CK+CS
Posts: 4
Threads: 3
Thanked 5 Times in 1 Post
Reputation: 15
Default not an advertiser

ok... first of all, I'm not an 'ad' for ximedus, I merely stated that I attended that course. I'm sorry you failed but I genuinely just wanted to help. I'm just really happy that I passed and wanted to share the tips that helped me a lot. To be honest I feel like I could have done without the ximedus course. The key to this exam is practice.
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