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Old 04-23-2014
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Default IMG cs experience, high performance in all 3

Hi everyone,

Thank God the painful waiting finally is over and I am board certified! I got high performance in all 3 aspects with star in SEP and CIS. Hopefully I can give back and help others.

I would like to thank this forum for providing very insightful tips: dr amir yosef, smashingdude, val7, mnypc, and several others. I read your experiences and I gained useful tips for my exam. So thank you for taking the time to write it. For those who are going to take the exam, please read their threads. You won't regret it.

Thanks to my wonderful SPs, peggylicious, joseph, ramza h, gurprit s, you guys really are a great help.

Time: This exam is doable but needs serious prep and practice. My prep was around 2 months time. Did the complete cases 2-3x, and modified complete cases introducing minicases 2x. Did 2 cases each during 1st mo and 3-4 cases each during the last month.

Resources: FA, kaplan core cases, CSA videos. The cases were all in FA minis + complete cases. So do not underestimate the minis. Kaplan core cases is a good additional book if you have time. I didn't finish it though, just read the stuffs not covered in FA. I wrote a thread on CSE videos, so I will not go over it here.

SP: I only have skype SPs. Thank God, my SPs were great, I learned a lot of things from them. They gave me honest review on how I did, which part was my weak areas and thus helped me to improve a great deal. So if you dont have live SP don't be discouraged. Committed SP is great as well. I did practice with my husband who isn't a doctor to get hold of real time and the manuvers for PE.

Practice: First month I did exactly 15 minute pt encounter and 10 min PN. During the last 3 weeks, we practiced 14 min (with warning on 8 min) and 9 min PN (with warning on 7 min). Didn't finished in the beginning, but got better and better each time that we managed to finish even before those shortened time.

Show each other the PNs, give honest review so your partner can improve, and learn from each other.

We also practiced as difficult patients, hesitant patients etc. Do practice as diff patient, bc the first time we did that, we were flustered and nervous and that was practice. I was more calm during the exam, although I still got a bit intimidated by my angry patient..

During the last week, we only focused on the high yield chief complaints.

On exam:
What to do before entering the exam room:
1. Do write your mnemonic before you go in!
I didn't write it on my 1st case my first case was the worst. --> because of this I missed everything from family hx to social hx to sex hx to obgyn hx. I got very little hx that I finished my PN w/i 5 min and sat there thinking how stupid that was. Used the 5 min left to pray, calm my nerves and determined to write mnemonic before I go in.

I didn't write the PAMHUGFOSS, I just write mnemonic for PMH/FH/SH/sxH. LIQORAAA if related. or SIQORAAA.
2. Write several DD based on chief complaint.
3. Write the key PE you will need. Eg: pulmonary, ENT, if cough/respiratoric case. Add or substract as you gather the hx.
4. Put a big smile, knock and go in.

In Exam room:
1. Listen carefully.
Don't think of what the next qs while listening to the SP. On my exam, the SPs were very understanding that we have limited time. I ask open ended Qs and they gave me several important infos. On my first case I was so nervous that I missed important hx despite the SP kept on hinting on that specific aspect I was too nervous to pick up the cue.

I also make abbreviations for common complaints to make it easier and faster to note it down and used it in practice. Eg: chest pain = CP, weakness/numbness/tingling = W/N/T; Cold intolerance = CI. etc.
2. Show courtesy
Shake hand at the beginning and end of encounter. Maintain eye contact. Show empathy. Ask permission to untie and don’t forget to tie back the gown. Help pt to sit, pull the leg rest for them and don’t forget to put it back in. One of my SP told me after I finished the PE, “can you please to the leg rest in? I’m not comfortable”. Respond to their emotions: hesitancy, fear, doubts, confusion. Eg: If you are finished explaining and they looked bothered, ask “you seem to be confused/bothered, please feel free to ask any time”
3. Take time to gather your mind and decide what PE will be needed.
After summarizing the hx, I took 30-60 sec to write the PE I will do, not in detail just like comp pulm, vascular, ENT, head. Put the note on the table, put on my gloves and if I forgot what PE next, I just peeked at my note. After I’m done, I rechecked whether I have done all.
4. Always ask “Anything else?”
After summarizing hx and PE always ask “anything else?”. They will spill the beans for you. One of my SP was very kind, I totally forgot to ask an important q and he gave me that info near my closure. He even emphasized on it.
5. Explain DD and work up.
I forgot to explain work up in 1 patient. Afterwards, I write DD & labs on my note before I go in and checked them after I did.

The threads I mentioned on the beginning of my note cover this section very well. I just want to add how to organize your PN:
  • I used the bullet style, w/o inserting enter. Eg: (+) for vomiting, clear fluid, no blood. Fever, 101F, 3 days. No need to worry whether I have the correct grammar, save space.
  • I wrote it in the order of LIQORAAA. à This way you wouldn’t forget the pertinent ones and it will be well organized for the reader.
  • Group all the pertinent negatives in clusters of DD at the end of HPI. eg: in headache case neg for fever, blurry vision, projectile vomiting, weakness/numbness/tingling (r/o meningitis, inc ICP), tearing, rhinorrhea (r/o cluster headache), aura (migraine). But this is just me, I find it easier for me and less likely to forget instead of jumbling everything together.
  • Include important hx related to the case not just the usual common FHx, eg ask for sudden death hx in cases suspicious for HOCUM.
  • Write it from DD --> work up --> Hx --> PE.
  • At closure (BIG thanks to Dr Amir Yosef for telling me this): before explaining the DD, ask for patients thoughts on what might be causing the problem. “Do you have any idea what is happening to you?”
  • ·Make sure they understand your explanations: “Is my explanation clear to you? Any other questions for me?.
  • · If they are worried and you cannot give definitive answer: Address that, “ I can see that you are very worried. I cant give you definite answer now, but I promise you I will call you as soon as I have your result. Or “whatever the result is, I will be here for you.”
  • ·Assess their willingness to comply to your plan: “Do you agree with the plan?”
  • Watch American TV series! This is how I learn to listen, common phrases, jokes, correct pronunciation. Try to friend native Americans and hang out with them.
  • ·I also memorized the list of qs in FA history taking section. Just so I won’t stumbling finding the correct words to ask.

Feel free to ask any questions. Last note: READ the CS BULLETIN. I noticed that sometimes people did not read the bulletin and hence missed important info as how the exam is graded, what can increase your score, what will hurt it.
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The above post was thanked by:
abeer (04-23-2014), bpjavi (04-23-2014), (04-23-2014), cumberbatch (04-24-2014), DNA 105 (04-23-2014), drmalany (04-24-2014), drmemon (10-07-2014), frunzaf (04-24-2014), inspired (04-25-2014), JLY7 (04-23-2014), sami trailer (04-23-2014), seemaCMC (09-28-2014), usmlerun (04-27-2014)

Old 04-23-2014
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Congratulation for becoming ECFMG certified and hop to read your note after matching soon.
I couldn't find you thread about the CSE, would you pleas guide me to that, because I am planning to use it, Or do you suggest something another one.

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Old 04-23-2014
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Amen for the match!!

Here's the link for CSE review:
honest review of the updated version of CSE videos

Overall, it was helpful for me, but watch it with critical thinking as there are some significant errors, especially in PN section.

Best of luck for your journey Sami!
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sami trailer (04-23-2014)
Old 04-23-2014
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Steps History: 1+CK+CS+3
Posts: 226
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Thanked 180 Times in 110 Posts
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Btw to make it easier for you guys, here are the link to the thread that I find very helpful:

1. Dr Amir Yosef
CS Experience IMG 1st attempt with 3 "high performance" and one star

2. Val7
val7 Step 2 CS experience: Philly, May 2013

3. mpnyc
How I Passed Step 2 CS

4. Smashingdude
Smashingdude experience for CS: An honest review!

5. Mastermind
MastermindDoctor CS experience Houston May 2013

BIG thanks to all the above members. Best of luck for the next journey guys.
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sami trailer (04-23-2014), seemaCMC (09-28-2014)
Old 04-24-2014
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hey.. everyone
i wrote my CS exam on april 2014 .
my Mistakes:
- did not make appropriate diagnosis of 3 cases .
- in my first case i screwed up as the SP said doctor you are not getting my problem . then i pretended as i knew the problem and modified my history .
- did not do a complete neuro examination , though i tried to cover most of it .
- did not do closure in one case , though i answered her questions and concerns but at the end of case i simply said because of an emergency i have to leave but i will come back .

THings i Did right:
did closure in almost all cases .
- counsel patients
-show empathy
- wash my hands
- ask permission before doing examination and keep explaining and asking during PE
- explain tests to them
- follow PAMHUGFOSS in all cases
- asked them if they have any questions for me
- at the end of encounter i offer them that they can call me any time if they need my help .
- summarize history and ask them if they wana add something

guys what are my chances ? i know it is a silly questions but this wait is killing me.
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Old 04-24-2014
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Steps History: 1+CK+CS+3
Posts: 226
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your mistakes seem to be minor IMO. I also only wrote 2 DD in several cases. I completely screwed up my 1st case too.
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