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Old 01-17-2010
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Star How to practice cases for the USMLE Step 2 CS exam?

It has been frequently stressed upon that practicing cases before the CS exam is of utmost importance and no one should ever think of taking this issue lightly.
However, in this thread I want to mention few points on how best to practice these cases as I've found several colleagues doing it in the wrong way.

Here's a list of important points that you should pay attention to when practicing the cases with your partner.
  • Real simulation: What I mean by this is that you should seriously simulate the exam environment as much as possible. Have the SP sit on a couch and if no couch is available then a sofa may do but do not do it on a chair. Also equipment should be available such as stethoscope, reflex hammer, otoscope, ophthalmoscope, pain sticks, box of tissues, and a nearby washing sink. The SP should be wearing a gown (you can wear it over your clothes), there should be a door to knock, PN papers, draft papers, pens, and a laptop if you want to practice typing.
  • Your partner: The frequently asked question. "Can I practice with my wife, husband, girlfriend, ...etc?" Well, the answer is yes but this is not the ideal. The ideal partner is someone who's also preparing for the CS. If at all you have no choice but a non-doctor family member then that person should carefully read the SP check list and try to assess you appropriately.
  • Timing: You and your partner should be timing the encounter exactly and I personally prefer to make it 23 minutes so that in the exam you are at ease. For that you need a digital or an analog alarm clock and set it to buzz after 10, 15, 23, and 25 Minutes (these are the real times in the exam when you will be hearing the announcements). In the case of 23 minutes set it to buzz at 9, 14, 22, and 23 minutes. Do not rely on the SP to look at the time and tell you the announcements because this will make frequent interruptions and usually the SP will eventually miss the appropriate timing as he/she is involved with you in the history or physical exam.
  • SP preparation: The one who's going to do the SP should read the case carefully and should seriously act the role as much as possible. Use of stains for skin rashes or bloody tissue is preferred. Also giving challenging questions during the exam is very important. Note that a puzzle SP face after a question reliably indicates that the question is not appropriate for the case which is exactly what will happen in the real CS exam. The SP should never help the exminee by any means, like for example giving extra information or reminding the examinee of something.
  • Assessment: The SP should assess the examinee seriously in all aspects including communication skills such as knocking, eye contact, introduction, greeting, showing compassion, addressing the patient name, clarity of language, professionalism and others. The points missed by the examinee should be carefully discussed after each practice case.
  • Which practice cases: First Aid chapter of practice cases is the most popular and perhaps the most adequately written as it has an SP check list and a proposed PN with each case. However, you can also do the First Aid mini cases and USMLE World cases if you have time.
  • How many cases: The more you do, the better. Generally at least 30 to 50 cases should be practiced (15 to 25 per partner) and preferably as close to the CS exam day as possible so that you acclimatize right before the CS day.

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