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Faith1130 06-24-2013 10:01 AM

Passed CS on 1st Attempt
 
Sorry for the delay in posting. But I wanted it to be a very good post where it's used as a guidance for others.

About myself:

- I am a 4 yr Carib medical student, currently finishing up clinical rotations. I completed my 2 yrs of basic sciences in the caribs.

Prep time:

- When I got my ticket back, I was half way through my Surgery rotation in March, and paranoid that I won't get a date till later June, as soon as I got my ticket I registered to take my CS on May 7th at Chicago center. Was a bit disappointed when I had to settle for the afternoon session, but I think it worked out for the better.
- Was a bit scared to prepare while on my surgery rotation, but I instantly started to look for a sp. And I found one we started with the big cases. It was great for the first 2 weeks, until she came to Chicago to prepare with a friend of hers. So In total my prep time was about 6-4weeks on and off, spent about 4hrs everyday.

How I prepared:

- Initially, I thought to know the minicases well, and then use the big cases off of FA to test myself. But I talked to a friend of mine who took the exam and she had to focus on the big cases and get used to the flow of things and timing yourself. So I did just that. Since my sp bailed on me, and I didn't have time to find another one, I used my husband as my standardized patient. Which I think worked out great for me, because he's not from the medical background, so he made me simply a lot of things.
- Since I was doing my surgery rotation, as soon as I got home I practice 2-3 big cases from FA on him...in timed mode almost everyday. There were days I did really well, and days when I was terrible went over my time...but my only mistake was I didn't practice PN from the start. If I had I think I would have been more confident with it.
- I started to practice PN when I had 3 weeks left till my exam.
- When I started to type my PN I realized I was having a hard time coming up with my DDx...so realized that I need to know my Minicases...So then for a week I stopped practicing on my husband...and I started to look for a sp for minicases, but really didn't have much luck, so I took note cards, and wrote every minicase out and basically quizzed myself. And I am glad I did this because coming up with DDx, workup...and supporting it with positives and negatives made it easy.
- As I went along the minicases, I started to realize that, I should have first did a couple of minicases and should have had my husband quiz off of those minicases by doing the big cases of those CC...I think that would have worked better...and if anyone where to ask me I'd give them that advice. I tell them to look at some minicases first and then practice those by doing the big cases, and the PN....
- I used the usmle practice PN page to practice typing my PN...and that was very similar to the one on the actual exam. The only thing I'd suggest is to practice on a keyboard, and not on laptop, because I had a difficult time adjusting with the keyboard.
- Seriously guys read the FA...its all you really need if your english is good...you really don't need any review course or anything.
- For the PEs I did look at the CSE videos..but only some esp. for the neuro exam. and I youtubed some if I wasn't convinced with the CSE videos, and honestly that's all you need. So say that the CSE videos are horrible, to a degree I think they are, but if someone wants to get just get a feel for what the exam/encounter will be like...then yes I think the CSE videos are good. If any one of you guys are from a Carib school had ICM,and you guys had a mock exam...then I think they prep you well on the island if you remember those. I honestly used my island experience from ICM..and the mock exam I had.
- Also don't forget to time yuorself... I used the 10min warning..and then 13mins...and for PN...I used the 8 min warning as my 10mins...and guys PRACTICE PRACTICE PRACTICE!!!
- A lot of ppl are concerned about the CIS portion...FA also has tips for this...right at the start of each big case...they have written what the SP should expect...and in their it tells you that if the patient is coughing did they offer tissue or glass of water...so if this guys it common sense. I was once reading a post from a different forum right before my exam..and they wrote it beautifully...imagine the SP is your mom or dad...and how would you treat your parents...you'd want your parents to get the top most level of service or care...so if you ask them to walk across the room make sure ur their to assist/spot them....
- A lot of ppl asked if they should wash their hand or wear gloves...I wore gloves...it saves time..and whenever I am nervous I have cold hands...so it added that extra barrier...also guys if your going to wash hands and your hands are cold...apologize for cold hands...its these simple manners they are looking for...I smiled...said sorry a lot...commended them if they weren't smoking,drinking,doing drugs...counseled them immediately if they did drink/smoke/drugs...or any other alarming lifestyle...I was just recently married 6 months ago... so I even talked about how I hope to go as many years of marriage as them. I had someone who told me they have everyone healthy in their family so I told them about how I have a grandmother who's 95..and is completely healthy...I was real with them and told them about my personal life..even though anything they said was scripted...but I guess that's why I got high performance on the CIS...This is exactly what this other person wrote in a different forum...that half through his exam...he just started to talk to the patient...you just get so comfortable that you just start talking to them...and that's exactly what happened to me.

How to type the PN:

- As far as the PN... guys I used the format as it is in FA big cases... I did type in ALL CAPS...and this was actually a last minute change I had made on the day of the exam...for some reason I felt it looked better when I wrote in ALLCAPS...so I went with that..someone wrote that oh if you write in all caps then you're telling the grader that you're a IMG or FMG...its the same rumor as the SPs will know that your a FMG or IMG or AMG...I don't think any of it is true.... I think what is true is how you present yourself to the SP...if you don't look or sound confident then yes its a problem... but if you believe in yourself...then they will believe you..and they do keep a good poker face....I was able to crack some with jokes here n there...but they went back to their serious face... but you have to watch out for that... bc then u know you have nailed the CIS part...
- I did do a focused PE...so even when I types my PN...it was focused first... ofcourse if I had time I organized it system wise... but I did write VS: WNL...except BP: 140/90....I avoided typing WNL...and actually wrote out what I palpated/heard/precussed....
- Also about the CIS guys...I haven't read much on ppl mentioning this...but I hope you guys are telling the SP what you're going to be doing before you do it...because that even applies to real practice..esp. if you're going to look into their ears...listen to their heart and you need to untie their gown...so make sure to ask permission and tell them what you're doing... after all it their body...would u want a stranger touching your abdomen just like that...
- the order of which I wrote my PN: DDx + supporting +/- findings, workup, HPI, PMI, PE....I did have a case and there was a lot of PE I wanted to type...so I typed my DDx...but forgot to type my workup...and I didn't realize it till the end when the time was up...and I had to click submit... but hey that was the only major I made...I also couldn't spell a herb....but hey I passed :)).
- About the + and - findings to support the DDx...this is the way I approached it...FA has an explanation why a certain DDx is most likely...and they even tell you why it might not be the top most DDx...I honestly used those to support myself...and for a lot of them I used the CC as my support for DDx....you will hardly has a positive PE finding...so for the PN...make sure you know the NORMAL...increases typing speed...also yes abbreviations are good...but only use them if you're sure..if you're not its best to spell it out...

EXAM day:

- NERVOUS AS ANYTHING!!! Stomach tied into knots...didn't want to eat anything....cried a lot....but again...the other post I keep talking about from a different forum..they wrote to talk to other students...it'll calm your nerves..which is totally true....
- Encounters....found them already draped so asked them if there is anything else I do to take them more comfortable in the room...
- My first case I was nervous but as soon as I read the doorway info...it was an easy case...I was so happy..and by then end of the night....I just got so comfortable...I just talked to them normally as if I would with my family..or some of the pts during my clinical rotations...
- Before I walked in...these were the things I did... I wrote down if its MR. Smith or Ms. Smith... this way I got the male/female part covered...I wrote CC... location...if its ER/ED/phone/clinic...any alarming vitals... my mnemonics...I honestly... used LIQORDSSAAA...PAMHUGSFOSSWAEDT...and some additions here and there based off the things I used to forget when I practiced on my husband... so I think this something you to come up with on your own... Someone I knew who took the exam long time ago...she told me something that made sense to me as I did my minicases...she told me make sure you ask all the systems questions associated with the CC...for example...suppose a pt comes in with chest pain...don't just automatically think its MI or angina...it could be a GI problem like angina of the esophagus that could mimic (btw this is just an example..it doesn't imply anything towards the exam). So I think when you do minicases it covers this so that you know to ask better questions... other things I wrote was PEs that I knew I should do..esp if its neuro...and if I already knew the DDx I wrote those down too... I honestly spent a good minute outside before I walked in....spend this time guys...bc once your in your just with them....you don't have time to think....and if you blank out its shows as lack of confidence...and you don't want to show your weakness.... At the end of the day...I feel if you have prepped well and don't show weakness...you will pass and do great...

I might have missed things here any there to type...so if anyone has questions pls don't hesitate to ask...I know how you all feel...I went not so long ago when through all this...and did it all with the help from forum members...GOD and my husband...whom I owe a lot of thanks to...GOD and my husband went through a lot with me...and with them, I wouldn't be here...so guys pls ask away...

leene1982 06-24-2013 11:59 AM

Thanks for sharing your experience. Congrats!

aaru20 06-24-2013 04:32 PM

thanks for sharing this experience..i have my exam next week and am superstressed about it..am not worried about the differentials but about the physical exam part.. how perfect is it suppose to be.. also time is a big issue with me..its the main thing which is making me think that I might fail this exam..i can finish the encounter in 15 min but with difficulty, I fail to understand what to miss out on because the history alone takes me about 9 minutes..also I am unable to finish my patient note on time..:scared::scared:

Faith1130 06-24-2013 06:47 PM

Quote:

Originally Posted by aaru20 (Post 199115)
thanks for sharing this experience..i have my exam next week and am superstressed about it..am not worried about the differentials but about the physical exam part.. how perfect is it suppose to be.. also time is a big issue with me..its the main thing which is making me think that I might fail this exam..i can finish the encounter in 15 min but with difficulty, I fail to understand what to miss out on because the history alone takes me about 9 minutes..also I am unable to finish my patient note on time..:scared::scared:

The PEs don't need to be perfect. As long as you touch on it that's all that matters. Like make sure you do Rinne and Weber. Do a focused physical. How are you practicing? Are you giving yourself the complete time? Or are you cutting it to 13mins? Because when I practiced initially I gave myself 15mins but then with the neuro exams I was going over so then I started to give myself only 13mins. Try to keep your goal to getting to PE before the 5mins remaining warning and you should be good. As for the PN keep practicing. Again if your giving yourself the full 10mins then don't. Give yourself 8mins. And no matter what make sure you put the DDx and work up first and then ur HPI bc that's where majority of your point will be. Hang in there and keep or acting your PN the whole day for the rest of the week I am sure you will improve.

aaru20 06-24-2013 08:01 PM

Thank you so much..yeah am running out of time for neuro cases and I m trying to finish the PN in 9 min but it usually takes me more than 10..u are right I should be finishing the cases in 13 min n Pn in 8 ..i'll work on that now..good luck for the match..����

Faith1130 06-25-2013 05:27 AM

Quote:

Originally Posted by aaru20 (Post 199154)
Thank you so much..yeah am running out of time for neuro cases and I m trying to finish the PN in 9 min but it usually takes me more than 10..u are right I should be finishing the cases in 13 min n Pn in 8 ..i'll work on that now..good luck for the match..����

For the neuro cases you will only have time to do that on the actual exam. I didn't have time to auscultate the heart and lungs so I just left it to that. So see if by only doing the neuro exam and not the other things in FA do u still run out of time.

Thanks for the match have to still take CK so not sure if I'll make this year's match. 😞

water 07-05-2013 04:08 PM

Congrats!! Did you have experience taking histories in English medium in the Caribbean?

Faith1130 07-05-2013 06:47 PM

Quote:

Originally Posted by water (Post 201281)
Congrats!! Did you have experience taking histories in English medium in the Caribbean?

I am not sure what you mean but yes as part of our 4th semester ICM we were exposed to sp on weekly bases and we were showed how to do PE and how to take hx on them. And all the classes are offered in English through out the medical career

water 07-06-2013 10:10 AM

What I meant is. In our medical school the patients in the hospitals speak only in the native language and therefore we took histories speaking in the native language. Did that happen to you?

Faith1130 07-06-2013 12:46 PM

Quote:

Originally Posted by water (Post 201378)
What I meant is. In our medical school the patients in the hospitals speak only in the native language and therefore we took histories speaking in the native language. Did that happen to you?

No they spoke English

ChicagoGrad 07-09-2013 05:34 AM

Another excellent CS experience post, thanks for sharing.

Quote:

Originally Posted by Faith1130 (Post 199043)
I did type in ALL CAPS...and this was actually a last minute change I had made on the day of the exam...for some reason I felt it looked better when I wrote in ALLCAPS...so I went with that..someone wrote that oh if you write in all caps then you're telling the grader that you're a IMG or FMG...its the same rumor as the SPs will know that your a FMG or IMG or AMG...I don't think any of it is true.... I think what is true is how you present yourself to the SP...if you don't look or sound confident then yes its a problem... but if you believe in yourself...then they will believe you.

Is there a resource that recommends typing in all caps? If not, I would (for future test-takers) generally recommend against it. This is one rumor that I think holds some actual weight. All caps usually does indicate IMG status. I don't think this makes a difference in evaluation despite some fears. But if people are worried about that sort of stuff, that's one thing to probably avoid.

Definitely agree with the last part. Confidence is one of the biggest keys to dealing well with your patient (and very few people are confident during a test, so you have to fake it :)))

Faith1130 07-09-2013 06:34 AM

Quote:

Originally Posted by ChicagoGrad (Post 201821)
Another excellent CS experience post, thanks for sharing.



Is there a resource that recommends typing in all caps? If not, I would (for future test-takers) generally recommend against it. This is one rumor that I think holds some actual weight. All caps usually does indicate IMG status. I don't think this makes a difference in evaluation despite some fears. But if people are worried about that sort of stuff, that's one thing to probably avoid.

Definitely agree with the last part. Confidence is one of the biggest keys to dealing well with your patient (and very few people are confident during a test, so you have to fake it :)))

I honestly typed in caps and trust me that was a last minute change I made. Honestly I don't think it does cause when was in with the sps no one could tell that I went to Caribs. I am sure they thought I was a USmed student. And hey I passed with all high performance.

Honestly confidence is key! By the second of the exam I just got so comfortable it was beyond believe I literally joked with them. And the smiles just came out naturally. But then again I am a ppl person.

ChicagoGrad 07-09-2013 06:49 AM

Quote:

Originally Posted by Faith1130 (Post 201844)
I honestly typed in caps and trust me that was a last minute change I made. Honestly I don't think it does cause when was in with the sps no one could tell that I went to Caribs. I am sure they thought I was a USmed student. And hey I passed with all high performance.

I agree with you, I don't think it makes a difference in your evaluation. But if I'm a grader, I know instantly that an allcaps note is an IMG. It's very rare to find an AMG (at least US born) that types in all caps. It's a cultural divide. In the States, that's usually viewed as Internet shouting. This is one "rumor" that's not a myth, it's true.

Again, I don't think it makes a difference in overall evaluation. The only reason I pointed it out is because I know to some people (friends in real life, and I'm assuming some people on this forum), these things make a difference and they think being an IMG may affect their eval. But as long as the content of the note is good, anyone will be fine in my opinion.

bullonto 07-11-2013 07:14 AM

thank you very much for sharing. I am following your advice and currently reading the minicases and it has helped me improve a lot, and gain confidence! now question: what do the SS mean in LIQORDSSAAA?? how did you balance your time? e.g. 8 mins to HPI, 4 for PE and 3 for counseling?? thank you.:)

Faith1130 07-11-2013 04:37 PM

Quote:

Originally Posted by bullonto (Post 202358)
thank you very much for sharing. I am following your advice and currently reading the minicases and it has helped me improve a lot, and gain confidence! now question: what do the SS mean in LIQORDSSAAA?? how did you balance your time? e.g. 8 mins to HPI, 4 for PE and 3 for counseling?? thank you.:)

I am glad that the minicases are helping :redcheeks;. okay so as I went along..I found somethings here n there that I kept missing and felt it was important to ask..so I changed the mnemonics to my liking...this is what I had come up with...but it'll work better if u come up with ur own:

Location
Intermittent/Constant
Quality
Onset/progression
Radiation/Frequency
Duration
Severity
Sleep (I had noticed that in some pain questions it was important to ask...so I threw it in there)
Associated symptoms: Fever,HA...for this I treated it as ROS...and just looked at the SP and went from head to toe and just asked relevant questions...like Fever,HA,dizziness, ear pain, runny nose, sore throat, chest pain, palpitations, SOB, ab pain...n/v, diarrhea, constipation...weakness,tingling,numbness...and if they had anything they'd just tell u...suppose they don't have ear pain but they might have discharge or ringing...so they'll tell u I don't have pain...but....
Alleviating/
Aggravating...

PMhx...so I went a head and asked the rest...PShx...
Allergies
Medications
Hopitalizations
Urinary problems (if u all ready asked b4 then this is just here to self check)
GI problems
Shx (I asked this with PMhx)
Fhx..(I asked this with PMhx...)
Ob/Gyn (females...and I think there is mnemonic for this too)
Before I continued...I threw in confidentiality here: "Now I'd like to ask you some questions that are a little personal...just wanted you know that anything we discuss here is confidential...so pls be as open and honest with me...is okay if I ask?"
Occupation
Sexual hx
Social hx
Weight
Appetite
Exercise
Diet
Travel

Once I was done with that...I went ahead and summarized...and basically just focused on HPI...I used to waste a lot of time here...finally some study partners honestly told me to just focus on HPI...and it cut 30-45secs down for me. Then I just asked is there anything else u'd like to add before I continue...and usually they said no...

Then I said now I'd like to go ahead and do a PE on you...but before I do that I am going to put on some gloves...while I do that do you have any questions or concerns for me?...if they did they addressed it here....

Then I asked permission to start PE on them...my goal was to start PE b4 the 5min warning..and this only came with PRACTICE!!! There was ONLY ONE case that I had started doing PE at the 5min warning...bc it was lengthy on HPI...AND for all the cases I made sure I still listened to their heart and lungs....I thought apart from the focused PE...chest and lungs was pretty fast and simple to listen to....

Once I was done I thanked them, and helped them drape back up...just to let you know the gowns were longer then what I had expected...and so had a problem with that...but I kept APOLOGIZING...and thanked them for everything. And then I just said now I'd like to discuss with you what I think maybe going on....of course the ones in FA are really long...but if you cover the jist of it u're good.

Honestly....at home I ALWAYS went over my time...but on the day of I think it was the adrenaline or what I dunno...I didn't run out of time...to be honest with you...at home u have that checklist from FA...that tells u what u should have asked on day of u don't...so u're not going to ask all those questions...so u will save time....HONESTLY...just make sure u write the mnemonics down on that blue sheet...if God forbid u blank out...that mnemonic is going to save u...if nothing at least u'll be able to start with PAM.....

I hope this helps...if u've taken CK...pls provide some tips...going crazy between MTB2,3 and uworld...:rolleyes:

cearamor 07-11-2013 11:31 PM

@Faith

Hey, I'm going to write my CK on July 24th. I don't know how much time you have right now, but UW is the backbone of your preparation for CK and you should go through it at least twice. Don't waste you time on kaplan! A good way to approach UW is to do it first subject wise/Tutor while you're reading MTB2 for IM/Psych/Peds and MTB3 for Peds/OBGYN.. After that, you can go through UW again random/timed.. For Peds/Surg/OBGYN sometimes I read a chapter here and there from kaplan LN, and use Pocket Medicine by marc sabatine to get more details about some subjects..

Faith1130 07-12-2013 06:50 AM

Quote:

Originally Posted by cearamor (Post 202488)
@Faith

Hey, I'm going to write my CK on July 24th. I don't know how much time you have right now, but UW is the backbone of your preparation for CK and you should go through it at least twice. Don't waste you time on kaplan! A good way to approach UW is to do it first subject wise/Tutor while you're reading MTB2 for IM/Psych/Peds and MTB3 for Peds/OBGYN.. After that, you can go through UW again random/timed.. For Peds/Surg/OBGYN sometimes I read a chapter here and there from kaplan LN, and use Pocket Medicine by marc sabatine to get more details about some subjects..

thanks cearamor! For the help. I am not sure at the moment when to take it. Was thinking taking it at the end of Aug. But not sure if that's enough time. Since I have just started 1st run through of uworld ...oh God pls help:sorry:

drtimmy 07-13-2013 02:08 AM

hey
i gave cs few days back in atlanta
i screwed up 2 cases badly
first case...i blanked up, missed the diagnosis entirely and wrote 3 ddx of which 1 is related to the system and maybe correct. however, i believe my history and examination was ok
second case...i made a blunder in the pn...1 of the 3 ddx was completely wrong...

Rest cases were ok....might have missed some points in writing pn due to lack of time...also i believe i might have missed counseling about smoking in 1 case...but overall they were ok...

Do u think i will pass??
This wait for results is killing me..


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