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aaru20 08-21-2013 06:42 AM

aaru20 Step 2 CS experience
I gave my exam in Atlanta and was very anxious for the past few days about the chances of failing this exam were 80 % when I compared my mistakes with those of others in this forum..

OUTCOME- PASSED :D with performance being in middle of borderline and high in all 3 components..I was really scared about ICE but I passed it comfortably..

BACKGROUND- IMG , currently studying for step 2 CK ..prepared for CS for 2 weeks..did FA all 44 cases only once and kaplan core cases book which in my opinion was very helpful..did not waste my money on coaching and staying at Greenway inn in Houston where so many IMG's already know half the cases beforehand..i practiced on skype with a few people and with my live study partner who was from Iran and english was not her first language..I gave my exam in Atlanta and there were very few IMG's

I thought after getting my result that the first thing to do is share my experience so that it can be help to others especially my mistakes..:-

1. i could not complete 4 closures..the time was up when the SP's were asking me questions.. but i had already explained them my D/D and workup.

2 this mistake of mine is plain stupid- in my very first case i forgot to read the SP's name but I pretended in front of him that I dont know how to pronounce his name..;) Also, WHEN I WROTE THE PN I WROTE THE HISTORY IN PE BOX AND VICE VERSA..:eek: isnt it unbelievable ??

3. a lower abd case in young female , in my PN all I could write in workup section was BETA HCG and that's it..time was up!!

4. one case in which i forgot to wash hands and the SP told me to..

5. one case of loss of conciousness where i was so uncomfortable with the patient that i could not convince him for undergoing any diagnostic test..and in this process i forgot to do the CNS exam..just did the reflexes on lower limbs..he was an alcoholic and kept interrupting me when i tried to counsel him for alcohol..

6. in one case where the female SP complained of dysuria and itching and 'difficulty getting intimate' i forgot to drape the patient..all my SPs were draped already and she was the only one who was sitting on a chair when i entered the room and i didnt pay attention to the fact that she was not draped..when I explained the workup to her and mentioned pelvic exam she asked me that I should not schedule a pelvic exam for her because that will be painful..I could not answer her concern properly..

7. two cases I totally missed the D/D and when I came out of the centre I realised how can I miss pancreatitis in patient who is alcoholic and has nausea and vomiting..but I totally screwed it up. Also in the same patient he mentioned the brand name of a painkiller that he was taking for months and I did not know that it was a painkiller and did not counsel him against its use..In my opinion its good to know some common brand names of common drugs before you enter the exam room..

8. one of my SP wanted me to address him as Dr but I kept forgetting that and only addressed him as Mr..Also , he could not understand me what I was saying at one point of time and i said ' mr xyz, do you have any difficulty with hearing , let me check your ears..':eek: :p

9. I made mistakes in every single case..believe me ..sometimes I didnt do the relevant Physical exam and sometimes i could not finish on time but I think since I spoke properly and gathered enough data and tried to make small talk with them ( was useless though, they werent interested) i was able to pass CIS and SEP very comforatbly. Moreover, I did not have time to finish all my PN properly and the keyboards were so worn out that i made endless spelling mistakes but in every PN i wrote only the relevant things..but still I passed ICE (which I was very worried about)

moral of the story- we are being told to be nice to a patient, speak in a tone that is understandable by the patient, comfort him , gather all relevant data and make three D/D all in 15 minutes..and then TYPE a PN in 10 minutes..not an easy job for IMG's..i dont think any doctor can deal with this in total 25 minutes time we are bound to make mistakes..
IMHO I think what makes you pass or fail is not the number of mistakes you did but being a little above average in all three components..nobody cares about getting a star..
but the one who manages the time wisely will pass this exam for sure..Also managing time wisely does not mean you finish your patient encounter in 12 way..according to me you should spend atleast 13.5-14 minutes in the room with the should not hurry up your encounter even if you get more time to write your patient typing speed is below average and I struggled with it..I did not write 3 D/D in all cases and I dont think it was a must..

In the end I can say only one thing..if I can pass everyone can unless you make very major mistakes..Good luck..!!

Dr.Albert 08-21-2013 06:55 AM

Nice experience.Congratulations! Is it true they know half of the cases in Atlanta beforehand? How is it possible?

aaru20 08-21-2013 08:01 AM


Originally Posted by Dr.Albert (Post 210125)
Nice experience.Congratulations! Is it true they know half of the cases in Atlanta beforehand? How is it possible?

i was talking about Houston..I took my exam in of my friends had advised me to go to Houston because most of the IMG's take their exam there..and they all stay at one particular hotel and practice in groups..and many of the cases are the same ones since there are only a limited no of SPs and cases and even though its illegal but they all discuss about the cases and they know atleast 50 % of the cases before hand .He said that he stayed there for a month and practiced and everyone in his group passed..I decided to stick to Atlanta only as i did not want to spend my money on staying in a hotel for so many days and my flight was already booked..
And I think I did the right thing..Everything is there in First Aid book whether in the major cases of mini cases and the cases are simple btw and we are doctors after all ..we can make up 2-3 diffrentials for a simple complaint like knee pain..the key is to believe in yourself and remain confident..

Dr.Albert 08-21-2013 08:24 AM

Thank you. So helpful. I will be Taking it in Chicago Next Year not in Houston.

aaru20 08-21-2013 09:45 AM

i would also like to tell you one more thing which really helped me reach my D/D in the cases..After summarising the history to patient, i always asked
'' Mr XYZ, I want to know about your opinion too.. according to what you told me,what do you think is causing your problem ?''
This really helped because firstly you get to involve the patient directly in your discussion and secondly because the SP's most of the time WILL lead you to the diagnosis..for eg an SP with vague muscle ache and fever and fatigue asked me what I thought he might be having..and I could not think of many things there..I asked him this question and he replied -' doctor I think i might be having some viral illness or flu' and this became my main D/D ..
just my opinion..

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