CS Experience IMG 1st attempt with 3 "high performance" and one star

[dr.amir.yosef]

My name is Amir Yosef, I am from Egypt, I passed (1st attempt) with a high performance in the 3 subcategories with a one asterisk and a star in CIS (which is extremely high)

To pass this exam you need things in the following order if importance:-
1 - study partner
2 - First Aid for the CS

It is strongly recommended for you to take the Kaplan course, especially if u are an IMG, at least take the one day exam if u won't be able to take the 5-days course.
It has been extremely helpful to me, and got me to the exam with high self-confidence and experience. It is quite expensive though.

REMEMBER, this exam is NOT to test your medical knowledge, it is mainly to check your communication skills.

[water]

Congratulations on passing!! Did you ask all the questions in the first aid checklist?

[dr.amir.yosef]

Originally Posted by water

Congratulations on passing!! Did you ask all the questions in the first aid checklist?

Thanks for your message,
Of course Not ! I didn't ask more than 70% of the questions in the first aid, and didn't do more than 50% of the physical of the FA.

The new exam standards has no checklist for ICE, your ICE is assessed mainly through your patient note and not through a checklist of your history taking and physical.

REMEMBER: this exam is to test your communication skills mainly, not your medical knowledge, there is a CK exam for the medical knowledge.

Good luck !

[water]

Thanks for your answer. The information given by USMLE says that there is a checklist. Can you/anyone explain that please?

[dr.amir.yosef]

Originally Posted by water

Thanks for your answer. The information given by USMLE says that there is a checklist. Can you/anyone explain that please?

What I have learned from Kaplan's five days course that A checklist for History and physical is not used anymore in the new system that started in Mai 2012.

If someone has a correction for this info, please tell.

[masterphysician]

So as I understand it SEP and CIS is graded by the SP and ICE is graded purely by physicians right?

[dr.amir.yosef]

Originally Posted by arrvindraghunat

So as I understand it SEP and CIS is graded by the SP and ICE is graded purely by physicians right?

POSITIVE, that is what we have been told.

[lilly123]

I must say that I have to agree that having the right study partner is so important because it gives the right training and boosts your confidence !

[Elvon]

I need help in ICE.is there any how you can help me.pls reply

[dr.amir.yosef]

How may i help u?

[Elvon]

Thanks.the last time i did the exam,i failed ICE.pls let start like this;can u pls tell me how you wrote your patient note in the exam.is it exactly as its in first aid.also the focused physical exam,if u can throw more light on what we are suppose to do.sincerely speaking i don't know where i went wrong in the exam.that is why i think i need the help of people like you who passed........if u are willing to help me,after answering my question above ,i can write a couple of patient note and focused physical exam for a few cases so u can correct me.how about that.thanks for your time and patience.

[dr.amir.yosef]

Sure
the most probable cause of failure in ICE is patient note
To write a good patient note, think of it as if you are writing one of this clinical vignette u face in MCQs in step 1 and CK.
u must write: e.g. 45 yo male patient presenting with e.g.chest pain. then write the analysis of the complaint: the paint started one hour ago, getting worse, retrosternal, radiating to the left arm increased with ... and decrease with ....

the history in the first aid is very good except for the part of the differential and explanation.

use the mnemonic: SIQOR AAA PAM HUGS FOSS. i think this one is enough for the history.

since u failed once in CS, i strongly recommend before the second time for you to take the Kaplan five days course.

sure, you can write a patient note and send it over so we may discuss it later.

[Elvon]

Ok,thanks.i will sure write patient notes and some focused exam for some common cases for us to analyse.but pls how can i send them to u or should i write it here on this forum page.thanks for your time

[dr.amir.yosef]

yes ok, write them here
what is ur name ?
where are u from?

[ifss]

I believe patients have a checklist for physical exam maneuvers. They check to see if you do them correctly. For eg, if you don't listen to the full ins and exp for lungs or you don't place the steth in the correct position to listen to the heart.

I think you should post your PN here so others can give input and others can benefit.

[Elvon]

Ok.thanks.i will write the PN later when its ready.thanks once more

[asidfg]

hi all, my result camei yesterday and i failed the ICE xxxx{xxx }. I was pretty confident I was going to pass. closed all my cases, got a high score in SEP. here is a sample of one of my PN I typed and sent to an a current practising MD in the states. please review and tell me where i went wrong...

54 YO F C/O PERSISTENT, PROGRESSIVELY WORSENING, PRODUCTIVE, BLOOD STAINED COUGH OF 3MONTHS DURATION. SHE HAS NOTICED FATIGUE, NIGHT SWEATS, AND 6LBS WEIGHT LOSS IN LAST 2 MONTHS. SHE DENIES CHEST PAIN, VOMITING, RECENT TRAVEL OR BACK PAIN. LAST PPD 1YR AGO WAS NEGATIVE

ROS: NEGATIVE EXCEPT AS ABOVE
ALLERGIES: NKDA
MEDICATIONS:COUGH SYRUP, ALBUTEROL INHALER, MULTIVITAMINS
PMH: CHRONIC BRONCHITIS
PSH: TONSILLECTOMY AND ADENOIDECTOMY AT AGE 11
FH: MOTHER HAS ALZHEIMERS
SH: NURSE AIDE, WORKS IN NURSING HOME WITH TB PATIENTS, USED TOBACCO 1-2PPD FOR 35 YRS, DENIES ALCOHOL OR ILLICIT DRUG USE
EXAMINATION
PATIENT IS IN MILD DISTRESS

VS: WNL

HEENT: AT/NC , PHARYNX, MOUTH WNL

NECK: SOFT, NO LYMPHADENOPATHY

CHEST: CLEAR BREATH SOUNDS BILATERALLY

CVS: PMI NOT DISPLACED, RRR, S1,S2, NO M/R/G
DIAGNOSIS 1
TB
CHRONIC COUGH
WEIGHT LOSS, NIGHT SWEATS, FATIGUE
H/O OF EXPOSURE
2) LUNG CA
CHRONIC COUGH
BLOODY SPUTUM
H/O TOBACCO USE
3) CHRONIC BRONCHITIS
CHRONIC COUGH
SPUTUM PRODUCTION
NO HX OF SOB, CHEST PAIN
Diagnostic studies
CXR,
SPUTUM FOR CULTURE, AAFB
CT CHEST
ESR
CBC, ELECTROLYTES

[dr.amir.yosef]

Hi there

first i am really sorry to hear about ur result, hope u do better next attempt

my subjective opinion is that the HPI is not satisfactory, u need to provide more info like associated symptoms, aggreveating and alleviating factors and other focused specific questions to the c/o.

also are u sure about ur differential?

did u do enough focused PE?

for someone to fail in ICE, he must have missed a lot of info, i remember i didn't have time to ask more than 30% of questions, and didn't do more than40% of PE, yet i passed with high performance.

Hope that helps.

Good luck

[asidfg]

thank you. that was just a sample from a first aid case I typed while practising for the exam. on the exam day I think i asked at least 80% of the questions and did focused PE and general ex. I didnt have any problems with my DDX , i had studied the mini cases thoroughly so after my patient encounter coming up with 3ddx was not a problem. THE EXAM WAS SIMPLE! I am so shattered. I really need to know what i did wrong ....

[dr.amir.yosef]

It is a pickle!

listen, next time change ur test center and take the kaplan course before the exam.

[Elvon]

Ok..i have a question for dr amir...does change exam centre have any help on passing....am asking for my own benefit.pls reply

[dr.amir.yosef]

Only rumors, nothing approved.
it has been said that Houston and Chicago's test centers are more "IMG friendly" while philly and Los angelos are not.
again, this postulation based on nothing but subjective opinions.
Objectively, this exam is supposed to be standardized, which means the change of test center or the SP's should make no difference to u as an examinee.

[vjwilliams]

How much should one prepare prior to the Kaplan course?

How long did you prepare prior to the course?

How many weeks later did you test?

Can you give an overview of the course focus that made it a great success for you?

I'm planning to take this course.

Thank you for your posts!

[dr.amir.yosef]

2 weeks FA - kaplan course - 2 weeks FA and reviewing Kaplan - EXAM

the course taught me well what THEY EXACTLEY WANT IN THE TEST: that it is not about ur clinical knowledge and data u have and history taking, it is rather about ur communication skills.
i practiced one simulation exam before the test, which was marked and revised so i knew exactley my points of weakness and strengthened them, and so i went to the exam well prepared
i practiced with many SP's and went over the PE more than once.

[vjwilliams]

Again, I truly appreciate your commitment beyond yourself as witnessed by your decision to post/support others on this forum as you have.

Many blessings to you!

Thank you!

[dr.amir.yosef]

Not at all!
best of luck!

[asidfg]

Amir, you said they are more interested in the communication skills but it seems that a lot of people fail due to the ICE. please from the kaplan courses what did they stress about the ICE for a comfortable pass in this category? Thanks.

[dr.amir.yosef]

They gave good scheme with pneumonics to apply for most of the cases
practicing many times the PE
practicing typing patient note in adequate time with relevant differential
correcting and feedback from the faculty members.

[medstar]

Congratulations on passing dr.amir.yosef,

I would also like to thank you for all the help and support you have provided for others, as it was very helpful.

I have done my exam a couple of weeks ago and i wont be getting my results till end of jan. The wait is a killer.

I just wanted to ask you something for my own peace of mind. I had practiced alot for my CS exam but on the exam day, obviously my nerves kicked in. For history taking, I forgot a few questions here and there including some common questions we ask all the day such as occupation, obgyn hx, illicit drugs, smoking. This was not in all pts, i forgot one or the other questions in atleast 3 of my patients. How badly do you think that this may affect my ICE??

thanks in advance.

[dr.amir.yosef]

Thanks for your message

if what u describe is accurate i think u will do more than fine

the exam is designed NOT for WHAT YOU ASK mainly, rather HOW you ask it.

It is expected from u in the exam to ask only 70% of the questions u need to ask in real-life encounter, so missing few questions is totally normal, u simply don't have time, u CAN't ask everything, plus they know that well, i read many times in FA and Kaplan course that: u don't have to be perfect.

GOOD LUCK!

[Laurentiu]

Originally Posted by dr.amir.yosef

Hi there

first i am really sorry to hear about ur result, hope u do better next attempt

my subjective opinion is that the HPI is not satisfactory, u need to provide more info like associated symptoms, aggreveating and alleviating factors and other focused specific questions to the c/o.

also are u sure about ur differential?

did u do enough focused PE?

for someone to fail in ICE, he must have missed a lot of info, i remember i didn't have time to ask more than 30% of questions, and didn't do more than40% of PE, yet i passed with high performance.

Hope that helps.

Good luck

Hi
I failed the CS with low score in ICE . The other 2 parts . were OK .
Need advise .
Thanks

[dr.amir.yosef]

one advice: PRACTICE, PRACTICE, AND ... AGAIN ... PRACTICE as much cases as you can with your study partner
try more than one study partner, preferably someone who alread passed the test.
good luck

[Laurentiu]

Originally Posted by dr.amir.yosef

one advice: PRACTICE, PRACTICE, AND ... AGAIN ... PRACTICE as much cases as you can with your study partner
try more than one study partner, preferably someone who alread passed the test.
good luck

Thanks Amir ,
Here are the issues :
I practiced on line with partner for 4-5 hrs every week for 3 months , did all FA cases , UW cases , watched many videos , did the PN times and times again .
My feeling is that the nerves were so tight in the exam day that I made mistakes in the first few cases.. I did not figure out the right Dx and probably not the DDX ... to re bounce with confidence for the last cases .. a kind of weird ... no issues with time management .. did not take any courses prior to the exam .. probably I have to do it this time around .. step 2 CK few years ago .. may be this is the main issue ... so puzzled , I do not blame anybody except myself .. shame on me again and again ...need to know if there are some on line courses as I work and no time to travel..
Thanks

[neisseria]

hello dr.amir! Congratulations on passing with stars!
I have few queries about which i need your help as you are done with the exam.
1. can we use abbreviations other than those mentioned on usmle website? many people do that. Even the simple ones like Mo for month. even FA uses many abbreviations not given on usmle website.
2. are we allowed copy/paste option in the exam? My center is Chicago
Thanks!

[dr.amir.yosef]

1 - No you are not allowed to use any abbreviations other than the aforementioned ones. it is Logical: they are not putting specific recognized abbreviations then allow you to write other non specified ones.

2 - YES you are allowed to copy paste, actually i was taught that u should copy paste the doorway information as the first sentence in patients personal personal History.

BEST OF LUCK!

[neisseria]

Thanks for your kind response dr. Amir. Really mean it. May Allah bless you in your future endeavours!!
If you find time and its convenient to you, could you give us some important pointers you learnt in kaplan live course? Because many of us either don't have the resources or time to access that, like me.
Thanks again!

[dr.amir.yosef]

You are welcome

the best thing about kaplan was last day's simulation exam
it was close to what happened in the real test and it helped me a lot, at least i had the same exam experience few days before the real test, so i walked in with high self confidence and wasn't very surprised.
otherwise, i am telling you u CAN pass this test easily, what u need is the FA book and a good study partner, kaplan is NOT mandatory still, it is just recommenced if u are and IMG and u are neurotic (like me ) about what may happen in the test and u don't wanna leave anything to chance.

[hepevirus]

Thanx for sharing your amazing experience, can you please tell me if its Ok to put 2 differentials if you cant find supporting evidence for your 3rd differential. Also the work up that you put down should be related to your differentials only or can you put something else as well. You said FA only is it importnat to memorize all the mini cases as well? Hope you 'll answer my concerns, THANX

[dr.amir.yosef]

The rule is "leave no empty spaces as much as u can"
if u don't have supporting evidences for third DD, just put the 3rd guess without it's supporting findings

The workup of course must be relevant to the case, some workups that are totally out of subject might cause u to lose credit

Mini cases are as important as the long cases, u should practice them.

Good luck!

[AiLSP]

have you ever had to address multiple problems despite they come in for 1 CC. For ex: they come in for cold, but is found a smoker and has chronic cough and you put on the 2nd ddx COPD?

[dr.amir.yosef]

Sure!
double diagnosis is Not uncommon

[AiLSP]

Originally Posted by dr.amir.yosef

Sure!
double diagnosis is Not uncommon

wow that's really relieving
Thank you!

[AiLSP]

sorry 1 more question.
During 1 of the encounters, the patient complained that the ophthalmoscope was too bright when i was doing the fundoscopic exam and asked me to turn it down. I quickly apologize and turned down the brightness. Is that ok? Will I lose point on CIS or ICE?

[cs.ice]

@AiLSP,#
If the patient had a neuro complaint, I think that could be photophobia.
Since you complied by reducing the intensity, your CIS should be ok in that instance.

[AiLSP]

Originally Posted by cs.ice

@AiLSP,#
If the patient had a neuro complaint, I think that could be photophobia.
Since you complied by reducing the intensity, your CIS should be ok in that instance.

I don't think it was photophobia, just a really bright ophthalmoscope
He acted fine when I reexamine after reducing the light

[dr.amir.yosef]

Think about it as a painful maneuver
If the patient ask you to reduce the light simply do so, if he has photophobia do not do it at all, but acknowledge it to the patient "sir i needed to examine the back of your eye, but since u get irritated from light i won't do it!"
DON'T APOLOGIZE THOUGH, u didn't do anything wrong.

[shehab]

Hi all,
I'm Shehab Hassaan from Egypt and I passed CS exam first time

[Ashora]

Thank you for sharing!

I learn from you that COMMUNICATION SKILL is really important!!

[cfresh]

Thanks for the advice

[shaguy]

thanks for the advice