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Trickster 08-23-2013 06:44 PM

June 2013, Philadelphia, Trickster Step 2 CS Experience
1 Attachment(s)
Outcome: Pass
Prep time: 10 days
Prep materials: First Aid CS + UW videos
Hotel: The Hilton Inn at Penn
USCE: none
Step 1 and CK: 260 +, 270+

Attachment 3285
click image to enlarge

Here's an account of my ruminations on the silliness that is the CS exam. I am including a snapshot of my performance bands so you can get an idea of the gravity of the mistakes I made (the ones I can recall anyway).

I gave the CS soon after the CK and having had a year of internship behind, I wasn't too worried about the CS.

While I did pass the exam comfortably, I was startled by my mediocre CIS and ICE performance bands. In hindsight, I realize more than ever that this exam is simply about doing things a certain way. I could have easily failed it regardless of the great feedback I received from faculty during a leading internship program in my country.

I read First Aid CS twice in 10 days, but didn't bother really practicing with a partner. A couple of days before the exam, I grabbed a relative and went through a couple of cases with them to get a sense of timing. I watched UW videos and went through the motions of the physical examinations on a pillow. Having given CK recently, I felt confident about the ICE section.

One of the most important things I did was to practice typing the patient note. I almost went into the exam arrogantly confident of my fast typing, and the thought of the tragedy that could have ensued terrifies me! I happened to casually open the software on the USMLE website to type out a patient note from a First Aid long case and realized it takes more than fast typing to create a good note in 10 minutes. Whew. After that, I practiced a few more notes to make sure I was able to do it in 8 minutes.

CIS: I wasn't the least bit bothered about CIS. I figured all I had to do was be human. :P More on that in a bit.

SEP: I speak as well as a native, so that wasn't an issue.

Exam Day

I drove to Philly from DC the day prior to the exam and stayed overnight at the Inn at Penn. Nice place, only a 5 minute walk from the testing center. I was too excited and couldn't sleep the entire night, but I function well even when sleep deprived so that wasn't really a problem.

The Testing Center
The proctors were very friendly and polite. The environment was very comfortable. We went through the drill of watching the tutorial and then fiddling with the bed and instruments.

The Exam
I blew the first case. Frankly speaking, had I practiced more, I could have gone through the motions mechanically well, but as matters stood, my nerves got the better of me. I missed a few important questions, forgot the patient's name, got confused at the challenging question etc. I forgot to note the vitals outside the door too, and only realized her BP was high (unrelated to the case and PMH) when typing the note.

After the first case, I took a deep breath and reminded myself that I'd done this a billion times in real life. The rest of the cases went marginally better. I ran out of time in one case only, and that wasn't so bad either - I was nearly done with the closure any way but the SP wasn't! :p I told him I had an emergency of course!

All the cases were pretty straightforward (covered in First Aid, more or less), and the histories were so freaking obvious that I had a reasonable differential in 7 minutes or so usually. I did extremely focused PE's, just so I could mention it in my PN. I rarely found anything significant, so I must have not been thorough enough. I never did any fundoscopies/otoscopies. I used the hammer and q-tip for neuro exams, but not other instruments in addition to my steth. I used gloves, never washed hands.

CIS: Never summarized H&P's (simply forgot! Should have practiced more!), rarely listed a differential for the SP, offered only a couple of lab tests to the SP, missed 1 challenging question, broke eye contact a lot (I brazenly took notes for 10-15 seconds at a time, that the SP could read! I don't know what came over the point it all seemed like a ridiculous facade, and I figured the SP would understand!:D), occasionally slipped into close-ended questions during the history, and did not ever get insight into the patient's thoughts and feelings about their problem. I was extremely polite though, and showed natural empathy - probably saved me a fail in CIS.

I feel that the reason I did poorly in CIS is because unless you drill the specific words and mannerisms into your routine with practice, it's simply difficult to fake it with fake patients! One SP was being ridiculously aggressive, and it was all I could do not to roll my eyes at the overacting. So guys....practice. And don't take CIS lightly even if you've been the sort of doctor who gets handwritten notes of appreciation from your patient in real life!

My performance in ICE was probably affected by the fact that having formed a clear picture of the differentials in my head, I wasn't very attentive to the PEs. I got no pertinent negatives, and only some positive findings! (some rebound here, some tenderness there...).

I hope my experience can help someone be smarter about their preparation. I wouldn't do anything differently since I passed, and who cares about the performance bands, right? But, if I had to do it again, I would make mechanical algorithms for dealing with the standard long cases in First Aid, and then practice them all twice or thrice with a partner. The exam is highly subjective, the SP's are grading you too according to a checklist, and you need to qualify for the points!

Moral of the story: Practice!! Don't be a smarta** and wing it like I did....this pass could have slid into a fail.

Good luck to all future examinees. The CS sucks, and I'm glad to have put it behind me. On to step 3 now! :D

taher 08-24-2013 10:14 AM

thanks for your article

I have a question how can I get the UW videos

are they included with the cases in the UW Subscription

or should I buy them alone and the cases alone?

please tell me

Trickster 08-24-2013 11:45 AM

You can't buy them separately.

MedPharm 08-24-2013 11:51 AM

Hey Trickster,

Congrats man ;-)
I'll give CS a go in not even 48 hours here in Philly. A shame we didn't meet earlier here, I live right next to the Inn at Penn.

I am extremely worried about the ICE section. Something I am really worried about is talking to the patient during the physical exam. Do you comment on what you are doing and/or can you sneak a bit of the history taking into that?

Trickster 08-24-2013 02:43 PM

Hey! Yes, during the PE, I made sure to tell the SP what I was gonna do next. Don't want to have to pry their eyes open! ;) And I snuck in Hx questions too. "Oh ... by the way, tell me about x or y". I stopped what I was doing though to make eye contact!

Trickster 09-02-2013 10:31 AM


Originally Posted by lawrencedoc (Post 212583)
this is fake ad for UW

What is a fake add for UW? And how? :p

val7 09-02-2013 10:55 AM


Originally Posted by Trickster (Post 212624)
What is a fake add for UW? And how? :p

don't worry, I think lawrencedoc is a little paranoid right now...
This does not sound like a fake ad to me

Ahuizotl 10-06-2013 10:05 PM

This sounds a little like my experience, so it gives me hope of passing first try. Thanks for posting and congratulations!

lyndab 10-10-2013 06:12 AM

Hey there congratulations to you for passing the step 2 and guess what, I have also passed the step 2 exam! It was a great help having attended the goldusmlereview workshop.

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