My step 2 CS experience

[sndhgrvr]

Hi everyone! I hope everyone is doing well. So I got a positive CS result and just wanted to give back a little to this forum by sharing my preparation and exam experience. I will try to remember as best as I can.
I gave my CS exam in Houston in the end of August '13 almost 3 mths after my CK exam.
Before I share I just want to say that each person has their own way of preparation and what works for me may not be the case for you.

Preparation-It took me almost 4 weeks to prepare .
- I started by reading the short cases of first aid and making my differentials for the common symptoms along with the routine tests for them. Doing that before starting to read long cases helped me memorize them better and helped me to create a way of thinking according to the symptoms instead of just cramming up the mnemonics.
-For the history taking, I followed up mnemonics only for the past history and personal/social history . I tried following LIqoraa but for me that didn't help much and I found myself missing out some relevant questions. But to each his own.
I also read Kaplan short cases. I found it to be helpful for taking some points about communication skills and for practicing different cases. I found it to be worth it but the foremost book was first aid.
-I didn't prepare via skype because I was able to get in touch with someone who was also preparing for the exam during my time frame, so that was really lucky for me.
We prepared for cases almost for 2 weeks together with each of us alternating as a patient and doctor. And like this we were able to practice first aid almost 2 times and kaplan one time. We prepared just like it was real exam with keeping 2 timers for 10 and 15 min. Doing that from the first day helped a lot with time management. And try to think of it as a real exam so that you get comfortable with asking personal questions in the history.
- We tried to take history by 10 min with counseling everything that needed to be counselled then and there rather than at the end because even if you ran out of time , at least you had counseling in your pocket.
-Examine in a focused manner. Don't spend more than 3-4 minutes on it especially if you are left with counselling in your closing. Do the relevant system first AND THEN IF you have a spare minute quickly listen to s1s2 and breathing sounds. It doesn't take more than that even in the real exam. For neuro I made an approach and used to do in that manner everytime so that by the end day I could do in a couple of minutes.
-For patient notes I followed a bullet pattern and practiced on the usmle site. I tried using a keyboard cuz it has a different feel w.r.t laptop and there are going to be keyboards on exam day. I practiced writing in 8 min so that I had a couple extra minutes in worst case scenario.
I put a couple of my PN on the forums to get it evaluated from others who have given the exam and people were really helpful .
-If you don't have a live partner, practice it on any of your friends/family members because you will feel the difference in time management

My approach-
Knock on door. Greet and introduce with a smile . Stop smiling if patient in distress. Tell patient that you will be taking notes in between . Maintain eye contact as much as you can. Say ' I am sorry ' at relevant places like death or accident (don't go overboard saying sorries). -Always use transitional sentences while changing from hopi to past to social history etc.
I summarized after history taking and while washing hands. Try not to be silent for too long. I used to ask them what they do in their free time etc,according to the mood of patient ,and almost all of them were willing to talk.
-For physical examination, Ask permission before doing anything especially while untying the gown. Tell the patient what and why are you doing this and what you found.
-In the end, Closure is really important. Tell him you would now like to discuss about his condition and give your views. Counsel if you haven't done so before and offer support. Ask him if he has any more questions and if the plan and tests discussed is OKAY WITH HIM. Say call me anytime if you have any questions .
All this may not always be applicable in real life but in the exam helps you develop a rapport with the patient.

Exam day-
I reached Houston 1 day before and had a good night sleep ( Really Important )
The staff at the center is really good and helpful . You can get familiar with all the equipment during orientation. The exam starts dot on time. There were only 2 IMGs including me I think. Almost everyone was AMG. Don't let that affect you. This is an objective exam. The SP won't be comparing you to others. Just do your thing.
- I always took a minute before entering to write down 2 or 3 differentials on my blue sheet to get my thought process going.
- so it took me 2 or 3 cases to gain enough confidence to talk to the SP without trembling. You could hear my voice wavering but the SPs were real nice. I think they are all accustomed to nervous doctors in the initial cases.
-I forgot to write the history notes on my sheet for the initial 2 cases because I was so nervous . Also missed out on a lot of points. But then you have to remember that if you screw up 1 case there is the next one and others which are in no way going to affect your previous one.
- I almost always made a minute or 2 early out of the room and even then everyone else was already typing out PN. But that 's okay , you just have to concentrate on yourself.
-I had mostly 2 differentials for the cases , maybe all 3 in 3 or 4 cases. Just explain your reasoning for differentials appropriately and you should be all right.
- I made some mistakes- Forgot to use ear speculum , had to untie gown unnecessarily twice on one patient ( but I apologized for inconvenience), I did really stupid counseling on phone case and the sp was laughing at the answer I gave , Forgot to discuss a really important and relevant differential plus some silly mistakes, forgot relevant family history in almost half of my cases.
But that's okay as long as you are professional and empathetic with them , its all good.
-I was lucky enough not to get any psych cases because I am really not good at those. All the cases were similar to first aid.
- Few of my friends had problem with african american accents because it's a little different from what one might be used to . So it helps to familiarize one with that so that you don't have to ask your patients to repeat everything . Speak clearly . Don't rush while talking. Don't talk in medical terms .
Even if you are running low on time don't rush the patient. If time is less I used to counsel first and tell him my impression according to history and then if time permits do a quick physical exam. I know I am compromising on physical exam but the closure and counselling is really important and needs 2-3 minutes including you answering the patient's questions.
- one of the difficulties I faced during my prep was that there is no way to evaluate yourself like you can do for step 1 and ck. So if you are lucky enough to know someone who has given this exam , try presenting even just 1 case to them . It doesn't have to be exactly to their standards but you can get to know if you are making any gross mistakes in your preparation.

I know it's a lot to take and I have rambled on a lot . Have confidence in yourself , practice and treat your patients with respect and care and it will be all good. I hope I haven't confused you or missed out on any important points. Good luck to all!

[drivenby]

Well said, I had similar training and techniques.

I ran out of time a lot during the exam but I was so empathic during my exam that it almost didn't matter that I missed closure in almost all the cases.

this exam is the real deal and it's so different to what we do in my country, I would not take it lightly! So try practicing with people that have taken it recently.

As for the physical examination, I went into panic mode during the 8 hours of My exam and I did cardiovascular and lungs in every single patient and my ICE SCORE, although it was above Borderline, it wasn't that high.

Focused physical examination, good data gathering and a decent patient note should be enough to get you through.

[Ahmed2660]

First congrats doctor
Could please inform me how long before you exam you started live practice with your partner?!,
How many hours per day is needed to be done in 4 weeks?

[drivenby]

Originally Posted by Ahmed2660

First congrats doctor
Could please inform me how long before you exam you started live practice with your partner?!,
How many hours per day is needed to be done in 4 weeks?

You should start with a partner as soon as possible. Read the first half of the step 2 CS first aid, up until the big cases.

It changes a lot, I've seen people pass the test with 2 weeks of practice and others fail with a month. I took 6 weeks and I practiced 4 hours per day.


I managed to pass comfortably but I didn't ace it or anything

[Ahmed2660]

Thanks for ur quick reply
The six weeks period are practise or the whole duration u needed for cs is 6 weeks?!
Thank you again

[jouberth14]

Thanks for sharing !!

[AleMD]

Good advice. Thanks for the information.

[NiDi]

Very thorough, thanks!!!

I will apply your preparation process and see if it also works for me.

[doczeesh]

Thanks for sharing

[OM17]

thank you for sharing

[Ashora]

Thanks for sharing!

I hope I can pass with 1st attempt

[shaguy]

thanks for the advice

[Barry2003]

Thanks doctor!

How many months in advance do we need to schedule to get Houston center?