CS method and 17 Tips for you

[docnas]

OK since I had just finished my CS a few weeks ago I will put in my input, hopefully it will help you prepare for the CS.

CS Preparation Method
Used FA for CS, Go through the mini cases every chance you have, that will be the basis of your physical as well as the history questions you are going to ask (like associated symptoms).
Have a study partner and practice the long cases make sure you are not just reading, you have to actually act out each part ie knock on a wall, walk towards the desk, say hello introduce yourself, mimic placing a drape over the pt, ask questions like u would in the real exam not too fast not too slow. Do the actual physical like u would for real. It gives u a sense of how much time an action can really take.
I personally didn't use Uworld but some people did and if your one of them, well more better for you.
MNEMONICS ARE A MUST !! I REPEAT MNEMONICS ARE A MUST!!! use whatever mnemonics you are comfortable with but try to have a mnemonic for everything for ur present history, past history, ur physical, for what DDs you will write for a specific symptom , The more mnemonics you have the better off you will be as u wont miss something.



17 Tips for the actual CS encounter

(NOTE- all phrases are just suggestion say whatever u feel comfortable with )

1) YOU MUST BE CONFIDENT!!!!!! - this is one of the most important parts , don't go "uhhh, umm, errr" ...etc

2) Personally I would write a quick differential diagnosis list on the scrap paper upon seeing the symptom on the door chart to help me focus also I would write the name and the age and vitals. The name because I tend to forget so its there in front of me, Age and vitals were for my actual pt note so I wont have to get back up and look at the chart while writing my note. Also I would write my mnemonic (for example, SIQORAAA and PAM HUGS HITS FOSS or whatever mnemonic you use for your history) then I would just cross a letter out if the pt answered nothing to it or write down the answer to the question. This was to make sure I didn't skip over parts by mistake as I could glance at it and see what I asked and what I didn't.

3) BE POLITE- smile at them, If they are in pain give them the "I feel your pain" look, if they are sad give the serious but helpful look etc

4) Actually listen to the patient because they will be telling you important information don't ask a question then start thinking about ur next question while they are talking, u will miss something important that way

5) I found in almost every case I had after asking a few relevant associated symptoms I was able to ask "anything else?" and they would usually answer me with some other symptom that i missed and it would give me a hint on more things I should ask

6) And I would keep asking anything else until they said "No nothing else".

7) Make sure u extend the foot rest when pt is lying down and also retie the gown after exam (a very easy to forget item )

8) On walking in and after introducing yourself drape the pt to make sure u don't forget it.

9) Distance should be an arms length and a half to 2 lengths (ie not too far or too close) also don't stand directly in front of the pt stand slightly to the side. NOTE- If pt has problem with vision or hearing in one side stand to the opposite side so they can see or hear u better. If they are lying on their side sit down on the stool with them facing you. A pt I had had a neck injury so she couldn't turn her head, I stood directly in front of her to make it easier to see me. What I'm trying to say is keep the pt happy and as comfortable as possible.

10) After u finish ur history questions (and b4 ur physical) ask them one more time "Anything else? "( if they are nice they might give u that bit of info u didnt get by urself)

11) Physical make sure u tell them whenever u plan on touching them and always say out loud when ur looking at an area for example " I'm just looking at ur stomach" or "I'm looking at ur hands" etc etc

12) If ur trying to elicit a specific sign u can manipulate a painful area again otherwise never repeat an action on a painful area . Also if you do make sure u say something like "I know that hurt but i needed to do it so i can get some more information to help me reach a better diagnosis"

13) Ask about anything you see it moles, scars, injuries, varicose veins, bandages, red marker (that's supposed to mean erythema), discolorations, everything real and fake, If it's relevant they will tell u about it if not they will say "don't worry about it" or "Its nothing important".

14) After physical make sure u give a short summery of history and relevant findings ( 4-5 pieces of info is enough i usually chose the chief complaint and its duration and an associated symptom or 2 and maybe a physical finding if there was one)+ diagnosis (in medical terms and its layman explanation)+ testing needed ( in layman terms).

15) Ask them if they have any questions. Answer them and then ask again if any questions( repeat until they say no nothing else)

16) Then counsel them on something ( drugs, smoking, sexual activity's, exercise, diet , taking their medication properly ) anything that u can think of that us relevant to their health.

17) Then give a conclusion like " OK Mr. Pearson I'm going to go write up for the tests u need to do and get back to you as soon as we get your results , good bye and see you soon" and walk out and your done with your encounter

A PDF version of the tips is attached below.

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[docnas]

Just wanted to add that i got my result today and passed with high stars !

btw didnt know this was going into the recommended section i had posted it but never got a reply in the first few days so didnt think it was helpful to anyone so i forgot all about it :P

[ag2011n]

This is really helpful.

[cingulate.gyrus]

Thanks for the tips...really helpfull..

[arani]

what pe findings should I write if there are not any?for example a psychiatry case?

[neisseria]

hello docnas! good to read your tips. they helped a lot.
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(not mentioned in usmle website).
2. are we allowed copy/paste option in the exam?
Thanks!

[usmled10]

Thanks for sharing!

[jouberth14]

Thanks for sharing

[NiDi]

Very helpful, thanks!

[drhyu]

Wow. This has great use. Very thankful for

[solo78]

Good stuff.
I wish I would have been on this page earlier.

[OM17]

thank you very helpful

[shaguy]

Thanks for your advice

[nada awny]

Congratulations,,,, And thank you for your very useful tips,
can I ask you about the physical examination.. which items are constant that I should do in every case regardless the diagnosis?

[jeevan473]

Thanks for the tips they are very useful

[sandeep424]

it helps a lot thanks

[frozenbanana]

What counts as counseling? What counts as closing? How do they rate how you answered difficult questions? Is it good if they asked you one?

[greg lin]

hi everyone
I took my exam 3 weeks ago. I still need to wait for 6 weeks to get the result.
I am feeling worried about CIS part.

I forgot to say patient's name on entry more than half of all cases. I just say "Hi. I am Dr..., I am a physician working here today. nice to meet you. How may I address you?"
SP said their preference. that's it. I didn't mention their name after that.

For the rest of the cases, I called their names on entry and I asked their preference and I didn't repeat their name after that.

I finished all cases in time. I did counselling, challenging and closure in all cases.
How do you think about my mistake?
Will I pass the exam?

Thanks in advance.