Thursday, April 7, 2016

Dr. Thinker: USMLE STEP 2 CS

When to give it? 
1.      Ideally give it after your clerkship or observership, as you will get to know how to talk to patients in the USA.
2.      It can be given before step 1 or after. It doesn’t matter. I gave it before step 1.

Where to give it? Obviously, only in the USA
1.      The centre/city doesn’t matter.
2.      Philadelphia is considered as a tough center to pass. But, I have seen many foreign medical graduates clear CS from this center. So, don’t be scared if this is the only center that’s available for the dates you want or to chose it if this center is close to where you live.
3.      Houston – You can find a lot of people practicing for CS here. So, it would be a very good option to give your exam here as you will get so many people to practice
with in live. You will get a lot of support and assurance – as you will meet a lot of people on the same boat as you. You can work on your accent and mannerisms.
4.      Any other city is equally good as long as you have someone to practice with in person.
Duration: 3-4 weeks of preparation is more than enough. (I gave it in less than 2 weeks and so many others, too.)

Resources: First Aid is enough. You can try the videos on youtube for clinical examination or cs videos. There is also a short and concise notes available which is very easy to remember and recall. It was written by someone who took the CS exam in the past. I didn’t even do first aid. I just read these concise notes which are only like 15-20 pages. It has all the questions you need to ask for each symptom and mnemonics to remember them all.  You can get it from your friends or other people who gave their CS already.

CS course in New York: You don’t need this at all. You can avoid it and save money.

1.      Practice is the most important – especially in person with someone.
2.      If you are slow with typing:
A.      Get a desktop keyboard and practice on it. – Not laptop keyboard.
B.      Spend atleast 2-3 hours every day or more on typing notes.
C.      Keep a time limit for typing a certain number of words or a case.
3.      1-2 days before the exam – Don’t overdo it as it may affect your voice. Remember, your voice is very important on the day of the exam.
4.      Work on your accent/speech delivery – It need not be American at all. As time is gold during the exam, you will have to talk as quick as possible while making sure that it is comprehensible. So, just work on the tone, speed and delivery.

KEY: Everyone has clinical knowledge, but the most important thing CS tries to test is
1.      Most important: How you approach a patient – Especially concern and empathy
2.      Your English proficiency – Ability for you to understand the patient and for the patient to understand you. This should be simple.
3.      Remember, the patients are actors. So, they will try to test you in every possible way – From wasting time to irritating you. Don’t lose your cool and try to stick to the topic in a way that’s not harsh or rude.

1.      Type everything with CAPSLOCK on. It will save some very important “SECONDS or a minute” overall, as you don’t have to switch between small letters and capital letters at the end of every sentence.
2.      Knock the door before entering. Remember the name and ask the patient if you pronounced it properly or ask them to pronounce it for you if you find it difficult.
3.      Explain the patient everything before you perform any simple kind of physical examination.
4.      Closure is important. Explain to the patient your differential diagnosis, what you think it could be, what are the tests you are going to do (explain what’s a CT or endoscopy is in simple terms) and that you would plan the management (by discussing with the patient) accordingly as per the outcome of the results.
5.      Whenever the patient gives a history of smoking/alcohol/drugs – Explain them how it can affect the health, advice to quit, ask if the patient is ready to quit and let them know of the rehab if the patient is ready to quit. It’s best to do it as soon as the patient gives a history, because you might forget to do it at the end along with the closure. If you want to do it at the end, make sure you write it in BOLD letters on the notepad you carry.
6.      Smiling is good, but don’t smile when the patient says he is depressed or in pain.
7.      Don’t try to shake hands with an emergency case.
8.      Use gloves for physical examination rather than washing hands as you will have to wait until your hands become dry every time you do it. Also, there is a risk of your hands being too cold for the patient.
9.      Your first differential diagnosis must be the most plausible one.
10.  Physical examination: Take care to give consideration to patient’s privacy and pain.
11.  Never do a private parts examination on either gender, as the case won’t be related to it.
What to expect on the day of the test:
1.      Be prepared to realize that the 15 minutes inside the patient room will pass like 5 minutes. So, don’t waste time doing unnecessary stuff.
2.      It is common for the first one or two cases to not go as planned. It is common to think that you screwed it up or it is common to genuinely screw them up. Don’t let it affect your next cases. Just forget about every case as you leave the room and type the notes. Don’t carry it to your next case.
3.      It is a very common feeling at the end of the day to think you would fail for sure. Don’t let it through you into depression. You will be good as long as you stick to basics and not try to do anything out of ordinary.
From my experience:
1.      I have seen people passing the exam despite failing to give CLOSURE for 4-5 cases. But, try to give closure for all the cases – just don’t worry if are not able to.
2.      I have seen people passing the exam despite failing to write all the three differential diagnosis for 4-5 cases.
3.      You will pass, as long as you don’t do any blunders – Like coughing in the patient’s face, not showing empathy at all or being rude and so on.
4.      People have done it practicing with others over skype. But, I would strongly recommend to practice at least once with someone in person before the exam.

Empathy, proper manners, and comprehensible speech delivery – You shall pass.

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