Showing posts with label USMLE Step 2 CS. Show all posts
Showing posts with label USMLE Step 2 CS. Show all posts

Monday, March 18, 2019

Sunday, May 6, 2018

Query on Step 2 CS deadline & match timeline

I read this link and I'm confused, it says:

To participate in the National Resident Matching Program® (NRMP®) Main Residency Match®, international medical students/graduates must have passed all exams required for ECFMG Certification. If you plan to participate in the 2019 Match (in March 2019) and still need to pass Step 2 Clinical Skills (CS), you should register now to take the examination.

To help ensure that your result will be available in time to participate in the 2019 Match, you must take Step 2 CS by December 31, 2018. If you do not register now and schedule soon, it is possible that you will not be able to obtain a test date in 2018. At the time of this writing, the earliest available test date at any test center is in August 2018.

Link: April 2018

I plan to apply for matching in 2019, do I need to take the exam in December 2018?

- Sent through email


Let me clear terminologies before I start explaining.

Match 2018 means: Application in September 2017, results in March 2018, Residency starts in July 2018.

You said apply for matching in 2019, which means apply in September 2019 for the March 2020 match, yes?

Let's talk about the 2019 match mentioned in the link you sent. It says currently, there will be no availability of testing centres for this year's match (September 2018 application, March 2019 Match, Residency starts in July 2019). The ECFMG website is able to predict the number of applications that they are going to receive. This year, they predict there will be no testing centers available, which is why I am guessing they are asking you to register in April (register now).

Your confusion arises because of two reasons:
You don't know the match terminologies with respect to the year.
You don't know the timeline for the match.

When they mean apply right now and give the exam before December, they are talking as a general mandatory requirement. IT IS A ABSOLUTE MUST HAVE.

To be a competitive candidate, IMGs tend to give the exam in such a way that the results are out before September so that we have all the exam results before the application cycle of the match. IT IS OPTIONAL BUT PREFERRED.

So really, the virtual deadline to give the exam for us is July. We also prefer to graduate before September to get ECFMG certified, however, it's not mandatory.

It is quite vigilant of you to keep an eye out for these notices on the ECFMG website.

Since the dates are not easily available, when you plan to go for an elective, try to register in advance.

If you go to the ECFMG website, there is a site called a step 2 CS scheduling and you can view the dates available at various centres. So register as soon as possible if you want to get your desired dates. Here's the link

PS: The step 2 CS permit is available for one year and it does not expire quickly (compared to other exam permits that expire in 3 months) which is a huge advantage.

So to summarize, July is the ideal deadline for Step 2 CS to get results before September (Application submission). December is the mandatory deadline to get result before February (ROL submission, to be eligible for the match).

Google the step 2 CS reporting schedule to help plan for your match.

Hope that helps!


Thursday, May 12, 2016

Step 2 CS: Domestic violence

Hey everyone!

I talk about approach to a patient with domestic violence in the video. I also stress on how to counsel.

These are some points from the PowerPoint Slide.

Saturday, April 30, 2016

Step 2 CS: Challenging questions

Here are some of my sample closures for challenging questions.

All my closures are generic with little word play. Whatever the SP says, I would say it back to them saying I understand it. So your sympathy - empathy is done.

See how all three closures are almost the same - 

"Will I need surgery?"
I understand that you are concerned about the possibility of having a surgery. Yes, you might require a surgery. But I assure you that we will be there to support you, throughout the treatment, regardless of the diagnosis. Does that sound okay to you?

Friday, April 29, 2016

Step 2 CS: Introduction

Here's how I introduced myself -

"Mr. Smith? Hi. I am doctor D. I'm the attending physician and I'll be taking care of you."
"Are you comfortable in the room?" (Yes.)
"May I take a seat and write a few notes as we talk?" (Yes.)
"So can you tell me what brought you to the clinic?" (Blah blah blah...)
"Can you tell me more about it?"

Monday, April 25, 2016

Step 2 CS: Counselling for PTSD

I can see that you are distressed about an event that occurred in your life. We have some medical therapy available that can help you with this. Medicines take time to work, in the mean while I can get you in touch with some support groups and social help organizations that have patients who have witnessed similar traumatic events in their life.

Saturday, April 23, 2016

Step 2 CS: Physical exam findings in a patient with calf pain

We were practicing a case of calf pain (DVT / cellulitis) today and my friends told me that I documented the physical examination findings well, which is why I posted the note on the blog :)

Things in brackets are for reference only and I didn't type those in my 10 minutes encounter.

Thursday, April 21, 2016

Step 2 CS: Headache LOC tip

In a case of headache or loss of consciousness, any weakness or numbness is the first question you ask - because if there is anything suggestive of stroke or transient ischemic attack, you can time yourself to do a neuro exam which includes cranial nerves and strength, reflexes and sensations.

Sunday, April 17, 2016

Step 2 CS: Musculoskeletal patient note

IPROM MRSP is a brilliant mnemonic
You can use it for patient notes as well!

For shoulder pain:
Inspection - R arm is closely held to the chest wall. R shoulder appears red compared to the L.
Palpation - Non localized tenderness on palpation of R shoulder, arm and clavicle.
ROM - Pain and restricted flexion, extension, abduction, adduction, internal rotation and external rotation.
Motor - Unable to assess strength due to pain.
DTR's - 2+ intact, symmetric (If time, mention - Biceps, triceps and supinator)
Sensations - Intact to pin prick and light touch
Pulses - 2+ in brachial and radial arteries

For wrist pain:
Palpation - Non tender to palpation
ROM - Flexion, extension, abduction, adduction are WNL
Motor - 5/5 strength in shoulder, elbow and wrist
DTR's - 2+ intact, symmetric
Sensations - Intact to pin prick and light touch except decreased sensation in the palmar aspect of right arm
Pulse - 2+ in brachial and radial arteries
Tinels, Phalens test +ve. Finkelsteins test -ve.

Thursday, April 14, 2016

Step 2 CS: Memory loss / confusion

Soo.. I wanted to remember "medical terms" to report my findings in my patient note. I made a mnemonic for remembering "findings in Alzheimer's disease:


- Decline in Activities of daily living
- Cognitive decline
- Memory Impairment
- Executive Functioning

For activities of daily living, DEATH SHAFT is a tedious mnemonic. Keep it simple -ABCD
Ask for ABCD - accounts, bathing, cooking, dressing and transport - Can you walk in the house / drive a car?

Other diagnoses:

Normal Pressure Hydrocephalus - Ask for urinary incontinence, gait disturbance

Syphilis / AIDS - Have you ever been diagnosed with a STD in the past?

Major depressive disorder (Psuedodementia) - SIGECAPS

Hypothyroidism - Cold intolerance, constipation, slowing of movement, etc

Step 2 CS: Writing a psychiatry note and mini mental status

Mnemonic: ABC MATTS

Appearance - Well groomed / Dishevealed
Behaviour - Appropritate / Inappropriate
Co-operation - Cooperative / Non-cooperative

Mood - Euphoric / Depressed
Affect - Normal / Blunt affect with poor eye contact
Thought Process- Direct / Disorganized
Thought Content - Normal / Delusional
Speech - Fluent speech / Slow speech

"Now I am going to ask you a few questions that may seem odd, but these are just to assess your mental status."

"What is your name?"
"Do you know where we are?"
"Do you know what time is it?"
AAOx 3

"I will name three objects for you, can you repeat them after me? I will ask you to repeat the same objects after a while."
3/3 registration, 3/3 recall at 3 minutes

Step 2 CS: Headache / photophobia

When dealing with a patient with severe photophobia, you might want to dim the light out for the patient just to make the patient comfortable. Say, "I see that the light is making you uncomfortable, let me dim the lights out for you to make you feel more comfortable."

Then you start taking history.

Think of differentials, then ask  about -

Migraine - Ask about aura, catamenial migraine

Cluster headache - Ask about tearing of eyes, rhinorrhea

Tension headache - Ask about stresses in life

Meningitis - Ask for neck stiffness, fever

Wednesday, April 13, 2016

Step 2 CS: Hoarseness

This is a very easy case because there are limited number of  things that can cause hoarseness of voice.

Tuesday, April 12, 2016

Step 2 CS: What to ask in cases involving joint

Any case of joint pain, ask OPDFCS LIQRAA first.

Then, ask - Calor, dolor, rubor, tumor, functio laesa (Mnemonic: CRaFTeD)

Calor - Is the joint warm?
Dolor - Is it painful on movement?
Rubor - Does it look red to you?
Tumor - Does the joint look swollen to you?
Functio laesa - How has this affected your day to day activities?

Saturday, April 9, 2016

Step 2 CS: Blue sheet

What's a blue sheet? A blue colored paper given to you during the step 2 CS exam.

I finally figured out what my blue sheet will be like before entering the room and maybe it will be helpful for you guys too!

I tailored it from existing mnemonics and things I used to forget. You should make a personalized blue sheet according to your need too.

This is what my sheet would look like before I enter the room:

Step 2 CS blue sheet

Step 2 CS: Asking for sexual history

Sexual history is always a dilemma for step 2 Cs exam takers. Here's a simplification.

Are you sexually active?
Patient will answer either "Yes" or "No"

If no: Don't ask why and make it awkward. If the patient has problems, he will tell you.

If yes: How many sexual partners have you had in the past one year?