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deleted699098
Here's a summary of some thoughts on preparing for CS. I found lots of helpful tips on StudentDoctor.net, so this is my way of paying it forward. Maybe someone else will find something helpful here.
Disclaimer:
My suggestions apply only to individuals of the same background, US IMGS. If your background is different, don't apply my experience to your situation.
I failed the ICE component on my first attempt. I blame it solely on me. I did NOT take it seriously enough.
I assumed that my previous successful preparation for Step 2 CK and my native-proficiency English would suffice for CS.
WRONG!
CS is mostly about time management. More on that later.
Preparation materials and my personal assessment of each:
1. Kaplan 5-day course (Chicago)
Utter waste of time and money.
This course is tailored for non-US IMGs. It focuses mostly on communication skills, or to be precise, the American way of doing it, something a physician trained overseas is, naturally, not accustomed to.
I recollect that 3 out of the 5 days were about how to talk to the standardized patient (SP), body language, proper phrases to address/questions SP's, etc. Only the last 2 days were actual CS simulation.
If you are a US IMG, you won't need too much coaching on mannerisms, expressions, language, etc (assuming you've lived in the US for a substantial period).
2. Kaplan USMLE Step 2 CS Lecture Notes
I believe it's a perfect substitute for the 5-days course.
It's a decent summary of the skills you need to pass the exam. Its sections have a detailed guide for time management, how to do your patient notes, etc.
Its 30+ practice cases are very well written and they touch on the most important clinical scenarios you are mostly likely to encounter on the exam.
3. First Aid
A bit redundant with its differentials and workups, but again, it helps with reviewing the most relevant conditions/presentations etc. you will need. At the end of the day, you can't have too many practice cases.
4. USMLE World QBank
As usual, the most important/useful resource.
How long should you take studying for the test?
Unlike Step 1 and CK, you don't need to become a hermit for CS.
THE SINGLE MOST IMPORTANT ELEMENT IS TIME MANAGEMENT.
Focus on the following:
#1. Coming up with correct differentials fast.
Based on the doorway information you have for each practice case, time yourself to come up with at least 5 correct differentials in no more than 40 seconds. You should not spend more than that at the doorway before knocking and stepping in to your SP.
One if the main reasons why I failed CS was I underestimated the importance of coming up with differentials at the door. If you don't get that straight, you'll either mismanage your time the next 14 miuntes (best case scenario) or downright **** up the encounter.
Bottom line: you do NOT find out the differentials after talking with the SP. You have your differentials BEFORE talking to the SP!
#2. Know your history-taking mnemonics.
And by "know" I mean spit them out without even thinking. Yeah, you'll need some fine tuning depending on each case (you don't ask about obgyn history for a male SP, right?)
These mnemonics will cover all the history you need.
Again, you won't need every single item for every single case. Use your discretion and judgement. And keep an eye on the time.
History of present illness: SIQOR 3A
Symptom/Site (if the chief complaint [cc] is pain)
Intensity on a scale 1-10
Quality (if pain)
Onset, course, & duration
Radiation? (if pain)
3A Aggravating & Alleviating factors, Associated symptoms
Past medical history: PAM HITS RUG SED FOSS (read it "Pam hits rugs ed foss")
Previous similar episodes of cc.
Allergies (meds & otherwise)
Medical conditions (HTN, DM, etc)
Hospitalizations/Illness/Trauma/Surgery
Review of symptoms (tailored to cc), particulrly Urinary & GI.
Sleep, Energy (or exercise/exertion), and Diet (appetite)
Family history of similar issues & major medical conditions
Obgyn (when applicable)
Social (includes occupational history, EtOH, smoking, and drugs)
Sexual
#3. Have a solid approach to your physical exam (PE).
You can always do basic heart & lung auscultation. That gives you an extra minute to think about the targeted PE based on the presenting complaint. So you can always auscultate 4 cardiac points and carotids, 6 points on the back for lungs (3 seconds for each auscultation point), feel radial and pedal pulses, look/touch for edema, and look for clubbing (almost always none). All of that can be done in a minute or less.
There is no time for a full PE, needless to say.
The only tricky system is neurology. You cannot do a full neuro PE, that's too much time. So in my opinion, that's one of the few situations where you'll actually have to think about what to do next, based on initial complaint and history.
- To be continued -
Disclaimer:
My suggestions apply only to individuals of the same background, US IMGS. If your background is different, don't apply my experience to your situation.
I failed the ICE component on my first attempt. I blame it solely on me. I did NOT take it seriously enough.
I assumed that my previous successful preparation for Step 2 CK and my native-proficiency English would suffice for CS.
WRONG!
CS is mostly about time management. More on that later.
Preparation materials and my personal assessment of each:
1. Kaplan 5-day course (Chicago)
Utter waste of time and money.
This course is tailored for non-US IMGs. It focuses mostly on communication skills, or to be precise, the American way of doing it, something a physician trained overseas is, naturally, not accustomed to.
I recollect that 3 out of the 5 days were about how to talk to the standardized patient (SP), body language, proper phrases to address/questions SP's, etc. Only the last 2 days were actual CS simulation.
If you are a US IMG, you won't need too much coaching on mannerisms, expressions, language, etc (assuming you've lived in the US for a substantial period).
2. Kaplan USMLE Step 2 CS Lecture Notes
I believe it's a perfect substitute for the 5-days course.
It's a decent summary of the skills you need to pass the exam. Its sections have a detailed guide for time management, how to do your patient notes, etc.
Its 30+ practice cases are very well written and they touch on the most important clinical scenarios you are mostly likely to encounter on the exam.
3. First Aid
A bit redundant with its differentials and workups, but again, it helps with reviewing the most relevant conditions/presentations etc. you will need. At the end of the day, you can't have too many practice cases.
4. USMLE World QBank
As usual, the most important/useful resource.
How long should you take studying for the test?
Unlike Step 1 and CK, you don't need to become a hermit for CS.
THE SINGLE MOST IMPORTANT ELEMENT IS TIME MANAGEMENT.
Focus on the following:
#1. Coming up with correct differentials fast.
Based on the doorway information you have for each practice case, time yourself to come up with at least 5 correct differentials in no more than 40 seconds. You should not spend more than that at the doorway before knocking and stepping in to your SP.
One if the main reasons why I failed CS was I underestimated the importance of coming up with differentials at the door. If you don't get that straight, you'll either mismanage your time the next 14 miuntes (best case scenario) or downright **** up the encounter.
Bottom line: you do NOT find out the differentials after talking with the SP. You have your differentials BEFORE talking to the SP!
#2. Know your history-taking mnemonics.
And by "know" I mean spit them out without even thinking. Yeah, you'll need some fine tuning depending on each case (you don't ask about obgyn history for a male SP, right?)
These mnemonics will cover all the history you need.
Again, you won't need every single item for every single case. Use your discretion and judgement. And keep an eye on the time.
History of present illness: SIQOR 3A
Symptom/Site (if the chief complaint [cc] is pain)
Intensity on a scale 1-10
Quality (if pain)
Onset, course, & duration
Radiation? (if pain)
3A Aggravating & Alleviating factors, Associated symptoms
Past medical history: PAM HITS RUG SED FOSS (read it "Pam hits rugs ed foss")
Previous similar episodes of cc.
Allergies (meds & otherwise)
Medical conditions (HTN, DM, etc)
Hospitalizations/Illness/Trauma/Surgery
Review of symptoms (tailored to cc), particulrly Urinary & GI.
Sleep, Energy (or exercise/exertion), and Diet (appetite)
Family history of similar issues & major medical conditions
Obgyn (when applicable)
Social (includes occupational history, EtOH, smoking, and drugs)
Sexual
#3. Have a solid approach to your physical exam (PE).
You can always do basic heart & lung auscultation. That gives you an extra minute to think about the targeted PE based on the presenting complaint. So you can always auscultate 4 cardiac points and carotids, 6 points on the back for lungs (3 seconds for each auscultation point), feel radial and pedal pulses, look/touch for edema, and look for clubbing (almost always none). All of that can be done in a minute or less.
There is no time for a full PE, needless to say.
The only tricky system is neurology. You cannot do a full neuro PE, that's too much time. So in my opinion, that's one of the few situations where you'll actually have to think about what to do next, based on initial complaint and history.
- To be continued -
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