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Step 2 CS in 28 Days – Experience by USMLE Lyfe


Hi!

This is my experience. First of all, this was my first step. I was too worried to take it as the first one but I had to because my visa had few months to end. With someone who is literally average like me, and less preparation than the others. I never thought i’ll make it! And if I did, you can too!! Guess what? I took it in Philadelphia, where everybody else was an AMG.

My less preparation time was because I still have finals to do in the medical school. I took 28 days to prepare. My first two weeks was just reading the cases and practicing with someone through skype, where it was miserable because i was cheating all the time of what questions i gotta ask lol. Through time, i started to be more confident and make my own mnemonics. I watched a lot of videos also through that time.

Went to New York 2 weeks before my exam, and took the NYCS prep course because I didn’t have any idea about the patient note. So practicing a lot was the key to ace the patient note.

Stick to practicing a lot, even if it was for two weeks!! Choose the right partner, who doesn’t give compliments

First aid, Kaplan cases were helpful, partner, and Patient Note practicing!!

Good luck all!

If this experience helped you, check out the following:

USMLE Step 2 CS (Clinical Skills) – An IMG Perspective

STEP 2 CS : An IMG Experience – by Dr. Sara Khan

Steps to Success – Step 2 CS Review by Dr. Mina Fransawy Alkomos

 

December 26, 2017

Steps to Success – Step 2 CS Review by Dr. Mina Fransawy Alkomos

Hello leute,

Passed cs on second attempt with about 3 weeks differance between score report and 2nd attempt.

3 weeks only because of the support i got from the people around me.

I wrote this post for the people who failed Cs ( ICE portion ) or havent taken it yet.

and whoever failed, Go Back to the hotel, practice as if nothing happened, donot let them tell you u re not good, show up again and show them.

i know how its hard for anyone to start again, but u got it .

first I hesitated in writing it, Because i see most of the people passing so whats the point, but after thinking, This can help at least one person so why not.

This can help that one person who might be doing mistakes in his preparation right know and he/she too shy or to confident to ask .

my first exam was in

may 1st 2017, report in june 28

2nd exam was

in july 24th/2017, report in october 11

i took the second one as soon as i found a date. Both was in houston, i got 3 repeated patients in the second time

I wont talk about how to prepare for Cs, Alot of you’ll can talk about this better than me.

Im gonna talk about A point in ICE section.

As shown in the pictures, i failed ICE in the first one

why ?

I only have two explanations

1- quality of the writing ex.

60 YO M PRESENTED TO ER C/O SUDDEN ONSET OF LT SIDE CHEST PAIN. CONDITION STARTED 30 MINUTES AGO, PROGRESSIVE COURSE. THE PAIN IS COMPRESSION IN QUALITY, 6/10, NON RADIATING, AGGREVAYED BY EXERTION, NO ALLEVIATING FACTORS. ASSOCIATED WITH SWEATING.

HE RELATES THIS TO RUNNING. HE DENIES …….

ANOTHER EXAMPLE

60 YO M PRESENTED TO THE ER C/O OF LT SIDE SCHEST PAIN WHILE HE WAS RUNNING, ITS SUDDEN, PROGRESSIVE COURSE, NO RADIATION, AGGREVIATED BY EXERCISE, NO ALLEVIATING FACTORS

ETC.

what i want to say that the first one was more organised, better quality and quickly informative.

2- my second explanation is

the order of DD and supporting evidence

i might have missed the order of DD

so what i need you to do

1- write PN early, and let someone revise them, and gives u notes

2- donot get overconfident with writing notes, if you wrote a note and no one saw it, consider it not written

3- show it to different people

NB i did a score recheck, and nothing changed.

Best of luck.

If this experience helped you, check out the following:

Step 2 CS in 28 Days – Experience by USMLE Lyfe

STEP 2 CS : An IMG Experience – by Dr. Sara Khan

USMLE Step 2 CS (Clinical Skills) – An IMG Perspective

December 26, 2017

STEP 2 CS : An IMG Experience – by Dr. Sara Khan

Bismillahi Ar-Rahman Ar-Raheem (In the name of Allah, The Most Merciful)

Name: Dr. Sara Khan

Exam: Step 2 CS, Morning Session, Chicago.

Exam Date: 13th October, 2017

Result: Passed on 13th Dec, 2017.

Prep Time: 1.5 months to be exact.

Steps taken before: None.

Resources used:

  • First Aid CS
  • Study Partners (both Live & Skype)
  • Sherazi notes (very well written) and Neeraj Notes – both are in the CS forum files section.
  • Blue sheet mnemonics – Also in CS forum files section.
  • CSE and UWorld videos for examination
  • A youtube video (https://www.youtube.com/watch?v=du7iyMtjvEM)

About me:

I’m an average IMG from India, who came to USA in July 2017 for settling down in this country with absolutely no exposure to hospitals here,  I was preparing for Step 1, wasn’t getting good score so decided to take a bold move and give Step 2 CS as my first step. I had scheduled my exam about 6 months ago, so I got the exam date and place I wanted. I took my exam on the last day when my eligibility period was expiring, this means I couldn’t even delay if I felt unprepared. I was obviously very terrified as this was going to be the first exam I had ever taken in USA.

No observerships, No clinical exposure here, No previous steps, No courses or mock exams- This is why I say I’m not the best person for guidance and I made a very bold move to give Step 2 CS right away!

Exam prep:

Phase 1: I started preparing for CS in August, I was trying to get familiar with the exam pattern and First Aid for one month and watching videos on youtube. Then I found a Live study partner, was practicing with him (as his exam was very near like 2 weeks away, I got to learn a lot form him as he was already exam ready — best way to learn is get advanced study partner).

Phase 2: I was practicing cases on a moderate pace, this is when I read Neeraj Notes and decided to stick to them along with FA, watched UW and CSE videos to get the hang of physical examinations. Here my partner had already taken his exam and said IT WAS NERVE WRACKING!! I thought to myself if he being a Caribbean graduate says this, I stand no chance coming from India just 2 months ago! (I couldn’t even postpone my exam as my eligibility was expiring the next day of my scheduled exam)

Phase 3: Last 2 weeks, I started putting in more effort, found another Live SP and 3 Skype SPs (I highly recommend practicing with different people as it breaks the person anxiety).. This Live SP of mine was very advanced as well, he helped me with physical examination and introduced me to SHERAZI notes which helped me very much. I kept practicing with him all the cases I could, practiced my patient note typing, I liked the the FA style so I stuck to it.

Day before: I practiced only 1-2 cases, couldn’t study anything was very apprehensive.

Couldn’t sleep properly, kept waking every hour!

Exam day:

Got off the bed 3 hours before time, revised Sherazi Notes one last time and went through FA differentials section quickly.

At the Exam centre, I saw ALL AMGS, except 2-3 IMGS from Caribbean colleges, everyone around me was very casual and joking pranking etc, because they were all from same class!!! This freaked me out and started giving me headache, so I popped in the Tylenol I took with me. I also took a lot of food items and coffee because I couldn’t do breakfast in stress (don’t do this please, you need energy to give this 8 hour long exam plus they do give food)

Exam Experience:

We were given our number and divided into 2 batches, all lined up, soon we were standing at the door of my first case, my heart was pounding, I couldn’t believe I was giving this exam! Announcement was made and my time started, I was scribbling my mnemonics on my sheet and I see around everyone was already in the room and I was only one standing out! (this will happen, please don’t freak out at this, AMGs are trained very well so they are quick and dont need any memory aids) I took my full minute outside the door writing my memory aids, took a deep breath and knocked… this is how my exam began, trust me the time was flying and i didn’t even realize when I came down to half cases done!

During the breaks I drank coffee and Vitamin water I took with me, along with snickers & granola bars to keep me energetic. They do provide meal but I was too anxious couldn’t even eat.

I had to use bathroom every break because of the coffee/water I was drinking too much fluids. when I in the bathroom, in the mirror I took a minute to see myself if I’m looking professional and said to myself, I came this far, I can do this! this boosted me for upcoming cases. My performance got better after first 2-3 cases because that’s when you actually get accustomed to the stress and anxiety and start performing optimally.

There were 2-3 cases where I actually messed up but they were not drastic mistakes except for in 1 case which I had no clue about, the patients were really nice, didn’t give me a tough time but you have to ask them right questions to extract history from them.. they will not tell you anything if you don’t ask!!!

I made sure I followed all protocols to the best of my knowledge, knocking, calling them by their last name, introducing myself, shaking hands, smiling, saying sorry when needed, asking permission before touching them, helping them sit up or lie down, wearing gloves etc, coz I knew these were the things which will fetch my marks, so I was very conscious about that!!

After Exam:

I felt I completely messed up and will fail it, other examinees felt the same, so its normal! Exam is designed in that way to make you feel you’re doomed LOL! Don’t lose hope, give your best shot and keep praying when waiting for results.

IMPORTANT TIPS:

  • Time yourself – train yourself to complete the cases 2-3 minutes before so that on Exam day you be able to manage in-spite of the anxiety.
  • Take Tylenol on exam day – you will get headache because of stress and tension
  • Take some snacks/drinks with you.
  • Dress professionally and neat – All formals.
  • Don’t wear any jewelry coz you have to remove them
  • I preferred standing in all cases (except one where I had to do the discussion and patient was sitting)
  • Do focussed exam only, you cant do a lot in such short time.
  • ALWAYS ask if there’s anything they’d like to tell you, 90% they will tell you what you missed.
  • Practice Patient note typing 1-2 weeks before.

P.S I wore good neat makeup on my exam day to feel confident, this is was suggested by my dear friend Moe Man, it actually helped boosting my confidence on D-Day! 😉

Why am I writing this?

I’m writing this hoping this will help someone as someone’s experience once helped me!

I know there are not many people writing CS experiences, not enough guidance, they say CS is easy, I say its easy for AMGs not IMGs, maybe at least wasn’t easy for me!!

Give your exam when you feel you’re ready, when you know you want to go for it, don’t listen to anyone who says you can’t or you should… You know what is best for you!!

Good luck in whatever you do!! Keep me in prayers.

Regards,

Dr. Sara Khan.

If this experience helped you, check out the following:

USMLE Step 2 CS (Clinical Skills) – An IMG Perspective

Steps to Success – Step 2 CS Review by Dr. Mina Fransawy Alkomos

Step 2 CS in 28 Days – Experience by USMLE Lyfe

December 26, 2017

USMLE Step 2 CS (Clinical Skills) – An IMG Perspective

Hello guys,

Today, I received my score report for the CS exam and I passed with high performance in all components. Here’s my experience:

PREPARATION

Total – 5 weeks

1st week: I read all the available material regarding CS on USMLE.org, the introductory sections of First Aid (i.e. excluding short and long cases), and a few posts here and there over the internet. I also watched some Youtube videos.

The other 4 weeks: I just practiced. I had 2 live study partners one of them was my wife who is not a medical professional and 2 online study partners.

Collectively I did all FA long cases a little more than twice “playing doctor” and a little more than once “playing patient”. I also did Chicago notes once “playing doctor” and once “playing patient”.

I also practiced about 40 – 50 patient notes, most of them right after each corresponding encounter.

EXAM SETTING

Chicago, 28th of June.

Test center was normal, nothing to talk about really. I was nervous during my first couple of encounters, then it flowed. I didn’t have time to ask 3 patients: “Do you have any questions or concerns? ” although in almost all the encounters patients would ask about things and communicate concerns during taking history. I also didn’t have time to do closure in one patient, meaning the encounter finished once I finished the physical exam. I think I got 1 DD in one case totally wrong i.e. I just invented something that wasn’t there because I thought the patient was taking a specific medication and he really wasn’t. Of course, I ran out of time in a couple patient notes but I made sure that history, DD, workup and +ve physical were already there i.e. in those encounters I just didn’t have time to write all the -ve physical signs I examined the patients for. One patient was semi-angry, another was slow and talkative at the same time which leads to not having any time for the closure as I said before. In general, it was okay. One patient though had a real problem while the encounter was on, but nothing to worry about.

TIMING

Timing is the most important factor to consider for the CS exam. You have to practice timing really carefully. Most patients had 2 or more questions. Most patients had something +ve in the social history. I decided a few days before the exam not to write the whole mnemonics I’ll use especially the ROS part before I enter the room because that was taking me a minute or more and this is a lot of time. In the exam I just took like 20 seconds on the door, that’s it. If you practice that way from the beginning of your preparation, you won’t have a problem in this regard. Also, make sure not to overdo the physical. Just do what is absolutely necessary, like a cardiovascular and chest exams in a patient with chest pain or a mini-mental in a patient with forgetfulness. Abdominal exam is for patients with either abdominal or pelvic problem. Don’t just do some exams for fun! You won’t have time for that.

 

SOURCES

First Aid long cases + Chicago notes were the most useful. Learn the exam techniques from any source you want, just make sure it’s the shortest version of this particular physical out there. We all know how to examine patients, but it’s necessary not to do something like a back range of motion in 2 minutes. Just tell the patient to reach for the toes with the fingers and to bend sideways at the waist and that’s it. This is just an example.

PRACTICE

Develop a routine for the encounter and the patient note. Stick to it throughout the entire preparation period, but modify it with the wisdom of your partners and the experience of the practice itself. Have at least one study partner, but 3 or 4 would be ideal. Doing FA and Chicago notes or other similar notes a couple of times will be enough.

 

PRAYING

As, I always say, praying is the key and without God, I would be lost. At least that’s my opinion and if you’re a believer, don’t underestimate the power of asking God for help.

Doubts Solved by the Author

  1. How should I write the patient note for bad news cases?
  2. You just type the history part. You don’t type anything in PE, DD or WU.
  3. What about a pediatric phone call? I know we have to write history and leave the PE empty. But what to do in the DD and WU (based on FA we should fill DD and WU, but in real life, we can’t make a DD based on just the history, right?
  4. You can make a DD with only the history. It’s not the perfect situation, but it’s what it’s. Do like what in FA.

Author

Dr. Abdulmunaim Eid

If this experience helped you, check out the following experiences:

STEP 2 CS : An IMG Experience – by Dr. Sara Khan

 

Steps to Success – Step 2 CS Review by Dr. Mina Fransawy Alkomos

Step 2 CS in 28 Days – Experience by USMLE Lyfe

December 25, 2017

USMLE Step 2CS Experiences

The USMLE Step 2 CS exam is the practical exam in the USMLE series of licensing tests. It is conducted by the Clinical Skills Evaluation Collaboration (CSEC) in 5 exam centers only in the USA:

  1. Atlanta, Georgia
  2. Chicago, Illinois
  3. Houston, Texas
  4. Los Angeles, California
  5. Philadelphia, Pennsylvania

USMLE Step 2 CS is divided into 3 sub-components:

  • Communication and Interpersonal Skills (CIS)
  • Spoken English Proficiency (SEP)
  • Integrated Clinical Encounter (ICE)

The exam format is divided into 3 parts:

  1. On-Site Orientation
  2. The Patient Encounter
  3. The Patient Note

Following are experiences of high scorers in USMLE Step 1 which are very helpful for everyone preparing this test:

December 12, 2017

NBME vs the Real USMLE

Differences between NBME vs USMLE Test ?

The NBME (National Board Of Medical Examiners) Test forms are a series of 4 block tests conducted at a cost of $60 to test USMLE exam readiness for potential examinees. The score received on the NBME forms is highly predictive of the real exam and is a good metric to gauge how well is your preparation. While the NBME is a good proxy to the USMLE score and is a must-do for USMLE preparation, there are certain differences that one should be aware of. I have in the past written an article on How to Best Use the NBME ? In this article I highlight those differences which are frequently overlooked by many. Being aware of these differences will better prepare you for what’s in store for exam day. Additionally every potential issue is followed by a solution to help you test yourself in an environment that best emulates a real exam:

Setup of the Test

The NBME tests are given at your home, in a familiar surrounding. You have a fridge full of your favorite food, can get up and grab a snack while giving the test and are in a comfortable surrounding. You can keep your feet up on the table and give the exam as you please all while checking your favourite cat photo pages on Facebook.

This changes completely in the USMLE Prometric exam center. Instead of being at ease, you are constantly forced to do a security check, patted down, fingerprint scanned and signed entry and exit. All of this adds to the high pressure situation and is uncomfortable.

We perform best when the situation is under our control. When we give the exam in the Prometric center, the same brain which performed well at home is under an immense amount of stress. Stress that may be caused by having to travel out of town, given an exam under unfamiliar surroundings, carrying documentations, and taking the test under strict security. In addition to this, if i may share my own experience, i was giving the test along with examinees who needed to type for their exam (like the GMAT, IELTS, etc). Their noise disturbed me a lot. In addition to this i had to tolerate the constant sniffing and coughing of a girl giving the test next to me. All of this lead to unnecessary irritation and distraction.

SOLUTION:

Because the real test was not a very comfortable experience, i made sure i emulate this. I took 2 NBME tests back to back every time i gave a mock test. I considered my score as a mean of the 2 tests. I have a little sister who plays with toys, i asked her to be in the room while i gave the NBME tests. In addition to emulating the noise distractions, i also prepared a small snacks packet including a sandwich and chips and 2 Red Bulls. I gave the exam with the snack pack on a table next to me. After every block i would get up and take a break if i wanted to. I would time my breaks and make sure that i don’t take more than the alloted time. This method of testing in uncomfortable situations helped me simulate the real exam environment

Length of the Exam

The real exam is 7 blocks whereas the NBME is only 4 hours in length. While the vast majority of people take only 1 NBME a day, this overestimates our performance. The reason is : In the early hours of a test we are fresh and perform better. However after 7 hours in an 8 hour exam, our brain starts to fatigue out and hence a 4 hour test is not rigorous enough to emulate a 8 hour test.

SOLUTION:

As alluded to previously, i took 2 NBME tests back to back in order to emulate a real testing environment. This was actually very helpful as i usually scored lesser in my second NBME as compared to my first one. I would take the average of the 2 tests as my mock test score.

Length of questions

The NBME questions are notoriously short. This is not the case with the real exam. While in most NBME tests, the questions are direct and to the point, in the real exam questions are filled with tons of labs which do not necessarily have anything to do with question but are kept in there to confuse you and use up your time. (NBME Lab Values are provided in every NBME just like USMLE Step 1 provides Lab Values)

SOLUTION:

The Uworld questions are of a similar length as the actual exam and since most people are going to do UWorld not once but multiple times, we already have decent practice with longer question formats. One extra tip i used to decrease time spent to solve a question and make longer questions easier is to not use the UWorld or NBME labs value button and instead memorize ALL the normal lab values. Following is a list of the lab values which you need to memorize for Step 1 , Step 2 as well as the for the clinics in the future when you are in a residency. Make sure you memorize these. The NBME lab values are same as the USMLE Step 1 Lab Values. Following is a list of the lab values which you can access from every NBME:

USMLE Step 1 Lab Values

USMLE Step 1 Lab Values/ NBME Lab Values

USMLE Step 1 Lab Values

USMLE Step 1 Lab Values/ NBME Lab Values

Media Questions

The real exam has a lot of media items which are not on the question sets of the NBME. For example, there are no 12 Lead ECGs on the NBME tests. There are only Single (1 lead) ECGs in the NBME tests. In a 12 lead ECG we have to pick out an aberrant finding from all the leads. The NBME forms have ECG questions with just 1 lead in the question. This makes the questions incredibly easy and hence are not a good proxy to the actual USMLE because the real USMLE has multiple questions with 12 lead ECGs. For example, you may encounter a practice question in an NBME of a single lead ECGs like an ECG segment with a clear cut T wave elevation (for hyperkalemia) [SEE IMAGE BELOW].

Single Lead ECG

Single Lead ECG

Now this is incredibly easy to diagnose as your options are narrowed down to just one lead. Had the question been a 12 lead ECG the difficulty level would have been very high. I recommend you practice 12 lead ECGs [Like the Below Image] to emulate the real exam scenario.

 

12 Lead ECG

12 Lead ECG

Also, the heart sounds in the real exam are not like those in UWorld or NBME and don’t have a simple, single play button. Instead they have different auscultation sites [AS SHOWN IN IMAGE] and then it is on you to find out where the abnormal sound is located.
The reason this is important to note is that the heart sounds you practice will have a simple play button with the abnormal area already given to you. This narrows down the choices sometimes to just 2-3 diseases and doing such questions will create a false feeling of being good at these diagnoses. However, the reality is that the questions on heart sounds in the practice tests like UWorld and NBME are MUCH MUCH easier than the real exam and hence
For example, having a single button which says, Apex area sound is as follows decreases the difficulty level a lot in the NBME questions. But  many people find it very tough and frustrating while trying to diagnose a multiple site heart auscultation in the real exam. Following is how the heart sounds are to be diagnosed in the real test (excerpt from Official USMLE Practice Materials):

Heart Sounds & Murmurs

Heart Sounds & Murmurs

Note that there are multiple auscultation zones and diagnosing the above scenario should be practiced many times before the real exam.

CONCLUSION

While the NBME forms are the closest you can get to the actual USMLE exam style and scenario, it is worth keeping in mind the differences between the 2. These differences may prove to be much bigger problems than anticipated, if not mitigated in advance. A lot of your USMLE score will depend not on your preparation but on your test day performance. I would suggest you keep this page bookmarked to refer to later. It will definitely payoff to have these in mind.

This highlights the differences between NBME vs USMLE. If you found this informational, I recommend you check out my article outlining how to use the NBME forms effectively to score well on your USMLE Step 1 exam.
September 30, 2017