USMLE Step 2 CS (Clinical Skills) – An IMG Perspective
Today, I received my score report for the CS exam and I passed with high performance in all components. Here’s my experience:
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.
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 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.
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.
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.
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
- How should I write the patient note for bad news cases?
- You just type the history part. You don’t type anything in PE, DD or WU.
- 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?
- 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.
Dr. Abdulmunaim Eid
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