Νίκος Ζαρειφόπουλος – USMLE Step 2 CS Experience – PASS


This group has helped me a lot so I would like to post my experience of the step 2 CS exam in case it would benefit future examinees.

Exam date- April 27 (Philadelphia 3700 center)

Scores released on June 19 (last Wednesday) – Pass, with average performance in all components (no overlap with borderline zone and no asterisks in higher performance).

For what it’s worth, my Step 1 and Step 2 CK scores are in the 250s, with both exams taken more than 2 years ago (late 2016, early 2017)

I am a final year medical student in Greece so because of our final year clinical rotations I never really took any dedicated study time. I decided upon my exam date during August 2018 (very far in advance) to avoid all the uncertainty associated with schedulers and people selling dates, which in hindsight is the one thing I did perfectly.

As for preparation, I read through First Aid 3 times in my downtime during clinicals throughout the year, and the last couple of months I practiced cases with my girlfriend (who is not in the medical field) once or twice a week. During the last month I also practiced patient notes and watched a few videos about the physical exam. That helped a lot, especially for the neuro and musculoskeletal exams, as I knew the individual maneuvers but had never really considered the most efficient way to perform a comprehensive exam in 1-2 minutes. The days leading up to the exam I did not study much as I started a research elective at Hopkins and was trying to adjust to life in Baltimore.

During the exam I made at least 2 major blunders which I suppose reduced my CIS score: I tried to pull out the leg rest during the first encounter while the patient was already supine, lost my balance and almost fell on the bed. A few encounters later while trying to summarize the history I paraphrased something the SP said and when she corrected me I told her that there was no difference between what I said and what she said. I definitely should have just apologized and thanked her for clarifying the matter.

Apart from that, the exam went smoothly: I entered each room 1-2 minutes late in order to fill out the LIQORAAA, relevant ROS and PAM HIT FOSS mnemonics on the blue sheet, knocked, introduced myself smiling at the patient, asked permission to sit down and then inquired about the cause of their visit. I wrote down all history findings during the encounter because there is no way I would remember the details 10 minutes later while typing the note. I notified the SPs of my intention and told them it was to ensure I do not forget what they are telling me as it is extremely important. After social history I asked if there anything else they would like to tell me, which helped a lot as some of the patients would volunteer information that was very helpful for narrowing down the DDx. I always summarized at the end of the history, washed my hands and asked permission to start the PE. I did brief PEs focused on the chief complaint. I did the most important maneuvers but I am pretty sure there are maneuvers I missed on every case. I did not do heart and lung for patients without relevant complaints, though since I finished most encounters early I guess I should have done it for extra points. Closure was hit and miss: I only counseled 2 patients about smoking, and I am pretty sure I missed a few other vital counselling points. In cases where the diagnostic workup was obvious (the history was like the next best step cases in CK) I focused on that, whereas in some cases where the diagnosis was obvious to me I would educate the patient on the natural course of the disease and reassure that it was benign. At the end of the encounters I would ask if the patient had any other questions, and after answering the challenging question I would tell them that it was a pleasure meeting them, that I hope everything goes well, that we have to schedule a follow up appointment and that in the meantime I am available 24/7 should they need anything.

I wrote the patient notes in the format suggested by FA, with a shotgun workup which I guess was wrong. I included 2 differentials for most cases, with 3 for the more vague ones and only 1 for a case that was a textbook presentation of a very specific condition. I wrote 2 supporting findings for most differentials that were unlikely, 4 for those that were higher up on the list.

The atmosphere at the center was pretty relaxed, with the proctors being very polite and helpful. We had coffee during every break and lunch after the 6th case. There were at least 2 IMGs aside from me, with the rest of the examinees probably being US students. Everyone was friendly and laid back, more so than expected considering we were in the middle of a high stakes examination. Could be because I took the exam on a Saturday.

As for general advice, I think 5 days of dedicated study and practice (4-6 h per day) would be enough to pass comfortably, so long as there are no issues with typing speed or with the language. It is best to take the exam after CK or at least after 1 year of clinical experience, otherwise coming up with a differential and workup may be difficult, which would negatively impact the PE and closure as well.

It is extremely disheartening to see so many here about people having difficulty with the SEP component. I was worried about that as well since in my country opportunities to speak English at the level required would be hard to come by, but I tried to work around that by practicing exclusively in English, watching the news on BBC and reciting the closure paragraphs from FA in front of the mirror. I am nowhere near as fluent as a native speaker as I speak very slowly and sometimes make long pauses due to an inability to find the correct word for what I am trying to say, but SEP was actually my strongest component. I couldn’t really find any useful information on how it is graded and what the performance profiles mean so I tried to formulate a simplified grading scale on my own hoping it may be helpful. Unless some people are chosen at random to fail SEP, I would guess that being a native speaker guarantees a high pass, whereas an accent, a few pronunciation errors and pauses bring your performance down slightly only slightly. Vocabulary and syntax errors that would significantly affect comprehension would bring performance down to borderline, as would speaking much faster than the SPs are used to. I guess it would take a combination of these to lead to a failing performance. On the opposite end of the spectrum, I suppose speaking like a news anchor with an impeccable RP accent would guarantee an asterisk for higher performance in SEP.

October 12, 2019
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