Anurag Sharma USMLE Step 2CS Experience

 

Here is my CS experience: I passed with high performance in SEP (finally all that binge-watching of American TV series paid off! )
First of all, let me start with a rant!
This is the toughest (read worst) examination in the whole wide world. Not because there are some big concepts or hard work required to pass it but just because most people are not well versed with showing fake sympathies and “act”. I mean come on, I am not applying for an acting class, am I?

There are a few challenges that you have to overcome to keep your cool in this exam:

1. First challenge is to get a date in Houston and then get a room/room-mate/SP in Park Inn/Venetian Inn/Hyatt. To all those are new to this exam, these hotels are a stone’s throw away from the exam center and are recommended. This group and Steven take care of these issues but try to start as soon as possible, not just for the CS date, but also for advanced reservations for these hotels.

2. If you take the exam in Houston (which I now recommend despite being a proponent of the opposite before I gave the examination), and stay in Park Inn, the first challenge will be to not get intimidated when people from all over the world discuss “physical examinations” from all over the world for all diseases, many of which you have never even heard of. I had almost given up on the first day! (Right Sabir Usmle?) I am a pathologist and I have no qualms in saying that I am a total baboon when it comes to clinical encounters. Keep in mind that you have to do a very focused physical examination (Thanks to Megha Lahori for the tip). Stick to the system of interest or you will never finish the test in time.

3. Third challenge is finding a date for a coaching class for CS. I did Gold USMLE but my classes were just one day before the examination and my main goal in those classes reduced to not getting intimidated and postponing the examination rather than learning anything new

I was more stressed on the Gold mock examination than on actual exam day coz I knew if they tell me you are not fit to appear on exam after 1 day, regardless of whether I was fit or not, subconsciously, my confidence would already be weakened and I will surely fail

So if you plan on doing a coaching class (Yes I recommend Gold USMLE at Houston), do it at least 15 days ahead of your exam date unlike in my case. For that, you need to book at least 1-2 months in advance! Dr. Thomas covers physical examinations and patient notes very well. The SPs gave excellent feedbacks in the mock test! I think it helped my confidence more than anything else (was out of touch from clinical encounters since last 5 years, coz I am hopelessly in love with slides and microscopes )

4. Next challenge is nobody knows what is true and what is not? Do you sit or you don’t? Do you say how would you like to be addressed or directly address them and wait for them to correct you? Do you say the nurse will come in and prep you for the tests before leaving or you don’t? Do you take hand sanitizer before moving out of the room or not? I would say follow what people at coaching classes say! It’s their day to day business, they know this examination. This is why it is important to develop these queries in your brains before going to a coaching class. If there are contradictory advises between two sources, use your judgement. But whatever you do, stick to it and practice the same in all your practice cases.

5. Use mnemonics! Write down those mnemonics before you enter the room. Also write down the, “THEN FRCS…” mnemonic whether or not you use it inside. What happens in exam is that you ask all pertinent negatives and positives and you almost always remember the positives. But you forget the negatives. If you have an “F” written on the paper somewhere, it is easy to put a “-“ in front of that alphabet to document that they had no fever. And trust me when you are sitting outside, you may go blank regarding that one small fact. Did I ask fever or not? (You should not write what you didn’t ask, not even the negatives). Trust only what you have documented in the blue sheet as far as entering data on PN is concerned. Having the mnemonic written there will save time and save your life.

6. There are no timers on screen unlike in the typing practice program! I wish somebody had told this to me in advance!

7. Another challenge is, okay so you have decided that you will spend 30 seconds of start time to jot down name, symptom, vitals, mnemonics, and differentials but what you are not prepared for are two (pardon me for the word) ASSHOLES! Who just read the name and entered They will do it 12 times in total…

I would have reached just the first half of my mnemonic and the asshole on my right goes, “KNOCK KNOCK KNOCK! GOOD MORNING MR. BROWN!!!” (Violating all HIPAA rules that ever existed). This makes you look on the right transiently and you see half the people are inside already. And just when you are finishing the “THEN FRCS” part the guy on the left goes, “KNOCK KNOCK! How are you today??” and you look on the left and everybody is inside except you Then you panic, enter prematurely, and screw up your first encounter!

This is not to scare you but just to tell you that you should expect people to disturb you, enter very early, or be loud around you while you are taking down your mnemonics! Be prepared!

Remember it’s not about entering quickly, it matters more what you do inside (something tells me, it could be a great dating advice too )

8. After the physical examination, you don’t get time to put 2+2 together and suddenly you have to put a perfect closure in front of the patient. I used to take my time, I used to say, “Okay Mr. Brown (gives me one more point for ICS), I have finished my physical examination, can I sit down and share my findings with you?” Then I used to take all the time in the world to drag the chair and sit. Remember from the start of this sentence to sitting on the chair and having an eye contact with the patient, you should be putting 2+2 together in your mind, coming up with what to say to the patient. I used this and saved my ass from going blank in front of patient or going,” amm, aaa”

9. Another thing that happens suddenly is the transition from finishing typing to going to next case. Before you are out of your love affair with the previous case, suddenly you find yourself standing in front of the next door and you panic! So be prepared to suddenly move from one case to another!

10. Last challenge is to look fresh while all you wanna do is go home and sleep. Last three cases are the worse! I was thinking good/bad, just get it over with You get breaks between all 3 consecutive cases, use caffeine accordingly! Eat adequately, don’t eat too much just coz it’s free food. Don’t talk in languages other than English (that too when absolutely necessary) and be good to proctors. If you feel like talking to someone to relieve stress the best person would be the proctor itself.

11. I didn’t do deep palpations, otoscopy or anything that would have been even slightly discomforting to the SP. That guy/girl has to check a checklist that decides your future! I mean, press hard on my abdomen (sorry belly ) and I will surely fail you. Just put two hands together while palpation and tell them you are palpating deep while doing it. Don’t poke the dragon

12. I had no problem in time management despite taking 30-40 seconds outside the door. I finished all my encounters 2 minutes earlier. One time, I was out 3 minutes before and there were still 4-5 students who came out ahead of me. So weirdos come in all shapes and sizes, you are not the only one in anything ever

13. No matter what you do in exam, after coming out you will feel you will fail. Everyone feels the same but wait till results and don’t screw up rest of your steps crying over this one.

14. Always be ready with a plan B, pay Steven in advance for re-exam if possible. I added him after my CS: P Just kidding!

To conclude, this is a shitty exam but you have to pass it anyway. Go with popular trends, coz they are usually true! Take Houston as center, stay in Park Inn, do everything that everyone else does and you should be good. Despite everything you may fail. But it does not prove that you are good or bad, it just proves that this exam is not so perfect!

If you pass, you are not “Gods and Goddesses”, please stop telling people that you passed coz you are extremely talented and they failed coz they are losers! Everyone is talented and everyone works hard, it was just your day, get over yourselves! This exam is all about luck with few tricks and has nothing to do with your talent, expertise, or experience! All the best! You can post your queries

October 13, 2019
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