Devansh Pathak – USMLE Step 2 CS Experience – RECENT INDIAN IMG

 

Post-CS experience:
  1. Breathe. Don’t get nervous. Think of these SPs like just a depressed friend you want to console. Pay attention to the orientation.
  2. No, it DOES NOT matter which test center your take the examination at. People say bad shit about a test center because they failed there. Why did they fail? Because they DID NOT practice ENOUGH. What is enough? = AT LEAST 1 FULL MONTH of preps if your are out of clinical experience or an IMG.
  3. Be super duper nice. Ask them how they are doing today.
  4. Shake their hands. KEY.
  5. CLOSURE is VERY important. COUNSEL them. Eat lots of fruits and veggies. Take plenty of rest. Do not exercise until we have the results. Have you thought about quitting XYZ? Go out for a walk, in the park, take a deep breath in, hold 2 seconds, breathe out, hold 3 seconds and repeat it 20 times whenever you get anxious/depressed. If for joint pain, tell them would you like me to put you in for a referral to Physical therapy in the meantime? Some of these are common, look up what on webmd for non-medicinal at home stuff they advice. Say like a couple of these, not all. And counsel your patients IMMEDIATELY. Also, if they have previously quit, tell them I am so proud of you and by your overall looks, you look far healthier now, I want you to keep doing whatever you are doing.
  6. Do NOT say MRI or CT unless its headaches, head trauma, spinal trauma. If you must on Abdominal pain, joint pain, etc., say it like this: depending on the x-ray results, we may have to do further investigations for an in-depth look. Mention CT/MRI in your Patient note, but never say it to the patient. Tell them what the tests are. Periodically ask them if they understand everything your told them.
  7. Bring Snacks. Something to much on during your breaks.
  8. Talk to your surrounding test takers about non-medical related shit to get it off your chest. Get that initial nervousness out of you. Just talk random shi, but DO NOT TALK ABOUT ANYTHING MEDICAL.
  9. PRACTICE YOUR PATIENT NOTE. I cannot stress this one enough. The patient notes WILL take time to complete, I am a quick ass typer and I still couldn’t complete my PT notes on time. Write Dx & Tests FIRST, then HPI then PE. Practice using abbreviations. Practice the proper terminology that should be used. Do about at least 5 PT notes daily until your CS exams.
  10. Go through the list of Commonly Asked symptoms USMLE website lists.
  11. Be prepared to write a written note, if your computer does not work.
  12. Be prepared for a telephone case. Practice these. Especially a pediatric telephone case. Youtube videos are good ideas.
  13. Ask your damn patient, is it okay if I use the hand sanitizer instead of washing my hands? Most will say yes, but if they don’t then wash your hands. Saved a BUNCH load of time.
  14. Cold hands? Tell your SPs before you touch them during PE that my hands are cold so I apologize for that, would you want me to warm them before I touch your XYZ?
  15. Don’t ask closed ended questions unless its ROS/Pmx/Fx/Sx. Your HPI should always be Open-ended questions.
  16. Make a 10-15 second stupid conversation about their work/hobby. And then go right back into your history. Its all about how good of a conversation skills you have. Gotta have a flow from one question to the next. Ums are okay, at times. But you wanna be a smooth talker. If you cannot connect with your SPs, cannot console them, cannot counsel them, cannot make them psychologically feel satisfied that this doctor will help me get better, DELAY YOUR EXAM and learn this skill set.
  17. Your first case will go TERRIBLE. So here’s what to do. Grab a person. Practice before you in walk in the damn test center. Do 2-3. Just to brush it off.
  18. EDIT: I forgot to include this – do NOT go in with mnemonics. Those PAMHITSFOS, FEVERCUDS, SIQORA. These are fail safe mnemonics. Like if you have Alzheimer or Dementia or memory problem, then use this. You went to med school for a reason. To learn to extract information out of them. You should know better. This is probably one of the reasons people fail this test, going in thinking mnemonics will help them out. Thinking SYSTEM. Patient has chest pain. What can it be? Lungs, Heart, esophagus, and muscular. Simple. Patient has knee pain. What can it be? Arthritis. Systematic disease like previous strep throat. Osteoporosis. Trauma. Abdominal pain – what can it be? Depends on the location of the pain. Think organs during that time. You know the anatomical quadrants. You know the pathology. You know the symptoms it can cause. So for RUQ – liver, gall bladder, and kidney. And edema? Any changes in skin color? Does it hurt after having fatty meals? does it hurt when you take a deep breath? Does it hurt during a certain position? Does it hurt when you go pee? What color is your pee? How often are you peeing now? Do you feel thirsty? Type of pain? Intensity of pain? This stuff is honestly self-explanatory. You should have learned all of these stuff back in med school when seeing your patients. Sorry, but not sorry. BUT, if you NEED to think which questions and type of questions to ask – highly suggest the following book: Current Clinical Strategies History and Physical Examination Tenth Edition by Paul Chan & Peter Winkle
Any other questions? Ask me.
NOTE: I WILL NOT share anything that directly relates to the cases I have had. I apologize for that, but its part of USMLE rules and I am NOT gonna risk it. So if your question is something that has any relation to the structure or contents of my CS exams, I cannot answer. Sorry.
October 12, 2019
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