Navangi Patel USMLE Step 2CS Experience

Passed Step 2 CS!
Test date and center: April 5 in Philadelphia
Accommodation: Holiday Inn – gave me student discount (Sheraton and bunch of surrounding hotels
including Airbnb were sold out, something was going on that weekend)
Testing center: very friendly staff
Dedicated prep time: 3.5 weeks
Sources: FA x2, Kaplan CS course guide (found it in the file section), Amboss
I enjoyed reading others’ experiences and found the tips to be very helpful. Here is my story and I hope it
help others!
I initially did not think this would be a crazy exam. However, as I started my prep I realized there were so
many components that needed to be taken care from typing efficiently to asking detailed history and
everything in between.
My eye-opening moment should have been in mid February when I had to take the Becker mock exam
(required by my school). I was not prepared at all for this as I was doing my rotations and was not really
thinking about the CS. I had only briefly gone through the assigned Becker cases. For the most part I could
communicate well with the patients and most of the feedbacks were positive. One critical feedback from
the patient was that I used some questions that made the patient feel very judged. I assured the patient
that I had no such intentions and she was very nice and told me that this is the time you learn. She
provided me with some tips about how to rephrase such questions. I realized I was struggling with the
notes, but I didn’t receive the feedback about it until I was in my dedicated prep time.
During my dedicated period, I started to read FA. I thought it has so much information, with all the cases
and all the possible differentials. After reading the first 20 cases, I tried to type the notes, but it was
nowhere close to what it looked like in FA. I would run out of time or my mind would freeze when I had to
write the differentials or I would forget to order the tests. But I continued to read the cases. After my first
read I did not feel confident at all. Then I found the Kaplan CS course guide book, it was a good
supplemental book. It had similar cases as FA and at it explained a little better about how to write the
notes. After reading that, I re-read the FA and felt more comfortable with cases and the diagnosis.
Starting from my second week, I practiced everyday with a study partner. I initially played around with
different mnemonics and decided that I will stick to ‘SIQOPRAAA’ for HPI and ‘PAM HUGS FOSS-wharted’
for PMH. These 2 mnemonics stayed with me till the end of the exam. My study partner realized that I had
no systemic approach for doing the physical exam. For instance, if I had two MSK cases back to back, I
would approach both differently. Then we started doing system based physical exam. I would then write
down the steps the way it would make sense in my head. In 3 days, I had all the exams for the major
systems (HEENT, abdomen, cardiovascular, lungs, neuro, MSK, and general exam) taken care of. Then
every day I would read out loud the physical exam write up. It is important to remember that there is
something called the “general physical exam.” You can find this in Sheerazi’s note (I stumbled upon this
resource way too late in my prep, so I only looked at the physical exam section and it was very similar to
what I had created). I used the general physical exam in one of two ways, when I didn’t know which exam
to perform or had extra time after finishing the focused physical exam.
I had to work the most for the note writing section. I couldn’t manage to type everything in so little time. I
am an average typer, but when I have to think I pause a lot and that would consume the time. That’s when
I came across Amboss. The cases are very good and similar to FA, but they have a timed note writing
template and once you submit yours you can compare it with their version. For me this worked like a
charm. I would read different cases and practice my note writing skills. Five days before the test, I made a
generic template for what to write for the PE section. I practiced typing it every day, so during the real
exam I didn’t need to think much about how to start writing the PE section. I had become a robot by that
time.
The exam day
My goal through my practice was to minimize as many variables as I could as I knew I would be anxious
and unexpected things are bound to happen. That’s why I kept my two strong mnemonics, wrote up a
generic PE template, and practiced my made up algorithm for the PE.
I really did not have any problems at the testing center. The staff greeted students very nicely and had
decent food. The location was close to Megabus terminal. There is a nice café across the testing center!
During the exam, it was very difficult to orient myself in the patient rooms. Every room looked different
and I had to look around where the equipment was. Also, the location of light switches varied from room
to room.
Things I think I did well
– regardless of the case I kept my blue sheet prepared with “SIQOPRAA” and “PAM HUGS FOSS.” I wrote
pt’s full name on the sheet and pertinent vitals. There was this one time when I mispronounced the
patient’s name, and I got a strange look back so I quickly glanced at my sheet. I corrected the name and
apologized several times and continued with the case.
– I would say out loud everything I was going to do. For eg: I would say “I will sanitize my hands before
proceeding with the physical exam”
– I did not feel rushed for the time (maybe because I approached every abdominal exam or chest and lung
exam the same way for every pt).
– I made sure I did a proper closure for every case and answered any questions the patient had
– I addressed the patient with their name at least 3-4x throughout the encounter (one of the SPs in the
becker mock test told me that psychologically people love hearing their names and patients are no
different)
– tried to make pt’s feel as comfortable as possible during the physical exam. Also, I explained most of the
things that I was doing as I was doing it.
– regardless of how difficult I thought the case was, I always smiled. There were times when I felt like I
don’t have any differentials, but I thoroughly inquired and tried not to look confuse. I think in times like
these the “general physical exam” was such a life-saving tool.
Things I could improve on
– I forgot to sanitize my hands in two of the cases. This is because I didn’t say it out loud and probably
because of the anxiety.
– I would have no time to check my notes. While typing I would forget common spellings and certainly
missed the spell check
– sometimes it was hard to decode my own writing from the blue sheet
– forgot to check for reflexes in few of the cases
– for many cases I didn’t know where the trash bin was, so I left the cotton swabs on the computer desk. I
am not sure if there is a protocol for it.
– had a hard time deciding if I should stand or sit during the interview. In one of the interviews I kept
switching between both. I have no idea what I was thinking at that time.
Overall
The exam day flew by. For some strange reason, it did not feel overwhelming, the breaks definitely helped.
I had frequent awakenings the night before, so not sure how much I slept (probably 5 hours). By the time I
slept, the alarms started to go off. I did set up an alarm through the hotel phone and I don’t think anyone
can sleep through that. I was very loud. I reviewed my notes in the morning, but really there was no need
for it. I felt like I was the only one who was super nervous and everyone else looked very calm. I continued
to have nightmares about the test and even before the score release day I had nightmares. Patients were
definitely very friendly, but they would not give any additional information if I said “is there anything else
you would like to add.” I had to ask specific questions to get the information from them. The test is very
doable, know your strength and weaknesses early on so there is enough time to work on it. I would say
prepare strategically and be consistent with your approach for each case.
Hope this helps. Thank you for reading this long document. Feel free to ask questions. Good luck!!!
Navangi

 

October 13, 2019
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