Rajat Dhand USMlE Step 2 CS Experience – Indian IMG


6th March, USMLE Step 2 CS Result: Pass
I intend to share my exam preparation and actual exam experience through this post. Everything shared in this post is personal opinion, and personal opinions vary with people. So please pick the info you find useful and disregard whatever seems out of place to you. Hope it helps alleviate some, if not all, anxiety regarding this exam. I do not intend to share any information regarding the specific cases I got on the exam, and I urge everyone to refrain from asking about the same. All other queries are welcome, and time permitting I shall reply to everyone in the best possible way.

Exam Date: 17th Jan, 19’ Centre: Chicago
My preparation for CS began sometime in December, and was irregular in initial phase and consistent during last two weeks. Approximate total preparation time was somewhere close to 4 weeks. Started off by going through the entire first aid cases on skype with a single study partner. Did not cover any examination or note writing that time. Only history and closure. Next was a two day preparation boost with a live partner (Thanks Akanksha Gulati). Highlights from this were formulation of a meticulous series of steps that need to be followed for each patient encounter. For example, we laid out steps in the format:
Knock on the doorConfirm patient nameIntroduce selfMake patient comfortableAsk for permission to take notes…………
I highly recommend memorizing such a format because it ensured that no steps, however trivial, were omitted in any case. Points are awarded for each step. And the better you memorize a fixed format, the less chances of ruining a case in the event of a mind block due to anxiety.
Also, I recommend using the blue sheet for mnemonics, but in a smart way. Time is of essence in this exam and there is not enough time to ask everything. A clean, relevant history with a focused exam, and an effective, non-hasty closure is the desirable process. Just an example, I would omit asking about N&V, headache, appetite changes, diarrhea etc. in a case of heel pain. I believe that is common sense, although in a rare case a patient might have any of those symptoms too, but the exam is about common cases and not rare ones.
Over the next few days, I started practicing cases from first aid with my cousin(Thanks Abhay Dhand), who is a razor sharp pre-med somewhere in Canada; hence, communication skills improved drastically (I took my exam without any prior US clinical experience). We practiced close to twenty cases randomly, exactly like the real exam: timed, history, exam, closure and ending with a note. Highly recommend doing the same to get a feel for the real thing.
Flew to Chicago two days before the exam and booked an Airbnb conveniently close to the center as well as the airport. Exam day itself went quite smooth, except for some initial anxiety which is inevitable and anticipated. The scope of the exam in my opinion was very well within the boundaries of first aid, if read well enough. Few other tips for the exam would be:

1. A few seconds to get some deep breaths and calm down are always worth it.
2. There’s a break after every three cases, so I recommend carrying some snacks to eat during those.
3. Prefer to stand during encounters as sitting puts you at a lower level versus the patients, and they can look down on your notes/mnemonics. Not that it makes a difference, I felt it to be sub-optimal for adequate eye contact.
4. I do recommend giving adequate time on closure as that is the part where you make the SP feel heard, which ultimately determines your passing/failing the test.
5. Never ever interrupt an SP. Only exception being when they are purposefully stalling you. For example, you ask if they had any history of trauma, and the answer comes out something like “ummmmmmmm let me think doctor……….i am not sure……i guess yessss……i toppled over my dog and fell down two and half flights of stairs…if that counts as trauma”. That’s stalling. You must interrupt politely.
6. Be conscious of time. Spend a few seconds at the door. Gather the info you need. Write the mnemonics if you prefer (I did). Try to write down at least two differentials, but in case you can’t think of any, don’t freeze. Just walk in and follow the drill: the mnemonics will give you adequate info to be able to make sense of any case. If you do have differentials before walking in, good for you. Maintain a decent pace on the history. SP should not ‘feel’ you’re rushing them, but in reality you should be exactly doing that. At the ten minute buzzer, if you’re not already some where into the examination, stop taking the history immediately and start examining. You are at risk of not finishing the case. Ask the remaining questions while you examine. Never miss out the closure.
7. I missed a whole bunch of questions to ask, some or the other examination to do, some point that I forgot to mention in the note. You can’t do everything in fifteen minutes. So don’t even try. Instead try to get a relevant history, do some relevant exam and give a good closure and answer most of patients’ concerns with empathy. That should fetch enough passing points.
8. Try to focus on the next case, however badly you might want to think about your mistakes in the previous case. Again, don’t forget to breathe.
9. Avoid breaking the rules of the examination center. When the time runs out, stop typing. When the fifteen minute buzzer goes off, walk out respectfully after thanking the SP.
I hope this post was helpful in someway to those who are yet to take their exams. Just remember, the exam is meant to make you a doctor, not stop you from becoming one. Approach it with a positive mindset and you’ll be fine. And at the end of the day, its just an exam, like any other. Win, lose or draw, life will go on.
All the best!

October 12, 2019
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