Rewana Khedr – USMLE Step 2CS Experience

 

Ahamdulillah, I PASSED!
This is a long post but these types of posts helped me so I decided to write one out. So I studied for about three weeks on and off. The last tens days were really dedicated. I practiced with a non-medical partner (my husband); practiced mostly history using FA cases. I would peruse the group for advice. Sherazi’s first chapter and PEX portion is really good [I didn’t do the cases from there though]. I practiced PEX in the last couple of days from FA, sherazi, and Youtube.

My experience: I took the exam in Philly. Alot of the SPs were really nice; cases were straight forward mostly. Some SPs offer up information randomly if you forget to ask about it. I was really worried after the exam because I messed up alot as you can see below.

Lets start with things I did wrong
*SEP: I interrupted patients a couple of times; but I always apologized and told them to continue. Sometimes I got flustered and felt that I was tripping over my words. Found myself saying a couple of times, “no headache, no bla bla?” and then would correct myself. You’re not supposed to start a question like that.

*CIS:
-Failed to fully close twice. I literally told the patient I had to go, shook hands, and left while she was talking
-In one case, it was really long so I decided to skip one of the pertinent PEX [a neuro exam]. So I closed and then realized I had time, so I asked if i could start the neuro exam and then time was up ?
– Wasn’t sure if I was eliciting or responding to the challenge questions properly. They seemed too vague
-Sometimes I remembered a question while asking another part of the history so I’d apologize and go back.
-Forgot to take out the leg rest in one case and the poor lady’s legs were dangling. I also forgot to help her up. Eventually I realized my mistake, apologized, and tried to get her up.
-Gave a wrong differential during closing and then when I sat down to write the PN, I realized what it could be.

*ICE: I was really worried about this because I had alot of mistakes
-I almost always ran out of time in the encounters
-PEX was my weakest point . I missed one pertinent exam in one of the cases.
-In one case: I wrote a differential in non-medical terms even though it was really easy. I just blanked because I had a hard time with that case.
-Missed some maneuvers in a pertinent PEX such as palpating something
-Palpated a joint over clothing ? But the SP was really nice
-Had no idea what two/three cases were.
-In one case I ordered workup that was for a specific body part; but in the HPI I described the location of the body part in another area.
-I was worried about missing things in my notes
-Almost never had time to review my PN

Things I did right:
*SEP: I’m a native English speaker

*CIS:
-With everyone: knocked on door, shook hands, asked them how they’d like to be addressed, told them the plan ” will ask questions, do physical, set up management plan”, asked permission to sit down and take notes
-Started with open ended questions, ” what brought you in, tell me more about it.”
-Was very friendly; chatted with the patients while washing hands. I felt like most of the SPs liked me and when I’d miss a symptom, they would actually tell me, ” Also Doctor, I’m feeling this symptom as well, it started….”
-Maintained eye contact
– Summarized history with most patients
-Kept asking if they had any questions
– Used transition statements for everything
-Washed hands before every physical exam. My hands are also usually cold so I apologized for the cold hands.
– Explained everything using medical terms and then explaining it in layman language
-Counseled and CAGED everyone in social history.
-Tried to give at least one differential to the patient with the workups; explained what it was and what we can do about it.

*ICE:
-Took full history, like almost too thorough.
-I nailed the diagnosis in most of the cases except maybe two
-I wrote 2 diagnoses for most of my cases; 3 for less then half of them. I only wrote things I was very sure of.
-I practiced note writing to look like how it’s written in first aid. I completed all my notes and my notes were thorough
– My PN were very thorough; I sometimes missed things but overall they were complete
-Asked everyone about any scars I saw or tattoos.
-I’m a fast typer: 60+ wpm

My results: star in SEP, 5 borderline stars in ICE, and CIS in the middle but no stars in borderline

What I would do differently:
-Take a more focused HPI. I would write a differential or two at the door and try to rule them out/in. I was given this advice but didn’t do it.
-I never practiced a full encounter with someone; I just did history or physical separately. I would practice the full encounter with someone because alot of times I was rushed on time.
– I don’t think I did proper closures, I was always sort of rushed. I barely told the patient what they had, threw some tests at them and asked if they had questions
-Practice PEX better.
-Practice note taking better; I had a hard time taking notes while the patient was talking; I also had a hard time remembering the HPI while writing the PN

And lastly my advice:
-Don’t take the exam lightly but there is a large margin of error I believe as long as you do the main things right and as long as you don’t keep repeating the same mistakes over and over in every encounter.
-Try to take this closely after your CK exam if possible, it’ll decrease the added stress of trying to figure out what the ddx is.
-Your first case will most likely be a mess because of anxiety. It’s okay; forget about it and move on. If you encounter a case that is difficult or didn’t go well; don’t think about it; recollect yourself and forget about it.
-Try to do the cases in a shorter amount of time. While practicing, I never ran out of time, but in the exam because of nerves and because you’re dealing with an SP that has complaints and you have to reassure; you will most likely lose time
-Ask constitutional sx for everyone: sleep, weight loss/gain, fatigue, appetite loss, night sweats.
-Go in confident, you did what you could; rely on your knowledge.

October 12, 2019
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