Thursday, June 6, 2013

THE NEW CS EXAM PATTERN EXPERIENCE!


As most of you applying for the 2014 match are aware, this is the season for giving USMLE Clinical Skill exams for those who have already not given it :P
Here is a latest step 2 CS experience by one of our guest authors!!! Hope this helps!!
Hi guys... I'm an IMG, 2012 grad. Took the CS in the second half of Feb at Philadelphia; got my result on April 24th, and passed, thank God! Just thought I would share my experience, as I've gotten a lot of help and advice from various people through similar posts in the past.

MY PREPARATION

I started my preparation exactly 13 days before my exam. This is my first USMLE exam (for those who ask if CS should be taken only after step1 and CK).
Materials used : only First Aid for CS, latest edition
(For people who are wondering, the latest edition only has 3 additional long cases and 3-4 additional pages of short cases more than the previous edition. If you have the old book, you can photocopy the extra cases, as one of my friends did - just a money saving suggestion)
I used some of the mnemonics from Neeraj notes and Khalid notes (These are pdf files compiled by previous test takers, that are in circulation; they can be googled and downloaded easily)
For the examination part, I watched examination videos on youtube, of the signs and tests of which I was doubtful. 
I did not take any prep course or online subscriptions. 

Study partners : The MOST IMPORTANT REQUIREMENT for CS prep is study partners, in my opinion. I had one regular study partner, with whom I studied about 3-4 hours a day, and others whom I practiced with whenever they and I were free.
I put up a post for a study partner, stating my exam date and place, and got 10-12 replies in about 4 days, of which I selected the people I felt comfortable with. It's really not at all hard to find study partners for CS (or maybe I was just very lucky).
Except for my live study partner, I studied with my SPs over Skype.
Method of Study : 
With my regular SP - We decided to study about 7-8 cases a day; then we would get together, and discuss the case through, practice it (with one being the doctor and the other the patient, and vice versa), and discuss the differentials and lab tests. This way, we finished the entire book in about 6 days (there are 43/44 cases in total).
With my other SPs - I would just practice the cases with them, in the same way (one being doctor and other the patient). This really helps.... The more number of times you practice, the less likely you are to forget the relevant questions for each type of case, and also it helps you to get used to it.
With my live SP - studied with her for 2 days preceding the exam, doing the entire case along with examination, while timing it. I felt that this was VERY beneficial, as I learnt how to be quick and efficient. Doing the actual examination is a lot different than reciting the steps while practicing over Skype. The timing comes out to be very different, and will be a crucial factor in the exam. Also, practicing with a live SP makes you comfortable with the entire thing.

Once I was done studying all the cases once (in about a week's time), I started to group the cases together and study them, like, GYN cases, pediatrics cases, abdominal pain, musculoskeletal, CNS, etc.
I found that this really helped me, because I was able to concentrate on what exactly needed to be asked for each type of cases. I made up my own mnemonics for each system, and then kept practicing them till I was sure I would remember everything I needed to ask. This is useful because you can save time by not asking irrelevant questions during the exam.
Patient notes - I used the sample patient notes given at the end of each case in FA as a reference, for headings and abbreviations. I only practiced the PN a few times, as I type fairly quickly and I wasn't too worried about it. 
There is a sample patient note form available on usmle.org , which you can download and use for practice.

LEADING UP TO THE EXAM

I took my exam in Philadelphia, and as it's about 4-5 hours drive from where I was, I decided to go to Philly the evening before and stay the night in a hotel, rather than be tired and worn out from travelling on the day of the exam. I am very lucky to have a wonderful sister, who very sweetly insisted on driving me to Philly (without whom I would have had to go by bus or train, as I don't drive).

I got to bed early the night before the exam, though I was tensed and kept waking up in the middle of the night.

About attire :  let me say this - no matter what anyone says, I feel appearance goes a long way -- If you're shabby, you will create a bad first impression. I'm not saying you need to look beautiful or mesmerizing. But looking professional, and being comfortable with the way you look goes a long way in creating a good subconscious impression. 

All in all, I felt I was reasonably prepared for the exam when I went in. 

THE EXAM

I must say that every one of the chief complaints were things which were in First Aid. But I felt that many of the cases were vague, meaning that the history given by the patients were not really pointing towards any specific or conclusive diagnoses. I felt this way for atleast half of the cases. 

I am very sure I forgot to ask something or check something in each and every one of my 12 cases, which I would realize when I was typing my PN. But I think it was not really that big a deal, as I asked a majority of the questions in each case. So, don't get stressed out when that happens - every one of my friends have said that the same happened to them.

I felt that the time for the encounter was sufficient - I usually had a minute or so to spare, which of course went towards my patient note time.
I did one very dumb thing though-- For the first three cases, I came out of the exam room a couple minutes early, and realized I forgot some small question or test during the patient encounter. I wondered if maybe I was rushing, and therefore forgetting. So I decided I would be more careful for the next case. 
And guess what happened? Somehow I totally missed the five-minutes-left warning, and was just finishing the physical exam when the time-up announcement came through! 
 Of course, I had no choice except to say that there was some sort of emergency and that I would get back ASAP for further discussion. I completely missed the counseling and closure part!
Luckily, there is a break immediately after the 5th case, which I used to regain my composure, or else I'm sure I would have messed up the following cases, too, I was so freaked out!
So, I would say, learn from my stupidity and don't worry if you forget a few small things. 


As for the patient note, I would always have been glad or 2-3 extra minutes. None of my patient notes were actually incomplete, but I did not have the time to check any of them. Not even a single one. And I'm sure they were filled with typos and spelling mistakes. 
So, I guess it would be a wise idea to practice the PN before hand, even if you do type quickly, because even if the typing doesn't slow you down, the pausing in-between to think, will.
I'm sure you all know that its a good idea to fill out the dd's and lab tests first, to make sure you don't miss them.

One thing I felt keenly while taking the exam - the standardized patients are VERY well trained. However much you practice with your SP, you will feel the difference. I had one who was moaning and lying on the exam table, with his face covered by his arm, who wouldn't get up for the whole patient encounter, and was getting annoyed at my questions. So just brace yourself for that and don't get agitated.
None of the patients were rude, though. A majority of them were somewhat bored and had ok-can-we-get-this-over-with type of looks, but no one was actually rude.

I don't specifically remember what cases I got, but there was only 1 Pediatrics case and no phone cases on the day I took the exam.

The exam center staff were EXTREMELY nice and did anything they could to make you feel comfortable. But don't try to keep typing after time is up, or something like that, coz they will note you down, and make you sign a form of some sort, for it. (It happened to one guy at my center).

AFTER THE EXAM

I was quite worried about the vagueness of my differentials, and sincerely thought that there was a chance of failing in the ICE component. 
I agonized in length over all the small things I had forgotten in each case, about differentials I should have mentioned and didn't, etc. etc. 
Especially as the ICE and CIS standards have been hiked since Jan 2013 (This is an official thing- check the usmle.org and ecfmg.org websites for confirmation)

I was sure I would pass CIS and SEP (I know that sounds arrogant, but I felt that I knew my strengths.)

I went on worrying about the result, at intervals, for the next 2 months. The most agonizing thing about CS, in my opinion, is the long waiting period for the result.


THE RESULT

Thank God! I passed! I was SO relieved 


But, I think I should mention, that I had borderline performance on ICE (which I fully expected), and also on CIS (which I didn't expect in a thousand years!)
I'm not complaining - I'm glad I never have to take that exam again.
 
But I've mentioned it to show that, none of the components should be taken lightly, no matter how good your communication skills are, or your clinical knowledge is. Imagine if I had failed in CIS, horror of horrors! 
 
So, prepare for each component separately and thoroughly.

Some other stuff worth mentioning

I know that there are a lot of IMGs who worry excessively about CS. And I don't blame them, especially the ones who don't come from a strong English-speaking background.
I said that I prepared for 13 days, and I must say that these 13 days are far more than enough - for preparing for the ICE part. ONLY the ICE part. I did minimal preparation for the CIS part, and none for SEP.
But, if you feel that your English, or your communication skills are not up to the mark, don't feel bad if you have to study for a longer period. It doesn't make you any less of a doctor than anyone else. We all have our weak areas, so don't lose heart.
Also, I was very lucky to find such great study partners, to have great seniors who were always ready to give advice and boost my morale, and especially lucky, as my wonderfully supportive family gave me no responsibilities except studying. Without any of these factors, I'm sure my path would've been much much more difficult. God bless them all!



So, I think I've rambled on and on for awhile now. Enough said. I hope you guys didn't fall asleep while reading it, or wonder "Does she ever shut up?!" 


Hope it helps someone. All the best, everyone! God bless!


ANONYMOUS!

8 comments:

  1. thank you for sharing your experience,GOLDEN WORDS!!!

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    Replies
    1. Awesome blog.. It really enlightened us.. Can u plz write about step 1 too ????

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  2. Awesome post.. Well written.. Can u plz write about step 1 too???

    ReplyDelete
    Replies
    1. There are several already :0 Check them out :)

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  3. Congrats on your pass. I just wanna ask, how long did the application process take before you were actually able to schedule a test-date?

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    Replies
    1. If you are done with your form 186 verification it usually takes a couple of weeks

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  4. Great blog. Do you think its okay to use use abbreviations beside those on ecfmg website? Like those given in FA or others?

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    Replies
    1. Its better not to as not all the abbreviations are universal

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