A*G
发帖数: 256 | 1 http://www.prep4usmle.com/forum/thread/109282/
08/17/11 - 8:40 AM
#1
Hello everyone,
I'd like to share my experience of passing Step 2 CS in the first attempt (
got results today) after 17 days of revision. Internet forums have been very
useful to me during my preparations for all the USMLE exams.
My background
I am a board certified ophthalmologist in the U.K. I went to medical school
in the UK, and graduated 11 years ago. I am of Asian origin and grew up in
Asia. I have not done any general medicine or surgery for 10 years - only
ophthalmology. I am taking the USMLEs, because I plan to do a clinical
fellowship in the USA in a very specific area of ophthalmology
What USMLE steps had I taken before Step 2 CS?
None. Step 2 CS was the first exam I took, purely because I need to get my
USMLEs as soon as possible and the results of Step 2 CS take the longest to
be published. Whilst waiting for these results, I have since taken Step 1,
and will be taking Step 2 CK in a month. Thus, I had no recent clinically
relevant knowledge from Step 1 or Step 2 CK to help me in Step 2 CS (such as
remembering all the different diseases, taking a relevant history, etc).
How did I prepare?
I only had 17 days to prepare for the exam (had other major work
commitments beforehand. Thus I had to be do a super targeted revision. These
were the ONLY resources I used:
1. Kaplan - history taking / examination section only. The physical
examination section particularly is more thorough (and necessary in some
cases) than First Aid.
2. First Aid - just a fantastic book. Long cases and mini cases. Even the
handling difficult questions during counselling section was a useful read.
3. Youtube videos for concise physical exam, particularly by this author (
there are others too - just look in Youtube): http://www.youtube.com/user/mdofola#g/u
4. Medscape online for basic clinically relevant information for almost all
diseases (presentation, differential, diagnostic investigations) - this was
extremely helpful.
5. I did not go to any general medical clinics or wards to see any patients
. I just did not have enough time. I am currently doing some ophthalmology
research.
6. CSE video - I subscribed to this but regretted it later. I only looked
at 2-3 videos and abandoned the rest because they really were that bad. I
thought the cases on CSE video were NOT professionally done. In fact, I
thought they were poor. For example, in one of the videos of a simulated
examination where the doctor examined the patient's shoulder, I think only 1
side was examined. As you know, you've obviously always need to examine
both sides (unless the patient is in severe pain and refuses despite you
asking for permission once or twice). In addition, the doctor in the videos
was seemingly referring to some prompting notes on the opposite side of the
room outside the view of the camera - just appalling I think. Just
completely unrepresentative of the exam. My advice - please do NOT use CSE
video.
This was my preparation timeline:
1. Day 1-2: read the clinical examination section of Kaplan and First Aid.
Combined the two sets of information. Learnt that.
2. Day 3-17: After that, I practised all the systems examinations
thoroughly with my wife, daily for the first week, then alternate days or
less for the 2nd week (because I was getting a little tired at the end of
all that studying). The real difficulty I found with the physical exams, is
that I had forgotten everything from medical school, including where to
auscultate for various types of murmurs (yup, that basic), the order to do
an abdominal examination, etc etc etc. The only ones I perform which are
relevant my clinical practice over the past last 10 years are ophthalmic and
cranial nerve examinations! Surprisingly, Youtube videos have been
extremely helpful in reminding me about the different examination techniques
, particular the ones from the author shown above.
3. Days 3-7: Started reading through mini-cases in FA to learn all the
different differential diagnoses. To be honest, this was a mistake. I should
've started immediately with the long cases in the second half of the FA
book. I got too bogged down by the fear of not remembering enough
differential diagnoses relevant to each patient / presenting symptom.
4. Days 8-16: Simulated history taking using FA long cases. My sisters who
are doctors, helped me by being the patient. As they are in a different
country as I am at present, we did this all over Skype. I think it's better
to ask fellow doctors to be mock patients, as they can better understand the
relevance of the history/disease and thus simulate more accurately. So they
would read through the relevant long case, and I'd simulate the whole thing
via online video, including knocking on the door, introducing myself and
taking a history. I simulated a physical exam relevant to each case (via
Skype video!), in the sense that I simply used it as a tool to go through
the motions of the physical exam so it would force me to think through what
relevant examination I would do in the time constraints. The only time I
practiced generic general systemic examination on a real person is as
indicated in "Day 3-17" above (i.e. not in the context of these long cases
practices).
I then counselled the "patient", closed, and typed up the patient note.. At
the end of each long case, we would go through which questions I did not
ask in the history taking based on the checklist in FA. Please note that I
feel it is IMPOSSIBLE to ask ALL the questions on the checklist in the FA
long case. There is just not enough time. Never did I ask all questions -
there were always a few that I missed out on. Felt bad at the time of
practice, but I just moved on to the next practice case.
5. Days: 15-17. FA mini-cases. Read through all of this again. Very
important.
6. Day 18. Exam day.
Exam day experience
I made a lot of mistakes on the day:
1. Forgot to pull out leg rest during supine exam - first case
2. Forgot sex history 1 case (16 yo with depression)
3. Time ran out when only just started closing statement …I’d like to
share with you what I think… 1 case. I didn't explain diagnosis, etc.
4. Forgot to document ophthalmoscopy exam 1 case in PN (even though I
performed the examination).
5. Forgot to ask PPD in COPD exacerbation case
6. Forgot to ask Pap smear in amenorrhea case
7. Forgot to ask menarche age in amenorrhea case (did ask about when
periods became regular)
Some final tips:
1. Ask patient anything else they’d like to mention before moving on to
physical exam - x2 cases brought up useful things in history I forgot to ask.
2. Ask patient for generic name of drug - they usually know and will help -
I asked x2 patients. I'm not familiar with the brand name of drugs in the
USA.
3. Use this blog for some useful tips: http://csprotocol.blogspot.com/2006/...-for-your.html
4. Atlanta great place to take exams if if you don’t live in one of the
CS2 site cities - hotel 5 minutes from airport by complimentary shuttle to
Country Inn & Suites By Carlson - Atlanta Airport South - EXAM CENTRE only 5
-7 minutes WALK away
5. Revision:
a. Use Kaplan for examination detail
b. Use First Aid, and in retrospect, this is what I should've done:
i. Firstly, read through practice cases - explanation needed for diseases
there, so I could've spent a lot LESS time trying to look up what Plummer
Vinson disease is, etc etc. The relevant explanation for each diagnosis and
test is all listed at the end of each long case.
ii. Secondly, read through mini cases
iii. Finally, go through (i) and (ii) again
Summary and Conclusion:
It is actually possible to pass Step 2 CS in just over 2 weeks. Remember, I
had been out of general clinical medicine for 10 years, and did not have
the benefit of clinically relevant knowledge from a recent Step 2 CK exam (
taking this in a month's time!). During my revision, I never saw or
practiced on any real patients on the wards or clinics, just because I
thought I could use my very limited time (17 days) more efficiently by
practising with family/friends. It was actually very odd when I examined the
first patient on the actual Step 2 CS exam day, because that was the first
time in 10 years that I did a systemic / physical examination on someone who
's not my wife (whom I had been practising on)!
Just be very focused with your revision, and you'll pass. Just don't
neglect any of the 3 main sections of Step 2 CS (e.g. don't leave your
introduction or counselling as an after thought - leave nothing to chance).
Good luck to all of you. Hopefully my entry can help you as much as others
on forums have helped me. | A*G
发帖数: 256 | 2 This guy hated the csevideo, but it is important for img to familiar with US
real clinical practice.
http://csevideo.com/index.php?option=com_content&view=article&i | A*G
发帖数: 256 | | u*****o
发帖数: 125 | 4 对大部分CMG来说，这个经验是很不现实的。即使有的AMG,还准备1个多月。我觉得如果你真的照他说的去准备，fail的可能会非常大。很多prep4usmle的帖子，只能是一笑了之，不能当真。 | A*G
发帖数: 256 | 5 You are right, everybody should create his/her own protocol.If you get some
useful information from the previous experience, that's all.
Nobody can exactly follow others' experience. This guy is from UK (no
language problem), he focused on CS for full time 17 days.
BTW, the other things we should consider are csevideo, NJ 2 day CS class and
so on.
果你真的照他说的去准备，fail的可能会非常大。很多prep4usmle的帖子，只能是一笑
了之，不能当真。
【在 u*****o 的大作中提到】
: 对大部分CMG来说，这个经验是很不现实的。即使有的AMG,还准备1个多月。我觉得如果你真的照他说的去准备，fail的可能会非常大。很多prep4usmle的帖子，只能是一笑了之，不能当真。
| A*G
发帖数: 256 | | a***r
发帖数: 2677 | 7 从他能记住那么多MISTAKES IN EXAM,就是高手，老中准备17天连门都摸不清. 老老实
实的练习比较好，别总惦记着放卫星。 | A*G
发帖数: 256 | 8 Please focus on the useful information and links, that's all we need to know
before preparing CS. Forget about 17 days.
【在 a***r 的大作中提到】
: 从他能记住那么多MISTAKES IN EXAM,就是高手，老中准备17天连门都摸不清. 老老实
: 实的练习比较好，别总惦记着放卫星。
| A*G
发帖数: 256 | 9 To avoid misleading, I deleted the '17 days' on title.
【在 a***r 的大作中提到】
: 从他能记住那么多MISTAKES IN EXAM,就是高手，老中准备17天连门都摸不清. 老老实
: 实的练习比较好，别总惦记着放卫星。
| h**s
发帖数: 1757 | 10 thanks ,got the info!!!
what is csevideo,is it UW video? | A*G
发帖数: 256 | 11 Please go to the link:
http://csevideo.com/
It's useful to get you familiar with the exam but still I suggest you
practice after you see the videos (the practice is the most important part
for CS).
If necessary, you could also attend CS class, such as Kaplan 5 days or NJ 2
days CS class. |
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