Hi friends,
As a current resident, and as somebody who has taken CS myself, I think I can offer valueble advice on taking CS exam. While time is a limiting factor, I would try to answer some of the CS questions on this forum. So, utilize this free offer to get answers to your difficult CS related questions.
TIPS from a Current Resident
As you might have already realized, the focus of the CS exam is not diagnosis but the skills in eliciting problem focussed history and do a problem focussed physical with a list of differential diagnoses. So, keep this in mind that you should not worry too much about "is it this or is it that" kind of stuff that we otherwise do in clinical practice. Just focus on the system and ask all the relevent open ended questions for that system. When I took the exam, I was amazed how they mixed up features from a few diseases of that system so that the differential is not too narrow. So, if you are getting only one diagnoses in CS, think again and broaden your scope.
open ended questions
When I took the exam, I had a little secret, I used to ask them one question always, can you tell me more about your (pain or what ever symptom) and typically I used to get 3 or more pieces of information, not only saving me time but gaining an extra point for open ended questions.
So, always ask them - open ended questions to begin with. The SP's are very professional and know how to respond to each question. For example, a lady with abdominal pain - will tell you a few things when asked what brings her to the clinic and stops. Then you should ask an open ended question like can you tell me more about your pain. Typically, they will give 3-4 peices of information about the pain in one shot and you gain an extra point for the open ended question. Then use the closed ended questions to expand on the pain to get all you need.
Use Mnemonics
You can use mnemonics like LIQOR AAA for pain. Location, intensity, Quality, Onset, Radiation, Associated Sx, Aggravating and Alleviating factors. Actually you can the same LIQOR AAA for few other symptoms with a few changes.
The same way - you can use PAM HUGS FOSS for a brief Overview of what to cover.
Past med hx
Allergies
Meds
hospitalozations
Urinary Problems
GI problems
Sleep
Weight
Appetite
Family
OB/Gyne or Occupation
Sexual Hx
Social Hx
You can actually jot down on your sheet of paper in Vertical Direction like this so that - in a hurry - you do not miss to ask a question about each of these. This is what I did-
I wrote like this this veritically on the sheet so that I can ask one question and note down any important things if I need to write in the appropriate column. Do not write too much while in the room just a few things to aid in memory.
P
A
M
H
U
G
S
F
O
S
S
It is actually an easy exam - after the first case, you would come to a rythm and before you realize it will be lunch. Just time it properly.
One thing that most people have problems with is - lack of practice. They study a lot and get confused with so much information and end up failing the exam. This is what I did. I had two weeks between step 2 and CSA out of which one week was hit by the worst blizard in NC history in the cold winter which knocked all power lines in for a week. So, I had only one week but in that one week - I found a friend who is preparing for USMLE and practiced the common cases with him. He will act as a patient and I will act as an MD, will time it and will get feed back after the case. After a few cases, I got the confidence and improved my speed and effectiveness.
For Physical Exam -
I used to go to a local medical school library - )Allmost all medical school and university libraries are open to public) and watch PE exam videos in their media center - all for free. I paid a small fee($100 for 1year) to become a member of the library and borrowed several of their videos so can watch them at home. I could also borrow books on that and Barbara Bates Physical Exam was a good book. I also found a Barbara Bates Physical exam video in the library there(That was at DUKE).
So, in just one weeek, I was able to review atleast one case from each system and practice. On the day before exam, I practiced again with a friend at the hotel and it helped a lot. Practice makes all the difference.
PE TIPS
Wash your hands in front of the patient.
Never examine through the patient?s gown.
If you ask the patient to get off of the exhibit concern for the patient? safety/
If the patient exhibits signs of distress or pain, acknowledge this and do what you
can to make the patient more comfortable.
Remember to read the opening scenario very carefully and that you are told to complete.
You should be sensitive to the patient?s comfort including degree of exposure, temperature of the room, and any pain that the patient is experiencing.
Be organized while doing the Physical Exam. Do the exam in a logical sequence so the patient
does not have to change positions during the examination.
Explain the patient what you are doing.
If any maneuver might prove uncomfortable, alert the patient
in advance.
When patient is 1ying on exam table. pull out leg support.
Practice is the key to success
I get phone calls from people who are American citizens but thought this exam is for testing English skills on FMG's and then fail the exam. Each exam needs some preparation. 2-4 weeks is more than adequate for this one, but practicing is the key. Just find somebody and start practicing. Could even be your spouse or other family members or friends. If you do not have anybody, practice on the phone with others on the forum. There is separate thread on how to do that.
Which courses to take?
If you are wondering about which courses to use - Choose the one that allows you to simulate the exam to the closest with a wide variety of cases. Usmlesource difinitely is one of the top courses given the number of cases and the approach using mnemonics. Other somewhat expensive courses include usmleworld, kaplan, c3ny etc. Which ever one you choose, practice is the key!
Overall, CS is an easy exam, just that it involves real people, unlike the MCQ's may cause some anxiety initially, but common, that is what we deal with everyday!
The approach at UsmleSource, as can be seen from the sample cases, uses the above proven Mnemonic based approach to help improve the data collection in the limited time setting. In real life, you can go back and ask the patient but in CS, you have to get all the info the first time!
Good luck! Just be professional and show you can be more than what USMLE expects you to be! A good doctor!
