USMLE STEP2 CS (Clinical Skills) - Dr. Zara Alvi

Dr. Zara Alvi, currently working in the department of Internal Medicine at Allegheny General Hospital, Pittsburgh, Pennsylvania has the following message for all you future steppers!

Step 2 CS


Prep Time 30- 45 days (Max)

Exam time: 8 hrs

Format: 12 cases of 25 mins each. This includes 15 mins of pts encounter MAX. and 10 mins of note typing.


People generally tend to take after all the other steps. This was the first one that I took and did reasonably well. It doesn't really matter because the exam doesn't have a score just performance evaluation, so you essentially just need to clear it. Just make sure you plan it in such a way that you can get a chance to do rotations when you travel to the US to make best use of your time.


Resources:

- First Aid

- Notes from those who recently took the exam

- USMLE practice software


- First Aid
Give this at least one read to get an idea of what kind of cases can be presented in the exam and what questions need to be asked for history of certain complaints and what is the most imp physical exam related to it. This is especially imp if you're taking the exam before all of your other steps. It may seem like FA has a lot of extra questions and steps but as you go along you'll know what to skip. It's imp that you do not forget to ask for imp positives and negatives in your case.


- Notes
Get in touch with anyone you know who has recently taken the exam and get whatever help they can give you about the way you need to approach the cases. You'll see multiple mnemonics such as DOPCAA - LIQRAA etc which may seem a little weird at the beginning but will be very useful in helping you cover a lot of the imp stuff.


-USMLE practice software

This I believe is the most under stressed part of the CS exam prep. More than all the theoretical knowledge what you need is to be able to type it in within the given amount of time. Anything that you do not type in will not be graded. So make sure you put in all the questions that you asked your patient into the software. Use a CS practice timer - you will find one on YouTube and plan to finish your practice cases with at least a few mins remaining. Please remember, DO NOT type in any finding that you did not ask the patient. Your interactions with the patient are recorded and as soon as you leave the patient also grades you based on what questions you asked and how.


Tips 


- Practice! This is most imp. Use a friend and practice complete scenarios including patient history, exam and note typing. People do practice on skype but patient examination is best when you physically practice on a person. The more you do it the better. Get in touch with people who are taking the exam on forums online and exchange tips on prep.

- Be POLITE! as polite as you can. Always start by saying you're sorry that your patient has an issue and then go along trying to be as empathetic as possible. If your patient is crying offer them a tissue paper and ask them if they would be ok to talk about it. Similarly for any other sensitive matter be careful and considerate.

- Try to sleep well before your exam. It's a long exam so you will need your focus. You will be given short breaks after 3 or 4 cases ( Don't exactly remember) but use those breaks for the rest room and take whatever snacks you feel you will need.

- DO NOT discuss any cases during the breaks. They are observing you at all times. Even if someone else tries to ask you about your cases or tell you about theirs please do not get involved.

- Remember these are actors not real patients so you are not likely to find any murmurs or wheezing so quickly go over those and do the relevant physical exams as needed.


The exam grades 3 components which are your Medical knowledge, Spoken English proficiency and you Interpersonal communication skill. You HAVE to clear all of the components independently. The interpersonal skill is esp imp which means you have to listen politely, try not to cut the patient short while he's talking, counsel them properly. Counseling for relevant issues is extremely imp. Please remember to not skip it.



And please remember that this exam has one of the highest passing percentages so it's very likely that with hard work and a dedicated month you can easily ace the exam. Good Luck!