Step 2 CS hints...part 1

There are lots of anxious candidates when it comes to step 2 clinical skills exam, but in reality it is the easiest of the series it only takes some preparation both in practice as well as knowing what the exam is about,  if you’re planning on taking the exam soon, these tips will help you on your preparation,

Practice a lot:  and we mean a lot, find a partner to practice, its better if its another candidate because both can review  mistakes and improve on your techniques but it could be anyone the important part is to have someone real to practice your physical, your most important aim should be to memorize the contents of each physical exam including neurological, and being able to do the exam without thinking what comes next, you have to practice until it feels easy to make a full body physical and also until you can make it in less than 5 mins. 

The only way to feel you are doing something automatically is to practice a lot; this should be one of your main focus during your preparation.

It’s about the technique not results:  this is important, many of the actors don’t have real findings in many parts of the exam, some can simulate findings like cardiac murmurs, but the reality is that most simulated patients will not have real pathologies, that means that the most important part of the process will be your physical and the correct application of each technique, for example fundoscopy.

Remember that this exam is videotaped for further analysis of your performance and this includes the correct application of each examination technique.

There is no diagnosis:  This is one of those things you should have in mind during all your patient encounters, all the simulated patients have syndromic diagnosis, that means symptoms that are common for many different pathologies and not a specific diagnosis, this is important since every encounter could be many different pathologies and your job is to explore this syndromes looking for the most common diagnosis, this means you should keep your interrogation and physical open to any possibility related to that syndrome, as an example an acute abdominal pain can be many different pathologies like acute appendicitis, pancreatitis, endometriosis, familiar intestinal polyposis etc. it all depends on the gender and age of your patient in relation to the symptoms presented.

If you keep in mind that all patient encounters have syndromes and not specific diagnosis, both interrogation and physical comes down to your imagination and your ability to explore different possibilities. You should prepare for the most common syndromic differentials to make your exploration easier.

Doorway information:  all rooms will have a general view of each patient that includes patients name, age, vital signs and chief complaint. It’s important to asses quickly if there are irregular vitals, remember the patients name and use it, and the most important thing is that the chief complain will give you a hint about the symptoms the patient could have, this is also important to elaborate toward differentials related to that syndrome. 

Once you have a syndrome in mind questions and physical will be directed toward each different diagnosis, this will make every case easier.

Ask a lot:  This sounds easy but it can be a little difficult, since many syndromes could make you focus on a specific diagnosis it becomes hard to think in other types of symptoms to ask, this is why it’s important not to think that each patient has a specific diagnosis, if you have 3 or more differentials in mind you can ask more questions related to  different diagnosis, interviewing skills depend on how much you explore a patient and a big part of this is how many different questions you can make.

A great advice would be to focus on each differential one at a time to be able to explore every possibility.

Hopefully these ideas will help you while preparing for your exam,  we will continue next week with part 2 of our step 2 CS hints, if you have other experiences and ideas, please share them with us in the comments,

Our USMLE STEP 2 CS TUTORING GUIDE, will help you prepare for your examination, it includes tips and information to help you in your preparation. For more information visit us at www.usmleprepguide.com