Step 2 CS hints… part 2.

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 take a look at our second part of step 2 cs hints,

Chief complaint.

This is by far the most important part of the doorway information, it will help you make an oriented interview and also to start the conversation, so when you enter each room you can introduce yourself and ask directly about the sp patient chief complaint, from there it’s pretty much downhill asking about different symptoms, finding possible signs and exhausting your questions for a syndromic diagnosis.

The chief complaint will give you the possible differentials; helps you ask oriented questions while you prepare a case in your mind, one thing you have to keep in mind is to keep all information in a coherent chronological order, that means that you should write down information so you don’t forget including their time of appearance, sometimes we find information about the case like appearance of symptoms, rash etc. in disorder, you can put them in order later while writing your patient note.

Ros

During your interviews with an sp (simulated patient), making a quick review of organs and systems may be a way to discover other symptoms not detailed or oriented during the chief complaint or your initial interview, it’s better to make the ROS after you have exhausted your questions about their chief complain, it’s not about detailing all  possible symptoms but to ask for example about headaches in a patient with abdominal pain, the idea is to discover other possible leads that may change your diagnosis.

Even when it doesn’t feel natural to ask about other organs and systems, it’s important to ask a lot and since it’s an evaluation of your questioning skills you should ask all you can about possible signs and symptoms, even if it feels uncomfortable to ask that much remember that is part of the evaluation, your skill to investigate in detail a patient story.

Ask for relevant familiar history.

Familiar history should be asked briefly a couple questions and you should be fine, for what is relevant depends on what you think your patient might have, there is always hereditary predisposition for cancer mainly breast, prostate and colon, heart disease, colon diseases, chronic conditions like diabetes and hypertension should also be asked, as for psychiatric conditions bipolar disorder and schizophrenia have familiar predisposition.

Don’t beat yourself up with knowing all familiar predispositions a couple relevant to your differentials will be good enough. For the patient note you may text 2 or 3 lines of relevant familiar findings, including negative findings.

Hand washing or gloves,

Many students question whether to use gloves or use the sink, for me I think it’s better to wash your hands, the reason being that when you turn yourself away from the patient you have a little time to think about questions that may help your note, details you may have missed or time to think about the physical you are going to make.

Using gloves you must maintain conversation and keep eye contact, hand washing gives you a little more time to think. Try yourself and choose the one that feels more comfortable after all that is more important to make your interviews easier.

Relax!!!

This is really important, you must be comfortable with the situation, feel at home, think of it as another day at the office, after all this is what you will be doing the rest of your productive life, so take it as another day, don’t pressure yourself thinking about anything but the patient behind each door, it’s not really useful to think about your last patient or what cases could be lurking ahead, just focus on one case at a time and relax.

 

Thanks to all for taking time to read our blog, it’s great for us to help in any way we can, for a detailed and complete guide for your clinical skills exam check our guide at www.usmleprepguide.com , if you have any comments leave them at the bottom.