Post by Admin on May 2, 2014 3:10:19 GMT -5
The step 2 CS (Clinical Skills) exam is the 2nd part of Step 2 which tests the clinical and language skills of candidates as well as their interpersonal and communication skills with Patients.
It is the only exam that people with many years of clinical experience and double 99's on step 1 and Step 2 CK can still FAIL if they don't prepare the right way.
It is designed to test the clinical judgment and systematic history and physical exam capabilities of the candidate and not his/her ability to find out what the patient really has. This means that they test how well you think and not how well you find clinical signs on the patient. This is because 95% of the patients you see are NORMAL people that pretend that they have a certain medical or surgical condition. They are called Standardized Patients (SP) which means that they are trained personnel that understand the medical disorder they are pretending to have and act out the symptoms and signs of that condition.
As IMG's , international medical graduates (specifically Egyptians IMG) , we have no previous encounter with such a test, where a patient acts out a condition. To be more specific these SPs act out not only a medical disorder but the whole differential diagnosis of a medical disorder. Which means that a patient with Right Upper quadrant pain will give you the history and physical not only of cholecystitis , but of hepatitis and retro hepatic appendicitis, so that you cannot pinpoint exactly what that patient is faking to have.
The SPs are trained to grade you on your history taking skills, physical examination techniques , spoken English as well as your communication skills . They do this right after the encounter is over on a computer inside the examination room which has a checklist of the things that you should ask or do, as well as the things you should not ask or do. They also grade how well you communicated in English, not how good you speak English. So what's important is to be understood by the SP, and try to understand what the SP is saying, your accent and grammar doesn't really matter that much, even though it gives a better impression. The final and most important thing they grade is your interpersonal skills, which is how you make the patient feel like a human being that needs to know what he has and what you think you'll do with him, and that you care about him and want to help him do the right things and avoid the bad things he's doing.
Finally after the clinical encounter is over the candidate would leave the examination room and sit outside to write a Patient Note , which is a logical summary of the pertinent history and physical exam, followed by the Differential diagnosis that the candidate inferred from the patients history and physical, then finally the investigations and further clinical tests that need to be done for establishing a diagnosis. This makes it very clear that the SP being examined should NOT have a single diagnosis, and if during the encounter a candidate notices that everything is pointing to one diagnosis, then he probably forgot to ask an important question in the history that will point to another possible diagnosis. The Patient note could be written down by using a computer or a pen and paper. There is no advantage of one over the other regarding grading , but if your handwriting is terrible, then type on a computer and do all your practice cases on a computer. But if you type to slow then just write using a pen and paper, and practice doing that.
Test structure:
There are 11 or 12 cases in Step 2 CS exam and only 10 will be marked and the other 2 will be trial cases for introducing new cases to exam later on. The candidate sees 5 cases one after the other , writing the patient notes in between cases , then takes a break. This is followed by 4 cases then another brake , followed by the last 3 cases.
You are allowed only to have a white coat, a stethoscope and what you will eat during the breaks into the exam area. Lunch and a light snack are served in the breaks and you can also bring in your own food.
The day starts at 8am for morning session and 3pm for the afternoon session so it is better to be at the exam center at 7:30 and 2:30 respectively.
The day start by an introduction about the exam and demonstration of the tools available in the exam rooms during the encounter, please feel free to use all the equipments during the demonstration so you can feel comfortable while using them during the encounters.
At 9am and 3pm the sessions begins with every candidate standing in front of an examination room with the patients notes written on the door, you are not allowed to see the patient notes until you hear the announcement that you can start the encounter then you knock and enter the room.
The encounter last for 15 minutes during which you have to take a focused history and do a focused physical exam, then after leaving the room you will be given 10 minutes to write the patient notes (history , physical , 5 differentials and 5 workup points)
The score that you receive for the CS will be either “PASS” or “FAIL”. To pass you must pass all the 3 parts , 1) Integrated clinical encounter (ICE) which includes History taking , physical examination and patient notes, 2)Communication/interpersonal skills (CIS)and 3)Spoken English proficiency (SEP).
Preparation for the Exam:
Just like Step 1 and Step 2 CK, the CS requires extensive preparation and cannot be taken lightly. The only difference is that the type of preparation needed is different. The single most important factor in passing the exam is the number of cases you practice and the person you practice with. We generally are not used to these type of Clinical skills assessment exams and so we have to have someone to help us who is more experienced, or at least has sat for the exam or practiced with someone that did. If that person is not available then joining a study group is the better alternative. Studying alone is very difficult for this exam and has in many cases resulted in failing . You need to practice with someone , even if that person is not a doctor, studying alone with no practice is a bad idea and a recipe for failure..
Extensive practice will make the flow of History taking and physical examination natural to you and will not require much thought giving you time to generate a mental checklist and differential diagnosis according to the patients complaints during the encounter. Practicing also the list of mental checklist and differential diagnosis is very important when starting to study for this exam.
The books mostly used include USMLE world and the First Aid for the Step 2 CS. They have guidelines for history taking and physical examination, differential diagnosis, and many practice cases. There are many other books out there, but these are the ones i used
The part that most IMGs fail in is the communication skills part. This includes being empathetic with the patient, talking with the patient about your findings during the exam, discussing the differential diagnosis and management plan with the patient, counseling the patient about faulty and hazards practices he’s currently doing and how to avoid them, providing assurance and support for the patient and answering all his questions. It also includes being friendly and doing things you would naturally do for people outside the exam . That’s the part that needs a lot of practice and needs preparation during the encounter. It’s also the part that if mastered well will make passing this exam a very accomplishable thing , as most of us can pass the Clinical and English portions easily . The USMLE.org website has an information booklet about the CS exam description. Also there is an orientation video in the orientation section
of the USMLE.org website which is important to watch early in your preparation.
Finally I need to stress about the importance of study groups where you not only practice being the doctor , but you practice being the patient (SP) and that helps a lot in consolidating the important things in the test that most candidates forget if they only practice being the doctor and never try to play the patient role. In this website you can go to study groups and register to find out where in your surrounding area are there study groups being done, and if none are available sometimes online or telephone study partners could provide the necessary practice you need. Just don’t do this alone..
Mohamed Soliman (passed the CS in 2007)
It is the only exam that people with many years of clinical experience and double 99's on step 1 and Step 2 CK can still FAIL if they don't prepare the right way.
It is designed to test the clinical judgment and systematic history and physical exam capabilities of the candidate and not his/her ability to find out what the patient really has. This means that they test how well you think and not how well you find clinical signs on the patient. This is because 95% of the patients you see are NORMAL people that pretend that they have a certain medical or surgical condition. They are called Standardized Patients (SP) which means that they are trained personnel that understand the medical disorder they are pretending to have and act out the symptoms and signs of that condition.
As IMG's , international medical graduates (specifically Egyptians IMG) , we have no previous encounter with such a test, where a patient acts out a condition. To be more specific these SPs act out not only a medical disorder but the whole differential diagnosis of a medical disorder. Which means that a patient with Right Upper quadrant pain will give you the history and physical not only of cholecystitis , but of hepatitis and retro hepatic appendicitis, so that you cannot pinpoint exactly what that patient is faking to have.
The SPs are trained to grade you on your history taking skills, physical examination techniques , spoken English as well as your communication skills . They do this right after the encounter is over on a computer inside the examination room which has a checklist of the things that you should ask or do, as well as the things you should not ask or do. They also grade how well you communicated in English, not how good you speak English. So what's important is to be understood by the SP, and try to understand what the SP is saying, your accent and grammar doesn't really matter that much, even though it gives a better impression. The final and most important thing they grade is your interpersonal skills, which is how you make the patient feel like a human being that needs to know what he has and what you think you'll do with him, and that you care about him and want to help him do the right things and avoid the bad things he's doing.
Finally after the clinical encounter is over the candidate would leave the examination room and sit outside to write a Patient Note , which is a logical summary of the pertinent history and physical exam, followed by the Differential diagnosis that the candidate inferred from the patients history and physical, then finally the investigations and further clinical tests that need to be done for establishing a diagnosis. This makes it very clear that the SP being examined should NOT have a single diagnosis, and if during the encounter a candidate notices that everything is pointing to one diagnosis, then he probably forgot to ask an important question in the history that will point to another possible diagnosis. The Patient note could be written down by using a computer or a pen and paper. There is no advantage of one over the other regarding grading , but if your handwriting is terrible, then type on a computer and do all your practice cases on a computer. But if you type to slow then just write using a pen and paper, and practice doing that.
Test structure:
There are 11 or 12 cases in Step 2 CS exam and only 10 will be marked and the other 2 will be trial cases for introducing new cases to exam later on. The candidate sees 5 cases one after the other , writing the patient notes in between cases , then takes a break. This is followed by 4 cases then another brake , followed by the last 3 cases.
You are allowed only to have a white coat, a stethoscope and what you will eat during the breaks into the exam area. Lunch and a light snack are served in the breaks and you can also bring in your own food.
The day starts at 8am for morning session and 3pm for the afternoon session so it is better to be at the exam center at 7:30 and 2:30 respectively.
The day start by an introduction about the exam and demonstration of the tools available in the exam rooms during the encounter, please feel free to use all the equipments during the demonstration so you can feel comfortable while using them during the encounters.
At 9am and 3pm the sessions begins with every candidate standing in front of an examination room with the patients notes written on the door, you are not allowed to see the patient notes until you hear the announcement that you can start the encounter then you knock and enter the room.
The encounter last for 15 minutes during which you have to take a focused history and do a focused physical exam, then after leaving the room you will be given 10 minutes to write the patient notes (history , physical , 5 differentials and 5 workup points)
The score that you receive for the CS will be either “PASS” or “FAIL”. To pass you must pass all the 3 parts , 1) Integrated clinical encounter (ICE) which includes History taking , physical examination and patient notes, 2)Communication/interpersonal skills (CIS)and 3)Spoken English proficiency (SEP).
Preparation for the Exam:
Just like Step 1 and Step 2 CK, the CS requires extensive preparation and cannot be taken lightly. The only difference is that the type of preparation needed is different. The single most important factor in passing the exam is the number of cases you practice and the person you practice with. We generally are not used to these type of Clinical skills assessment exams and so we have to have someone to help us who is more experienced, or at least has sat for the exam or practiced with someone that did. If that person is not available then joining a study group is the better alternative. Studying alone is very difficult for this exam and has in many cases resulted in failing . You need to practice with someone , even if that person is not a doctor, studying alone with no practice is a bad idea and a recipe for failure..
Extensive practice will make the flow of History taking and physical examination natural to you and will not require much thought giving you time to generate a mental checklist and differential diagnosis according to the patients complaints during the encounter. Practicing also the list of mental checklist and differential diagnosis is very important when starting to study for this exam.
The books mostly used include USMLE world and the First Aid for the Step 2 CS. They have guidelines for history taking and physical examination, differential diagnosis, and many practice cases. There are many other books out there, but these are the ones i used
The part that most IMGs fail in is the communication skills part. This includes being empathetic with the patient, talking with the patient about your findings during the exam, discussing the differential diagnosis and management plan with the patient, counseling the patient about faulty and hazards practices he’s currently doing and how to avoid them, providing assurance and support for the patient and answering all his questions. It also includes being friendly and doing things you would naturally do for people outside the exam . That’s the part that needs a lot of practice and needs preparation during the encounter. It’s also the part that if mastered well will make passing this exam a very accomplishable thing , as most of us can pass the Clinical and English portions easily . The USMLE.org website has an information booklet about the CS exam description. Also there is an orientation video in the orientation section
of the USMLE.org website which is important to watch early in your preparation.
Finally I need to stress about the importance of study groups where you not only practice being the doctor , but you practice being the patient (SP) and that helps a lot in consolidating the important things in the test that most candidates forget if they only practice being the doctor and never try to play the patient role. In this website you can go to study groups and register to find out where in your surrounding area are there study groups being done, and if none are available sometimes online or telephone study partners could provide the necessary practice you need. Just don’t do this alone..
Mohamed Soliman (passed the CS in 2007)