Exam Center: Los Angeles Exam Date: 4.September.2007 Result: Passed Weeks for Result: 5 My Experience: I UNDERESTIMATED USMLE Step 2 CS. I am a physician from India. I completed my MD in Internal Medicine in 2005 and have been teaching in a medical school. I had passed the Step 1 and Step 2 CK with 4 and 3 weeks' of preparation each scoring 97 and 96 respectively. I had used Kaplan notes (2005) and USMLEWORLD. I applied for the residency interviews right on Sep 1 for 76 programs. So the days leading to my Step 2 CS were spent browsing all the residency programs because I had no dearth of emphasis from my friends about the importance of applying for the programs as early as possible. Also, a lot of my friends had told me Step 2 CS would be a "cake-walk" as I had already faced tougher exams in my life... I took USMLEWORLD course and read First Aid For CS for - believe it or not... 3 DAYS. And for practice, I did it with my brother as the SP over Skype! And it was when I was actually doing this, I started becoming aware that this exam is not as simple as it seems... But it was too late... I was doing all these on the exam eve. The proctors were friendly. I had forgotten my stethoscope! But it was no problem. They gave me a Littman's to use for the exam. The lunch was good, retrospectively. But given the enormity of the exam, one can hardly think about gastronomic delights... The cases I had were as follows: 35y M Headaches with flashes of light 25y F Amenorrhea and vaginal discharge 40y F Acute RUQ pain abdomen 65y M Rt Heel pain 6 weeks 14m F "picky about eating" (telephone interview) 25y M Diarrhea 10 days 55y M Chest discomfort 25y F Sore throat and abdominal pain 55y M Emphysema exacerbation 15m M (Black) Fever and sick 2 days (father interview) 55y M Hypertension refill 25y M Fatigue and fever 3 weeks These cases are NOT in the order that I got. I felt I handled the first five cases decently - did everything needed for the case. The next four were average - I felt I missed quite a few things. And the last three were pathetic. In the pediatric case, I didn't ask diet history, social history and had totally forgotten the immunisation schedule. In fact the father showed me all the shots the kid had taken in a piece of paper. I could see that one or more shots were missing. I just didn't know what else to do there but to pacify him that everything could be taken care of, and he didn't seem too happy. In the hypertension refill, (my first case) I forgot to ask him the dose of his medication! Can it get sillier than that? And for the fellow with fever and fatigue, there were no localising symptoms or signs. I completed the ICE just on time but had no clue as to what it was. So my D/Ds were very nonspecific like HIV etc. I missed counselling the suspected infectious mononucleosis lady for need for rest and abstinence from exercise. I did NOT counsel any of the smokers (surpisingly there were only 2 or 3 current smokers and alcoholics and NO drug abuser). I did NOT summarise the history for my patients. I FORGOT to counsel regarding need for PV or PR exam as indicated.... I DID drape them appropriately. When washing hands I asked a few things about personal life like "Where do you stay" "Who do you stay with" and so on... I took permission to do everything... as transition in between different histories, and during examination of various parts... I was somewhat confident about my ICE but for my patient notes... with years of habituation into putting things in abbreviations and skipping normal stuff, I found it somewhat difficult. Nevertheless my notes were more or less covering all important points, though not very pleasing to the eye.. I used flowing format. I was also confident about my SEP as none of my patients asked me to repeat anything I said. In only one instance when that happened I apologised for my accent which was foreign. Probably the most amusing case was the Emphysema one. He coughed when I was washing hands. So I immediately stopped and offered him a tissue. He thanked me and again started coughing. It just didn't strike me that I have to offer him water. I offered him ANOTHER tissue! And he refused politely saying he already had one. And that was not the end... I teach my UGs all respiratory cases with the patient sitting erect on a stool. So I asked the SP to step down and sit on the stool. The very look of exasperation on his face made me feel I have committed a blunder and I immediately apologised and justified saying that the lungs are best examined that way and that I was really sorry for having made him to go through all this discomfort... And I finally examined him sitting on the stool itself! When it came to CIS, well, I just could not evaluate myself as I just did not (and still DO NOT) know how much Americans expect out of a physician. For example, I never said words that empathised with the patient's problem (things like "I am sorry to hear that and this") but I felt the expression on my face was that of genuine concern. I do not know because at that point in time I did not know these were so important, so I was just my natural self... it probably paid off. And the CIS was what made me have nightmares and sleepless nights. A close friend of mine who had done MD in Anesthesiology failed the exam once because of CIS. My Advice & My Errors: LA is a good center to take the exam. First Aid for CS and USMLEWORLD course and Necessary and Sufficient for taking the exam. Do practice - it helps alleviate situations which you may encounter for the first time with the SP and leave you wondering what to do - practice makes you do things by habit. NEVER, I repeat, NEVER underestimate this exam. My Stay / Cost / Travel to Center: The LA exam center is close to the LAX airport. The safest way to get there is a cab. But cabs are very costly in LA! I was staying with my brother in law about 15 miles from the venue and each trip cost me about $43! The public transport buses are very infrequent but prompt as indicated in the website www.mta.net but one cannot take chances with the probably costliest exam in one's life, considering not only the cost involved but also the time lost in recuperating a loss. In any case, you can have a look at the venue and the adjoining road beautifully in Google Maps. That would give you much needed confidence that you are going to a well known place... Name : Voldemort

  Search:

  New entry: