Step2CS experience

[Eileen]

I was concerned about being able to come up with differentials and ordering the right diagnostic tests...however, you don't need to worry about this at all. They make it so there doesn't even seem to be a "correct" diagnosis (i.e. there will be so many options you will have no problems getting the differentials).

Instead, focus on remembering all the parts of the physical exam. And also practice saying the patient's name frequently and using summary statements and open-ended questions.

I found the gowns to be a little challenging as you can't examine anything over a gown. Sometimes, depending on the patient, it was more difficult to remove the gown from the top. It got to the point where I would just ask the patient, "I need to examine your heart. Would you prefer to pull the gown down from the top or lift it from the bottom?" Some seriously chose to pull the gown up (and therefore I used the sheet to cover the bottom half) because they could not easily pull the gown down over their shoulders (especially if the gown was too small). Can't go wrong with asking...

Some standardized patients are bad actors, nothing you can do about that. Try to keep your focus.

Also, I ran out of room sometimes when typing. If you have a lot to say, consider writing it out with the pen for that station.

And just like with step one, you may get the same system and/or situation over and over again. You would think you would have at least one each of a cardio, abdominal, pulmonary, neuro, psych, musculo-skeletal, etc. However, I had the same thing over and over. Never know what you are gonna get I guess...

Wash your hands.

[hnaggarmd]

So I just took this test yesterday in Atlanta. First, you need to print the scheduling permit from the NBME site. They do not send you one. (Thanks to Jordan) You need to logon to nbme.org, then click on "check exam status." Click on the button that says "Step 2 CS" and scroll to the bottom of the screen, the click on the hyperlink that says "print scheduling permit."


So the test begins at 8 and runs until about 3:15. You see 5 SPs, then a 30 minute lunch (provided by your $1000), then 4 SPs, then a 15 minute break, then 3 more. You have the option of writing the patient note or typing it at every station.

It is pretty well run in Atlanta. I would recommend watching the orientation video that came with the Step 2 CK CD. You will have the same orientation video on your test day, but you might as well prepare for it as much as possible so you don't spend another $1000 on this test.

To prepare: I felt First Aid for CS was dead on. All of the scenarios I had were covered in 1st Aid. Memorizing the differential and workup was key for me. That way when you walk in you will know what tests to run and the differential before seeing the patient. It will save you time during your encounter if you talk about the diagnostic workup while you are examining them.

I thought time would be an issue for me, since I needed it during the OSCE, but it wasn't during test day. Of course, I don't know if I passed, but I feel pretty confident I did. I would consider your approach to the cardiac exam as Eileen stated. You may want to practice how you will tackle the heart sounds at the lower left sternal border with female SPs. I had several of them.

All instruments are in the room. You need to bring your scheduling permit, White coat, stethoscope and ID. Analog watches are allowed, but digital watches have to be removed. I don't recall seeing a clock in the room.

So, I would focus on 1st Aid and you should be fine.
Good luck.

[hnaggarmd]

I forgot to say that I stayed at the Country Inn and Suites. It is the closest and cheapest to the testing center. It costs a total of $67 with taxes included, if you tell them about the USMLE Step 2 discount. Also, it takes about 3 minutes to walk to the site, and it's all through parking lots. The room was quiet and I didn't even hear Todd yelling and making obnoxious noises.

[Adam Beall]

I took my CS exam in Atlanta this Tuesday on Halloween. I was very disappointed not to see anyone in costume at the testing center. The guy who is in charge talks to everyone in a tone that implies you must be an idiot, but other than that everything was fine.

I feel like this was the biggest waste of my time and money so far. All of the scenarios were so basic that anyone who has taken half of ECM1 will pass the test. Some of the patients are nice, some are difficult on purpose. Some will volunteer a lot of information when you bring up a topic or diagnosis by name, but many will tell you that they have no other medical problems if you don't spout off a list of common things when you do a past medical history. For example, if someone were to say that they have no other problems, but then you were to run the list of CAD, DM, hypothyroidism, cancer, CHF, kidney disease, etc... and they go "oh yeah I have Diabetes" if you hadn't asked specifically, you wouldn't know to ask about blood sugars, diabetic control, HGBA1C, neuropathy... and you probably wouldn't just check between their toes for the fun of it. So basically my advice is to ask really specific questions, and run a list of common disorders with every patient. I don't know if they tell them to be like that, but that was my experience.

Other than that, this thing is super easy. I guess I didn't realize it but seems like an equal number of FMGs and US medical school students are taking the exam. There were people from western europe, russia, and about 9 FMGs from India taking the test with me. None of the US students were sweating it at any point during the day. Oh, you might as well leave your valuables at home because they make you empty your pockets into cubbies that have no doors, and they just lock the room. I didn't feel really great about leaving my stuff out where the first person to walk in to get their stuff can just grab it. If you have to bring items in with you, you'll feel better if it's at least in a bag in there. Oh, and don't bother bringing your own pens, they won't let you write with them.

I finished most stations with 5-10 minutes to spare, and had a full list of differentials and diagnostic procedures for most of the stations. A full list wasn't necessary for others because the complaints were so basic and the findings so specific. In all, this test is a colossal waste of time and money, and from what I can tell, it's basically nothing more than an English proficiency test disguised as a clinical skills exam. I guess someone along the way complained we were discriminating against FMGs and made the point that they could make twice as much money by taking advantage of US medical students. As long as you don't get hit in the head with a tack hammer immediately before taking this exam, you're going to pass it. Don't waste your time on first aid; if you paid attention for one single day in ECM clinical skills lab, you'll do fine.

[Betsy]

I agree with what everybody has said. I also stayed at the Country Inn and Suites - South, and I would recommend it to anyone that needs a place close to stay. $60/night, clean, and quiet. I know someone that got stuck in traffic and was almost late. I didnt want to be out $400, so I decided to stay close.

As for the test, its frustrating because the patients were so fake. I felt like most of them were horrible actors, but you have to deal with it. First Aid is very helpful, and its good to read through before the exam. I dont think its necessary to read the whole thing, but just to get a feel for what to expect. Dont waste alot of time on it. Oh yeah, and they do provide lunch, so you dont need to bring anything unless you are picky. They have stuff for vegetarians too.

Despite the rumors, this test isnt going away anytime soon, so we just have to suck it up and do it. And it may seem dumb, but believe it or not, there are some US schools that have up to a 20% failure on this test. So, I guess we should feel good that we are well prepared. Good luck to everyone! It will feel good to have this thing behind you.

[chase]

I concur, I concur. It was a painful experience but you'll actually be glad that we've done all those
SP encounters through ECM. It made everything very easy. None of the situations were that intimidating
and there were half good actors, half bad. But the bad actors made it very easy. They were like automatons
when they spouted their lines. Plenty of US students there didn't have SPs at their school or had a bad
program, and they felt like they were in uncharted waters and kind of intimidated. So be proud and happy for
being at MCG for something.

You see 12 patients, 15 minutes for interviewing and 10 minutes for their simple abbreviated write-up (25 min per patient). It runs from 8am to 3:15pm. Just briefly read through First Aid for CS--you paid so much for the exam, another 45 bucks is worth it. Most of the info is obvious but there's good scenarios for the "challenging patients" and "Difficult situations" which I got every single one of in my exam. They're not terribly hard things you would fail from normally but it was nice to be on top of stuff. It helped to know verbatim what to say that the CS exam people woudl want. There were practice differential lists for every scenario possible and appropriate tests to order. Good stuff.

If you finish each patient early, you have to wait for the full time. I finished each 25 min patient period in like 17-18 min and just starred into space. You can't bring anything so have fun with that.

Food is decent, actually. I stayed at the Country Inn and Suites - South for the 72 bucks after tax rate. Just tell them you're there for CS exam. Plenty of friends to stay with in ATL but none within a 10 minute drive and I didn't want to take the chance of having to reschedule my exam--it's another $400 dollars if you miss and have to reschedule on the day of your exam. Lots of stories about traffic in ATL with people and a few people from last year's class having to do that didn't make me comfortable staying in Decatur or Tucker.

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