10-19-2011, 07:54 AM
1. Tips for CS preparation:
• My English is not that good. What should I do?
o English proficiency is very important component of step 2 CS exam. Also it is very difficult to improve a lot in short period of time.
o You can improve your performance by following simple steps.
o Ask small questions. Never use long questions or counseling sentences.
o Speak slowly, clearly and loudly.
o Most important is to have enough practice.
o Rehearsal your questions many times. If you have difficulty in pronounce any word, find alternative.
1. Tips for CS preparation:
• I have difficulty to finish physical examination in timely manner. Any suggestions.
o It is very difficult to finish physical examination in timely manner especially cases of CNS or any difficult patient.
o You should only do focused physical examination. Think about most relevant system of your cases, it could be either 1 or 2 system.
o Quickly finish focused physical examination while explain what you are doing.
o You should not spend time to look for any abnormal signs. Quickly move on to next steps of physical examination.
1. Tips for CS preparation:
• Which points do I need to include in my closure?
o Closure is very important part of encounter. You should have at-least two minutes for it.
o You should include what you think- give about 2 differential diagnoses including possibility of something else, tests you want to order, explain any medical terminology before patient ask and offer pain medications if patient has pain.
o You should also give patient opportunity to ask question. Patient might ask you challenging question.
1. Tips for CS preparation:
• How to do counseling for mother of 2 year old child with Vomiting & Diarrhea.
o You will have at-least one pediatrics case during exam, It is very important to have good counseling in this case. You will have enough time as you do not need to do physical examination.
o You should explain what you are thinking, importance of continue hydration while patient is being transported to hospital, importance of physical examination, and if patient’s relative can’t bring pt. to hospital, offer them help for transportation.
1. Tips for CS preparation:
• How to build confidence for step 2 CS
o It is very important to have confidence before you appear for exam.
o You should prepare each case. Remember differential diagnoses & which questions to be asked for each case, and counselling for alcohol, smoking, illegal drugs and high-risk sexual practices.
o Most important thing is that you should have enough practice with your study partner, so do not wait any more, find study partner easily and start practicing.
o Please check below, you will be able to find study partner.
1. Tips for CS preparation:
• Which points should I include in my introduction?
• You should greet patient professionally by last name, professional hand shake, your name, your role in the hospital, what you will do in next 15 minutes and offer to ask any questions.
• You should also drape patient at this time.
1. Tips for CS preparation:
• How to better prepare for patient note:
o Patient note is very important sub-component of step 2 CS exam. Please do not ignore it. Prepare it very well.
o It starts from door information. You need to know age, sex, chief complaint and any abnormal vital signs.
o When you ask history, please inform patient that you will take small notes. Patient will never mind.
o Try to remember things if you can, if you can’t remember specific things, write it down in your notepad.
o Organize your thoughts before you start writing PN.
o Always have enough practice for PN
1. Tips for CS preparation:
• How to continue history when patient insists pain medication during encounter.
• In CS exam, you will encounter difficult patient. If patient is in pain, than it would be difficult for him to answer your questions and he will ask for pain medication. It will tests your counseling skills.
• Your should convince this patient to continue encounter. You can say something like this, "Mr. XYZ, I can understand that you are in pain. But to give you right pain medication, I need to know what is causing it. So let me ask you few more questions and quickly I will do physical examination. After that I will give you pain medication. Is that OK with you?"
• Most likely patient will say yes and you can continue encounter.
1. Tips for CS preparation:
• How to answer challenging questions.
1. In CS exam, every case has one challenging question to test your counseling skills.
2. You should remember few points when you answer challenging question.
o Always be diplomatic, never say yes or no to any diagnosis. Exp. A 59 year old female came with blood in stool with strong family history of colon cancer. She asked you, "Doc, do you think, I have Colon Cancer?". Never say yes or no. As you do not know. You need to do physical examination and run tests such as colonoscopy.
o Always offer help when you answer questions. Say something like"Whatever the diagnosis, I will do my best to help you."
o If patient ask about any trip planning before getting full work up. Explain him/her that accurate and early diagnosis is very important and these tests will not take much of your time.
1. Tips for CS preparation:
• When to do counseling for smoking cessation, alcohol rehabilitation, drug de-addiction and high risk sexual behavior.
1. You will get each of the above counseling situation during your CS exam.
2. When to do counseling is always challenging. Best time to do counseling is right after you ask about social history and sexual history.
3. You will get two advantages by this.
o You will not forget to do it at the end as you will be focusing on closure.
o You will save time by doing so.
1. Tips for CS preparation:
• How to remember questions to be asked during encounter.
o In exam, once you read door information, please have 5 differential diagnosis in your mind.
o You need to ask specific questions to rule-in or rule-out each diagnosis.
o You will also ask : PAMHUGS FOSS.
o Please prepare cases system-wise. Like you can prepare all cases for Central Nervous System. (Numbness, Weakness, memory loss). In each CNS cases you need to ask about motor strength, sensory changes, speech problems, vision/hearing changes, gait problems, difficulty in remembering things etc.
1. Tips for CS preparation:
• Should I take Blood Pressure during encounter?
o You will be given vitals on door information. You should not take blood pressure or any vitals during encounter.
o You should use door information to formulate your differential diagnosis.
o If you think, Orthostatic vital signs is important in your case, write it down in your work up.