Muhammad Ali Khan M.D.

Step 2 CS…….. Made Ridiculously Simple

The Exam Overview

The Exam Itself

How to Prepare

Mnemonics for History (made by Adnan

Saleem Polani)

Pearls for the Exam

Step 2 Clinical Skills Exam

5 cities ( Atlanta, Chicago, Houston, Los Angeles & Philadelphia)

Schedule the exam 4 to 5 months before the intended date.

One year eligibility period, you have to take the exam within it.

Choosing the Center and myths about them

Preparation time varies from 2 to 4 weeks.

Check out the reporting period at www.usmle.org

Watch the orientation video at www.usmle.org

The Exam Overview

Orientation of 20 minutes

12 patient encounters

An encounter includes History takingPhysical ExaminationCounseling and Conclusion

Each patient encounter is of 15 minutes followed by a 10 minute patient note

The Exam Itself

Book to use First Aid for CS

Practicing is the key for successPractice preferably with a medical student or

doctor.If not the above you can practice with anyone.If you do not find anyone then you may

practice in front of a mirror.Do all cases at least twice

Preparation

Doorway informationYou write down patient’s name, age & chief

complaint.Write down the mnemonic.Make four differentials.

Knock on the door.Address the patient by his/her name.Greet warmly, shake hands and introduce self by

name.Ask the simulated patient (SP) if he/she is

comfortable in the room.Drape the patient.

The Clinical Encounter

The Clinical EncounterPlease during the encounter, no matter what

goes wrong, do not have this question mark look on your face.

Just be CONFIDENT, YOU ARE GOING TO DO WELL.

O OnsetP ProgressionF Frequency

A Alleviating Factors A Aggravating Factors A Associated Symptoms (Depends on

the DDs)

Mnemonic for Presenting Complaint

P Previous Episodes of this particular complaint.

F FatigueF Fever

R RashA Appetite changes (Diet and Exercise)W Weight changesS Sleep changes

Mnemonic

R Review of systems (go head to toe)A AllergiesM MedicationsP Previous medical history Previous surgical history Family history

Mnemonic for General Health

Sex Sexual history (Active, Partners within last 1 year,

contraception, protection etc.)S SmokingO OccupationD Drugs (Recreational)A Alcohol

T TravelL Living conditionA Anything else?

Mnemonic for Personal History

L Last menstrual periodM MenarcheP Periods lasting how long

R Regular/IrregularT Tampons/Pads (How many )V Vaginal Discharge

C Cramps in abdomenS Spotting P Pap SmearA AbortionsP Pregnancy

Mnemonic for Ob-Gyn

B Birth History

D Development History

I Immunization history

D Diet

Mnemonic for Peds

After completing the history (say in 7

minutes), wash your hands.

Proceed on to the Physical Examination after

taking permission from the patient.

Do the relevant system first, then if you have

time you can do CVS and Respiratory system

examination.

Physical Examination

Be precise in your clinical methods and do

not waste time, there are no findings on the

simulated patients.

When the 10 minute warning announcement

occurs you should be half way through your

examination.

If you are lagging behind, speed up, you will

need time for counseling and closure.

Avoid medical terminology.

Physical Examination

Tell the patient about your initial diagnostic impression and the tests you would like to run.

Counsel the patient as required forSmokingAlcohol consumptionSafe sex practicesSocial issues

In the end ask the patient if he/she has any questions for you.

Shake hands and say good bye.

Closure and Counseling

Relax the day before the exam (do what you like & enjoy).

Book a cab the day before your exam.Reach the exam center one hour before the

mentioned time.HOLD YOUR NERVES.Most important thing in the encounter is to

finish it with adequate counseling.It does not matter if you mess up a case or

two or even three, just keep on telling yourself that you will pass.

Pearls for the Exam

Just be yourself and you will see how things

click for you.

Confidence is the key.

You should be polite and smile (but not

excessively).

Show empathy to the patient.

The best time to take CS is when you go for

electives in final year.

Pearls for the Exam

Feeling sad or after the exam????????????

It is PERFECTLY NORMAL!!!!

Pearls for the exam

Thank you