I gave CS 2 days ago, and still cannot believe I actually was there. This was a surrealistic experience, to which I still don¡¦t have a name. For these 2 days I ¡¥ve been trying to figure out what is the reason I have not liked this exam so much (besides of the fact I have done a number of gross mistakes and feel frustrated and disappointed about my performance).
Well, may be this. From the very first minutes after you submit yourself to the CS people, you become nothing else but a number, just like in Nazi¡¦s concentration camps. You are bent, you are shrunk, and you are squeezed into the box. And they watch you all the time, every second (there will be 28, 800 seconds). They watch and register every move of your body, every scent of your flesh, every word, every expression on your face. You become a guinea pig. They acknowledge you biology, they will feed you once, and let you urinate twice.
Yes, being in that box is not an easy task. You are forced to give up your personality totally. Some people say in their exam experience ¡V just be yourself. And I wonder how it is possible? In those 15 minutes face-to-face with patients you don¡¦t have time to be yourself, because you have to:
1. Be overwhelmingly charming, but be careful as not to look idiotic.
2. Make him comfortable as in a five-star hotel suit
3. Show empathy (not as you might be doing this in the real life, but accordingly to the USMLE standards of how we¡¦re allowed to express this noble feeling)
4. Address all his concerns
5. Anticipate all his needs
6. Be confident even when you have no idea what the hell are you doing, or talking about
7. Fool him convincingly that he is in good hands (you don¡¦t honestly believe that you¡¦re doing him a favor by treating him, do you???!!!)
8. Gather all the information. He will not tell you anything unless you ask, but be careful as not to intimidate him like FBI agent.
9. Examine SP as if he is a priceless Faberge Egg.
And so on¡K
Now tell me, where is the place for being yourself???!!! Unless you¡¦re all these things, which you¡¦re not, at least for now, otherwise you wouldn¡¦t be taking this exam, but would be the one who is making it up for you. Understand what I¡¦m saying?
Advise #1 ¡V know that exam stinks, and this is very unpleasant to be in the epicenter of its fumes.

Sps are not professional actors (not like on Dr. Swartz courses), the fact that makes exam even harder for you. They are not performers, and the way they say it hurts does not convince you it does, but you pretend you believe. . This whole game of pretending was very exhausting for me.
You¡¦re acutely aware all along that everything is staged. Nothing is real there.
What I was trying to do is to pretend that EVERYTING is real. When I was standing by the door waiting for announcement, I was trying to elicit a genuine desire to help the suffering human being behind that door. It helped for a while. But as the exam progressed, I was so tired, that the only person to whom I was able to feel compassion and empathy was myself.
SPs might even pity you, for they are guinea pigs too. They were visibly exhausted toward the end, after saying the same stupid things over and over again, and letting total strangers to dig into their abdomens for 8 straight hours. One SP was playing whatever disease by yawning endlessly, and I had to bite my tongue, because I already open my mouth to say ¡V why don¡¦t you nap for a while, and I¡¦ll come back later.
Some SPs are ¡§nice¡¨, others ¡§nasty¡¨. Don¡¦t let yourself to react on ¡§nasty¡¨ one in any way (I¡¦m not sure if I managed it). I think, my eyebrows gave away my emotions. This is very stupid.
I¡¦ve heard, SP¡¦s goal is not to fail you, but to challenge you, and see how you deal with this challenge.
Advise #2 ¡V don¡¦t let yourself to be taken by surprise, and even if you are, don¡¦t show it to your SP. Just deal with this to the best of your ability, and accordingly to the advises from FA, UW, Kaplan, or whatever source you¡¦re using for your preparation.

Preparation for the exam is necessary. This plan might work for some of you.
1. Print all UW cases. Combine them in groups such as: Cardio, Respir, GI, CNS, Psyco. You will find many similarities in Hx taking within one group, which will make it easier for you.
Don¡¦t ignore group of Unspecific CC (Fatigue, Weight loss, Night sweats, etc.), and Counseling cases. They are very important too.
2. Study one group at a time. Begin with differential diagnosis. Use your previous knowledge; consult CMDT, if you want. Make sure that once you read CC, at least 5 diseases pops up in your mind immediately. And now think. Think again. See how Hx taking is similar and how they¡¦re different for each of CC. For example, Acute diarrhea (<2 weeks) and Chronic diarrhea (> 2 weeks). Similarities: after careful description of CC, you assess the severity of symptoms: whether inflammation present (fever, blood in stool, tenesmus, abdominal pain) and the level of hydration (dizziness, lightheadedness, amount of urine in adult; tears, saliva, wet pampers in infant), also ¡V whether malabsorbtion is present in a case of chronic diarrhea (malabsorbtion = fatty stools + weight loss). After this, you try to find out a cause: extra GI manifestations, relation to food, h/o antibiotics, h/o travel, h/o anal intercourse, etc.
If the Hx is too extensive, and you unable to grasp it all at once, just work out a plan. For example: if Fatigue is a single dominant complain, think about Psycho first (depression, alcohol abuse). Then think about cancer (brief review of systems), then think chronic infections (fever, TB, HIV), then think endocrinology (Thyroid ¡V adjusting to T, skin; DM ¡V polyphagia, polyuria, etc + family Hx). During actual encounter, don¡¦t be fooled if he¡¦s playing psycho, and ask everything ¡V he might have other symptoms too.
This is not very much time-consuming, just use your common sense and previous knowledge.
People say exam is not about testing your knowledge, and this is probably true. You will learn nothing knew. However, what you do is reorganize the information you already have in the way suitable for the exam purposes. Why do I think we need it? Because: 1. It will help us to stay focused during Hx taking and at the same time do not miss anything important (during encounter you will miss something anyway, but at least not crucial info). 2. You will stay calm and confident during interview, your mind will be at peace (sort of) and you will be able to concentrate on your patient and proper communication skills. 3. It also allows you to skip memorization of checklists, which is boring and really hard task.
3. Take workshop if you can afford it, either Swartz or Kaplan. I took Swartz, and it was good. Dr. Swartz greatly improved it. It¡¦s 3 days now, and each of us had SP, and extensive feedback from SP, Dr., his assistant, and classmates. Very useful experience. I only recommend not to delay exam for too long after the course, 1 month maximum, because some of the important massages will eventually fade away, and it will be difficult to remember them, and the spark and confidence Dr. has given to you.
4. Start practicing Hx taking with your partner. Do as many as you can. Be creative. Deviate from written cases. Pay attention to what you say as well to how you say. Work out standard sentences, the ones you will be using in every case, such as greeting and closing. Closing is very important. Toward the end of encounter the stress will accumulate, the nasty voice will announce remaining time and interrupt you, and you might be running out of time. For this instance, short and well-rehearsed closing will help you a lot. Partner should pay attention and correct you every time you make a mistake. Discuss the cases carefully afterwards. In the beginning, it¡¦s not necessarily to fit in 10 minutes. Develop good habits and interviewing techniques first. Then do timing sessions. Same with Pt Notes ¡V learn how to write them, then practice in timed fashion.
5. Practice physical exam. Follow UW format. Practice it many times, so it become automatic.
6. Do several cases in exam format. It is an excellent idea to have 3 partners ¡V two play the case, one is watching to give a feedback.
When exam is over, don¡¦t torture yourself. I did it though. I woke up 4 am the night after the ordeal, and couldn¡¦t get back to sleep. All the mistakes I¡¦ve done, wrong words or gestures ¡V all came alive in my visions. I think I did not do such a good job. I was awkward, I did too much unnecessary moves, I sometimes used wrong grammar ¡V it¡¦s horrible. And my physical exam!. If there is a special hell for medico souls, I¡¦ll reserved a warmest spot for myself with my physical (along with CS people ƒº)) I forgot to wash my hands in one case, I forgot to put specula on otoscope, I did not percuss the abdomen, and my CNS exam was pitiful. God knows what else.
I am very worried about the results. I¡¦m in my 6th month of pregnancy, and the passing score will be the greatest gift for me on the birthday of my son.
By now, guys, take care. Prepare well.
Perch.