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Thread: Tips on cs?

  1. #1
    Macgyver1MD's Avatar
    Macgyver1MD is offline Senior Member 535 points
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    Tips on cs?

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    Holy molly I failed CS. Yeah in my haste to take it in time for match I studied for a few weeks but I really didn't do a lot of the cases in first aid and only practiced a few times with a partner. I failed the ICE portion which is the history taking and patient note. I did well on the other 2 sections but u need to pass all 3 sections to pass the exam. I know it's because I blew it off and didn't study enough. This is just a warning to anyone else who might blow the test off as nothing. There is a 87% pass rate for a reason, it will take some practice and knowing first aid in my opinion. So I taking it again in jan and this time I'm gonna put an effort into it. I did well on step 1 and step 2ck with studying a little everyday instead of cramming for a few months, but I sure got fooled on cs. Learn from my advice and just because you did well on ck and on rotations doesn't guarentee a easy pass on cs. CS might be easy for some but it sure bit me and I became a member of the 13% that failed. So sometes we fall and learn from our mistakes, maybe someone else can learn from mine.

    Any advice from passers would be greatly appreaciated.
    PGY-Attending Hidden Content FP

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    Scientific is offline Senior Member 531 points
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    Definately know First-aid well. Do all of the practice cases and the key is PRACTICE PRACTICE PRACTICE!! Timing is everything on this exam. 10mins is not enough to do a thorough H&P, but that's the time we are given. For the physical exam, First-aid says to do a focused exam, but always check the heart & lungs, and I also did a quick abdominal exam on every patient. These should all be done super quick (just go through the motions), unless your patient's chief complaint involves them. Don't pause too long to hear any positives (wheezing, murmurs, etc.), the patient will make it very apparent if they have any pertanent positives on their exam. Another key thing is learn to do the Neuro exam QUICK. You will need to do it on several of your patients so be able to do a full neuro exam in about 2-3mins. Also, First-aid says to do the MMSE during your physical exam, but you have the option to write for a mental status exam on your write-up, so just do the quick 3 question version and then write for a MSE to save time. Always be courteous to the patients, and remember to SUMMARIZE AT THE END(Extra points) and ask the pt if they have any questions.
    I wrote out my note because IMO, the computer doesn't have enough space. For the HPI, write out as much info as you can and cram as much of your review of systems as you can (this is where the practice comes in handy, you must learn to do this very quickly or you will run out of time, but you still need it to be complete). For the physical exam part, remember to put pertanent positives AND negatives (do this for your review of systems as well). The A&P portion should be the same as the examples in First-aid. Remember, try to get through your H&P as early as possible (but still do a throrough exam or you will miss some key details), and then get the extra time for your note. If you finish your note early ADD IN MORE DETAILS, This can be more pos/negs on your Review of systems or Physical exam. Timing is everything for this exam. It's not necessarily hard if you study First-aid, but being able to do a good write-up in 10mins is the hard part. Just keep practicing every day and you'll be fine.
    (just another extra piece of info, rumor has it that LA and Philly grade harder than the other sites...)

  3. #3
    shawnm3 is offline Member
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    As can be gathered from this post, the test is not a total joke. You need to practice some, especially if you have crappy clinical rotations. I was lucky to do my IM and other primary care rotations in good places that also had US students ( who have a pass rate of like 98%), so that forced me to learn to take a good history and write a good note. However, having done some typical carib rotations as well, I can see that you would need to use first aid and prep a lot more if your IM and family rotations were not very demanding. Point being, the prep amount will depend on you clinical experience. Good luck.


    Quote Originally Posted by Macgyver1 View Post
    Holy molly I failed CS. Yeah in my haste to take it in time for match I studied for a few weeks but I really didn't do a lot of the cases in first aid and only practiced a few times with a partner. I failed the ICE portion which is the history taking and patient note. I did well on the other 2 sections but u need to pass all 3 sections to pass the exam. I know it's because I blew it off and didn't study enough. This is just a warning to anyone else who might blow the test off as nothing. There is a 87% pass rate for a reason, it will take some practice and knowing first aid in my opinion. So I taking it again in jan and this time I'm gonna put an effort into it. I did well on step 1 and step 2ck with studying a little everyday instead of cramming for a few months, but I sure got fooled on cs. Learn from my advice and just because you did well on ck and on rotations doesn't guarentee a easy pass on cs. CS might be easy for some but it sure bit me and I became a member of the 13% that failed. So sometes we fall and learn from our mistakes, maybe someone else can learn from mine.

    Any advice from passers would be greatly appreaciated.

  4. #4
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    11 is offline Member 510 points
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    I took the Kaplan CS course in NJ, it was like 5 days + one simulated test day. You know you will pass after this course. I knew nothing going in, couldn't take a H&P worth a damn, kept stuttering and going blank. But they teach you the specific way to take a history/physical and the right way to write the notes that pretty much guarantees even a monkey to pass.

    I came out 100% confident and of course did well, you don't need to study anything outside of that course - if you have the means, take it!
    If anything it will give you a lot of confidence and I think the CS is 80% nerves and 20% performance.

  5. #5
    rocky_wayne is offline Member
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    Step 2 CS

    I know your story well. I am a first year resident. I took it the first time in Houston and failed the interview portion. I was devistated to say the least. I felt the patients in Houston were rude and condescending. I studied first aid like a mad dog the second time. I found out I failed in early December. In order to make the match, I had to take it by early Jan. There were no centers available so I had my mom sit by the computer for two days constantly clicking on the site and by a miracle, one popped up in Atlanta. If you have this problem, I suggest you be on point and constantly click every two seconds on that thing to refresh it. People are constantly "swapping" spots so you can grab one when they go to switch it. They dissappear fast so click vigilantly.

    I took it the second time without studying much more in Atlanta and the patients were much friendlier. Did not seem like they were "out to get you" so to say. I passed and moved on with my life. Now that test seems like a distant memory and will to you in time. Just hang in there and don't give up. The chances you will fall into the fail category the second time are very slim. As for the course, that thing is a jip. I looked into it and they wanted 1200 bucks just to play on your fears. You are going to beat this thing the second time so just study First Aid and hammer it out. Always write VS WNL and make your HPI focused and flow easily. If it does not read well (not in timeline form or does not include pertinent ROS) they will nail you again for it.

    God bless and I know it makes the holidays harder to deal with but you are a med student and this is what they go through--good times and bad times. Hope this helps

  6. #6
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    stateofequilibrium is offline Super Moderator 6105 points
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    CS is about timing. You need to have the timing down on how to approach the most likely cases you will see during your patient encounters. Not only do you have to ask the right questions and get a complete history and physical, but you have to act appropriately towards the patient. Do you smile, do you give reassurance to someone who is worried? Offer support? Etc etc. All those are probably just as important during the clinical encounter as asking about Family History, etc.

    When doing a physical, be absolutely sure you don't surprise the patient with anything you're doing. Explain what you're doing and why, and help the patient into position.

    Close properly. Tell the patient your thoughts and go over the plan. Don't just say "I'm gonna order me a BMP and CBC." Explain what they are and why you're ordering it for them. If you have to order a rectal, be sure to walk them through it.

    You probably did a million H&P's during your cores, and it's OKAY to miss stuff, it truly is, even on CS. But I think they're really looking for how you approach the case and how you handle the patient. If the patient is grumpy, are you grumpy back? If a patient tells you a story about their grandkids, do you smile and laugh with them? Stuff like that.
    Posterior Fornix.

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    ChanceCount is offline Senior Member 510 points
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    For info gathering, I just used a mneumonic. Find something that's pretty standard and covers a lot. You're going get nervous, the key is to make sure you don't forget anything by doing it almost the same way everytime. Timing is helpful, but if you're going to cut anything short, I'd make it the physical exam.
    "Always carry a flagon of whiskey in case of snakebite, and furthermore always carry a small snake."

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    stateofequilibrium's Avatar
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    Quote Originally Posted by ChanceCount View Post
    For info gathering, I just used a mneumonic. Find something that's pretty standard and covers a lot. You're going get nervous, the key is to make sure you don't forget anything by doing it almost the same way everytime. Timing is helpful, but if you're going to cut anything short, I'd make it the physical exam.
    Yeah, I only spent 5 minutes or less on the physical parts, and I didn't even bother to pretend I was truly checking anything, just going through the motions and talking to the patient.
    Posterior Fornix.

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    something an upper class gave me.

    East Carolina [A]
    YEAR 1 [ ]
    YEAR 2 [ ]
    STEP 1 [ ]

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    ds_in_tx is offline Senior Member
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    I found when I was practicing that I couldn't get through a thorough HPI in time (let alone the bogus physical exam) by trying to remember all the questions. I actually took 45-60 seconds before I went into the room to write out the nmemonic and every semi-relevant question I could think of onto the blank page.

    First Aid was really all you needed if you actually were going to practice or prepare for CS; all of the scenarios were mostly the same and as long as you asked most of the same questions and made your note look like the FA note in 15 minutes without being a dork, you should be fine. It had been at least four months since I'd taken a H&P on anyone when I took CS (having taken 1 month off for CK prep and then 3 months of path before CS), so I gave a good effort to prepare by doing 2 FA cases per night in the several weeks before my exam (finished the book the night before the test).

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