Time:
I feel about 4-6 dedicated weeks is enough time to prepare for the CS. I know of people who passed after reading for only one week and also know of those who failed after preparing for more than 6 weeks. I also know double 99ers who failed the CS at first attempt and those who passed even though they had low step 1 and CK scores. All in all this is a very unpredictable exam and should not be taken lightly.
Material:
First aid for the CS is the most widely used book for step 2 CS. I personally used it and found it very useful. For an IMG like me just First Aid is probably not sufficient and I strongly recommend using an additional resource. Most commonly used ones include Usmleworld, and Kalplan. Also there are a number of scattered blogs and discussions full of advice. Do not get lost reading too many things. Read few things but read them well.
I recommend making a diary with useful notes from all the available resources and then using that diary for practice. You should try and make a rough ‘pro forma’ that you can use for every case.
Importance of practicing with a partner can not be overemphasized. You should hard try to get a 'guinea pig' for yourself. If not you must at least practice with the mirror. Read a scenario from the text (for example Usmleworld or First Aid) and enact the case. After that go back to the text and see what you missed.
Patient notes are very crucial in scoring your exam performance. Many tend to underestimate this part of the CS exam. You must practice writing the patient notes many times before you actually take the exam.
In the end do remember to view the tutorial beforehand and familiarize yourself with the flow of things.
General things to remember:
Act as if this is a real life situation. That is what is expected of you. Patients are actors but they are experienced. They do what they do every single day! If you are not comfortable they will know. So practice well and be comfortable in saying things however artificial they may sound to you.
Listen to them carefully. If you don’t get what they say request them to repeat it. When talking talk clearly. IMGs have a tough time speaking slowly. We tend to rush through what we say. Try to avoid that. Keep your sentences short. Many people focus on speaking English the American way. I don't think one should attempt doing that. It may end up as a blunder if you try to mask your accent. Speaking slowly should suffice. Also the Simulated Patients are quite used to hearing all kinds of accents.
Do not ask more than once question at once. If the patient’s facial expression tells you that he didn’t understand – repeat/rephrase.
Keep talking to the patient when examining him. Keep him aware of what you are doing. Be gentle, polite and make them feel that you care! Show empathy. If you are an IMG you will soon realize that ‘sorry’ and ‘thank you’ are used much more frequently than you are used to.
Wrapping up and ending well is as important as making a good first impression. Be prepared to summarize and discuss the ‘plan’ with the patient.
What are they looking for*?
Have a look at the following Step 2 CS failed report.
Components of the scoring system:
 |
| Click on the image to enlarge |
Components of the scoring system:
A) The Integrated Clinical Encounter or ICE subcomponent which includes assessment of:
1) Data gathering - patient information collected by history taking and physical examination
2) Documentation - completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up
1) Data gathering - patient information collected by history taking and physical examination
2) Documentation - completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up
B) The Communication and Interpersonal Skills or CIS subcomponent which includes assessment of:
1) Questioning skills
2) Information sharing skills
3) Professional manner and rapport
C) The Spoken English Proficiency or SEP component which includes assessment of
1) Clarity of spoken English communication within the context of the doctor-patient encounter (e.g. pronunciation, word choice, and minimizing the need to repeat questions or statements)
The most common sub-component in which students fail is ICE.
2) Information sharing skills
3) Professional manner and rapport
C) The Spoken English Proficiency or SEP component which includes assessment of
1) Clarity of spoken English communication within the context of the doctor-patient encounter (e.g. pronunciation, word choice, and minimizing the need to repeat questions or statements)
The most common sub-component in which students fail is ICE.
Click here to view the dos and don't for each of these components