Step 2 CS Advice
Advice from one student:
- Closing remarks are emphasized.
- I read First Aid for Step 2 CS and Kaplan’s Step 2 CS Core Cases (both of which I read twice).
- One strategy I incorporated into my exam day was asking the patient if they had any questions before I began my physical exam. I think this is a safeguard in the event that time becomes an issue. On my exam day, time wasn’t an issue so I got the chance to answer the patient’s questions both before the physical exam and also during the closing.
- I think the goal of time management should be to end the physical exam with enough time to really review the important points of the encounter, differential diagnosis, further management, counseling and questions.
Advice from another student:
- Counseling during each patient encounter; I think this component may be overlooked in a lot of people's preparation; you have to counsel the patient at least one time during the encounter-it may NOT be obvious as when you have a patient who is smoking or with heavy alcohol use; but you can counsel almost anyone very briefly on things such as: low salt diet, exercise, mammography, pap smears and colonoscopy. The counseling does not and probably will not relate directly to the chief complaint.
- Books: Kaplan for CS-the key is to have a partner to practice with and to at least do each case twice.
- Create a history-taking flow chart for each common presentation (dysuria, chest pain, etc.) with the most relevant questions; pertinent questions can be found in a number of history taking books such as Symptom to Diagnosis or First Aid for the CS.
For each encounter it is important to have a basic history taking mnemonic-which will ensure that you do not miss questions about allergies, medications and social history
- Coming up with a good set of pertinent differentials; the key is to support each one with as many pertinent findings; pertinent negatives are overlooked and can play a big role--such as being afebrile and so can acuity and chronicity-these can be applied almost to any case.
- Practicing and timing the introduction and closure, which I rehearsed in front of a mirror several dozen times. Also practicing a screening H and P several dozen times with transition statements; the key is to develop a good work-flow in these encounters that allow you to gather everything in a sequential fashion during each encounter.
- Time management, to successfully complete the encounter and answer each patient’s questions. It will be important to complete the physical exam before the five minute bell.
- Minimizing note taking-this will allow you to make eye contact with the patient during the encounter. One way to do this is to always ask your ROS and H and P in a sequential manner every time and only writing down positive responses. This way you will always know where you are in the H and P and also that what you did not write down was a negative response.
- Active listening-the standardized patients will only know that you listened to them if you paraphrase what you told them-I paraphrased each time before the end of the encounter. Likewise, it is important to ask if the patient has any more questions--I did this at the end of each encounter-and ultimately it is for this reason 5 minutes at minimum need to be budgeted for counseling/closure/questions.
- Practicing typing the patient note, this can slow you down considerably and is also overlooked. My notes mirrored the sequence of the H and P.
Updated Step 2 Clinical Skills orientation video
Posted: May 29, 2015
An updated version of the USMLE Step 2 Clinical Skills (CS) orientation video has been posted to the USMLE website.
The video includes updated information regarding break time, personal items, and use of hand sanitizer.
All Step 2 CS examinees are strongly encouraged to watch the video and to read the USMLE Step 2 CS Content Description and General Information booklet before taking the exam.