USMLE STEP 2 CS
USMLE Step 2 CS is without any doubt the most feared part of the USMLE, especially for foreign trained doctors. No matter how competent you are, if you are not familiar with the system in a US clinic, you are at gross disadvantage and be forewarned that no matter how extensive your knowledge base may be, the failure risk is very high. The only way to properly prepare for USMLE step 2 CS is to get a observership at a US family practice clinic, where you can shadow an American physician, and learn the ins and outs of the system. There is no book or software or video or lecture program or any other magic wand that can substitute for this. This is a simple, cold hard fact of life. The better you understand this simple fact and the better you prepare for your CS exam day, the better you will do, and spare yourself unnecessary sorrow and humiliation.
The CS exam itself lasts for 8 hours.There is onsite orientation before the examination is due to start. Be sure to arrive on time. Remember, there is no waiting area for your spouse or family. There is no place to put your luggage. You will be provided with a locker where you can store valuables such as your cellphone, your watch etc. You are not allowed to carry any kind of gadgets into the examination area, and this includes wrist watches of all kinds. If you need a hearing aid or other medical assistive devices, seek permission in advance. Remember to bring a government issued photo ID such as a passport or driving license.
The testing area may look exotic and intimidating to someone who is not familiar with the US healthcare system. If you are familiar with an American Family Practice clinic, you will be right at home, and you may even find the entire process enjoyable. The exam area consists of a group of patient exam rooms, which are equipped with one-way mirrors. The proctors will observe you during the entire process. Outside each room there will be a computer station. You will also find a clipboard , a pen and a paper for taking notes. At the door of the room you will find some basic information about the patient such as vital signs and the reason as to why they are here. Do not get caught up with the fact that these are actors playing the role of patients. Do everything exactly as you would do in a real patient setting.
Remember, you have only 15 minutes for each patient encounter, and you have a total of 12 patient encounters. These are not rare and exotic cases, these are the common conditions you will see at an ordinary US family practice clinic. You may have heard of prior examines claim that the CS is a discriminatory test that aims to kick out IMGs. This is not true. The US healthcare system is in no way discriminatory, it is the most open system in the world, it is just that if you are not familiar with the system, you are at a fatal disadvantage.
You have to know how to introduce yourself properly. Remember to be friendly but professional. You already have the patient's name given on your clipboard. Make a friendly introduction such as "You must be Mrs.Jennings.. I am Dr.Wang.. How are you today?" A good opening line would be something like "So what brings you here to our clinic today?" Remember to shake hands. You must find the chief complaint immediately. Is it headaches? Is it back pain? Once you have the chief complaint, do a quick and focussed history that includes information such as timing, frequency, severity, duration etc. Always ask for allergies, current medications, past history etc, but be careful to tailor everything to fit into the minimal amount of time available. Before you examine the patient, be sure to ask permission, "Mrs.Jennings would you mind if I examine you quickly?" All you have is 15 minutes. Do a five minute history, then a five minute focussed physical examination and then for the last five minutes explain to the patient your impression, the differential diagnosis if any and the investigations that you would like to do. Make sure you answer any questions he or she may have. Be courteous, do not interrupt the patient. At the end be sure to thank the patient, something like "It has been very nice meeting with you Mrs.Jennings and thank you for allowing me to be your doctor." American culture attaches great importance to this kind of courteous behavior. And this is something to remember not just for your exams but also for your future practice as a doctor in the United States. Your patients will love you for it, they are more likely to forgive any errors you make and your staff will sing your praises to everyone they know.
And last but not the least, remember that at the end of the encounter you may be required to type the note on the computer. So if you do not know how to type, you better learn that also before you plunk down more money into the USMLE's already bursting coffers.
If you are an IMG, and you have a heavy accent you would be well advised to attend spoken English classes run by an American born and raised teacher. If there isn't any such classes available, one effective and low cost option is to regularly listen to Voice of America broadcasts and train yourself to speak clearly and coherently in US English.
