Don't panic. You are well-prepared. You have had plenty of SP experiences to help you prepareCSA is a good trial runResidency program directors rate our students' skills highly. Step 2 CS. 12 patients
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
1. Step 2 CS Tips
Pam Shaw, MD
February 5, 2009
2. Dont panic. You are well-prepared You have had plenty of SP experiences to help you prepare
CSA is a good trial run
Residency program directors rate our students skills highly
3. Step 2 CS 12 patients15 min encounters
Knock in room after 10 minyou have 5 left
5 pts-30 min lunch break-4 pts-15 min break-3 pts
One you leave the room, you are done
Post-encounter note after each patient10 min
Approximately 8 hours
4. Step 2 CS Test Sites Chicago
5. Step 2 CS No PDAs
Only white coat and stethoscope and blank paper
6. Step 2 CS: Possible types of encounters Acute, chronic cases
Counseling vs. PE cases
Follow up lab results
Peds cases with child out of room
Cases with a simulator
7. Step 2 CS: 3 components Integrated Clinical Encounter
Data gathering (with SP) scored by checklist
Documentation scored by physicians
Communication and Interpersonal Skills (SP scored)
Information sharing skills
Professional manner and rapport
Spoken English Proficiency (SP scored)
Must pass all three to pass exam
8. Integrated Clinical Encounter Components History taking
Post-exam discussion with patient
Focused H and P
9. Integrated Clinical Encounter tips: History Focus on the process
Keep diagnostic possibilities wide open
Dont focus on an obvious dx early
Open-ended questions first, second and third. You can be specific later.
One question at a time
Get all the concerns on the table early--Anything else?
10. Integrated Clinical Encounter tips: History Ask ALL appropriate attributes of a symptom: LOCATES
Things that make it worse
Experience of the symptom/Quality
11. Integrated Clinical Encounter tips: History ALWAYS ASK Past Medical History
Occupation, Smoking, Alcohol, Drugs, Sex
Review of Systems
12. Integrated Clinical Encounter tips: Physical exam Focused exams
Think about your differential before you do your exam
Wash hands every time
Keep your patients modestly draped
If you have questions, review before Step 2CS
13. Integrated Clinical Encounter tips: Physical exam ALWAYS listen with stethoscope on the skin
Vitals given, but you may want to repeat
No GU/breast/corneal examsgoes in write updo talk to your pt about these
There may be abnormalities!
May be real or simulated
If you observe something abnormal, it is supposed to be that way
14. Integrated Clinical Encounter tips: Post-exam discussion with patient Dont just leave the room!
Discuss differential dx with patient
Discuss your diagnostic plans with patient (GU exam for example)
Be prepared for difficult questions
Eg. Am I going to die? Did I do something to cause this?
Dont let these sidetrack you from your task
15. Integrated Clinical Encounter tips: Post-encounter note Think of this as a short H and P rather than a SOAP note
10 min per note
Write everything (relevant) you learned or did down
Pertinent negatives as well as positives in HPI (no separate ROS needed)
Typing is generally better
If you hand-write, make it legible
16. Integrated Clinical Encounter tips: Post-encounter note Instead of A/P do Diff Dx and Diagnostic Work-up
GU/breast/corneal reflex exams belong in diagnostic work-up section
NO treatments, consultations or referrals
Do NOT include things you forgot to do in the pt encounter
Examples and practice available on USMLE website including abbreviations
17. Integrated Clinical Encounter tips: Post-encounter note HISTORY: Include significant positives and negatives from history of present illness, past medical history, review of system(s), social history, and family history.
PHYSICAL EXAMINATION: Indicate only pertinent positive and negative findings related to the patient's chief complaint.
DIFFERENTIAL DIAGNOSES: In order of likelihood (with 1 being the most likely), list up to 5 potential or possible diagnoses for this patient's presentation (in many cases, fewer than 5 diagnoses are likely)
DIAGNOSTIC WORKUP: List immediate plans (up to 5) for further diagnostic workup:
18. Communication and Interpersonal Skills Questioning skills examples include:
use of open-ended questions, transitional statements, facilitating remarks
avoidance of - leading or multiple questions, repeat questions unless for clarification, medical terms/jargon unless immediately defined, interruptions when the patient is talking
accurately summarizing information from the patient
19. Communication and Interpersonal Skills Information-sharing skills examples include:
acknowledging patient issues/concerns and clearly responding with information
avoidance of medical terms/jargon unless immediately defined
clearly providing - counseling when appropriate - closure, including statements about what happens next
20. Communication and Interpersonal Skills Professional manner and rapport examples include:
asking about expectations, feelings, and concerns of the patient; support systems and impact of illness, with attempts to explore these areas
showing consideration for patient comfort during the physical examination; attention to cleanliness through hand washing or use of gloves
providing opportunity for the patient to express feelings/concerns
encouraging additional questions or discussion
making empathetic remarks concerning patient issues/concerns; patient should feel comfortable and respected during the encounter
21. Communication and Interpersonal Skills tips Introduce yourself every time
Call pt. Ms. or Mr. or ask!
Dont interrupt your patient!
Dont use jargon (eg. Say high blood pressure, not hypertension)
22. Communication and Interpersonal Skills tips Partner with the patient
Ask the pt what they think/want to do
Ask the pt if they have questions (and answer them)
Explain what you think and want to do. Make sure your pt is ok with the plan!
Counsel pt if appropriate
Provide hope, follow-up plan
23. Spoken English Proficiency For most, should not be an issue, if you are concerned, please touch base in student counseling or with Student Affairs
24. Quick word on telephone cases Treat as if the patient were in the room
Take your time
Ask all your usual questions
25. Resources Mastering the USMLE Step 2 CS by Reteguiz
First Aid for the USMLE Step 2 CS by Bhushan et. al.
More info: http://www.usmle.org/step2/Step2CS/Step2CS2007GI/description.asp
Use your clerkships/faculty!
26. Rock Chalk Jayhawk!