What I have learned in preparing for the USMLE STEP 2 CS Exam.
So, I am 5 weeks into my surgery rotation and loving the experience so far. I have my Step 2 CS exam coming up in 18 days and have learned a lot through my preparation. This post is to help you with finding resources that I have been finding useful and discovered them from my peers and my own meandering by consulting Dr. Google.
Just like FA for Step 1 is crucial to success, so is this book. The layout of case examples is great and will help you with planning your approach the day of the exam. The exam itself consists of 12 patient encounters, broken up by three at a time. You can watch the orientation video you would see on test day here. An algorithm for what you can expect on test day:
Other resources that you may find helpful:
Step 2 Content Information Booklet from the USMLE - This is a must read as it is from the exam developers and lists accepted abbreviations for your note, examples of written notes along with feedback, and a general layout of what to expect from the exam.
Medical-Institution Resources - this website is helpful for students who swear by mnemonics. Personally, I do not use any mnemonics outside of OLD CARTS for my encounters but some of my peers enjoy this resource. What I do like about this resource is their example "Blue Sheet" which is basically a layout for how you can approach your encounters in a systematic way.
I use the four-quadrant layout they have in their example photo although I do not use the same flow during an encounter. How I learned through our clinical skills courses and the approach I use: Introduction, HPI, Allergies, PMH, Meds, SxHx, (ObGyn Hx if female/Peds spec hx if child), FamHx, SocHx, ROS then PE and Closure.
My time goals (as timing tends to be the issue I think is most common when preparing for this exam) include 8 min for history, 4 min for PE, 3 min for closure...I still have work to do to get closer to these goals as I find I tend to spend closer to 10 min for history 3 min for PE, and 2 min for close... meaning my PE skills seem rushed under these time constraints but I do not want to sacrifice the closure.
What I have found useful instead of learning the million mnemonics listed is to read through them to get an idea of questions I might want to focus on during a history for a specific presentation if it arises.
YouTube Video Timer - There are different timers out there, but get used to using one during the mock encounters you should be practicing with your peers or a family member. Use the cases in the FA 2 CS book and practice writing the note directly after so you can get a feel of the flow.
Step 2 CS Coach iOS app - This is a $2.99 iPhone/iPad app that you can use to practice timing your patient encounter, write up, or both combined while maintaining a log of each case that you do. You can also see some tips for preparing for game day. I do not think this is an essential app, but I like the log feature so I can look back and see which case presentations I have actively practiced and how I did with my timing. I am unsure for those of you who have platforms other than iOS.
Write the note - This is an online platform provided by the USMLE to allow you the chance to practice in the same program you will be using on test day. Use the timer to time yourself, and remember any time you save during the 15 min encounter is available for you to use on your note, provided you leave the room and start writing.
Geeky medics PE videos - These are really awesome reviews of correct ways to perform PE maneuvers. Although you do not need to do a full CV or Resp exam, it is recommended to auscultate CV and Resp for a majority of cases.
Friends and colleagues are probably your best allies through this. PRACTICE!!! You will be surprised at how rusty you have become with some PE skills. You should be able to perform Homans' sign, and will be expected to if the PE warrants that maneuver (Pun intended?)... If you've never had the opportunity to practice Kernig's sign or Brudzinski's sign, then find a buddy and practice until you are proficient. The same goes for all of your PE skills. You do not want to be fumbling through measuring JVD on exam day because time is vital (during the exam and as a one-day practicing physician). My impression is this exam is a way to measure if we will have the skills necessary to perform quality H&P's expected of an incoming resident, so take this seriously as you would the other STEP exams!
So, there you have it. This is a list of what I am using to be ready for my Step 2 CS experience. There are a million resources you can use out there on the internet, and everyone has a different approach. If I have anything to add after taking my exam, I will. Best of luck on your med school journey or the journey of your friend/family/spouse/etc. If you have any questions or feedback, please reach out anytime!