Preparing for USMLE Step 2 Clinical Skills - PowerPoint Presentation

Preparing for USMLE Step 2 Clinical Skills David Becker dbecker@kumc.edu

Step 2 CS US students first required to take it for 2005 graduating class Only offered in 5 cities Is expensive ($1290 doesn’t include travel, hotel) Pass rate adjusted in fall 2017 KU better than stated rate but not 100%

KU’s Preparation Mid-Clerkship Assessment (MCA) Dry run Formative, will get very precursory feedback Lower performers will get more Clinical Skills Assessment (CSA) Runs in May Follows same format as Step 2 CS Timing: 12 patients with 25 minutes to complete each encounter Will get more robust feedback Lower performers will meet with Skills Lab faculty Will be able to reach out to Skills Lab faculty if you wish

Step 2 CS Timing Recommend spending June preparing for Steps Take about 3 weeks studying for CK Schedule CS 1 week after CS You are studying for CS while studying for CK If you are worried about losing skills get to Jaydoc

Study Materials Read all the materials supplied by USMLE ( https://www.usmle.org/pdfs/step-2-cs/cs-info-manual.pdf ) Use First Aid for Step II CS Practice the USMLE style note ( usmle-cspractice.com ) Review common abbreviation list during travel too (page 13 of manual)

Test Day Sleep well night before Bring a clean white coat, stethoscope Light lunch provided, you may bring your own

Patient Visits Read the face sheet but don’t anchor before going into room Wash hands—soap and water v alcohol solution Introduce with first and last names; establish roles You have 15 total minutes for visit 7-10 minutes for history 3-5 minutes for physical exam 2-4 minutes to give assessment and negotiate plan

History Open ended at beginning HPI is most important to make sure you hit well Don’t need full H&P but need all key elements Tobacco, drugs and alcohol almost always needed Sexual history or living situation probably not always necessary Logical transitions and organization

Physical Exam Focus on the things that will define your differential Take notice of anything abnormal and bring it up Obvious things like visible cigarettes or black eyes are there for a reason Sensitive exams not part of the test If need one, make it part of your diagnostic plan on the note

Assessment and Plan Remember, you are a doctor Close the case! Use simple language but give your concerns and obtain confirmation Don’t forget to negotiate a plan

Patient Notes Character limits in each section Give facts, positive or negative, that tell the patient’s story while leading the audience to the DDx you come up with Narrative or bullet pointed okay List vitals and general statement in PE Most will need CV and Pulm exams and more indepth on the main issues Have more than 1 DDx and give supporting information for all them, prioritize the DDx Be specific in DDx and plans

Grading No score beyond pass of fail Must pass all three components Graded by the standardized patients and physicians Will take several weeks to get score back, come in bunches 2016-17 1 st  time pass rate 96% for US MD candidates Late fall 2017 adjusted scoring, pass rate aimed at 92-94%

Grading, continued Spoken English Proficiency (SEP) Scored by SP, you’ll have no problems Communication and Interpersonal Skills (CIS) SP scored based on checklists Open ended questions, active listening, delivering news, showing concerns and gauging understanding

Grading, continued Integrated Clinical Encounter (ICE) Data gathering and interpretation skills Physical exam scored by SP Physician ratings based on note “Pharynx without exudate or erythema” scores higher than “HEENT, throat clear” Correct DDx and appropriate order of likelihood Non-exact terminology—pulled muscle—scores lower Not using evidence (even if right Dx ) or listing improbable Dx with no supporting evidence

Closing Take the MCA and CSA seriously Ask for CSA feedback Use First Aid for Step II and usmle-cspractice. com together while preparing Read the USMLE materials