A story to tell.(ICE)

[surgmed]

I hope you are doing well.
With hesitation i decided to post this thread hoping that i may recieve the kind of help im looking for.

First of all , congratulations for all of you guys in passing the CS result.

Im an IMG, and Im in trouble with the CS , i have failed 3 times!!. The last one was yesterday.Every time ICE was the problem.I have always passed SEP and CIS.

Few times in my life i felt the fear im feeling now, my entire career is in front of me and im hopelessly looking at it and doesn't know what to do.I finished Step 1 and CK successfully. I have applied this year and already got one interview!.

As long ICE is the problem, i was wondering if you can share your experience with me particularly under the ICE division.
More specific is the physical examination and the patient notes. And im not talking about what is the right maneuver, anybody can find out about that, im talking about what to do as a must ( in addition to the main system complaint) and what to leave?.

In the writing notes, I found this link http://www.usmle.org/pdfs/practice-materials/patient-note/example-note-1.pdf in their official website, is that what they are looking for? very brief and upto the point? is that what you guys learn to write down during your clerkships as AMGs?.Is there any tips in doing smart notes yet comprehensive?

A lot of what the guys posted i have already done, i can see people writing down my exact experience in the exam, and they ended up passing.
I have been hardworking and decent medical student, and i went through a very very long journey in order to make it up here, i don't believe such exam is a fair one and i don't believe they are following a strict standards as they preach!!, if thats true, why do you see the contradictions in different stories and experiences. Why do you see AMGs from the top 20 medical schools failing these exams?. And the biggest Q, why don't they be more detailed in what they want to be achieved from this exam beside being general "Deliver appropriate patient care under supervision!"

I have spent thousands of dollars and have lost one match season already and now im in the current one.

Im going to try to find a date by end of this month(october) so my result will be end of december , hoping to pass this time and of course match and turn this dark page forever.

Please help out with what you believe is perfect/right way of doing this portion of the exam.


Thank you.

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[aaru20red]

hey..sorry to hear about your situation..i am an IMG too and passed CS in august this year..so i can only tell what worked for me and what in my opinion CS is all about..

1. first of all, its a wierd and unfair exam and we all know that but at the same time it still doesnt fall into a 'tough exam' category which means there are only certain things you need to do right to pass it..

2. since you have always passed CIS and SEP i am going to talk about ICE only here..well, you know that ICE has two parts ie the patient note and the data gathering

3.regarding the patient note format let me tell you that you have to come up with your own way of writing it..i mean the way PN is written in usmle.org website is right but the data in their PN is NOT enough for CS..you have to use First aid and come up with your own format..make sure you are practicing enough notes before you take your exam..and ask your seniors to review your notes..make corrections accordingly..

4. regarding data gathering- you dont need to finish a case in 12 min or walk out of the room thinking that you have gathered enough data..remember that we cannot compare ourselves to AMG's in CS..I was the last one to walk out of the room in the entire group of 24 people in every single case..plus my typing speed sucked and i struggled to finish my note in 10 minutes or sometimes even less than that in 4 cases in which i ran out of time in the closure..i felt that i failed for sure and even broke down in my second break..people were talking about how they couldnt REVISE their patient note after they completed..and i was thinking how can i be so slow that i left my workup section blank in one of the notes.. But i think i did the right thing by taking my time with clinical encounter because those 15 minutes are given to finish your clinical encounter and 10 min for PN because they both require that much time only...make sure you have asked all relevant questions before you leave the room..

5. coming back to patient note, a lot depends on your typing speed..being an IMG i am assuming it wont be that good..its okay because thats the case with all of us ( maybe not US imgs) but remember that before the exam you should work on that ..you just need an average typing speed in order to finish your notes on time.
Also when you write a PN, write the differentials first followed by workup and then go to the history..make sure you do not miss any 'relevant' points..

6. physical exam- do only focussed exam..take only 2-3 minutes for physical exam in each case but make sure you keep 5 minutes for the closure and summary..

7. PRACTICE PRACTICE PRACTICE..this cant be stressed enough..dont rush this exam because you are short of time..practice with a person who has passed this exam or your seniors so that you can know where you are going wrong...if they point out mistakes , work on that..

what i realised after i got my result was we dont need to be Perfect in each case. we just need to be a little above average in order to pass this exam..i hope i was able to help a little ..good luck..

 

[mvenus929]

Data Gathering
- Scored by the SP.
- Start with open ended questions and allow them to tell you the story. (This may fall under CIS, but if you're interupting, the SP may not feel the need to tell you what you need to know)
- Then ask questions to narrow down your differential.
- Meds, PMH, PSH, Allergies, Family Hx, social history (smoking, drinking, sex)
- Are you doing a review of systems at the end?

Patient Note
- Write the HPI. include pertinent positives and negatives.
- Write out the pertinent PMH, PSH, FHx, SHx. If nothing is pertinent, write something like 'Family history noncontributory'
- For the PE, include vitals if necessary (if you're thinking infection, temperature would be a good thing to include). Write out the heart and lung exam, and whatever else you did.

As I'm not sure what you're already doing and what you're not, it's hard to give any feedback, but that's generally what I do with my H&P and notes, and that's how I was trained to do it.

 

[surgmed]

Thank you very much, will take your advice very seriously.

 

[surgmed]

Yes i do ROS and i mention positive and negative findings in the notes.
I mention the heart and lung in my PE notes almost always.
Will keep your advice in my mind.

Thank you very much

 

[surgmed]

After passing my CS exam and matching in the program I like, I would like to update my thread.

After I posted my concerns and disappointment, few people has contacted me in my privet inbox, those people were trying to help me to pass the exam. One of them was a privet USMLE tutor, his nickname is "Dumb". Through a structural analysis, he found out the missing link and he helped me in overcome it. Dr. S. educated me about the fundamental concept behind each part of the CS exam and what exactly the NBME wants from you to achieve. By reaching such understanding, I had the ability to accelerate my way toward success, not in the CS exam only, but also in my entire career.

I highly recommend Dr. S. "Dumb" for any person who have difficulty in passing USMLE exam or faced an experience similar to mine.
http://forums.studentdoctor.net/threads/elite-usmle-tutoring.1125638/

Good luck for all.

 

[D1stant]

Your story must be a great inspiration, and i'm sure that this is just the tip of the iceberg.

Care to share what was the "missing link" that cost you 3 CS failures?

Thanks