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Step 2 Clinical Skills

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yassmin gabr

on 21 September 2015

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Transcript of Step 2 Clinical Skills


Step 2 Clinical Skills
by Dr. Yassmin Gabr
“I do not claim to own any of the copyrighted material used,
they are simply shown for educational purposes. All credit goes to the original sources, some of which links are included.”

Disclaimer


This wouldn't have been possible without my PARENTS, Uncle & brothers;
Dr. Amir, Dr. Sherif, Dr. Mostafa & Dr. Omar.

Also my friends;
Dr. Hoda Amer, Dr. Heba Gad, Dr. Dalia ElSouhagi,
Dr. Marwa Sabe, Dr. Lamees Atteya & Dr. Rania Nour.

And colleagues;
Dr. Ahmed Moussa, Dr. Karim Hegazy,
Dr. Hossam AlNawasra, Dr. Hussein Touny &
Dr. MOHAMED SALAH SOLIMAN.


Acknowledgments

Gratitude
Special Dedication..

Renew Intention..

Make a Difference..

Introduction
Important Concepts
Plan Ahead
Test Layout
Score Oriented
Study Resources
Official Updates
Ready, Set, GO!
Take Home Messages
Conclusion

Overview
First Impression!

Glad Tidings

Brief Intro

http://www.usmle.org/practice-materials/index.html

Orientation


Chances
lost if more
than once

More than once

1st time

Average Number

http://www.youtube.com/watch?v=TbMS_TmDSo8

9

2

MATCH

Interviews

1st PASS

cs

Mind Shift

More than once

1st time

Average
Number

http://www.youtube.com/watch?v=TbMS_TmDSo8

2

MATCH

Interviews

1st PASS
Chances
lost if more
than once

9

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

To Avoid Law Suits!!

WHY the CS exam??
As if “own” family

“Serve” your patients

Keep in Mind

Sees the big picture

Minded with details

Differences

Standardized Patients (SP)..









..Oscar Winning Doctors!
Acting??

Approach

Diversity

Please & Thank You


Entireness VS “Effectiveness”

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..



hotel & flight reservations
http://usmle.org/Examinations/step2/step2cs_registration.html

exam permit + confirmation notice

professional & “comfortable” shoes & outfit

white coat & stethoscope -
highly recommend to take your own

(2) signed photo ID(s), your name spelling..

..MUST BE IDENTICAL..


..to your ECFMG records

PRE – Exam

Test Centers

culture shock expected,
please don’t feel timid!

8 hour day , AM / PM session

allowed to check instruments before exam

light meal provided (but pls bring your own)

1st break (after 5th case) 30 min

2nd break (after 9th case) 15 min

11-12 cases total (only 10 are scored)

cell phone / digital watch / notes -
put away in small storage cubicle,
can’t access till end of day
(not even on breaks)
EXAM Day

POST- Exam

relax… & wait!


please be very keen to write down

& share your experience..

..with the sole intention

of giving back &

benefiting others..





Communication Skills = Communication & Interpersonal Skills
(CIS)




English Language = Spoken English Proficiency
(SEP)



Data Gathering/Sharing/Documenting = Integrated Clinical Encounter
(ICE)

Categories



Full Encounter - Hx, P/E



Follow up Encounter - no P/E



Phone Encounter - no P/E


Types of Cases


Differential Diagnosis for each C/O
Write a Draft Sheet


Ask focused History Questions
Perform a focused Physical Exam
Go over 3 C’s with Patient


Document in a Patient Note


Need to Know


15 minutes (*5 minutes)


Doorway ~ 1 minute


History ~ 7-8 minutes
Physical ~ 3-5 minute *
Closure ~ 2-3 minutes


10 minutes (*2 minutes)


Pt. Note ~ 9 minutes

Timing

Spoken English
Proficiency (SEP)

Data Gathering,
Sharing &
Documentation (ICE)

Communication
& Interpersonal
Skills (CIS)

C/O
DD
Draft


Hx
P/E
3 C’s


PN

Complete Picture

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

Draft Sheet

http://www.mediafire.com/?rio8ft3tp75qiso

♦ Professional manner and rapport:
• ask about
- expectations, feelings, concerns of pt
- support systems and impact of illness,
“with attempts to explore these areas”
• show
- consideration for patient comfort
during the physical examination
- attention to cleanliness through hand
washing or use of gloves
• provide opportunity for the patient to
express feelings/concerns
• encourage additional questions or
discussion
• make
- empathetic remarks concerning
patient issues/concerns
- patient feel comfortable and respected
during the encounter

2.The ICE subcomponent

3.The SEP subcomponent

1.The CIS subcomponent:

♦ Questioning skills:
• use
- open-ended questions,
- transitional statements,
- facilitating remarks
• avoid
- leading questions
- multiple questions,
- repeat questions unless for clarification,
- medical terms/jargon unless defined,
- interruptions when patient talking
• accurately summarize information from patient

♦ Information-sharing skills:
• acknowledge patient issues/concerns and
clearly responding with information
• avoid medical terms unless defined
• clearly provide
- counseling when appropriate
- closure, statements about what happens next

Checklist

Typing Tips..

practice

simple

clear

loud!

accent?

Spoken English

start practicing early!

use desktop keyboard, not a laptop

test center keyboards are new
(keys will feel easier/faster to use)

if can’t adjust your typing speed for PN,
try to leave patient encounter early to save time for typing

there are online/offline software to help you improve your skills

be sure to practice using official website’s free program


http://usmle.org/practice-materials/step-2-cs/patient-note.html

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

Neeraj’s Notes CSE.com

ECFMG.org USMLE.org

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

2013
2012
2011
Starting
Mid June 2012!


beginning June 17, 2012, the Communication and Interpersonal Skills (CIS) scale will focus on five functions:

1. Fostering the relationship

2. Gathering information

3. Providing information

4. Making decisions: basic

5. Supporting emotions: basic 


updated practice materials for Step 2 CS will be posted to the USMLE website in March 2012



Updates!

Starting
June/July 2011,
All PNs must be typed!

Patient Note

3rd

4th

1st
2nd

3rd

4th

1st

2nd

http://www.usmle.org/general_information/announcements.aspx

Starting
Jan 2013!


The Step 2 Committee decided to increase the performance levels required
to receive a passing outcome on two of the three Step 2 CS subcomponents:
Communication and Interpersonal Skills (CIS) and Integrated Clinical Encounter (ICE).

There will be no change to minimum passing requirements for the Spoken English Proficiency (SEP) subcomponent of Step 2 CS at this time.

If the new minimum passing requirements were applied to the group of first-time examinees who recently tested under the new examination structure, the overall passing rate for examinees from US medical schools would be approximately three percent lower and the overall passing rate for examinees from international medical schools would be approximately eighteen percent lower. 

Announcement

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

DD & Inv : First Aid - mini cases


Hx : First Aid - long cases


P/E : UW videos


3C’s : Neeraj’s notes


PN : usmle.org

Where to Start?!

Question

don’t give definite answer (too soon)

don't give false reassurance

be honest

acknowledge concerns &
address feelings behind the Q

offer sincere support

3 C’s

praise positive
accomplishments

don’t sound judgmental

educate about health risks & possible complications

ask if willing to quit

inform of support groups
or social services

3 C’s

inform patient what’s next..

if you run out of time, say
“I hear them paging me,
I’ll check to see if it’s an
emergency & be right back”

3 C’s

Electives

e

ECFMG certification

Goal Oriented!

#2 Take Home Messages = 3 C’s!

It’s OK!
English as 2nd language
US current events
Dr. “serves” Pt.
Confident, Compassionate
Dr. & Pt. are “acting”

Being Different

For acceptable mistakes, pls check; EAMTAR website CS experience
http://www.eamtar.com/Exp-of-people-Step2CS.html

These are pass/fail mistakes!! If done in one or two cases, it’s usually OK, but if done in most of cases, it’ll cost you the exam!

not knocking before entering
being impatient / unkind
forgetting to wash hands
not asking permission before examination
talking in a way the patient can’t understand

Unacceptable Mistakes

Introduction

Important Concepts

Game Plan

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

Step 2CK

Step 1

Step 2CS

#1 Take Home Messages = DD, TT

Introduction

Important Concepts

Plan Ahead

Test Layout

Score Oriented

Study Resources

Official Updates

Ready, Set, GO!

Take Home Messages

Conclusion

Overview..

Practice Makes Perfect!

Your Attitude.. is Your Choice!!









Baraka Boost!


Please Share

Thanks!

Group Discussion

Remember..

First Aid Kaplan

esp. “long cases” esp. wording of “qs/statements”

USMLEWorld.com

esp. “communication skills” section.. …AND “examination videos”
Differential Dx
Draft Sheet
Timing
Challenging Q
Counseling
Closure
Study Partner

EAMTAR.com CS Fb group

Bonus
Record Session
www.youtube.com/watch?v=Z0IoQPwOQG0

Online Powerpoint
www.skydrive/live

Prezi Presentation
www.prezi.com

EAMTAR Page
www.facebook.com/eamtar

Compass Medical
www.facebook.com/Medical.Compass

Ten Tips Pass CS
www.youtube.com/watch?v=7c_aGn4NCYI

Harvard CME
cme.med.harvard.edu/

4Bike
www.facebook.com/4bikeegypt

Cairo Runners
www.facebook.com/CairoRunners
..Your Attitude ..Is Your Choice!
Current Patient Note
to be continued..

2014
Scoring Feedback
Updated
Jan 2014
Full transcript