Friday, June 1, 2007

Challenging Questions..

Mug up and try to answer balancing the facts and being in the safe side. Try to mug up the ways of First Aid. Every case has one challenging question. Prepare yourself for that.

DONT Forget!!!

Don’t forget to wash hands.
Don’t forget to pull the leg rest.
Don’t forget to Drape the patient.
Don’t forget to make good eye contact.
Don’t forget to show expressions of empathy and concern.
Don’t forget to speak politely, and use polite language.
Don’t be in too much of rush, they may find it hard to understand the language if you speak too fast.
And at last , don’t forget to smile , smile and smile.


Knock, Knock.
HI!! Good morning, Mr...... I am Dr. …… Its nice to meet you. What brings you in today?

At least 4/ 5 cases would be pain case. So LIQORAAA, + PAMHUGFOSS.. with show of concern and compassion all the time.
Use transitional sentences time and again.
Make a note about smoking, Alcoholic habit, diet, exercise, occupation and sexual habits, because they all need to be addressed at the time of counseling.
If you have enough time at the end of history, just summarize what you have learnt from the history. That re-emphasizes the history and makes the conversation more natural and you can double check the facts.
For eg; “ Well!! Mr ....., you said that you are having pain…….., associated with vomiting ….. and you’ve been smoking since…., having multiple sexual partners. Is that it? Is there anything else you would like to tell me about?”

Physical Examination:
Don’t waste too much time in physical examination , as it counts along with history and overall case approach together as Clinical encounter, and you should also preserve as much time as possible for counseling.
Okay, Mr ......., Now I would like to do some physical examinations on you, for that I need to untie your gown. Is that alright?
Thank you.
If the pt resists: “Mr ........., I could understand your feelings, but to clearly understand the disease I have to do this examination, it wont take more than a minute. Don’t worry I am here to assist you, I will tell you whatever I am going to do. Is that Okay with you?”

At the end of physical examination: “Thank you for being so cooperative Mr Bush.”

Patient Counselling:
Try to counsel the patients in at least 8 to 9 cases out of 12. This is the part I think that contributes a lot to interpersonal communication skill. Though interpersonal skills is overall evaluation of how friendly, concerned and compassionate you are to the SPs, but still Counselling time is a time to show concern and make the SP feel that you really care for overall betterment of the patients condition. So try to save time at least 2 to 3 minutes of the encounter for Counselling.
Simulated counseling:
Okay, Mr Bush, Now I would like to sit down and tell you what I think so far. From your history and physical examination, I think it’s a case of ………….. ?? , (eg, Appendecitis, TB etc, whatever diagnosis you think of) , but there are few other possibilities in my mind. To be absolutely sure I have to run few tests and imaging studies. As soon as the report of the tests and imaging studies come back, we would sit down again and discuss the further manangement plan. Is that all right?!!
Meanwhile, I would like to advise you regarding few things. You have been smoking for such a long time. I would strongly advise you to stop smoking as it has a lot of negative impacts on your health. Also you should cut taking alcohol. About your sexual habits ………………. I recommend you to have enough exercise. (If possible, be specific about how much n all) and dietery habits.

Don’t forget to ask “Do you have any further questions for me?”
Thank you Mr ....... It was nice meeting you. We ll be meeting again soon. See you.

Monday, February 5, 2007

Some Great Tips for CS:

1. Practice Cases well.

2. Smile all the time. Smile at the biginning before you greet, smile at the end after you finish the encounter, smile and try to win their heart all the while. Smile before you enter the room. Practice smiling before you go to sleep even from the few days before exam. Practice smiling while you wake up, smile while you go to the rest room. Basically smile all the time.

3. Learn to say 'Thank you' and 'Sorry' for even a pity things. That is one thing we dont usually do being from this part of the world.

4. Be clear while you speak. Not too fast. Some try to finish things without leaving a thing in history and PE. But its more of the efficiency of everything. While you try that, you tend to forget smiling, help or say thank you, sorry kinda stuffs.

5. Learn to counsel the cases. What we did was we used to make a protocol for how we proceeded with it too. I will post it soon.

6. Practice answering the challenging questions. The SPs there in the exam will ask you one challenging questions mostly just after the history, but it can be at any moment. So prepare well for that. You tend to get stuck picking words if you dont practice, and the answers wont be as free flowing as you want, and not exactly what the SPs expect. So prepare well.

7. Try make the SPs feel that you are very concerned about them all the time. Try adding spices to your expressions with few words like 'Oh!' , 'AHH', 'Excuse me for a while','Aww, You must be having great pain' and what not. Whatever you can. It helps to show that you care for them.

8. Respect the SPs. We are used to being respected and not respect the patients. But there its the opposite that counts. They are your real examiners. So think about it. And use all the respectable words and expressions as much as you can.

9. Practice writing patient notes. Its very important how you write. People have flunked in it too. So be prepared to write the cases like here in US.

10. Have confidence. You can do it. Its only the mixture of everything that gets you through it. You dont have to finish up all the cases. But you have to do good in many. You can miss out some history, some physicals but do it efficiently.

The only way through is 'Practice, Practice and Practice'. You dont need to have very good knowledge to pass this exam as other part of USMLE. But you need to have good balance of preparedness and confidence.

Step 2 CS

Dear Fellas,

I know everybody feels very uncertain about this exams. First of all, money matters. 1200 dollars!! And the stake of having to need it again if in case we dont make it. Then low level of confidence, being in the new world and trying to adapt with the american styles. And then having the creepy feelings of 'My english aint good' in some corner of our mind. Everything has its toll at the same time. And so when you are preparing or actually appearing in the CS exam, you feel like very vulnurable creature uncertain about many things. But guys we can do it.

First of all, I personally think its more of your smile and your persona' thats measured there. We IMGs fail mostly in this regard. We try to focus more on history and physical exams, and in the course of it forget to think about the rapport and the bond you are trying to make in that very 15 mins. Our english!! Well nothing much can we do about it. Its been like that for ages. So you just practice the things, and you see that you dont have many extra materials to speak out there, apart from the normal things. Same questions, LIQORAAA, PAMHUGFUSS and practicing physical exam would do it more or less I think. Well saying all this, we shouldnt underestimate the value of practicing data gathering and writing patient notes. We have seen people failing in that too. So what we can do it PREPARE WELL.

Preparation time: Well We think 21 days, thats around 3 weeks with 10 days to 2 weeks of intensive practice would do it.

Materials: What we would like to say is that USMLE world is good to make a note of it.
We would like to say what we did during our preparation. There were three of us. So we went through USMLE world pattern of history taking, and physical questions, keeping in mind all the transitional sentences; and smiles and 'Sorry & Thank you' at our tip of the tongue. Learn to take history in your own pattern, so that it will make everything flowing and you wont be jumbled up in webs of what have i asked and what i havent. For the simulated case practice, we followed The First Aid to CS. It helps a lot guys. If you have some one who had already appeared in CS, it would be great because they know exactly how they had gone through the exam time. If you find someone like that before you even fly to america, just ask to simulate for you the fifteen minutes of the exam. You will have the images all set in mind. If you can find two or three of the persons like this, then it would be ggggggggggreat. So catch them wherever u can. Then if they agree, ask them to be your patient and have a go at them. Just practice, and they will tell it what you really need to improve. Practice the last 27 Cases in the First Aid thoroughly. Around 70 to 80 % of the cases are Dittoo. And when you practice those, you are all set for whatever the examiners throw at you.

Good luck!!

For Step 2 Clinical Skills.


Here comes the hardest ( Easiest, some say with the first attempt) part for us International Medical Graduates. Its not that its very hard, we think its more of very subjective type of all our exams. For this, you need more of the practice than knowledge.
You can do it!!!