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Eye2011: STEP2 CK 248/99 / CS 考经
作者:USMedEdu
发表时间:2011-01-22
更新时间:2011-01-22
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地址:24.
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发信人: Eye2011 (Eye2011), 信区: MedicalCareer
标 题: STEP2CK 考经 248/99
发信站: BBS 未名空间站 (Sat Jan 22 14:55:48 2011, 美东)

成绩:248/99 (Oct 2010)
准备时间:2月, full time postdoc. 平时晚上看4个小时,周末不一定. 考前请假2周
全天复习. STEP1 251/99

材料:
UW twice (1st round- 4 wks, correct 68%; 2nd round-4 wks, final 77%)
KAPLAN NOTES (外科和心理)
FA (没看完)
SECRETS (零散看了2遍)

NBME 1: 5wk before test 580/235
NBME 4: 3wk before test 580/235
NBME 3: 2wk before test offline 650/248
UWSA: 10 d before test 680/254
NBME 2: 1 wk before test 670/252
USMLE CD: 3 d before test 41/40/39

经验:
我准备CK的宗旨就是速战速决。因为自己申请眼科,是个EARLY MATCH,所以希望在11
月份去面试前拿到CK成绩和ECFMG CERTIFICATE.
KAPLAN NOTES, 看了一遍外科和心理,因为比较短。其他的三科都没看。不过如果时
间充裕,还是看下比较好,因为对STEP3也有帮助。本来打算看遍FA,也是不了了之。
上来就买了UW做,一天2、3套,仔细看答案,从来没见过的知识点就记笔记。中间穿插
着看了SECRETS。后来又做了一遍UW,把相近的知识再总结一下,记了笔记。最后几天
就是翻看自己的笔记。
考试时候没有STEP1那么紧张,2、3个BLOCK休息一次。5个BLOCK后吃午饭。考完没有感
觉,属于正常发挥。

感受:
最重要的就是UW,还有STEP1的基础。因为STEP1考的不错,比较有信心,所以也不想花
太多时间复习。从自己的经历看起来,2个月够考99了。
考试难度比UW低,题干比较长,考的时候觉得不确定的东西很多,每个BLOCK提前10分
钟左右做完,MARK7、8道题,还能再斟酌一下。没有太偏的题,有几道心音听力。
复习材料方面,FA比较系统,但是太笼统; SECRETS考点很详细,总结的也不错。 如
果非要买本书,钱还是花在SECRETS上值。 自己记笔记和总结相似的知识点还是挺有用
的,因为复习STEP3的时候还可以用到。没有用其他书籍,没有参加学习小组,没有做任
何其他题库.
如果从来一次,还是会这样复习,复出回报比较合理。
感觉考到260以上是个质的飞跃,能够给自己的APPLICATION增色不少,不过恐怕要复出
很多。

再次感谢论坛上的前辈,我受益匪浅, 也希望我的一点经验能帮助到别人.

--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 69.133.]


发信人: Eye2011 (Eye2011), 信区: MedicalCareer
标 题: STEP2CS 考经
发信站: BBS 未名空间站 (Sat Jan 22 14:54:51 2011, 美东)

成绩:PASS Aug 2010 CHICAGO
准备时间:3星期 , full time postdoc. 没请假。每晚练习4个小时。还没有开始复习
CK。

材料:
UW 和FA
麦地高人总结的PROTOCOL

报名:
虽然6月份考完STEP1的时候,就知道应该开始准备CS了,但是还是等到7月份STEP1成绩
出了才去报名,发现已经晚的一塌糊涂了。。。LD每天晚上一过半夜就守着电脑刷新,
终于帮我约到了8月的考试时间。要考的同学千万不要重蹈覆辙呀!

经验:
宗旨是在最短的时间内PASS。 看了一遍FA之后就开始上SKYPE练习,和一个第一次FAIL
的缅甸MM还有一个印度MM各练了一两次。还在SKYPE上和考友YL(哈哈,小心你被人肉
出来哦)练习过很多次, 她知识比我强很多,我们一起过过DDX,印象很深刻。之后就
是拿LD联系,LD非常配合,经常指出我的错误和说话语气态度上的毛病。感觉从他身上
学到的最多。在UW上看的体检,练了FA上没有的CASE,其他的就过了一下。FA上的CASE
每个都
练习过两遍。考试的时候不紧张是不可能的啦。大部分的CASE都见过,都比FA上简单。
体检都是糊弄过去,除了心肺腹,基本没做别的体检,挂在墙上的那些东西基本没用,
居然一个NEURO的CASE都没赶上,运气好吧。每个CASE都花不少时间在COUNSEL上。大
部分CASE提前至少3分钟就出来,有一个CASE居然是第一个出来的,不禁寒了自己一下。

感受:
最大的感受就是千万别把CASE想的和FA那么复杂,最后的诊断都是非常简单常见的病。
问诊要短,集中火力问和主诉相关的7、8个问题足以,如果真要把所有系统都REVIEW掉
,不仅时间紧,病人也会很烦。我考完的时候觉得自己忘问了很多问题,但是最后DATA
GATHERING 和QUESTIONING SKILLS都是带小星星的HIGH PERFORMANCE。

其次就是和病人沟通很重要,感觉如果病人对你印象好,是不会给你打差分的。 我很
重视COUNSEL,做很真诚状,我感觉好几个病人都被我热情的EYE CONTACT感动了,最后
都是眼里带着笑听我COUNSEL。

PATIENT NOTE 没什么可说的了,FA足够,遇到了两个没见过的CASE,当时的第一感觉
就是这2个CASE肯定是试验CASE。因为没有复习CK,所以DDX简直就是胡编。所以如果有
的选,大家还是先有点CK知识再准备比较好。我是TYPE的,空间足够用。

最后说英语问题,我的口语不错,没有沟通问题,也没请人纠正过。如果对口语没信心
,还是找个老美纠正一下比较踏实。说实话,觉得自己有点OVER PREPARE了,时间紧张
而口语又不错的同学,2个星期够了。

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1   [USMedEdu 于 2011-01-22 16:13:26 提到] [FROM: 24.]
发信人: Eye2011 (Eye2011), 信区: MedicalCareer
标 题: Re: STEP2CS 考经
发信站: BBS 未名空间站 (Sat Jan 22 16:03:36 2011, 美东)

这是我copy精华里面的。


THINGS I FORGET ALL THE TIME:
Night sweats
Stool change
Tampon/pads
Travel/ill contact


PROTOCOL
Write down the chief complain, sex, name and a list of DDX from the doorway
information.

Knock 3 times with confidence, a smile, walk in (close the door behind) and
say:
“Hello, Mr. (Ms) XYZ. I am Dr. and the physician on duty today. Nice to
meet you.”
(Shake hands) don’t shake hands with SPs in severe pain, pat on the
shoulder instead.
Then ask: “Is everything in the room all right for you?”
After that ... say... “Let me make you a bit more comfortable”
Saying this open up the drape ...OPEN IT COMPLETELY (cover the legs in the
beginning as it seems more courteous)

Start with ... “Mr. Xyz, may I ask you why you came to see us today?”
After that ....you say...”Oh I am so sorry to hear that. I shall try my
best to help you (smile). I will need to ask you some question and do a
brief exam in order to do that. Is that OK with you? Do you mind if I take
some notes while you speak?”
And after the patient say “yes”, write quickly the mnemonics.

Now ask the patient:
Chief Complaint
OCDFPPAAA
 Onset: When did it first start?
 Constant: is it constant or does it come and go?
 Duration: How long does it last? (If applicable)
 Frequency
 Preceding: Do you have any proceeding symptoms/events?
 Progress: is the problem getting worse?
 Aggravating: Is there anything that can make your pain worse?
 Alleviating: Is there anything that can make your pain better?
 Associated: Do you have any other symptoms associated with that?

When you finish with them...then start with questions specific for DDX.

After that... ask “Okay Mr. Xyz now I would like to ask you something about
your health in general. Is that okay with you?” (transitional Q 1)

PAM HUGS WA
 P Have you had similar problems before? Do you have any other
major diseases?
 A Do you have any allergies, including drugs, foods, chemicals,
dust,etc?
 M Are you taking any prescribed medications? Are you taking any
over-the-counter medications?
 H Have you been hospitalized before? Have you had any surgeries
before?
 U Have you had any problems with your urination?
 G Have you had any problems with your bowel movements or diet, i
.e. nausea, vomiting, constipation, diarrhea or change in stool color? If
there is vomit, ask for the color, smell and the presence of blood.
 S Do you have any problems sleeping or waking up?
 W Have you noticed any weight change recently?
 A How is your appetite?

After finishing off with "PAM HUGS WA", before you move on to "FOSS", it is
good to say, “The way medicine works; there could be some additional clues
in your personal information, which I’d like to ask. Is that OK with you?
Thanks. Let’s begin with your family history, OK?” (Transitional Q 2).

FOSSED
F Family history (similar chief complaints/serious illness)
• Does anyone in your family have similar problems?
• Are your parents alive? Are they in good health?
O OB/GYN history (LMP, period condition, pregnancy, abortions, Pap smear)
S “Mrs --- , now I would like to ask you few very personal questions
regarding your sexual health. Whatever you tell me will be kept confidential
. Is that okay?” (Transitional Q 3)
Sexual habits (active/partner number/preferences/STD...)
• Are you sexually active?
• How many partners do you have during last year?
• Do you use condom or any kind of contraception?
• Have you ever been diagnosed for STD/HIV?
S “Mrs --- , now I would like to ask you few questions regarding your
personal life style. Is that OK with you?” (transitional Q 5) Ask SODADE
for Social History
Do you smoke? If so, how many packs a day for how long? S
Do you work? What do you do? O
Do you use any recreational drugs? D
Do you drink alcohol? If so, how much do you drink per week? CAGE questions:
1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your
nerves or get rid of a hangover (eye-opener)?
Exercise
Diet


"Let me summarize here about your medical condition.…... Do you have more
information to share with me? Or do you think I miss anything?”
“OK. Now I need to perform a quick general examination and then look at
your heart - is that fine?"
"All right! Before we begin, Mr. (Ms.) Xyz, excuse me for a moment here so
that I can wash my hands"
Remember the patient’s occupation and commend on how wonderful that is
during hand wash to keep his/her attention.

Transitioning to a Physical exam:
Before you begin physical examination say "I will now need to perform a
quick general examination and then we shall have a look at your chest [or
abdomen - whatever the chief complaint is]" and do keep talking about what
you are doing during each thing your examine.

Closure:
At the end of the entire general + systemic examination, summarize: Mr/Ms
XXX, based on your history and physical examination, we need to consider
several possibilities. There is a disease that caused (inflammation, lack of
oxygen, etc) in your (organ), in our medical term it is called (blahblah).
Right now it is first thing in my mind to consider, but it can also be
caused by some other situations. Such as 1._____, 2. ________ or 3. _______
and others. Therefore, we need to run a few tests on you. We have an
instrument which can give a rather accurate image for the structure of your
(blahblah); we are also going to do some blood tests. When the results come
back, we will have a better idea about what is going on, and decide how to
manage it.

a. First, Counsel!!!
For a case of diabetes, it is good to say a few words on foot care!
If the patient smokes or drinks alcohol - say "Being a concerned physician,
I must advice you to limit the quantity of alcohol/tobacco and try to quit
it. Are you aware of the harmful effects of smoking / alcohol? Have you ever
considered quitting - if you wish to, we have a good support team that is
willing to help you quit the habit".
If they say no then say “I understand that it is very difficult to quit an
old habit and I know that you are not ready to quit smoking/alcohol yet, but
I want to assure you that whenever you are ready, I will be here to help
you. Please let me know if I can be of some help to you.”
For sex counseling you can say: “the reason why I asked you this is because
not practicing safe sex methods that include using condoms as well as
limiting yourself to only single partner puts you at higher risk of getting
STDs, HIV and cancer of the neck of your womb. As your concerned physician I
must advise you to observe safe sex methods”
For obese, hypertensive, diabetic, hyperlipidemic pts, advise lifestyle
change: healthy diet and regular exercise

b. Then "Have you understood everything we have discussed today?"

c. Then "Are there any special concerns you have?"
For difficult and challenging questions: make your own protocol for
answering them:
“I understand your problem/concerns/ that you want to go for hiking/you are
in pain”
"But right now it is difficult for me to say for sure as I need to run some
tests and once the results come out I will be in a better position to tell
you what we are dealing with.”
d. "Okay then Mr. Xyz. I am glad that I was able to work with you. Is there
anything I can do to make you feel more comfortable? If not, let’s meet
again when the test results are back. And I shall leave my contact
information - feel free to contact me anytime if you have any questions.
Thanks for your cooperation and it was really nice meeting you.” (Shake
hands) “bye now and take care".



--

※ 修改:·Eye2011 於 Jan 22 16:05:27 2011 修改本文·[FROM: 69.133.]
※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 69.133.]
 
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