Transcript Step 2 Clinical Skills and CSA Tips

Step 2 CS and CSA Tips
Pam Shaw MD
December 3, 2015
What is CS?
Step 2 CS uses standardized patients to test
medical students and graduates on their
ability to gather information from patients,
perform physical examinations and
communicate their findings to patients and
colleagues.
Don’t panic. You are well-prepared
You have had many SP experiences that
have prepared you and you’ll have more
CSA is a good trial run
May 2-4, 9-12, 16-18, 23-24
Residency program directors rate our
students’ skills highly
We have a high pass rate for CS, but
USMLE set the bar higher in 2012
Step 2 CS: 3 components
 Integrated Clinical Encounter
 Data gathering
 Documentation (or note) scored by physicians
 Communication and Interpersonal Skills
SP scored
 Spoken English Proficiency (SP scored)
 Must pass all three to pass exam
Communication and
Interpersonal Skills Tips
 Introduce yourself every time, first and last
name
 Call patient Ms. or Mr. or ask!
 Use open-ended questions
 Use transition statements
 Don’t interrupt your patient!
 Don’t use jargon (e.g. Say high blood
pressure, not hypertension)
 Empathize
Communication and
Interpersonal Skills Tips
 Partner with the patient
 Ask the patient what they think and want to do
 Ask the patient if they have questions AND try to
and answer them
 Explain what you think and want to do. Make
sure your patient is okay with the plan!
 Counsel patient if appropriate
 Closure
 Provide hope and a follow-up plan
Integrated Clinical Encounter
Tips: History
 Focus on the process
 Keep diagnostic possibilities wide open
 Don’t focus on an obvious diagnosis early
 Open-ended questions first, second and
third. You can be specific later
 One question at a time
 Get all the concerns on the table early
“Anything else?”
Integrated Clinical Encounter
Tips: History--ALWAYS ASK
Past Medical History
Medications
Allergies
Social History
Occupation, Smoking, Alcohol, Drugs,
Sex
Family History
Review of Systems
Integrated Clinical Encounter
Tips: Physical exam
Focused exams
Think about your differential before you
do your exam
Wash hands every time
Technique matters
Keep your patients modestly draped
If you have questions, review before
Step 2CS
Integrated Clinical Encounter
Tips: Physical Exam
 ALWAYS listen with stethoscope on the skin
 Vitals given, but you may want to repeat
 No GU/breast/corneal exams—goes in write
up—
Talk to your patient about these too
 There may be abnormalities!
 May be real or simulated
 If you observe something abnormal, it is
supposed to be that way
Integrated Clinical Encounter
Tips: Discussion with patient
Don’t just leave the room!
Discuss differential dx with patient
Discuss your diagnostic plans with
patient (GU exam for example)
Be prepared for difficult questions
“Am I going to die?”
“Did I do something to cause this?”
Don’t let these sidetrack you from your
task
Post-Encounter Note Format
 http://www.usmle.org/practicematerials/step-2-cs/patient-note.html
Post-Encounter Note
Data Interpretation
 Based on what you have learned from the history
and physical examination, list up to 3 diagnoses
that might explain this patient’s complaint(s)
 List your diagnoses from most to least likely
 For some cases, fewer than 3 diagnoses will be
appropriate
 Then, enter the positive or negative findings from
the history and physical examination (if present)
that support each diagnosis
 Lastly, list initial diagnostic studies (if any) you
would order for each listed diagnosis
 For example: restricted physical exam
maneuvers, laboratory tests, imaging or ECG
Quick word on telephone cases
Treat as if the patient were in the room
Take your time
Ask all your usual questions
Usually a pediatric case
Feedback before taking the exam
If you plan on taking Step II CS in May or
June, you need to meet with Dr. Shaw
before taking the exam
Everyone who scores in the bottom 15%
of the class on the CSA will have to meet
with Dr. Shaw
CSA will be scored like the CS so it is
good feedback
Resources
More info:
USMLE® : Test Content & Practice
Materials
http://www.usmle.org/examinations/step2/
step2cs.html
Use your clerkships/faculty!
Recommended resources