Pointers for the CSE and Step 2 CS:

Go to this site and download and print the Step 2 CS booklet. View the available video and review all the information.

You will be there all day, get plenty of rest the night before and wear comfortable, BUT professional attire. Bring only your white coat and a stethoscope.

12 stations: 1 is often a pilot case, all others will be graded. You will not know which one is the pilot case. 15/10 timing (25 minutes per station).2 breaks (30 minutes with lunch provided, 15 minutes in the afternoon)

Communication/Interpersonal Skills (SP):

  • Talk to the SPs as though they are real patients…because they are!
  • Use open-ended questions and follow up with specifics
  • You need to be fluid with your questioning and PE…practice if necessary
  • Share information: do not leave the room without telling the patient your initial impression and plan! If you are not sure what is going on, confidently tell them that you intend to find out. The SPs are not grading you on whether you get the right DX, they are interested in how comfortable and confident they feel about your plan.
  • Avoid jargon
  • Answer the SPs questions
  • Always confirm with the patient that they understood you and that they are comfortable with your plan of action. “Do you have any other concerns?”

Data gathering (SP):

  • Resist the urge to jump to conclusions
  • Review the door information, develop a plan prior to entering, and then follow through
  • HPI is not all there is to a focused examexcept in some acute situations. Get pertinentfamily, social and past medical history at minimum. IF THE CASE appears cut and dried and you still have a lot of time left, do a ROS!! They are not giving you 15 minutes for 6 minute cases, use your time in the room to determine the most likely diagnosis (or diagnoses) and rule out the zebras
  • PE: Review ALL relevant systems. For someone with chest pain, you should focus on the most likely system, and then follow up with the peripheral, less likely, but possible systems. Do a full heart exam (all 4 valvular areas), then examine the lungs and abdomen. Still focused, but covering your bases.
  • Never listen, inspect, or otherwise examine a patient through the gown. Move clothing as needed.
  • Tell the SP what you are doing during the PE, just like you would a real patient (“I’m going to listen to your heart now”). You do not have to state every maneuver, but always tell them if you are inspecting something.

Documentation (modified SOAP note):

List ALL pertinent positiveand negative findingsfor your differential list. Include PMH, FH, SH, etc, if pertinent. List pertinent VS only. Your differential should drive your list of pertinent findings. The note should include all relevant information regarding your dx decisions.

Diagnostic workup:

IMMEDIATE plans…what information do you need ASAP to determine this persons’ problem? This is where you will “order” the invasive exams (pelvic, rectal, breast). Also, you might order a physical exam in a situationwhere the patient is out of the room (you interview Mom while baby is gettingsomething done outside the room) or on a phone call case. NO treatment or consulting goes here. It is also okay to write “no diagnostic exams needed at this time.”