Posted by DD from IP 184.108.40.206 on April 29, 2009 at 17:04:09:
First, I want to take this opportunity to thank all friends who gave me help, encouragement, advices in my CS prep, otherwise passing is not possible.
My background in CS: 1st fail in Oct, 2006 in Phylly, 2nd fail in Nov, 2007 in Atlanta, 3rd fail in Sept, 2008 in Phylly. I Passed in my 4th attempt in March, 2009 in LA.
I got my passing result today. I promised to myself I will put my experiences here so that all IMG, no matter you are Chinese IMG(I am Chinese IMG), Indian, or other origins, can get some clues from my experiences so that you do not need to suffer from this exam.
1. For personal Hygiene
Take shower on that test day morning, use soap that has good smell, do not use hotel soap; all clothes, shirt, pant, tie, shoes, lab coat, are New one. Put a mint gum in your mouth before encounter and between the breaks so that you may have a good mouth smell.
Note: Do pay great attention to this point, Americans take shower in the morning, if you do not have a good personal hygiene, they will think you are impolite towards them!
2. How to greet SP and ask Qs after the entering the door.
Here is the way I did.
Dr: Hello, Mr. Michael, I am Dr. Young in this clinic in this clinic, how can I help you today? Shaking SP’s hands with Moderate strength, LOOKING into SP’s eyes with Smiling facial expression (knok the door 3 times, enter, Smiling, Looking into SP’s eyes)
SP: Dr. I fell tired these days.
Dr: Mr. Michael, I am really sorry to hear that. Mr. Michael, is everything is fine for you in this room? (SP will say it is OK), First, let me cover you with this bed sheet so that you can feel a little more comfortable.
Dr: Mr. Michael, jus now you told me that you feel tired these days, can you tell me more about that? I am here to help you (Look into SP’s Eyes with very Sincere, Eager facial expression!, real one, not pretend!).
SP: Dr. I started to feel fatigue 3 days ago…….
Dr. Anything else?
SP: I also have bad appetite and ….
Dr. Anything else?[ this is to give SP chance to talk and give you as much infor and possible, let him talk until he has Nothing to say!]
SP: I think that is all, Dr.
Dr: Mr. Michael, in order to find the cause of your fatigue, I need to ask you some more Qs so that I can help you, is this Ok?
SP: OK, Dr.
Then ask him related Qs that can help you differentiate your DD, remember you just need to ask 3-5 screening Qs for each DD, otherwise you have no time. Then quickly move to PAM HUGS FOSS.
3. How to do Paraphrasing
I use “Fatigue” as example.
SP: I started to feel tired 3 day ago.
Dr. “3 days ago”.(here, “3days ago” is Paraphrasing; you need to do paraphrasing 3-5 times; remember, it is just to Repeat the key words in SP’s sentences, NOT full sentence! This paraphrasing to let SP know you get the right information from him).
4. How to use Transitional words.
Dr: (Before Past medical history), Mr. Michael, thanks for telling me all these information, then I need to ask you some Qs about your health in the past, is this OK with you?
Dr. (Before FH), Mr. Michael, then, I need to some Qs about your family’s heath, does any one if your family also have this similar problem?
Dr. (Before Social History), Mr. Michael, then, I need to some Qs about your social history. What do you do to make a living, Mr. Micheal? Do you smoke? Do drink? Do you use some recreational drugs? (write down positive ones, Do counseling on them at the closure! Never forget!).
Dr. ((before SxH), Mr. Michael, then I need to ask some Qs about your personal habit, all your answers will kept confidential. Are you sexually active? Are your partners male, female or both? etc, if to ask STD Qs, that depends on the case, like condom, STD before, etc).
5. Before PE
Ask SP like this, “Mr. Michael, thanks for telling me all these information, I will just put on my gloves(DO NOT wash hands, Use gloves, this will Definitely Saves your time), then I will do a quick physical exam, before that do you have more information to tell me or do you have more information to share with me? Or do you think I miss anything? (this is to Give SP last chance to tell you his story, this will make SP Remember that you are very complete in the History taking!!!).
6. About Closure
In this section, you need to summarize your history taking (4 key symptoms are enough) and finding in PE (positive ones; if no positive one, just say “I do not find anything in PE”), 1 clinical impression in layman language, 3 work up plans. Then ask SP, “do you have any Qs to ask before I go?”, do counseling for smoke, etc. Here is the example.
All right, Mr. Michael. First, let me summarize. Just now you told me that you feel fatigue and have poor appetite, you also told me that you have poor sleep and lost 5 lbs in the last 3 months, right? In the PE, I found that you have a dry skin, but all others are normal. Based partly on this, I think you may have problem in your Thyroid. In order to find the cause of your problem, I need to run some tests, I need to do some blood test, urine test, and imaging (just for example, Do not say X-ray, CT, or MRI, just say “Imaging”, it is for everything); after getting these results, our nurse will contact you to make an appointment so that you can come, we will then sit together to discuss your diagnosis and treatment options, does that sound good? Mr. Michael? Mr. Michael, do you have more Qs you would like to ask before I go?
Thanks for coming in today, Mr. Michael, I want to reassure that I will be very careful and through in helping you.
Bye, Mr. Michael, take care (Shake SPs hands with Moderate strength, Looking into SP’s eyes with Sincere, Smiling facial expression).
Note: my closure is different from Kaplan style, my closure was modified by an American Christian lady, she said, she, as a patient, will feel more comfortable if I say in the above way.
FA, Neeraj’s note for CS. (do not use UW, FA is enough)
For Chinese, or non-Englsih speaking IMG, find an English speaking partner to rehearse every day, if you are so tired, you need to do at least one case each day.
If you have problem with spoken English, find an American tutor, you read the sentences in FA, let him correct for you. Recite the common sentences for different diseases in FA (in the front part) every morning. At least 100 times! Recite the Closure in Kaplan at least 100 times! They should be flowing out of your tongue before your test!!!
Good luck, my friends, pls feel free to ask any Qs in your brain, I would be glad to help. I passed this time; it is just because God help me.
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