Thursday, March 14, 2013

Time off...for studying

I've been finished with more cores for the better part of two weeks now. I have about two weeks to go. In the mean time, this past week I had my USMLE Step 2 CS (Clinical Skills). Basically, this is an all day test whereby prospective medical students are given ten to eleven cases over the course of the day, and work them up. Doesn't sound much different from the last year of my life, right?

I practiced for over a week, a couple hours a day with another student who is due to take it some time within the next week as well. We started by practicing our interview questioning format, what pertinent exams to conduct, and then stressing differentials. The first few days we weren't too focused on timing, but that ramped up later. Examinees have 15 minutes to gain a history and do a physical, and then ten minutes to type it up with relevant exams. By the end of the study session, it was clear that we were going to be ok time-wise for the H&P, but ten minutes sounds like a lot, but really isn't for typing out all that information, especially when you are character limited to 950 characters (why not 1000???). 

In preparation for test day I had determined that 30-45 seconds of outlining would save me a lot of time and keep me on track in the room. So, when practicing, after getting the demographic data, I wrote out my plan and order. It looked something like this:

This helped me immensely. For starters, it ensured that I interviewed every patient the same, that way nothing would get left out, I would stay on track and in a rhythm that was practiced and somewhat second nature, and it did indeed give me a reminder when I summarized as I looked through because once or twice I forgot to ask a question. It's very easy to get taken off on a tangent. 
For the Review of Systems (ROS) section I would simply do a head-to-toe questionnaire and only write down something if it was relevant. Same for the PE. If it was normal, I didn't write anything on the paper and saved it for my standard spiel in the note, eg: CV: Regular rate and rhythm, +S1/S2, no murmurs, clicks, or ejection sounds. You might note in the upper right corner I have DDX, or differential diagnoses. For any given presentation, I jotted down a few things that I wanted to keep in mind, and/or quickly rule out or in. Not to blow my own horn, but usually one of my differentials was correct, though it's really not that difficult when somebody comes in complaining of chest pain that you write down MI, PE, pericarditis, costochondritis, and aortic aneurysm. Boom. One of those IS going to be the answer, and if it's not, then you've eliminated all the immediately fatal problems, and nobody is going to yell at you for ruling any of those out.

On test day, I had originally planned to just take CTA to the testing center and then go straight to the airport (I was to visit friends in New York). However, a giant fly landed in my chardonnay when friends who had already taken the exam noted that there was nowhere to place my overstuffed suitcase. Which meant that I now would have to drive to the test site. Lovely. I had thoroughly enjoyed not needed the pain in the rear that is my car. I don't mind driving, and I like my car. Just figuring out where to put it while I do my business is always an aggravation. But I really didn't have much choice with the timing of my flights and Friday afternoon Chicago traffic. So long story short (too late) I ended up driving to the test center. I was annoyed because I was faced with having to park my car at the airport, and pay no less than $6.50/day, for four days. Not cheap considering the CTA would've gotten me there for $2.50. After taking the test, I realized I had just enough time to get home, and turn around and get on the bus (that would go right back down the road I just slogged) to get to the airport. So I tried to book it. I checked my email, boom, my flight was delayed at least two hours. Perfect, so I endured a mind-numbing slog into the city on the Kennedy. Chicago is one of the few cities where there can be just as much traffic going into the city as out of it. 

All in all, I get to O'Hare, only to sit around for three hours while a slight dusting wreaks havoc on New York City's airports. How annoying!! Needless to say I slept quite well that night.

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