Monday, March 30, 2009

USMLE Step 2 CS Books And Study Strategy

Three days ago, I took USMLE Step 2 CS. The CS stands for Clinical Skills. Unlike the other exams, this one is not computer-based and instead involves live, standardized patients. Relative to USMLE Step 1 or even USMLE Step 2 CK, preparing for Step 2 CS is a much shorter, much more straightforward process. Since Step 2 CS is graded on a pass / fail basis, the goal here is also much simpler: pass!

USMLE Step 2 CS Exam Format

The basic format of Step 2 CS is a patient encounter. A patient encounter consists of a focused history and physical exam conducted in 15 minutes, followed by a patient note, for which you are given 10 minutes. The note includes pertinent positives and negatives from the history and the physical, as well as a differential and plan. The differential and plan can have up to 5 items on them, each. There are 12 patient encounters throughout the day. The first five are followed by a thirty minute break for lunch, the next 4 are followed by a 15 minute break, and then the day ends with the last 3 encounters. The exam is only given at 5 locations throughout the United States: Atlanta, Chicago, Houston, Los Angeles, and Philadelphia. On top of that, it costs over a $1000! The USMLE site has a more extensive description of the clinical skills exam here.

USMLE Step 2 CS Study Schedule

I'd say I spent about a week studying for the exam. I read through First Aid for the USMLE Step 2 CS, first familiarizing myself with the format of the test and basic differentials for common complaints. Then, I recruited one of my medical school friends to play the standardized patient for me and went through some of the cases at the end of the book. Even though I was unable to complete all the cases, I felt pretty comfortable going into the exam.



As far as preparing goes, my advice would be to take Step 2 CK before CS. If you have a good fund of knowledge for CK, you will be more than prepared for CS. Also, when writing the patient note, use the computer as it will be faster and easier to edit than pen & paper. Oh, and bring your own lunch and snacks. They provide food, but your own food will probably be better. Other than that, just remain calm and you'll do just fine.

Sunday, March 15, 2009

Match Day Gift Ideas

What is Match Day?

For those of you who are not aware, Match Day is the day that U.S. medical students (and foreign medical graduates applying for residency positions in the United States) learn where they will be going for internship and residency the following year. The National Resident Matching Program (NRMP) is the entity that coordinates the Match Day process. It begins in the summer of the previous year, when students begin filling out the Electronic Residency Application Service (ERAS) application. They are allowed to submit it after September 1 to programs of their interest. Programs invite applicants for interviews between November and January. After interview season, applicants rank programs on a Rank Order List (ROL) which they submit to NRMP by the end of February. At the same time, programs rank all the applicants they interviewed. Between the end of February and the middle of March, NRMP runs a computer program with the Match algorithm to determine where each applicant matched, and the results are revealed in the middle of March. 

The Week of the Match

The Match week follows the same pattern each year. The schedule for the 2009 Match is as follows: on Monday, March 16, applicants are notified by email or on the Web whether or not they matched to some program. They are not notified which program. If they did not match for an preliminary / intern year, advanced position, or categorical position, they will enter the Scramble in an attempt to secure a spot that went unfilled in the regular Match (a topic for another post). By noon on Tuesday, March 17, the list of unfilled programs is released. Match Day ceremonies at medical schools across the nation on Thursday, March 19. At my institution, the basic schedule is: class photo at 10am, speeches til 11am, at which point a board with all our results in envelopes is brought out. At 11, we all rush to the board and rip open our envelopes to find out the results. In the afternoon, there is a party at our Dean's house, followed by a class party that night. Now, for comparison, some other schools have an even more formal ceremony, where each student goes on stage, walks across to a Dean, who hands them an envelope. The student is then required to open the envelope and read the results to the entire audience of classmates, teachers, family, and friends. I am not a fan of that approach. Not only is the process longer, I feel it also violates the student's privacy and right to divulge that information in the manner he or she sees fit. Regardless, most people will be happy enough with the result after four long years of hard work. 

Match Day Gift List

Now, for all those family and friends gathered, this is a time of celebration for the soon-to-be M.D. What gift is most appropriate? Frankly, I do not know since the event is still a week away for me, but if anyone out there wants to buy me something, here are some ideas! Heh, I will try to suggest things that I think are generally applicable and hopefully useful for a future intern. 



Interns work long hours. It's just a fact. And given that fact, interns drink coffee. Lots of it. What better gift than a single cup than a Black & Decker Personal Coffeemaker with Travel Mug? They are not going to get through morning report without it.



After working all those long hours, interns and residents need something to kick back and relax. How about a Nintendo Wii Console? Or, if they already have one, maybe get them something to play on it, like Rock Band 2. The Wii is especially nice since it requires one to be marginally more active than with other consoles, which interns can use to fool themselves into thinking they exercised for the day.



Of course, internship is not all fun and games. There is a lot of reading to be done. But, not all of it has to be of the "Harrison's" / Pocket Medicine kind. For the latest in reading technology, check out Amazon's Kindle 2. As thin as a magazine, and about as light, the Kindle lets you wirelessly download e-books and read them anywhere. While the cost of the Kindle is a bit pricey, the average cost per book is cheaper (about $10). Also, the books download to your Kindle almost instantaneously, so no waiting at a bookstore or waiting for something to ship. While it may be premature now, I think this is truly the wave of the future as far as how we access printed (e-printed?) materials.



A particularly useful title (that is actually available on the Kindle) is Personal Finance For Dummies. Now, I picked the title because I have enjoyed the 'Dummies' series in the past, but I cannot say I have used this book in particular. My point in including this title is that, for many interns/residents, this is their first real job. Yet, for all their knowledge of medicine, many know very little about personal finance. It is especially important to educate one's self about these issues, as one not only begins to earn a salary but also has to begin repaying student loans. So, while not the 'sexiest' gift, a book on personal finance could turn out to be the most useful.



And, since another 4 years have passed, it may be time for a new laptop. Just a thought =) You reading this, Dad??

While clearly not a comprehensive list, hopefully this gives you a few ideas on some practical gifts for the newly Matched loved one in your life. 

Saturday, March 07, 2009

USMLE Step 2 CK Books And Study Strategy

I recently took USMLE Step 2 CK, which explains my absence from blogging on here. While I do not have my score yet, I figured I would share my study strategy as well as the books and resources I used to prepare for the exam. Relative to USMLE Step 1, preparing for Step 2 CK is a much shorter, much more straightforward process. Of course, people may have different goals and needs for their Step 2 score, but I think for most people it ends up being a test you simply have to pass to continue with your training as a physician in the United States. 

USMLE Step 2 CK Study Schedule

With regards to a study schedule, someone mentioned the saying "2 months, 2 weeks, 2 days" to me, meaning that one should take 2 months to study for Step 1, 2 weeks for Step 2, and 2 days for Step 3. And, from what I know so far, I think that is roughly correct. I'd say I spent about 2 and a half weeks studying for the exam. For the first week or so, I simply read through a review book on Step 2 concepts (more on that below). For the remainder of the time, I simply did qbank questions. The schedule was pretty packed, but it worked out well in the end. I don't think spending any time over 3 weeks would have been worthwhile. Some people may be considering taking a review course. If you feel like your basic science and clinical knowledge are not as strong as you want them to be, or feel like passing may be a challenge, then it is worthwhile to consider. However, for most test takers, a Step 2 review course should not be necessary if you simply are studious, read a bit, and complete a qbank. 

USMLE Step 2 CK Books

As with any major exam, everyone always wants to know what is *the* book to use to study. When I was looking, the main options people seem to gravitate towards were First Aid for the USMLE Step 2 CK, Crush Step 2, and USMLE Step 2 Secrets. Honestly, any of the three books would be fine, I think. However, I first narrowed it down between Crush and Secrets. You may note that both books are actually written by the same author, Adam Brochert. I can't imagine they would contain very different information, so I went with Secrets over Crush (I guess I like having Secrets more than Crushes? I don't know). Then, I compared First Aid for the USMLE Step 2 CK and USMLE Step 2 Secrets. Initially, I thought I would go with First Aid, given how much I liked First Aid for the USMLE Step 1. As I read through the comments though, I noticed that many people found that First Aid for the USMLE Step 2 CK was not clinically-oriented enough for their tastes, which matters as Step 2 CK is more of a clinical exam. Therefore, I ultimately decided to go with USMLE Step 2 Secrets.



USMLE Step 2 Secrets was indeed well-written. The book follows a format of questions and answers a la the Socratic method. The material is divided into chapters based roughly on organ systems, but with a few exceptions thrown in (such as preventive exams and smoking). For students who feel a bit rusty on their clinical material, the book provides a good, broad refresher. However, if you were recently on clinics, or feel generally comfortable with your knowledge base, I think it is debatable whether one needs to read a book to prepare for Step 2 CK at all. What no one is debating though is the value of doing a question bank. 

USMLE Step 2 CK Q-Banks

While there are many qbanks for USMLE Step 1, I think the right choice is much clearer for USMLE Step 2 CK. Sure, there are still just as many options, but I think there is much more broad consensus about using USMLE World. Similar to Step 1, the Step 2 CK UW software is a downloadable application written in Java that mimics the FRED Software used by CK. It contains approximately 2300 questions (which translates into about 50 practice sections). It took me about 2 weeks to go through all 50, although I must admit I was rushing a bit at the end. If you were to do 4 sections a day and review each one, then it would take about 6 to 8 hours per day, and about 12 to 14 days to complete the entire qbank. Clearly, doable, but it requires you to be very committed to finishing. I wish I had budgeted a little more time to review the questions I missed, but I think it was fine. 

USMLE Step 2 CK Test Day

Again, just as with Step 1, the exam is on a computer at a Prometric Testing Center. Registration is done months beforehand, similar to USMLE Step 1 registration. While Step 1 had 7 sections of 50 questions each, Step 2 CK has 8 sections with 46 questions each. After signing in at the test center, you can place your belongings in a locker. The proctor then calls you into the anteroom, check your ID, takes a photograph, and gives you a laminated sheet and dry erase marker for notes. After entering the testing room, you are assigned a computer and the exam begins. You have a total of 9 hours from this point. The first section is a tutorial that is budgeted at 15 minutes, but you can skip through this if you are familiar with the FRED software, giving you 15 extra minutes of break time. The next 9 hours are just... tedious. You can take up to an hour of breaks, scheduled however you want them, in between any of the sections. I chose to take a 15 minute break after section 2, a 30 minute break for lunch after section 4, and a 5 minute break after section 6 just because my eyes were getting tired. Although Step 2 is longer than Step 1, the test day felt much better simply because I was not as stressed. You'll be tired at the end of the day, but glad to be done. Good luck!

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