This edition of USMLE Step 2 CS Complex Cases has been revised to to expect the day of the exam; it can be downloaded as a PDF file. Go beyond the basics with Kaplan Medical's USMLE Step 2 CS Complex Cases, the only guide to focus specifically on challenging cases seen on the USMLE. Kaplan Medical USMLE Step 2 CS: Complex Cases: 35 Cases You Are Likely to See on the Exam plz send it to me at [email protected]
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Phillip Brottman, MD, is a board-certified emergency medicine physician. He currently serves as faculty for Kaplan Medical and teaches Step 2 CS in Chicago. USMLE Step 2 CS Complex Cases: Challenging Cases for Advanced Study Step 2 CS Lecture Notes Patient Cases + Proven Strategies (Kaplan. "M U S A T- H A F OR IM Gs V £ '• ® Step 2 CS Core Cases Third Edition ALSO KAPLAN MEDICAL Books Master the Boards USMLE" Step 2 CK USMLE" 2 CS: Complex Cases), thoroughly updated to address the changes to the Step 2.
However, SPs certainly do know how they want to be treated by their physicians. For this reason, it is important that you do not speak to the SPs outside of the role of a patient. The CIS component of Step 2 CS relates to fostering the relationship, gathering information, providing information, helping the patient make decisions about next steps, and supporting emotions. Having excellent communication skills is necessary for success in the real world as well as on Board exams.
As part of your role as doctor to the SP, you will need to be empathetic. By your actions and words, you show the patient that you understand how he feels and that you respect his concerns. No patient wants to be dismissed as someone whose problems are not worthy of your attention. Express empathy early in the encounter. Pay careful attention to any emotions that are expressed, whether expressed verbally or nonverbally, and respond to them. Some key verbal cues are hearing the patient say that they are worried, scared, or concerned, or using any similarly emotionally charged word.
This is especially useful when a patient is crying. Touch only the shoulder or forearm—never the leg. Do not grab, pat, squeeze, or rub the patient. This is the most common problem in communication: Doctors do not listen to their patients. While the patient is speaking, concentrate on what he or she is saying.
Do not think about what your next question will be.
If you have to write yourself a note on the clipboard, look down at it only briefly. Many doctors score low on all elements of the exam because they were not listening. If you ask a question, let the patient answer. Do not speak again until the patient is finished speaking!
Yes, this can be hard to do. The cases are designed and scripted to be doable in the 15 minutes allotted. Interrupting is seen by the patient as rude. However, there is one exception when it comes to not interrupting your patient: When your patient is rambling and talking about unimportant, perhaps tangential, issues.
It is a challenge to you—and part of the case—to see if you can gently redirect the interview. An effective strategy is to acknowledge what they have just told you, and then refer to something else they said and ask a related question.
For example, I can see how upsetting it is when your sister talks about you behind your back. You said that Saturday was the first time you had chest pain. Can you tell me more about that episode of chest pain? If the patient is crying, grimacing, or displaying overt emotions or discomfort, it is part of the case! Comment on it and respond to it empathically. Do not hide behind the clipboard. Hold it so it does not cover your face or mouth. It is normal to look down occasionally at your clipboard when you write notes.
If you nod up and down slightly when writing on your clipboard, it communicates that you are still listening. SPs are looking to see if you are calm, confident, concerned, and caring.
Both verbal and nonverbal communications are important. How you stand or sit can project calmness or nervousness. You will appear nervous if you constantly tap your pen, touch your hair, or twist your ring. Nervous physicians make for nervous patients. Patients start to wonder if the doctor really knows what he is doing when he acts nervous. Facial expression is part of nonverbal communication.
Generally, if the patient is in no distress or is smiling, you should be smiling as well. If the patient is in distress, is in pain, has respiratory distress, or is crying, you should drop the smile and look calm, caring, and confident. You do this by pretending this is a real-life patient whom you want to help. Your facial muscles will then take care of themselves. Your tone of voice is also important.
Never be angry or condescending or appear uncomfortable when you ask delicate questions. One of the ethical tenets of being a physician is to be nonjudgmental.
We treat and care for everyone with the same respect. In the context of counseling, there is no conflict between counseling and being nonjudgmental. We are expected to help patients change behaviors that can be damaging to their health. The key is that we are basing our recommendations on medical science and, we hope, are offering realistic advice our patients can comply with.
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Yes, I took and passed Step 2 CS. And when I started studying I had lots of questions. Like in the CS when I examine a system, do I do complete exam or just a focussed one. Anyway, we all have a zillion little stupid questions and this book answered many of them. First Aid for Step 2 CS, in my opinion, is still a must have book to practice cases with a partner. But, this Kaplan book is also very helpful.
The first 64 pages answer lots of nuts and bolts Q's about what is expected. The cases are not designed too well for going over with a partner, but are great for solo practice.
When my partner and I could not meet I would just go through the Kaplan book cases myself, take written notes from them like I would in a live encounter, then practice typing in my notes on the USMLE note practice template with a timer if you don't already know, the exact CS exam computer format for writing the post encounter note is available on the Step 2 CS section of the website.
That was my weak spot from the beginning, getting my HPI, Ddx and lab orders typed in time. The Kaplan cases were great for practice for that. Bottom line: I used both First Aid and Kaplan. They are both short enough to get through with no problem and they both have stuff the other is lacking. I am super glad I went ahead and got this book. This was a good supplement to First Aid. I think this was good in addition to First Aid but I would not recommend this as your sole study book.
I found the introduction in this book much more helpful than that in First Aid. Great book. Had EVERY case we encountered on test day, and they were almost exactly like as presented in this book. Of course the book has more than the 12 you see on the actual skills exam day, but wow these cases were so similar to the exam day I almost felt I was in a dream. If you use this, and then go over your notes from it you will absolutely destroy CS.
I also used First Aid CS as well, and got benefits from both. You really will do great and feel great leaving the exam. This book really was excellent.
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