王盈方醫師瘋狂之旅 Dr Yvonne Wang's Blabberings

I give all the credit to God in having passed everything related to medicine on first attempts – there is a lot of luck involved.

Step 2 CK: 5 Dec, 2006
I didn't use Kaplan or USMLE world for the CK. I only did 50 Qs from kaplan diagnostics one day before the exam and got only 50% correct. I took CK right after I graduated from medicine in Australia, so I underestimated this exam and thought it will just be similar to the exam we went through in Aus right before graduating.
However, when I did the 50 diagnostics Qs I realized the approach is totally different. I still sat the exam the following day and miraculously passed (but with a low score of course).

Step 2 CS: 6 June, 2007

As a busy intern in Australia this year, and not wanting to spend too much of my annual leave to sit an exam, I took 1 week of annual leave and went over to take the exam w/ only one day's rest between arriving in LA and having the exam... furthermore, the time lag was the worst it could be! Right before coming to LA, I was doing emergency room shifts at the time when people in LA would be sleeping, and sleeping at the time when people in LA would be awake! Took some melatonin - dunno if that was helpful or not. Booked a cheap flight w/ China airlines (approx $1200 Australian dollars) which allowed me to stopover in Taiwan for a few days^^ LA was the cheapest I could get (flights to other US cities were a lot more expensive!). Lived in Hacienda Hotel, which was approx 5min walk from the exam center. Went off w/ a study buddy to Disneyland right after the exam (oh yeah!)~ tried walking to the nearest beach from Hacienda hotel the day after and seriously regretted it~ It took forever! I'd advise people to take a cab! then flew off from LA that day! A short, but economical trip^^

I am not allowed to disclose the cases in the exam, but I can talk about my preparation. I think digitaldoc's website www.usmletomd.com was crucial for my success. I also looked up some step2 CS exeperience forums. I concentrated on the first aid. Then a friend of mine lent me a kaplan book and some stuff printed off from the USMLE world, which were also somewhat useful. I've read up this book on communication skills because I didn't think this was one of my strong points. Have a look at my website for some of my notes on communicating w/ patients in general:

http://www.wretch.cc/blog/goodyvo&article_id=6585698

I did not attend any live courses- I guess it wouldn't be helpful for people who graduated med from an English speaking country~ Another thing is, I couldn't find anyone else in Australia that was also sitting this exam, so I just got a friend to act as a patient for 2 days (but I didn't practice doing physical examination on my friend).

It was a nerve wrecking exam. In the exam, one surrogate patient was trying very hard to control himself from laughing at me (dunno what I was doing that seemed so funny to him)! Some of the other surrogate patients were just plain scary – those actors/actress really can act!

Notes (this was the format I followed when I wrote my patient notes):

l       DD & Mx first

l       P/C & their description

l        Significant –ve Hx

l       Systemic exam

l       If time left: PAM HUGS FOSS

General

Mildly ill appearing, no apparent distress observed

VS: WNL (BP T R P)

HEENT (can be more concise than below or omit if irrelevant)

Head: normocephalic, free of visible lesions. Facial muscular revealed N movement.

Eyes: ocular mvts normal, conjunctivae clear, PERLA

ENT w/o alteration

Neck (omit if irrelevant)

Supple, no JVD, thyroid gland normal, cervical nodes negative, no bruit

Chest

Resp: Clear breath sounds bilat (Breath sounds, added sounds)

Cardiac: RRR, Normal S1S2, no murmurs, rubs or gallops (rhythm, HS, murmurs)

Abdomen

Abdo soft, non-distended, non-tender, no organomegaly, +BS

Neuro

MSE: Alert, orientated, MSE & speech normal

CN II-XII: normal

Motor 5/5

Coordination: unremarkable

Sensory: intact to pin, vibration, proprioception

Reflexes: DTRS 3/4, Plantar downgoing

Gait

Musculoskeletal (head to feet, don’t have to examine each part, know RICE)