麦地联合百歌医学邀请已通过Step2CS的Xiaoyuhu同学，为正在准备该考试的考生讲授备考经验（原考经链接：考经参见http://www.mitbbs.com/article_t2/MedicalCareer/31594155.html  （需翻墙），考经全文复制与本页下方），敬请参加。

• 时间：美国东部时间2016年3月13日晚21:00-23:00，北京时间2016年3月14日10:00am-12:00
• 方式：百歌医学webinar公益讲座平台，免费注册链接https://attendee.gotowebinar.com/register/7806420780140576513

• 嘉宾：Xiaoyuhu
• 主持（逗哏）：王耀宏（麦地Newman）
• 主持（捧哏）：李旸

Step2CS，我一个月考了两次。为了不让大家重复我的错误，也为了感谢所有支持和帮助我的人，我的总结如下。

1st attempt: CS fail in the CIS component.

2nd attempt 1 month later: all three areas are high performance 星星在最右边.

总结：

• 关于准备考试。Step2CS first aid book足够。Mini cases 锻炼 developing ddx, full-length cases 锻炼问问题，随机应变，和记忆的能力。step1, step2CK都不错，英语也不错，Full-time的话一个月应该够用了。英语一般，2-3个月也就可以了。
• 关于补习班，还是很有必要的。补习班我上了两个，usmle gold review –new York 和 Ximedus- Florida. 两个各有千秋。 Ximedus 组织更好，更偏重于communication 和 interpersonal skills 的训练，也是外国学生最欠缺的。前提是对一般的病例要比较熟悉。 USMLE Gold纽约感觉乱哄哄的，但是更擅长对病例的总结，尤其是对哪些是 high yield 的cases把握很好，会经常训练，考试必考。而且他们的mock 是full-length exam. Kaplan 没上不知道。太贵太难约了。一般补习班之后2-3周考试比较合适。如果很担心自己的复习情况，可以在考试前两周做一个模考，推荐Ximedus，比较便宜而且好约到。如果模考不错，基本上就没有问题了。
• 关于test center：除了Philadelphia, 剩下的好像都差不多。我第一次在费城考，第二次在LA考的。考试在上半年考比较好。下半年之后美国的学生考试就多起来了。从夏末到整个秋天到圣诞前都是美国学生集中考试的时间。
• 到最后CS考试70% 是在考communication &  interpersonal skills (CIS)。我分享一下我的心得。
  • 必须要做一个很strong的opening. Opening 要熟悉到做梦说梦话都可以说出来而且每一次opening 都一样，这样在真正考试很紧张情况才不会丢三落四。我的opening 是这样的 “Good morning, Mr/Mrs X? (一个夸张的笑脸，与病人握手，等病人说yes), my name is Dr. X, I am your physician today. Very happy to take care of you! I am going to ask you a few questions and perform a physical exam. Would that be all right with you? (病人: yes) Are you comfortable in this room?(病人: yes)  May I sit down with you and take some notes? (病人: yes)  How can I help you today? 这个练熟了，第一印象就没有问题了。
  • Empathy 是CIS 考试的核心。Empathy我想了一下有三点：第一要简单。第二要有变化，第三要把握好机会。
  • 关于第一点和第二点： 我到最后发现有3个empathetic statements 什么时候都可以说，经常换着说不会显得重复：
    • It must be a difficult time for you
    • you sound really worried/concerned
    • I can imagine how hard/difficult/painful this is for you. 一个技巧是像我们这样的外国学生，遇到这样的情况，基本上会脱口而出  I am sorry to hear that. 稍微不注意就会重复，一重复效果就大打折扣。
    • 关于第三点：把握机会可能最重要。两个地方必须有Empathetic statement：第一个是在 chief complaint之后, 千万不要忘记. 另一个是在family history，提到家人去世, 千万不要忘记说 :  I am sorry for your loss. 还有一些是随机应变，基本上有这样几类： 打喷嚏 (do you need tissue? Or ask to look at the tissue if patient is holding one him/herself for hemoptysis)  病人哭 (give patient tissues and say “ it must be a difficult time for you! You must be really worried/upset/concerned),  challenge questions (eg “I don’t drive and my baby is having a fever. What can I do?”) ( 首先说 I can imagine how worried you are! 然后提供解决的办法, involve social worker etc).
    • 必须有Strong closure. 我的closure是这样的 Mr/Ms X,  lets talk about what this is and what we can do for you. Based on the history and physical exam, I think there are a couple possibilities. First it could be X (医学名词), which is Y（解释）. It can also be Z (医学名词), which is (解释)。 To figure out what this is, I am going to get some blood tests, and a CT (or other tests), which is (解释). Once I have all the results available, I will be able to tell you what caused your symptoms and develop a treatment plan that works for you. How do you think of this plan? (病人：it is good) Do you have any questions for me? （回答问题）最后不要忘记再说一两个empathetic statements: I know you are very worried about your condition, but I will be there with you every step of the way. Hang in there. OK? I will be in touch once the results comes back. It was nice to work with you!
    • 不能超时，少记笔记，maintain eye contact。
    • 最后是challenge questions。联系熟练考试遇到才不会太紧张。为了不让帖子太长我回帖单独发我的总结。
    • 我第一次的失误主要是在于没有重视，自己复习了10天就去考了。希望各位引以为戒。

技巧：

Difficult scenarios:
patient panicking ( I can’t breathe, etc) (Hi Ms, are you OK? can you come and sit on the exam table, would that be more comfortable for you?) (one thing we can do is to take a deep breath, can you follow me, breath in and out slowly like this, in and out, in and out).

patient is suicidal. “Mr X, I would like you to stay in the hospital for the time being so that I can run some tests. would that be Ok?”

patient crying ( give tissues. Do you need tissues? Mrs--, I am here to help you. Can you tell me what’s bothering you?)

Patient doesn't engage/acts weird/has an attitude. "Mr/Ms X, it seems you are concerned about something. Would you like to share it with me?"

“I am a bad person/mother” ( No Mrs X, I don’t think you are a bad person, it is a difficult situation and you did the best anyone could have done).

Did I come in too late? (Mr, I am glad that you are here. I want to help you and it is never too late.)

Lights bothers me. can you not do this? (Mrxxx, it is important for me to look into your eyes to understand better about your condition. I will be as brief as possible. Is that Ok?)

Cancer talk: don't mention cancer if possible if you have to do it:  “one possibility is that this could also be cancer. I know this is very scary, but I do feel this is something we have to rule out. That’s why I am going to get some tests and imaging studies to figure out what’s going on. Regardless of what this is, I am going to be here with you every step of the way.”

Do you think this is X (a terminal dz like parkinson’s disease) (asked while still in the HPI, you want to defer). “ Mr, X, I understand your concern. this is a possibility, but there are many conditions could also cause XYZ. I just want to ask you a few more questions to make sure we don’t miss anything and talk about what this might be in the end. is that OK with you?”

Can you give me something for pain right now? (Mr XY, I can see that you are in a lot of pain right now. Depends on the causes of your pain, there are different pain medications that work the best. I would like to ask you a few more questions to make sure we know what’s going on, then give you something for pain at the end. Is that ok with you?)

Can she still eat sweets (mother with a daughter who has diabetes)? (Make it more uplifting.) “I understand your concern. Diabetes does it make it challenging for she to eat the sweets that she enjoys. But the good news is (be excited and smiling) she can still eat them, just in smaller amounts.”

counsel a 75 year old who don’t want to quit smoking because he is too old (Mr. X, I understand where you are coming from. But smoking can causes many harms to your body, especially to your heart and lungs. you will notice the difference soon after you quit smoking. it is never too late to quit.)

strong emotion towards cancer diagnosis “I just was told about cancer, how am I supposed to feel?!”  Answer: I understand your are frustrated. Anyone in your situation would feel upset. I want to assure you that we are here with you every step of the way, and we are going to work together with you to find the best treatment for you.

"My car was totaled in the car accident". “That must be a terrible experience for you.  let me make sure there is nothing serious going on with your health so that you can put this behind you soon”

“Maybe I will give my baby up for adoption” a young mother has an unplanned pregnancy. answer: whatever decision you make, we will help you.

“how many partners do you have?” “just my husband, I am faithful” “ I don’t mean it that way, I really apologize if this offended you”

you: How may I help you? I don’t think you can help me. “ Mr. XY, I understand it must be a difficult time for you. Can you tell me whats going on?

patient: I don’t want to talk about it (sex or smoking etc).
you: ‘ Mr XX, I didn’t mean to pry. These are just questions I ask every
patient of mine to make sure we don’t miss anything.”
Patient: “again  I just don’t feel comfortable”
You: “are there anything in particular that concerns you?” (open-ended questions)

If run of out time “I will be in touch once we have all the test results. I know it is difficult for you. Hang in there”

"I don’t think the treatment is going to do anything. I’ve already tried everything" “I understand you have been through a lot. but we are not going to give up and I don’t want you to give up”

"Can I still go to the trip and then do the tests” “ Mr. I understand your concern. I can see how excited you are about this trip. it doesn’t sound as though you are well enough for this trip. How about we do some initial tests and see how you are feeling, then decide whether we are comfortable letting you go away?

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