There are all kinds of prep materials available for the USMLE CS. If you are a foreign doctor, unfamiliar with the American way of Medicine, watch out! This could very well be your downfall, no matter how high your med school scores were. The American way of medicine is different from anything you have seen anywhere else. The most important part of it is what is described as 'establishing a rapport with the patient'. You have to know how to start a conversation in a friendly yet professional manner. And forget about that 'I am the almighty doctor' complex that some of you from certain parts of world may be used to when talking with patients. There is only one way to learn how to interact normally with patients, that is to hang around with a US doctor in his clinic, preferably an internal medicine clinic or family practice clinic to see how the system works. Apply for a observership at a family practice clinic, and you will learn what to say and not to say.
The CS test lasts for 8 hours. You are not allowed to take any devices such as cellphones of a wristwatch into the testing area. If you need any assistive devices such as hearing aids , get permission in advance. Remember to take your government issued photo ID with you, either a US driving license, or any kind of passport. Your name should be exactly as it is given in the USMLE's records.
In the exam area, there will be a group of patient rooms, each one of which has a one-way mirror. The proctors will watch you during the entire thing. And outside each room will be a PC, and you will also find a clipboard, pen and paper. Also provided to you at the door will be some basic information such as vital signs (for foreign doctors not familiar with this term, it refers to BP, PR, RR and temp) and the main reason for the visit. The individuals you find in the room are actors, but handle the situation as if it was an actual patient.
You will face 12 patient encounters. You have 15 minutes for each encounter. These are common things you will see in an ordinary American family practice clinic. If you check online, you will see many IMGs whine about 'discrimination' during the course of the CS exam. This is entirely untrue. It just means that you were totally clueless , trying to do the aimless things you would do in an overseas 'clinic' as you swagger around with a stethoscope around your neck and a halo around your head and patients greet you with folded hands and bows.
If you are an IMG, there are some fundamental differences you have to understand about your healthcare system and the US healthcare system. In America, individuals have rights. You have to ask permission before you can even touch a patient, such as as "Mrs.Schmidt, would you mind if I listen to your heart sounds with my stethoscope?" Remember to introduce yourself properly, and find out very quickly without wasting any time the reason for his or her clinic visit. You could phrase it politely as in "Mr.Hoover, What brings you to our clinic today?" And if he says "my head is hurting, my tummy is too big and my toes are tingling", try to get things more focussed by asking, "Mr.Hoover, of all those things you mentioned, what is the one thing that bothers you the most?"
Remember to shake hands, even if it is a woman patient and you are from Afpak. You must find the chief complaint immediately. Is it headaches? Is it back pain? Once you have the chief complaint, do a quick and focussed history that includes information such as timing, frequency, severity, duration etc. Always ask for allergies, current medications, past history etc, but be careful to tailor everything to fit into the minimal amount of time available. Before you examine the patient, be sure to ask permission, "Ms.Ford, would you mind if I examine you quickly?"
Use five minutes for the history, five minutes for the physical exam, and the last five minutes to explain to the patient your impression, your differential diagnosis, and the investigations that you would like to do. Remember 'patient counseling'. If the patient has seizures, remember to advise them not to drive. These restrictions vary from state to state. If you do not know something, do not bluff, like you would do in India. Say "I am not sure, I will have to look up that information." That tells the examiner that you are genuine and honest and you are not stupid and dangerous. At the end of the interview, remember to thank the patient , say something like "It has been a pleasure meeting with you, Mr. Rowling, and thank you for allowing me to be your doctor". This is miles away from what you may be used to doing in your country, so if you want to practice medicine in the United States, you better change your way of thinking.
Another important point is, you should be able to talk English in a way that people can understand you. Attend classes with an American teacher if possible, so that you don't sound comical or incomprehensible to your American patient. If you are from China (no offence meant), this is absolutely necessary and wise.
You may be expected to type the encounter notes into the computer, so if don't know how to type on the computer, you better figure that out.
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