k**e
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Mcdoudou (laowu) 于 (Fri Sep 10 01:50:41 2010, 美东) 提到:
看这个版也有几年了，一直觉得这个版挺和谐，有很多有用的帖子。我一般不大记得住
ID, 能记住的有老刀，acne, teabao, Eric， 还有一个前版主（个人偶像：此人在IT
浪潮时下海做了码工，考板热时成功考板match, 不记得ID了，只记得他的头像是他女
儿，极cute）。不过最近有点乱，有英语语法癖 （个人很反感，尽量跳过，跳不过就
只好当吃苍蝇了），有26岁问自己是不是太老的（use you common sense, please），
这不又有99er考经是不是炫耀贴。平心而论，有些是有一些炫耀的意味在里面。不过呢
，一是有可能不经意的，二是不影响交流。现在可好，有人抱怨一下，有人砸，乱了套
了。现在我带头发一下我的非99er考经和不成功的match经历。
个人情况：male, 老CMG, (15+), Ph.D无绿卡。
Step1: 06年3月底ebay拍到Kaplan notes (2004)。4月，女儿出生，当了一个月幸福的
爸爸。6月正式开始复习，非full time 因为还要做实验，6-8小时/天。Kaplan notes,
Kaplan题库下载版（败笔），first aid。 10月中考试，成绩90。经验：Kaplan
notes+first aid+Kaplan 题库应该足够。 教训：要服老（应该给自己多一个月时间）
，不要省钱（应该买题库，我的下载版是那种截屏的，不好）。最后一个月强度没上去
（我请了一个月假，但first aid没有吃透）。
Step1之后，觉得有必要补补实验，看看能不能毕业。07年3月，发现动物实验结果阴性
。无法毕业。4月ebay进kaplan notes (2007), 每天能有6-8小时看书。预定9月初考，
提前2个月买的usmleworld。前一个月请假全天复习。成绩95。经验：kaplan notes +
usmleworld 足够。教训：我挺满意这个成绩，我想我恐怕考不到99—即使再给我一个
月的时间复习。
Step2后放松了两个月，结果CS只有08年4月了。看了板上考经，觉得3个月足够了。
First aid+usmleworld, 自己练。成绩：fail (speaking English)。教训：也许有人
一起练练会好一些？09年4月再考CS, pass. 经验：First aid+usmleworld足够。考试
时不要说得太快。 PN：first aid 上的例子太长了，我觉得按USMLE官网上的格式就行。
这期间跟老板谈毕业，但一拖再拖，期间甚至想拿master毕业（我念了7年了，我容易
么我）。
毕业后做了3各月externship。6月， ECFMG certificate。9月申请。4LORs都是美国医
院的医生写的。IM program 100+。被拒无数。在朋友帮助下拿到一面试。自我感觉和
PD谈的挺好，现在还记得我问“What do you look for in a candidate”，回答：“
成绩：你的成绩挺好；口语：不错；LoR: 你的LoR很好。身份：最好是公民或绿卡。
10月，pass step3：85. 经验：usmleworld。 他家的CCS很好，我觉得和考试时候的界
面很一致。CRUSH step3 也可看看。我复习了3个月。
10年3月，no match. 又做了两个月externship. 现在在申请。
感想：
1. 要考早考，不要像我一样起个大早，赶个晚集。
2. 一定要有家庭支持，我非常感谢我家LD对我考板的支持。
3. 对成绩一般的老CMG来说，绿卡>成绩
太困了，就写到这吧。最后给自己加油，祝自己好运，也祝大家好运。
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daisyy (Daisy) 于 (Fri Sep 10 02:21:31 2010, 美东) 提到:
赞一个。
楼主很有毅力啊。一边做实验一边还能每天6-8小时学习。STEP 1复习的时间不长，能
考90已经很不简单了。
祝今年MATCH 好运！
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showdown (showdown) 于 (Fri Sep 10 02:25:15 2010, 美东) 提到:
身份和只申请IM可能是问题，
不过还有起的比你更早还没赶集的了，楼主好运！
你在哪家做的externship啊，多长时间啊，我很有可能要去做一个COMMERCIAL的这种培
训
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xiaoruilan (wannagainweight) 于 (Fri Sep 10 02:28:41 2010, 美东) 提到:
你肯定会成功的，有你的成绩，5个月的extenship，你的努力和不懈。祝今年好运，多
拿几个面试，match成功。
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goodgene (Addison) 于 (Fri Sep 10 02:42:48 2010, 美东) 提到:
很感动，你的条件算是很不错的了，今年一定能match!
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md2008 (md) 于 (Fri Sep 10 07:39:22 2010, 美东) 提到:
thanks for sharing
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aemon (麦地小核桃) 于 (Fri Sep 10 08:45:51 2010, 美东) 提到:
祝福楼主！
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zhanghaowei4 (dahuaidan) 于 (Fri Sep 10 08:53:46 2010, 美东) 提到:
I am also a Ph.D.without GC. You must have a LOR from your current Ph.D.
program. It is required.Without it,people might think negatively about you.
One LOR from your boss or program director is mandatory.
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lingzMainz (lingzMainz) 于 (Fri Sep 10 08:59:10 2010, 美东) 提到:
好感动啊！楼主加油，祝今年成功match!
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hmis (hmis) 于 (Fri Sep 10 09:06:22 2010, 美东) 提到:
谢谢你，帮你祝福。
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Mcdoudou (laowu) 于 (Fri Sep 10 09:16:06 2010, 美东) 提到:
.
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Sahara4 (ninimomo) 于 (Fri Sep 10 09:47:05 2010, 美东) 提到:
With such strong determination, You will suceed! Good luck with this year's
match!
IT
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HIV (AIDS) 于 (Fri Sep 10 11:35:20 2010, 美东) 提到:
先给楼主鼓鼓劲，有一个问题想问，
是不是有一个什么从考试开始到拿到执照7年的限制？
如果这样的话大家都要抓紧才是
IT
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abcd2010 (abc) 于 (Fri Sep 10 11:43:51 2010, 美东) 提到:
Is it true?
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USMedEdu (US_CMGs) 于 (Fri Sep 10 11:51:31 2010, 美东) 提到:
not accurate:
it's a rule:
you must complete step 1, 2, and 3 within 7 yrs, otherwise, you need re-take
one which is >7yr from step3. nothing to do with license, but ECFMG
certificate.
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usmle123456 (Judy) 于 (Fri Sep 10 11:54:18 2010, 美东) 提到:
你一定会成功！Bless！
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timingchain (timingchain) 于 (Fri Sep 10 12:05:43 2010, 美东) 提到:
祝福楼主, 凭着你的韧性和坚强毅力, 你一定会成功的, 期待着你成功Match而且会指
日可待的好消息!
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fionaww (加州无鱼) 于 (Fri Sep 10 12:07:34 2010, 美东) 提到:
Bless.
今年我们一起加油。
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lzumc2008 (麦地乖乖虎) 于 (Fri Sep 10 12:26:16 2010, 美东) 提到:
真不容易！祝今年好运！
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giantsfan (nobody) 于 (Fri Sep 10 12:27:34 2010, 美东) 提到:
Thanks for sharing your experience with us.It's a very encouraging post. You
got a decent package, hope you good luck this year!
Quick question, were you doing any full time job while you did your
externship after graduation? I am also a PhD student trying to finish step1
or more before greaduation, just want to plan ahead what I am gonna do
afterwards. Any suggestion is appreciated!
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xlvivian (Match2011) 于 (Fri Sep 10 13:01:37 2010, 美东) 提到:
谢谢分享这么感动的故事，楼主今年一定match！
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Mcdoudou (laowu) 于 (Fri Sep 10 13:09:16 2010, 美东) 提到:
No I did not do any full time job when I was an extern. After all, that was
60 hours per week. I used my OPT. My understanding of the current rule is:
you can start your OPT 2 months after the graduation date. You can do
nothing in the first 3 months of your OPT, after that you have to find at
least a volunteer full time job. The OB or externship is equivalent to a
volunteer job in my opinion.
You
step1
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zhanghaowei4 (dahuaidan) 于 (Fri Sep 10 13:15:36 2010, 美东) 提到:
Believe me, a letter must come from your current Ph.D. institution. It is a
general rule. LOR without your past employer will be much less credible.
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lzumc2008 (麦地乖乖虎) 于 (Fri Sep 10 13:24:32 2010, 美东) 提到:
小师弟，找你导师和Dr Ard各写一封就得了：）。我们系除你Lu师兄和你没见面得Pan
师姐，剩下的过去十年内毕业的都match上了，眼科，神经科，内科，牙科住院医等等
。你今年肯定行的。多申请点就可以了。
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Mcdoudou (laowu) 于 (Fri Sep 10 14:14:42 2010, 美东) 提到:
this is my summary for my second CS. Hope this could help others, especially
old CMG like myself.
Introduction and greeting:
Knock the door 3 times, come in and say: “Hello, Mr. xxx. I am Dr. xxxx.
Nice to meet you.” Shake hands. Say: “I am here to see you today as your
physician. I would like to ask you some questions and do a physical exam. Is
that OK with you?” (Look around the room and say "Is everything in the
room alright for you?" - SP says yes - ）Then you say "Is it okay to drape
you first with this sheet to make you a little more comfortable?" SP says “
yes” then drape the patient legs up to his belly.
Next ask: “What brings (brought) you in today” or “How can I help you
today?”
Next say: “Could you tell me more about your problem?”
Onset:
“When did it (first) start” or “When did you (first) notice the problem/
pain?” and “Was the onset all the sudden or progressive?”
Progression: is it getting better or worse?
Frequency:
“Is it constant or intermittent?”
If intermittent, “How often does it occur? How long does it last? How do
you feel between attacks?”
Location: “Could you show me exactly where it is?”
Intensity:
“On a scale of 1 to 10, which number would (you use to) describe your pain
?”
If not a pain, ask: “How bad is it” or “Does it interfere with your
daily activities (sleep etc)?”
Quality: “How do you describe your (the) pain?”
Radiation: “Does it radiate to another region of the body?” or “Does the
pain travel anywhere?”
Precipitating factor: “Do you have any idea of what might have brought this
on?”
Aggravating: “Does anything make it worse?”
Alleviating: “Does anything make it better?”
Associated problems: “Do you have any other symptoms besides the (cc)?” SP
may ask “like what” Then you continue with the questions:
Fever:
“Do you have a fever?”
“Do you have chills?”
“Do you have night sweats?”
“How high is your fever?”
Cough:
“Do you have a cough?”
“Is it a dry cough or productive cough?” “What color is the sputum?” “
Is there any blood in it?” “Is it foul smelling?” In all chronic cough,
ask about HIV status and tuberculosis.
SOB:
“Do you get short of breath?”
“Have you ever had any problem with your breathing?” “Have you had
wheezing?” “How far do you walk on level ground before you have trouble
breathing?”
“Have you had any attacks of breathlessness in the night?” (PND)
“Do you have trouble sleeping while lying down?” (orthopnea)
Nausea and vomiting:
“Have you felt nauseated?” (Do you feel nauseated?) “Have you been
vomiting (throwing up?”
If yes, then “How many times? What does the vomitus look like? What color
was it? Was there any blood?” (one question at each time)
Headache:
“Do you get headaches?” If headache is the cc, follow LIQOR AAA
“Tell me what happens before/during/after your headaches.”
“Do you notice any change in your vision?”
“Do you notice any fever or stiff neck with your headaches?”
Edema:
“Have you had swelling in your arms or legs?” or “Do you ankles swell?”
If yes, ask “where did you first notice it?”
Ask about diurnal variation, “Do they swell more in the day or night?”
Thyroid:
“Have you ever had problem adjusting to temperatures?”
“Have your voice changed recently?”
Urinary symptoms:
General: “Do you have any problem with your urination?”
Pain: “Do you have any pain or burning during urination?”
Urgency: “Do you have to rush to the bathroom to urinate?” or “Do you
have trouble holding your urine?”
Frequency: “How often do you have to urinate?”
Nocturia: “Do you have to wake up at night to urinate?”
Hesitancy: “Do you have to wait before you start urination?”
Hematuria/Pyuria: “Did you notice any blood (pus) in your urine?”
Straining: “Do you have to strain/push during urination?”
Weakness: “Have you noticed any weakness in your stream? Any dribbling of
urine?”
Incontinence: “Have you ever been unable to control the passing of your
urine?” or “Are you able to hold your urine until you get to the bathroom?
” or “have you ever urinated without your knowledge?”
Empty: “Do you feel that you haven’t completely emptied your bladder after
urination?”
Bowel symptoms:
General: “Do you have any problem with your bowel movement?”
“Have your bowel movement changed?”
“Do you feel any pain when you have a bowel movement?”
Stool: “Are they hard or soft? What consistency? What color?” “Have you
noticed any black or tarry stools?”
“Do you feel as though you strain to go to the bathroom and then very
little feces or none at all come out?”
Travel: “Did you travel recently?”
(refer to urinary symptoms for similar questions)
Sleep:
“Do you have any problem sleeping?”
“Do you have any problem falling asleep/staying asleep/waking up early?”
“Do you snore?”
Appetite: “How is your appetite?”
Weight: “Have you noticed any change in your weight?” If yes, ask: “How
much? In what period of time?”
Diet:
“Can you please tell me about your diet?”
“What do you usually eat?”
“Did you eat anything unusual lately?”
Dizziness:
“Tell me exactly what you mean by dizziness.”
“Did you lose consciousness?”
“Did you notice any change in your hearing?”
“Do you ears ring?”
“Did you feel the room spinning around you, or did you feel lightheaded as
if you were going to pass out?”
Joint pain:
“Do you have pain in any of your joint?”
“Have you noticed any rash with your joint pain?”
“Is there any redness or swelling of the joint?”
PMH: “OK, Mr. xxx, now I would like to ask few questions regarding your
past medical health. Is that ok with you?”
Previous episodes of CC: “Have you had similar problems in the past (before
)?”
“Do you have any other medical problems?” (Q: should be more specific?”)
“Have you been hospitalized before?” (What for? When?)
“Have you had any surgeries before?”
All:
“Are you allergic to anything?” (Can be specific such as pets, foods or
dust if the case is related to allergies.
If SP say yes, ask: “Could you please describe more about your allergic
problem?” or “What kind of allergic reaction did you have?”
Med: “Are you taking any medications? (both prescription and over-the-
counter)”
FH: “OK, Mr. xxx, now I would like to ask few questions regarding your
family’s health. Is that ok with you?”
“Does any one in your family have similar problems?”
“Are your parents alive (living)?” if yes, “How is their health?” if no,
“Oh, I am sorry to hear that. Could you tell me the cause of their death?”
If necessary ask for the family history of diabetes, HTN, stroke, heart
problem and cancer history.
SH: “Mr. xxx, now I would like to ask few questions about your personal
life style and habits. Is that ok with you?”
“Do you smoke?” if no, ask: “Have you ever smoked in the past?” if yes,
ask: “How long have you been smoking? How many packs per day?”
“Do you drink alcohol?” if no, ask: “Have you ever consumed alcohol in
the past?” if yes, ask: “How long have you been drinking? How much do you
drink per day?”
CAGE:
“Have you ever tried to CUT down on your drinking?”
“Have you ever Annoyed other people by your drinking?”
“Have you ever had Guilty feeling about your drinking?”
“Do you drink alcohol Early in the morning?”
“Do you use any recreational drugs?” if yes, ask: “What kind of drugs?
How long have you been taking them?”
Occupation and exposure:
“Do you work? What type of work do you do?”
“Does your job involve prolonged sun exposure?” (in case of rash)
“Are you exposed to loud noise at work?” (in case of hearing loss)
Exercise: “Do you exercise regularly?”
Stress: “Do you have any stress from your family (or work)?”
Sexual H/O: “Mr. xxx, now I would like to ask few questions about your
sexual history. Everything will be kept confidential between you and me. Is
that ok with you?”
“Are you sexually active?” if yes, ask “With men, women, or both?” “Do
you use any means of contraception?” if no, ask: “Do you have any problem
in your sexual life?”
In high risk group, ask: “Have you ever been tested/treated for STDs?” “
Have you been tested for HIV?”
OB/GYN H/O: “Mrs. Xxx, now I would like to ask few questions regarding your
gynecological health. Is that ok with you?”
If it is not a ob/Gyn case, just ask: “When was your last menstrual period?
” “Are your cycles regular?”
If it is a Ob/Gyn case continue to ask:
“How old were you when you had your first period?”
“Are your periods regular?”
“How many days does your period last?”
“How many pads do you use in a heavy day?”
“Have you ever bled between cycles?”
Vaginal discharge: “Have you had any vaginal discharge?” If yes, then ask:
“What is the color? Does it have any bad odor? Do you have any vaginal
itching?”
Pregnancy: “Have you ever been pregnant? How many times? Any miscarriages
or abortions?” “Have you had any other problems or complications with your
pregnancies?” “Did you have any complications during delivery?”
Pap smear: “Have you been getting regular pap smears? When did you have the
last Pap smear? Was it normal?”
Pediatric H/O: “Mrs. Xxx, now I would like to ask few questions regarding
your kid’s health in the past. Is that ok with you?”
“Was it a vaginal delivery or a C-section?”
“Did you have any complications during your pregnancy/delivery/after
delivery?”
“Did you breast-feed your child or use formula?”
“Are your child’s immunizations up to date?”
“When was your child’s last routine check-up?”
“Does your child have any allergies?”
“Has your child had any serious illnesses?”
“Is your child taking any medications?”
“Has your child ever been hospitalized?”
Daily activities (for dementia patients):
DEATH: Dressing, Eating, Ambulating, Toileting, Hygiene
“Do you need any help getting dressed/ feeding yourself/ going to the
toilet/ bathing?”
SHAFT: Shopping, Housekeeping, Accounting, Food preparation, Transportation
“Do you need any help shopping/ cleaning your house/ managing money/
preparing food/ getting from place to place?”
Psychiatric H/O: depression patients (c/o: fatigue)
SIG E CAPS
“Do you have problems sleeping?”
“What interests/hobbies do you have? Do you enjoy them now?” (have you
lost interest in things that used to interest you?)
“Do you feel guilty about anything?”
“Do you lack your usual energy?”
“Do you have difficulty concentrating?”
“Has your appetite changed?”
“Have you ever thought about hurting yourself or ending your life?”
“Do you have a plan to end your life?”
“Do you have any idea what might be causing this?”
“Do you have any friends or family members you can talk to?”
“Would you like to meet with a counselor to help you with your problem?”
Abuse:
“Can you tell me about the bruises on your arm?”
“Are you safe at home?”
PE:
1. Say: “thank you for answering my questions. Now I'm going to do a
physical exam, do you have any questions before that." Then “Now if you can
just relax for a moment, I am going to wash my hands."
Then go toward him/her and say: "Is it okay to untie your gown in order to
examine your heart and chest"
2. Help him in any movement, make his position comfortable for him, ask
his permit always, and ask about his comfort while u r examining. Elevate
the bed and extend the leg or the bed if u need him to sleep. Always drape
him and never expose unwanted areas, just uncover where you are examining...
3. Every time you want to examine something say that and take permit: as
Sir" thank you
4. Never repeat your examination, once and only once, be gentle...
5. Warm your hand before touch body, (may scrub your stethoscope with
alcohol swap if u have time.)
6. After completion of ur examination, correct SP position, thanks him
for letting you examining him and then tie his gown again
Closure
7. Summary Hx: Mr.xxx, thank you for letting me examine you. Now I would
like to sit down with you and give you my impression. Based on what you told
me and your physical exam, there are several (certain) diagnostic
possibilities like 1._____, 2. ________ or 3. _______ and others . But to be
more certain, let us order a few tests - like blood tests, chest x-ray, and
EKG. After we get the results, (we can reach a definite diagnosis and) we
will meet again and then discuss further management.
8. While concluding, keep this 4-stage pattern in mind to be complete
and to be courteous:
a. First, Counsel !!! For example - for a case of diabetes, it is good to
say a few words on foot care! If the patient smokes or drinks alcohol - say
"are you aware of the harmful effects of smoking / alcohol? Have you ever
considered quitting - if you wish to, we have a good support team that is
willing to help you quit the habit" that is it – don’t get personal about
it.
b. Then say "Have you understood everything we have discussed today?"
c. Then "Are there any special concerns you have?"
d. Finally "Thank you very much Mr. Smith. I shall leave my contact
information with my nurse - feel free to contact me anytime if you have any
questions." Smile and shake, Say: “take care yourself, bye.” (In case Time
falls short... If you have to leave, don’t make it abrupt and embarrassing
. Rather it is good to pretend looking at your beeper and say "Oh! Mr. Smith
, We have an emergency and I have to leave - I will see you as soon as I get
free" and leave with a smile.)
was
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daisyy (Daisy) 于 (Fri Sep 10 14:33:19 2010, 美东) 提到:
楼主真是好人那。写得那么详细，先收藏了。 感激！
especially
exam. Is
drape
says “
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susan1980 (susan) 于 (Fri Sep 10 14:54:04 2010, 美东) 提到:
Good luck!
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giantsfan (nobody) 于 (Fri Sep 10 15:14:38 2010, 美东) 提到:
楼主人品真好,回复又快又详细！不好意思，还想问一个问题，请问如果毕业3个月之内
找到volunteer的工作， 能用opt工作多久呢？谢谢前辈指导！
祝好人好运, pray for you!
was
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Mcdoudou (laowu) 于 (Fri Sep 10 15:26:35 2010, 美东) 提到:
my understanding is that you can work as a voluteer for 12 months, or I
should say till the end of your OPT.
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sillybird (sillybird) 于 (Fri Sep 10 15:37:41 2010, 美东) 提到:
Thanks for |
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