X******u
发帖数: 35 | 1 Step2 CS 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：
1)关于准备考试。Step 2 CS 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。Full-time的话一
个月足够。
2)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。
3)关于考点：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。
4)到最后CS考试70% 是在考 communication& interpersonal skills (CIS). 我
分享一下我的心得。
a.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。
b.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。
c.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：1： It must be a difficult time for you 2:
you sound really worried/concerned 3: 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。
d.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).
e.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!
f.不能超时，少记笔记，maintain eye contact。
g.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。 | X******u
发帖数: 35 | 2 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?)
“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.)
upset patient “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? | B*******e
发帖数: 278 | | b****k
发帖数: 409 | | S*******y
发帖数: 18 | 5 谢谢！非常有用，祝你成功match！太谢谢你分享经验给大家啦！我正在准备step1，看
到前辈考完每一步考试的考经，都能从复习的困难打击中走出来 | w*********p
发帖数: 125 | 6 Ximedus不错，我前年去过。但时间很紧，很stressful。能得到非常系统的reflesh。
当时有个以前在纽约指导舞台的先生教我们神经系统的检查，另外还教我们怎么有逻辑
性的讲话，我觉得这个人很有水平（不是医学知识）。
我没参加过其他的，没有比较。 | e*******g
发帖数: 39 | 7 感谢分享宝贵的经验，很有用的信息，赞，祝match成功！ | E****3
发帖数: 151 | 8 Many thanks for sharing!!! | S*********l
发帖数: 783 | 9 Thanks a lot for this very detailed fresh experience! It's very valuable!
Wish Louzhu all the best! | s*******g
发帖数: 115 | 10 牛！先在此多谢过，回头好好消化经验之谈。祝你一切顺利！ | | | w******8
发帖数: 44 | | s*********e
发帖数: 120 | 12 如果病人看上去表情有变化，直接指出变化
I noticed that you : looked down/voice changed 。。。
不建议直接label: you look sad, etc. 以免不准确的猜测。 | X******u
发帖数: 35 | 13 Step2 CS 我三个月考了两次。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 with 1 additional month's preparation: all three areas are high
performance 星星在最右边.
总结：
1)关于准备考试。Step 2 CS 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。step 1, CK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。
2)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。
3)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。
4)到最后CS考试70% 是在考 communication& interpersonal skills (CIS). 我
分享一下我的心得。
a.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。
b.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。
c.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：1： It must be a difficult time for you 2:
you sound really worried/concerned 3: 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。
d.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).
e.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!
f.不能超时，少记笔记，maintain eye contact。
g.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。
h.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。 | X******u
发帖数: 35 | 14 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? | B*******e
发帖数: 278 | | b****k
发帖数: 409 | | S*******y
发帖数: 18 | 17 谢谢！非常有用，祝你成功match！太谢谢你分享经验给大家啦！我正在准备step1，看
到前辈考完每一步考试的考经，都能从复习的困难打击中走出来 | w*********p
发帖数: 125 | 18 Ximedus不错，我前年去过。但时间很紧，很stressful。能得到非常系统的reflesh。
当时有个以前在纽约指导舞台的先生教我们神经系统的检查，另外还教我们怎么有逻辑
性的讲话，我觉得这个人很有水平（不是医学知识）。
我没参加过其他的，没有比较。 | e*******g
发帖数: 39 | 19 感谢分享宝贵的经验，很有用的信息，赞，祝match成功！ | E****3
发帖数: 151 | 20 Many thanks for sharing!!! | | | S*********l
发帖数: 783 | 21 Thanks a lot for this very detailed fresh experience! It's very valuable!
Wish Louzhu all the best! | s*******g
发帖数: 115 | 22 牛！先在此多谢过，回头好好消化经验之谈。祝你一切顺利！ | w******8
发帖数: 44 | | s*********e
发帖数: 120 | 24 如果病人看上去表情有变化，直接指出变化
I noticed that you : looked down/voice changed 。。。
不建议直接label: you look sad, etc. 以免不准确的猜测。 | n********3
发帖数: 6 | 25 请问楼主，你怎么可以一个月考2次CS呢？不是都要6到8周才出成绩吗？ | X******u
发帖数: 35 | 26 你是对的。我记错了。我是考完CS马上考CK,CK考完一个月内再考CS.总共是三个月吧。
所以是三个月两次。我已经纠正。
【在 n********3 的大作中提到】
: 请问楼主，你怎么可以一个月考2次CS呢？不是都要6到8周才出成绩吗？
| X******u
发帖数: 35 | 27 其实没有问题。可以想一下，病人没有你说的那种情绪,他/她也得回应你， 然后你就
有线索了。比如：
You： “Is everything all right? you look sad. "
patient "No, I am not sad. I am just concerned that I may have XYZ"
如果病人说 "No I am not sad" 然后就没有再说什么。你也可以说 "Let me know if
you have anything to share with me. I want to help you."
这里面最关键是要recognize the need to address emotions.你只要做了这一点，无
论你怎么做，只要不是太离谱，病人都会给你线索。当然你建议的方法也是好的。看官
们各取所需吧。
【在 s*********e 的大作中提到】
: 如果病人看上去表情有变化，直接指出变化
: I noticed that you : looked down/voice changed 。。。
: 不建议直接label: you look sad, etc. 以免不准确的猜测。
| c*****l
发帖数: 113 | 28 Thank you so much for the sharing!! Really appreciate.
high
【在 X******u 的大作中提到】
: Step2 CS 我三个月考了两次。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 with 1 additional month's preparation: all three areas are high
: performance 星星在最右边.
: 总结：
: 1)关于准备考试。Step 2 CS 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。step 1, CK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。
: 2)关于补习班，还是很有必要的。补习班我上了两个，usmle gold review –new
|
|
