Just got over with my USMLE Step 2 CS!!! Finally, my trilogy is complete and I will be ECFMG certfied by next year. Yippee!!

But Step 2 CS experience was not that good, rather like hell…not because my exam went bad, the exam is NOTHING, a piece of shit, a cakewalk…but because I was having cold and high fever when I went into the exam :-{ Man that one week prior to exam was terrible. Firstly for month of July and August I was in the sucker surgery department, where you have to work like an ass whole day and I took risk to bunk 1 week and then even after taking the risk I get fever and terrible cold, enough to ruin my career!!! I could not sleep at nights, had these nightmares and woke up sweaty with terrible headaches and feeling dizzy. Then during day I was down with fever as high as 104 and backache, just did not feel like doing anything. I was miserable. Then there came the indecisiveness, I felt like postponing my exam the day I was leaving for US, but I did not want to do the stupid CS preparation again for the earliest next date was available in January 2009!! To be honest, I was fed up with CS preparation: you have to act, do fake physical exam and everything is so artificial!! So I wanted to get over with it but in the back of my mind, I was like…what if I fail? What if I get sweaty and dizzy during my encounter? Man, it was tough to make decision. Finally I went forward, and I am glad I did. Here I am, writing my exam experience. Don’t have fever right now, but frontal headache and slimy green scum coming from my nose…yummmy….

OK, enough of my brave and inspiring story. I was just lucky in that my fever broke just before my exam day and I was able to take exam feeling a bit upbeat about my health. But still I had a husky voice and cold and I was really worried about whether the SP will understand me or not!! Luckily they not only did understand me but also followed whatever I said without a fuss. And I had to only repeat twice in my 12 encounters!! Now my exam experience…

Well, my exam was scheduled in Houston. Why I choose Houston? Well people say that SPs at Houston are friendly and it has been an IMG friendly test center, but I chose it for a different reason. I wanted to complete my American story (at least its first part, i.e. till being ECFMG certified) from where I started. I was in Houston for my first US clinical elective and what better way to wrap things up than giving your CS there!! But one thing for sure, SPs at Houston center are very friendly and I did not encounter a single hostile SP or uncooperative SP. They pretty much allowed you to do everything without much cranking.

OK, now the exam. Well, exam has 12 SP encounters. The SP encounters deal with common medical problems (read First Aid and USMLE World cases!!) Most of cases are about simple stuff like headaches, abdominal pain, dizziness, yada…yada…and few typically American “lifestyle” diseases like domestic abuse, elder abuse!! You just need a fundamental preparation for this exam. Come on we don’t need to be told by any book (yeah even FA) as to how to take history and do examination. That’s redundant and demeaning!! You just need to polish your skills a bit and practice to be polite and apologetic, something which doesn’t come naturally to us and our egos. So what I did was to practice FA cases. I didn’t have a study partner and I used to both ask and answer questions. This made my preparation all the more boring and sucking…and I really wanted this exam to get over. I did all 31 FA cases THRICE (holy shit!!) AND all 43 online UW cases also THRICE (u are psycho, man!!). So by the time I was ready for my exam I had done an astounding 222 cases and I was fed up like hell with CS and wanted to just whip its ass off. And then coupled to this I get fever, which makes me skeptical about postponing my exam. I hope you can understand what I was going through!! During my preparation I made mnemonics for almost all FA cases and I will be uploading them fast, so that morons like you and me can kick USMLE in ass!!

OK, so what’s its like on exam day. You have to reach exam center like 30 min earlier and you sign in and sit at your assigned seat. My seat was 11 (which I consider lucky!!). Then you read a “what’s allowed in exam center” like stuff and wait for others to tickle in. There are usually 24 examinees taking an exam on a given day. Considering you are in morning session, as I was, by 8:30 am registration closes. They then take you for an orientation video and to lockers where you should keep everything but food you brought with you. Try to keep your food on your assigned table, so that you can eat it during breaks. And don’t forget to take your tiffin with you once exam is over. I did and also forgot to take back my medicines and tissues (I suck!!). So what’s the orientation video deal about? Its the same video you got on USMLE CD, the only difference being that its shown on a projector!! Once the video is over you get to try all instruments and the examining table. After that the proctors, divide the candidates into two groups: the red team and blue team (Its a Deathmatch or what??). The red team dudes wear their roll numbers on a red paper and blue dudes on blue paper. The red guys get placed on one side of hallway, which has 12 rooms, and the blue guys get the 12 cases on the other side of hallway. I would assume that cases on two sides on a given day would be similar as the people on other side also got free at pretty much the same time as we did.

So the encounters. Before the encounter begins you hear “SP prepare” and 30 seconds after that you receive the instructions to begin. This “SP prepare” sort of announcement really removes apprehension as to when the case will begin. The first encounter is always tough, but if you are lucky and the SP understands your English well and is cooperative, it can be a piece of cake. Luckily for me both happened. I felt so relieved after the first encounter that finally my preparation paid off and I took the right decision about taking the exam and getting over with it in spite the hardships. Writing patient notes is breeze and the time they give you for encounters and writing PN certainly seemed more than adequate on test day and I was like sitting idle for 3-4 minutes, having finished my encounter and PN early. (Of course I was not sitting idle, I was cleaning out my nose!!!). You get confident after your first few encounters and after that it’s a breeze. Infact you start looking for breaks (sort of like…OK, one more case before the break!!). There are 2 breaks in exam: first one is of 30min after 5th encounter in which they also give food (for my vegan friends you will have to suffice with fruit salad, cookies and mashed potatoes only :-{ ). The second break is after the 9th encounter and is for 15 min (no food is served so you should try to save some food from the previous break, at least the fruit salad!!). Finally after 12th encounter, you complete a survey just like in Step 1 and 2CK and they give you a confirmation that you appeared for the exam.

And when it does get over, you can’t help but think…bachaon kaa exam thaa yaar…