My experience with the CS exam was a year ago. This may sound a bit old, I now, yet when I was reading what I wrote on my diary on that day, I found that I wrote my algorithm that I used from the moment that they say "You can now open the doors to your patients", till I finished writing the patient's note. Here it is:
"Wedensday, 23rd of April, 2008. 10:17 am.
Right now I am on the train (Amtrak) heading towards Harrisburg from Philadelphia. Yesterday was my CS exam. I returned to the hotel very tired that I was not able to write anything about the exam. I spent the rest of the day eating, drinking (soda and water), lying in bed and watching TV. Today, I woke up abit later than I was planning, but I was able to make it to the train in time. The train is almost empty. In my car, there are only 3 people. That's nice. I will be able to work on my laptop uninterrupted.
Yesterday, I reached the exam center at 7:15 am. They waited till 7:30 then they brought us inside. They checked our ID, then they lead us to the room where we would put our bags, cell phones, and any electronics in a cupboard, then to put our food on tables assigned to us. They then started an orientation video, that was very similar to the one on the USMLE site. They confirmed several times that nothing should be with us except our white coat and stethoscope. They gave us a board with 12 blue scrap papers on it, and a pen. Then they allowed us few minutes to talk with each other so as to relieve the tension (and that trully worked effectively). The doctor on my left side was an MD, PhD (in neuroscience) and he already has been accepted in an ophthalmology residency. He visited South Africa for sometime doing some ophthalmology work there.
They then lead us to.....(sorry, I feel tired, I will continue later)
8:26 pm.
Now I am in the hotel in Harrisburg. Back to the exam. They then lead us to a hall containing around 22 doors, and each one of us stood in front of a door. We heard an announcement “SP, please be ready”. 30 sec later, we heard “Examinees, you may now begin your first encounter”. These 2 calls were repeated at the beginning of each encounter. We were now allowed to slide the small lid to read the clinical scenario. The first thing that I did is to write down the name of the patient, his age and the complaint. I then wrote down a list of the diagnosis I am suspecting in a column along the left edge of the paper. Then, underneath it, I wrote the systems that I would need to examine, in addition to the “PICKLE”. To the right of the examination column, I wrote a heading “investigations”, then to its left I wrote a heading “Counseling”. This left me the middle part of the page to take the notes I wanted during discussing the patient. I know what you will say, “this will take me a long time”. Well, I took me around 1.5 to 2 minutes, but I believe that it is worthed (I will know for sure after the results of my exam are available :) Then I knocked on the door and introduced myself “Good morning Mr. XYZ. I am Dr. Sherif, (shake hands), nice meeting you. Is every thing alright for you here in the room? (yes Dr, thank you) OK,let me make you more comfortable (and I would drap the patien)”. I then excused the patient to take notes while he speaks “Hope that you don't mind if I took some notes while you speak”. I then would proceed with the patient. The advantage of writing the DD before entering to the patient is that it will make you proceed in your questions without hesitating in front of the patient which makes an impression that you are not confident of yourself.
During the encounter, whenever the patient would tell me about something that would need counselling, I would write it beneath the heading “Counselling” eg smoking, alcohol intake or unsafe sexual practice. I also cleaned my stethoscope with alcohol swab after I wash my hands, before examining the patients.
After we finished the encounter, we would have 10 minutes to write the patient notes. I chose to type because I know that my handwriting would be awful if I wrote rapidly. During the clinical encounters, I didn't have any chance to look at the clock on the wall. And during writing the PN, the clock on the wall was away from me. But what really was of benefit was the 5 minutes and the 2 minutes announcements that they would make. For the PN, I practised to write the HPI and review of systems within 2 minutes, the rest of PAM HUGS FOSS in 2 minutes, then 3 minutes for writing the DD and needed investigations, leaving 3 minutes for writing the examination (in that order).
After we finished our first five encounters we had a 30 minute breaks, during which I uesd the restroom, ate some toast and drank some water. Then we resumed for 4 encounters. Then we had 15 minutes break then the last 3 encounters. The time for the encounters was a bit tight and I was only able to perform focused examination. I was worried that the 2.5 hrs of the first 5 encounters would pass slowly, but actually I did not feel any of them. They passed very rapidly. After the exam I felt that I had made a number of mistakes. I am waiting for the results, hoping for the best."
And for those who are curious, I passed my CS exam on first attempt, thanks be to God.
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