The Step 2 CS is unlike any exam you've likely experienced in
your medical career. For many candidates, part of the difficulty
in taking the Step 2 CS is getting over the fact that the
patients aren't "real." It is important that you treat the Step 2
CS's standardized patients as if they were real patients; if you
don't, your performance will be compromised. The other major
challenge is taking the patient's chief complaint and quickly
narrowing down the differential so that you can perform a
directed history and physical in only 15 minutes.
Maintaining a positive personal manner
Step 2 CS Interpersonal Skills Advice Communication skills are
a large part of success on the Step 2 CS. When a doctor relates
to a patient in an empathic way, asks questions clearly, listens
carefully, and involves the patient by explaining, paraphrasing
and summarizing, then the patient responds more readily and
fully. The more skilled the doctor's interpersonal style and the
clearer his communication, the easier it is to elicit the
significant data from the patient.
After you finish an encounter on the Step 2 CS, the
Standardized Patient will complete a checklist that rates your
skills in interviewing and collecting information, counseling and
delivering information, establishing rapport, and maintaining a
positive personal manner.
Six Tips
This following six tips can help you maintain a positive
personal manner. This advice isn't specific to the Step 2 CS;
it's also great general advice for your clinical career.
- Always knock before entering
the examining room. Knocking on the door before entering is the
first step in building trust and showing respect.
- Introduce yourself by name.
After entering the room, you should introduce yourself by name
and address the patient as Mr. or Mrs./Ms. ________ . Don't
address the patient by his/her first name, as this is
considered less respectful. An appropriate introduction might
be something like: "Hello Mr. Smith, I'm Dr. Jones and I'll be
taking care of you today." You should also shake the patient's
hand as you introduce yourself. An exception: if the patient is
doubled over in pain, you can forgo the handshake out of
deference to the patient's comfort.
- Maintain comfortable eye
contact. During most of the encounter, you should look directly
and easily into the eyes of the patient. It's ok to break eye
contact to take notes or perform some of the physical exam
maneuvers. In general, however, if the doctor seems embarrassed
to make eye contact and avoids doing so, or keeps looking
distractedly around the room, he/she would not be given
"credit" for eye contact on the checklist.
- Focus your attention on the
patient. Throughout your 15 minutes with the patient you should
focus your attention on the patient- not on your watch, not on
your notepad. While this seems obvious, in the stressful
environment of a high-stakes test, it's easier said than
done.
- Convey a sense of concern. You
will be evaluated on whether you appear empathic. You can
convey empathy in a number of ways, including attending to the
patient's physical comfort. You should extend the leg rest when
the patient lies back and push it back in when he/she sits back
up. If the patient seems to be in pain, you should ask if there
is anything you can do to help him/her feel more comfortable.
If the patient appears to be in emotional pain, you must be
supportive as well. A few minutes of silence are appropriate,
followed by an expression of concern such as "this must have
been a difficult time for you, can you tell me about it?"
- Be respectful of the patient's modesty. To convey this
respect, you should drape the patient's legs no later than the
beginning of the physical examination. You should also ask
permission or let the patient know when you're going to untie
the gown or move the drape and you should expose as little of
the body as necessary to perform the physical exam maneuver.
Once you complete the maneuver, you should immediately replace
the drape or retie the gown.
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