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Key to Success

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Key To Success
Why do students fail? Every student who appears for the CSA is capable of
passing. Then, why do certain students pass and certain students fail?

Based on my observations there are several apparent reasons why certain

students fail. Becoming aware of these reasons you can avoid potential pitfalls
while taking the CSA.
TIME MANAGEMENT is key!
The best way for success is repeated timed practice of simulated cases on real
people. Practice, practice, and more practice...
Most of the candidates who appear for CSA mess it up by becoming nervous and
anxious. Don't do that. Maintain your cool and composure.
Don't be over confident. Some of my friends who got above 90 in both the steps
flunked the CSA. They thought that they could easily pass the CSA and they did
not do the preliminary preparation required for the CSA. That doesn't mean the
CSA is tough. If you think you speak English well and you will pass because you
are fluent, think again. This exam not only tests your communication skills, but
how you collect and digest info to reach a diagnosis, and your writing

proficiency.
If you fail, don't feel depressed. It's not the end of the world. It just means you
need to regroup, brush up on your technique, and try again. Don't give up!
If you are poor in English, try to improve it. You don't have to speak like a
Native American but you should be able to communicate clearly with the patient.
You might want to consider having several sessions with an ESOL teacher who
could evaluate your dialogue and help you with pronunciation and the word
order of your sentences.
Read the CSA orientation manual well. The exam is very similar to it.
The exam is a very basic assessment of your data gathering ability (history
taking), communication, and interpersonal skills.
You need to know how, and become proficient at, taking a highly focused history
and P/E in 15 min.
When they say focused, they mean focused. If you overdo the history taking
your communications part will suffer. Remember: manage your time well.

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Try to be half way through the P/E when they announce that five minutes are

remaining.
Unfortunately, up to 80% of students failure of the exam is due to data

gathering. So, don't neglect that part.

The way you introduce yourself to your patient is very important. The following
introduction appears good, but is not: Hi, my name is Dr.

. How are you

doing today? What brings you here?

1. The main fault with the above introduction is that the patient is

never addressed by name.

2. The correct way to introduce yourself is, Hello Mr.____ (patients
last name) I'm Dr.____ (your last name). What brings you here
today?
3. Always address the patient by name and never introduce yourself
without addressing the patient.

Keep as close as possible to the CC and related history. When asking the family
history or past history, use broad open questions. If there is anything
significant, they will tell you. In fact, they will be anxious to answer the
questions.
Expect every day common cases only.
Remember to knock on the door, shake his hand, and show him your teeth!!!
SMILE!
You may be nervous with the first S.P. Never panic.
The first S.P may be the hardest because you don't know what to expect.
Remember to concentrate, make the best use of your time, don't leave the room
early, and don't rush the patient.
Take a good history and make a mental note of the questions you must ask for a
particular symptom.
Most patients are spontaneous up to a point, but then ask them specific
questions to further explore the symptoms.
Study the differentials of common symptoms, two to three of the most common
in America will do. You can't rule out more in 7-8 minutes time.
Prepare differentials of common symptoms not diseases.
Always be polite and smile, even if the patient is acting difficult.
Use common sense, and try to communicate effectively. Getting the message
across is more important than talking endlessly.

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If a patient is in pain, don't immediately start interrogating him like an FBI

agent. But ask him if he can answer some questions so you can better
understand the cause of his pain.

Do a focused history and always address the patients concerns as you go.

Always be honest with him.

Don't waste time on a complete history; move from stage to stage quickly and

efficiently.
Always wash your hands before the physical examination.
Always remember to drape the patient well.

Try to have a running commentary with the patient. This means explain what

you are going to do before actually doing it and if possible explain things as you
go. For example: Now, Im going to listen to the heart sounds by placing the

stethoscope on different areas of your chest.

Keep your thoughts flowing. You cannot stop, even for a second, in front of the
patient to think.
A good technique to help you review whether you've asked all of the important
questions or not is to concentrate on them while you're listening to the patients
heart or breath sounds. That is, pretend you are listening to these things but
mentally be going over your checklist of the history intake. Most of the vital
signs of the standardized patient will be normal so don't worry that you will miss

findings.
Help the patient move from one position to another.
Make sure the P/E is focused on the chief complaints.
Stay focused and calm throughout the exam.
At the end of everything, help the person tie the gown, sit up, and then seat
yourself on the footstool. Good closure is extremely important. Good closure
involves discussing your possible deferential diagnosis (Don't panic if you have
only one. Never say that you know the diagnosis. Instead, tell the patient the
several possibilities you are considering and that you will need to wait for the
test results before giving your diagnosis.)
Take time to explain your findings and your diagnostic plan of management with
the patient at the end of the encounter.
Tell the patient that you are concerned about him and would like to discuss his
condition further with him when his tests get back.
Make sure the SP understands every thing you have planned for him.
Be sure to talk about risk factors with the patient and offer the appropriate
counsel.
The standardized patient definitely asks you certain questions. Don't evade

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them. Be ready to answer challenging questions with common sense. It's very
important that you be honest with your answers. If youre not sure, tell the
patient that you dont know at this time but will get back to him with the
answers to his questions and concerns at your next meeting.
1. Ex. Like when you are dealing with a case of pericarditis the patient may

ask, "Is this an episode of heart a attack?"

Your reply should be: It really doesn't look like an episode of a heart attack
because the pain is chronic, postural, and increased by breathing. Although, I
cant rule out the possibility completely. Im going to do some investigations,

and will get back to you.

Before leaving, ask if there is anything else they would like to talk to you about.

A difficult patient is one who will not answer your questions in a polite manner.
This is by design to see your response. Remain calm, smile, and try to extract
the best history possible. Behave like a professional doctor doing your job and
move on from there. Remember that they have been told to act like that. Try to
determine why he is behaving in a particular fashion. For example, if he is
angry, you could say, "Mr. xyz, you seem to be angry. Could you please tell me

whats wrong and is there anyway I can help you?"

Be confident. Confidence is the key to success, Never lose your cool.
Avoid the temptation to be overly friendly with the patients. Remember, you've
spent $1,200+ to take this exam, {not to mention a few $1000 more to get to
Philly or Atlanta and for accommodations etc.}, so there's a lot at stake.
Memorize the patient note format in the CSA orientation Manuel.
Know the abbreviations given in the ECFMG booklet/USMLEWORLD and practice
using them.
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