‫بسم هللا الرحمن الرحيم‬

‫َوأ َ َّما ِبنِ ْع َم ِة َر ِب َك فَ َح ِد ْث‬

“as for the favor of your Lord, report
his gifts to you.”
 USMLE CS Exam
 Cs exam on 27/ May / 2016
 Result: With All Thanks to Allah Alone….
Pass with high performance In all partitions
 Center: Philadelphia…
 STORY?!!!
Cs exam:
 5 centers in US only:
 1.Atlanta
 2.Chicago
 3.Houston
 4.Los Angeles
 5.Philadelphia has 2 centers by the way!

 Which is Best?!!!
Exam Format:
 1 day exam, 8 hours, 12 patients
 Now every 3 cases/ you get 10 min break/ one 30 min
break.
 Each patient encounter 15 min (1 bell when 5 min left)
 Then 10 min for patient note (1 bell when 2 min left)->
computerized PN
 Test 3 parts:
1-ICE: Data gather and data interpretation.
2-CIS: Communication skills.
3-SEP: spoken English proficiency.
TIPS!
 Morning or evening sessions..!!
 Which center..!!
 Dress.. Hijab!!
 Take with you: Faith, Passport, Scheduling permit,
Food..in Center
 In Center: bathroom+ break 
 Costs..Exam: 1200 $, Travel: 1300$, Living:500-700 $ a
month, House: 400-800 $ depends..
 Time is US before Exam: 2 weeks enough.
 English..!!
 Failure Causes..!!...Attitude..
 Draping.. An Old Story 
Time to prepare:
 Depends!!
 Free person: 1-2 months
 Working with available study time: almost 3 hrs daily
for 5 days a week: 2-3 months with almost 10 days to
2 weeks completely dedicated to the CS study.

 When:
 With any sequence, either before doing any other step
in USMLE or I prefer to be after step 1, step 2CK
Sources:
 A lot, but FOCUS in few will be your guide:
 1. First Aid CS step.
 2. Mohamed Elsayed Notes.
 3. Neeraj notes (for transitions and Communication skills).
 4. EAMTAR videos: Dr Hosam Elnawasrah, Dr Omar
Zakaria Videos.
 5. CSE videos for clinical exam and practicing the
encounter.
 6. STUDY PARTNER..Very.Very. Very Critical..
 7. Asmaa Shaboun Notes..(for systems) 
Encounter Management
15 min as follows: (as they Say, not me!!)
7-8 min:History
3-5 min : Physical exam
2-3 min: counseling..
Finish before the encounter End…Always Practice so….
Patient note: practice to finish in 9 min only..will need
only 1 week before the exam to think of it.
DOORWAY information:
Name/ age/ Vitals/ Complaint you can have 40 sec to 1
min. (VERY important?)
How to prepare?
 The start POINT: 8 days…..
 1. Practice the encounter start , transitions and
Closure: 3 days only.. Each part 1 day
 2.Study the frame
 3. Practice Review of systems : FEVER/BURN/SWADE
mnemonic : 1 day
 4. Practice the Past history part: PAM/H/FOSS
mnemonic: 2 day
 5.Practise the previous part in your room: 2 day..
Start…=1 Day
 Counter Starting.. To take 1 day only Please..
 Save these lines:
( Knock the Door: open , don’t enter but say the patient name as a question:
MR James?!
He will say Yes, then enter and say the Following:
Hello Mr James, Ia m Dr Asmaa the attending physician here Today, I will take care
of you.
Nice to meet you Shake hands at this statement
I will be asking some questions and perform physical examination, Do you mind if I
write down some notes while we talk?
He will say No, then say:
Thank you, ok mr James ,How can I help you Today?
He will mention his Complaint  (I have pain in my chest since this morning),
then you say:
I am sorry about that, I will do my best to help.
Then 2 options:
1> either start to analyse the complaint
2>or ask the following: Can you tell me more about it?
Transitions….=1 Day
 Statements in between.
 BE FAST please…
 1. before System review:
 (now I want to ask you few questions to review your other systems, is it ok?)
 2. before the past history:
 (now I will ask you some questions about your health in the past, is it ok?)
 3.before family history:
 (I will ask few questions about your family health, ok?)
 4.before social and sexual history:
(now I will ask you few questions about your day to day activites and your sexual health,, I
assure you that every thing will be kept confidential, is it ok?)
 5.before physical exam:
(thank you Mr James for sharing your problem with me, just to summarize what you have
said, you told me………….
Ok, now I’d like to perform a quick physical exam, is it ok?
Thank you very much, excuse me for a moment, I will wash my hands).
 6.While washing hands:
(Is there anything else you would like to add or discuss ?)
Closure…=1 Day
 The Pass Part….
 1.(thanks Mr James for your Cooperation, from the history and
the Physical exam, you are most probably have……, however there
are some other possibilities such as .... And …….
 To rule out these possibilities and to know what exactly the
problem, we will need to run some blood tests and some imaging
studies. Once the results are available we will meet again and
discuss the final diagnosis and further management to that.)
 2.Then the counsel part about Alcohol/ Smoking/ Sexual part.
 3.Closure:
(Ok Mr James, Do you have any other questions or concerns?
Ok, we will meet soon once the Results of your lab are available, feel
free to contact me if you have any other concerns,
It was a pleasure meeting you..have a nice day..)—Shake hands here
M/ James/ 46 / BP:160/100
O FEVER
P B
D U
SFC R
L N S
I W
Q A
R D
AAA E

P Counsel
A
M
H
F
O
S
S
Complaint analysis….=2 Days
 Any complaint: OPDSFC/AAA/
(from Neeraj notes)
 Pain Complaint: LIQR/AAA/
(from Neeraj notes too)
 Any fluid or discharge: ABCO
Amount: How much is it, tea spoon, table spoon or cup
full?
Blood: Is there any blood on it?
Color: what color is it?
Odor: does it have any special smell?
System Review…=1 Day
 FEVER/ BURN/ SWADE
 FEVER: (do you have any fever/ chills/ sweating/Travel?)
 BURN: B: Bowel: (is there any chnages in your bowel habits? Any
abdominal pain?)
U: urinary: is there any change in your urinary habits?
R: Rash: Do you any rash?
N: Neuro: Do you have any headache?
 SWADE: S: sleep/stress/: how is your sleep? Do you think you
are under more stress recently?
W: wight: did you notice any change in your weight?
A: Appetite: How in your appetite?
D: Diet: what about your dieting habits?
E: Exercise: Do you exercise regularly?
Past History…=2 Days
 PAM/H/ FOSS
 P: Past: similar episodes/ Medical problem/ Surgery
 A: Allergy: Do you have any allergies?
 M: Meds: Are you taking any medication, or have taken any?
 H: hospitalization: have you ever been hospitalized? When? For
what?
 F: Family: Does any one of your family has a similar problem?
 How are your parents?
 O: Occupation: what are you doing for living?
 S: Sexual..( from Dr Mohamed Elsayed)
 S: social..(from dr Mohamed Elsayed)
 NOW………
 almost 8 days done….
 Now going to SYSTEMS…..
 My Strategy…is different…
 Strategy
 Each system to be studied alone in few steps:
 1. Dr Mohamed Elsayed List of Questions for each system..
 2. then My own frame to each system
 (Asmaa Shaboun Frame)
 3. Allocate all the long cases in FA for that system. Study
well, and read the mini cases too…
 4. from the mini cases make DD list for each system and
Mind map to each complaint.
 5. Study at your own room with your door too that system.
 6. Study that system with someone in SKYPE or any where.
Then?!!
 You finished all the systems??
 Congratulations…
 Now: Physical exam start…
 SOURCE: 1.CSE exams….either take them from any one or
actually buy it online too, really worth…
 2.USMLE world: Good to teach you proper examination , really
perfect…(Physical exam must be studied from here first)
 Then have your own style…
 Be Fast and efficient please…be comfortable..
 At last, 2 weeks before the exam, you will be in US, practice there
LIVE with any partner, especially to master the encounter time
and Communication skills part.
STUDY partner
 Find online, you can find, just search…
 How to make your practice efficient:
 --go to youtube, find a video called USMLE timer, this will
be the back ground while practicing…(FINISH the
encounter within time)
 The physical examination part while online practicing …!!
 Custom your self while practicing with your own style and
fix it.
 Study the long cases with your friend as we said, each
system alone, at the end, get mixed cases to practise..
 In US: practice at least 4 hrs with your partner before you
exam day to feel the exam exretion.
SUCCESS Startegy
 Faith…is every thing..
 English: work in your English, listen a lot, to get good accent and
pronunciation.
 Attitude…is really what matter.
 Thank the patient..smile with him, shake hands .. Be A Human, better to
Say a Muslim with manners..
 Don’t fake anything..the are patients..if you think for a second that they are
acting you fail the Exam..
 They are just patients, they will not say if you are a doctor or not..give your
care,, be a doctor with good attitude
 Remember that there is a part in the checklist I knew about it from a friend:
they ask the SP: Do you want this doctor to be your future doctor?
 While in Emergency case: seem worried about the patient..tell the patient the
lab will be done today, he will not leave the hospital until you have an idea, and
you are sure your patient is ok to go home…
At Last
 Remember to pray for me..
 Keep Good Motivation in your heart to your nation..
 Teach others..Help others..Be a good Model..
 At last..
 MAY Allah guide you all my colleagues in your future
ways,,
 Thanks to Dr Ahmed Hamed, Dr Ahmed Anwer from
Alexandria University who helped me to record this
Video…May Allah Guide you throughout your way..
 Thank you for listening..all that time