DIP Episode 60 - The USMLE Step 2CS Guide

Okay, welcome. My name is Devine. I am a PGY1 transitional year resident. This is the 60th episode of the Divine Intervention Podcasts and today we'll be talking about the step 2 CS exam. Basically I'm gonna call this the USMLS step 2 CS guide. Okay, this is gonna be in a some order and a motor, but I think if you follow this advice, I think you'll do really well on your exam. Step 2 CS is traditional and exam that, you know, I mean a lot of people pass, but some people freak out about it and I truly, some people truly feel it. So I'm all encouraged to sort of like take this advice seriously and I think it should be well on your way to doing well. And the first thing is this has no slides. Just something you have to listen to and take notes if you want to. But basically the structure of step 2 CS right, it's you have 12 stations, you have 12 cases, right. Some will be pizza cases, right. So there'll be like phone cases. And basically you have 15 minutes to see the patient and then you have 10 minutes to write your notes about 25 minutes per patient and they'll give you a belief two sets of break time during the day. You'll learn about that when you go for your actual test. But the thing is how is step 2 CS itself graded, right. So I mean the information these supplies kind of vague, right. But from my research right there are three big areas that are graded, right. So one is spoken English proficiency, that's kind of self explanatory. Another one is your CIS, right.

And CIS, I mean a few things that could give you great scores, right. If you ask open-ended questions, right. Like that's especially at the beginning of an interview or you use easy like language that's accessible to the patient or you you demonstrate empathy, right, with the patient or you show interest in the patient like your pin-rock attention during the interview or you're using techniques like repeat back like, oh, can you, can you the patient Somarie's would be just talked about just to make sure you're on the same page, right. Or same what you're doing on why, right. So let's say for example we say like, oh, I'm listening to a chest because I'm trying to make sure that you don't have any like weird heart rhythm or weird heart sound, right. You're doing a physical exam, we explain what you're doing, you explain why you're doing that thing. That gives you a lot of a CIS points. And you may have recalled that a few seconds ago, I said like, oh, you should use accessible language in your in your interview. You certainly don't want to use like that kind of language in your notes like belly penny or note, no, you want to use abdominal pin, okay. If you write the term belly penny or note, you lose ice points. And that I guess is a nice segue into the third portion of the US Emily step to CS exam, which is the ice, the ice section, the ice section basically tests a couple of things, right. It tests like how good are your gathering information.

It tests how good you are interpreting that information, right. So like do you interview appropriately? Do you gather information that's pertinent to the most likely diagnosis? Are you selecting treatment plans? Are you selecting diagnostic modalities that are greenisely with the diagnosis that's been made? Those are kind of like key things that are tested with ice. So you want to do well on those three domains because if you actually do poorly in one domain, you would actually fill the entire exam, right. So again, you want to keep those things at the back of your mind. And to be perfectly honest, this is not an exam you want to retake, right. It's a whole day, it's like eight hours, right. So it's something that you'd want to try to avoid retaking if you have to. So let's, I guess jump right into I guess a bunch of rules. I feel that are useful for step to CS, right. So the first one is don't run out of time, right. The thing is if you keep running out of time, I mean if you run out of time on one station on two stations, not the end of the world, right. But the thing is if you keep running out of time, you'll hurt your CIS scores, right. Then you can throw you off during the exam, right. So again, don't feel terrible if you run out of time on one station, but I don't want to run out of time on like six of your stations, right. That begins to put you in a precarious situation. And then another thing I found to be useful on step to CS is to always cancel on the spot, right.

So if for example, patient tells you, oh, I smoke or I drink, cancel them right there and there. Because the chances of you forgetting are pretty high. And then if a patient expresses a problem, this is a great chance to get your CIS points, right. Apologize for the problem. Oh, I'm sorry. It must be first reading that you are going through all this stuff, right. Through problem X. So it's like you apologize for that and express empathy again. That will give you CIS points. And for those of you that feel the exam, I will try to get the earliest date possible for your retake, right. The thing is, I mean, I don't have much information about this, but I do believe you actually I'm quite certain that there's software you can use to monitor like the scheduling website so that you can try to get your, like once a change happens on the website, like a new date pops up, you will get like some kind of alert or something. That may be something you want to look into. Because I mean, in general, if you are applying for a residence, you want to try to get your step to CS scores before rank lists made, right. Some programs actually require step to CS scores to be able to rank you. And then the next thing is to kind of make sure you summarize at key points during the case, right. It's actually a pretty powerful strategy and it helps a lot with CIS points and with ice points, right. So for me, at least when I took my test, I always did two summaries.

I always did one at the end of the HPI, right. Just to make sure that I have the detailed straight, right. So I could say, like, oh, so you presented with a chief complaint of this, this basically I summarize like the high-yield portions of the history and say, do I have everything right. It's a very nice way to establish rapport with patients. And then I also do a summary at the end where I basically, like after I've done the chief complaint on the HPI, done the physical exam, I basically like give like a one-liner of the chief complaint, talk about any pertinent physical exam findings I had, right. Talk about the likely cause of the patient's presentation, right. The things I plan to do, and then I do any additional counseling if need be, right. And then I ask if they have any questions, right. Again, super important. This is where a lot of CIS points are come from. And another key thing for step two CS is you want to book you exam early, right. Because the thing is the date school by relatively quickly. So you want to try to book like six to nine months in advance if you can. And I mean in terms of prep for the exam, right. First step, first step to CS is a phenomenal resource, right. It's a great resource. Basically what I did was I read the cases first and then I practiced them. Okay. So read first, then practice them. Okay. And the thing is if you want to practice like the time crunch when you're writing your notes, right.

Because you have 10 minutes to write your notes, I will encourage you to use the US Mly software. They actually have like a time to notes thingy that you could just use to practice your notes. So you can very easily make a word document and then use a stop clock on your phone or something to time yourself. And then, but let me just sound a note of warning on first step to CS. Again, it's a great resource. It's an amazing resource. It's super thorough. But the thing is for many of their cases, they recommend doing like a crap ton of stuff that you may not necessarily have time to accomplish on the exam. So I will strongly encourage you to come up and use first step to CS as a nice foundation to sort of come up with your own script for things you want to do consistently with each patient, right. A more a smaller I feel like more manageable set of tasks is probably more prudent for the exam. And then the next thing I guess I'll see is kind of good to do is develop your own scripts, okay. And commit these scripts to memory, right. So what do I mean by scripts? I just sort of think of them as checklists that you develop, right. It almost makes you exam like mindless. And again, it's like you're making you're making checklists blah blah blah. But the thing is it basically enables you to like not miss out on big things, right. Mix it possible for you to do really well on your exam, right.

And it also makes it possible for you to go very rapidly go through your exam while making very few errors, okay. You don't want to make huge errors, right. So the thing is, for example, I had essentially had scripts memorized for like intro's like high introduce myself to patients. I had scripts for like common clinical scenarios, right. Like chest pain, like, oh, these are the things I'll try to get through or abdominal pain or dysuria, right. To fever or something or headache. These are like common things, these are like high ill things I would want to get through for those kinds of cases. It just made my exam go by that much quicker and that much smoother. And then, um, memorize right tops for the physical exams, right. Again, it makes you a lot quicker when you're because the thing is if you have the physical exam right off memorized one, it will actually inform the process of you actually doing the physical exam. And then the other thing is it actually makes it very quick for you to write your notes, right. Because if you have the script memorized, it becomes almost mindless. You just turn it out like super quick in that short 10 minute 10 minute period you have to write your notes. And the thing is, um, please do not write what you did not do, right. So if you did not do an abdominal exam, do not write an abdominal exam. Um, and the thing is in general my approach was for every patient I listened to their heart and lungs.

And then I did like one or two systemic exams that are that were relevant to the achieve complete, right. So if, for example, a patient presented with epigastric pain, right. I'm like, ah, maybe it's peptic ulcer disease or I don't know like pancreatitis or something. I would listen to their heart, listen to their lungs and then do a complete abdominal exam, okay. The only system I'll say that you should probably not do a complete exam for is the new exam, okay. You would not finish that case. If you did a complete new exam for new exams, I'll just encourage you to develop like a four, five minute high old new exam that can basically help you cover most of your pieces, um, to sort of convince yourself that, okay, I've checked for like the key things. Um, and again, we'll continue with a mantra of having scripts, right. Sort of memorize scripts for like the way like I'm not saying like memorize like exactly what you write, but like, know your headers, right. Like know that, okay. Uh, for my note, I'm going to do the HPI first and then I'm going to go to review of systems and then I'm going to talk about pass medical, past medical allergies, meds, stuff like that, right. And the thing is, I mean, obviously a note will differ by patient, complete, right. But the thing is you should follow the same structure, right. So like if it's an old car, it's no money to use or if it's a far quarter no money to use or whatever, it doesn't matter.

But just have like a defined approach that you use for every patient so that you are not flustered during your exam because the thing is in life, like, regardless of how difficult something is, if you prepare for it and you have an approach to it, you can accomplish that task with high fidelity while making very few errors and succeeding very well in those activities. So you just have to plan, right. Like for example, for my HPI, I had a constant, consistent, the money I use for every chief complete, right. Like a constant, consistent approach and I just always used it. And basically with that approach, I already knew my notes because I just said, okay, I asked this person this question. This was their response. I asked this person this question. This was their response. And I just crafted it into a series of sentences and boom, I had my HPI. And the thing is your HPI does not have to be super, super long. You don't have to write like a half page behemoth for you to know that oh, you have a good HPI. No. Many of my HPI's on step two years were like 12 lines or 12 sentences or thereabouts. And that was it. Okay. Because again, ask yourself the people that wrote these exams, they understand that you have only 10 minutes, right. So they're not going to give you like, it won't make sense for them to give you scenarios where you have to write like very thorough, super thorough notes. No, no one has time for that. Okay. Let's see what I was right. I want to talk about.

And one thing I will say about the interview is the thing is, I sort of think of step two years, patient encounters as clinical vignettes that you see on like a regular example, step one of step two CK. The thing is usually the patient who dump some kind of clue in the interview. If a patient says something like the thing is while you're interviewing a patient for step two years, try to be aware of the words that are coming out of their mouth. I mean, obviously, it should be a good listener, but actually like I try to listen for clues, right. So if for example, a patient comes in and we have like abdominal pain, right. But some really just weirdly say that, oh, I've been having back pain for years. They're probably trying to give you a clue that, oh, if you have back pain, I don't know, maybe they take NSAZ chronically. And maybe those NSAZ are giving them peptic ulcer disease, right. So that like non-descript clue, they may have dropped in the interview somewhere along the line. Maybe the key to your ultimately figuring out your diagnosis. So basically pay attention. And then taking step two CS in close proximity to step two CK or step three is not a bad idea. Many schools have something called like the like a it's like a mock step two CS. If you take your step two CS exam in close proximity to those, that's also not a bad idea, right.

Because the thing is most cases on step two CS, you're super simple classic cases, what the thing is, you, what the thing is, you do need to have some actual clinical knowledge to essentially decipher what they're going after. Right. So again, for common complaints, I'll encourage you know the classic high-year differentials like you want to know like differentials for like chest pain, for abdominal pain, by quadrant, for headache, stuff like that, right. First day for step two CS super helpful for this. Okay. Again, a lot of your ice points come from this, from this. And again, like I said, first day for step two CS is a guide. Okay. But again, you're occasionally overdosed things, right, with respect to their recommendations. So don't overdo it. Okay. You really cannot do everything they recommend for each case in the aloft at time. And one thing that I did, at least this was one advice I got before I took my exam and he helped me tremendously was before I went into the patient's room after reading the door information, or usually spend like 15 to 30 seconds outside the room, basically sort of coming up with a differential diagnosis in my mind. Okay. Basically, this differential diagnosis helped me a lot in targeting my review of systems. Okay. And my review of systems questions, I mean, the thing is my review of systems always had two domains.

One domain was asking questions relevant to the door information to help me roll out like, oh, like of the four things I had on my differential. Basically asking questions to roll out one versus the other. And then I had like a 45 second generic review of systems to just sort of clear up like, oh, like sort of make sure I check out everybody's system just to again, sort of like go through the motions. And when you're getting to the room, please don't forget to wash your hands. And before you do a physical exam, do not forget to wash your hands after you do a physical exam, do not forget to wash your hands. Okay. And again, like I've mentioned, use these, most of these things are common sense. User standardized means to obtain your HPI, right? So you can use their different nominings, their old cards, their spark order, whatever you want to use. And you basically use the answers to these questions to make your HPI. Okay. And then like I said, you don't get review of systems after you run through the basically what I do is the patient comes in and I tell them what brings you in today. Usually the patient will not be super forthcoming. They won't tell you like they won't like go from this five minute tire it on what brought them into the hospital. They'll just say, oh, my belly hurts. Right. But the thing is you don't want to use that occasion to immediately jump into closed ended questions. The next thing you want to say is tell me more so that you can give you more things.

Okay. After they then give you more, you then use the old cards or whatever nominings that floats your boat to sort of like quantify things like, oh, when did it start? Can you point to the area? How long has this been going on for? Blah blah blah. Right. And then after that, my next approach was to do a review of systems pregnant to my differential that I jotted before getting to the room. So for example, it's chest pain, right? I'm like, okay, maybe this is an MI, maybe this is the audit dissection. Maybe this is a pericarditis, right? So my review of systems I could ask questions like, oh, does the pain get worse when you lie back and get better when you lean forward? If they say no, then I cross out pericarditis from my differential. But then after that, I then have like 30, 45 second generic review of systems where I just try to sort of like from head to toe, head on each key body system, okay? And really after that, I think transitions to like the other stuff like pass medical blah blah blah. That was essentially how I approached most of my patients. And the thing is when you're going from one thing to the other, I'll encourage you to use transition statements, okay? Again, CIS and ice points come from here, right? So you don't just like finish and jump to the physical exam, you say like, oh, if you don't mind, I would like to transition to performing a physical exam, right? Transitions, right?

Oh, if you don't mind, I would like to transition to asking you a few questions about your past history. Simple as that, okay? But again, those things are great. Whether you like it or not. And then again, be open ended in the beginning, okay? And then become closed ended. Don't start off saying, oh, when did it start? Point to the area, no, let the patient speak. I should really give my patients like two minutes to sort of just lay everything on me, okay? Do not start closed ended. If you start closed ended, you're going to lose points. And then when you're writing your note to save yourself some time, just copy and paste the vital signs, okay? Instead of like individually typing it out, that's like just a classic, easy strategy to make yourself more efficient. And then for the physical exam section, right? In my note, I always commented on the patient's general appearance, like well appearing, not acute distress. Simple. Won't take you more than 10 seconds. And then again, if a patient says the drink, the next thing that the next words that should be dropping out of your mouth, I mean, obviously you're going to ask them like, how much would you drink? How many every day, blah, blah, but the next thing you want to deploy is the cage questionnaire, okay? And again, always cancel on the spot so that you don't forget. And then during physical exams, my approach with physical exams was, I would explain what I was doing in each part, okay?

Many times I'll tell the patient, let me know if any of this hurts. And then after that, I sort of like see my findings. And the thing is, I don't like stop and say this, no, I just do this dynamically as I'm performing the physical exam and over. So I could say like, oh, I, so if you don't mind, I would like to listen to your heart to make sure I'm not learning in like weird noises, right? And then I listen to the patient's heart. And then as I'm moving on to my next physical exam and over, I'm saying like, oh, yeah, your heart sounds fine. And then I just keep going, okay? Again, if you keep the patient engaged, you'll get more CIS points. Let's see what else? One nice area to demonstrate empathy is after the patient maintains your chief complaint, right? Because the chief complaint is a problem, right? So again, was you see the chief complaint? No, I'm so sorry you're going through this. It must be frustrating. Hopefully by the end of this encounter, we'll figure out who get to the bottom of what's going on and do everything we can to make you feel better, right? Again, easy way to demonstrate empathy, okay? And again, always use transition statements when you're going from one section of your interview to the other. And for pediatric species, right? There's specific questions, there's some specific questions you want to ask, right? Like, oh, how was their birth? Any problems at birth? Did it stay like in how long did it stay in the hospital?

Were there any complications from delivery? Ask about their developmental history. Are they up to did on your vaccinations? You don't have to ask like, oh, have they had HB? The HB vaccine? Have they had the root of our vaccine? No, you just ask. Are you up to did on your vaccinations? That's it. And then for female patients or like OB patients, there are certain questions you want to ask as well, right? Like, oh, your G's and P's and all that stuff that you learned on your OB-GYNR rotation. And then one unusual thing that may actually help you a lot on your test is if a patient has a serious condition, actually an idea that's a lot on my exam. At least as I was preparing for my test, these are things I kept in mind. Admitting the patient to the hospital may not be a bad idea under your plan, right, for a particular problem. And then, and I mean, you can do this with your canceling at the end and also in your note, right? You want to write like, oh, you're doing blah, blah, blah. And then if you have a phone case and the patient is sick, you want to bring the patient into the hospital without exception. You want to bring the patient into the hospital, okay? Despite anything that may come up, bring the patient into the hospital. And again, before you start the physical exam, ask for permission, right? Don't just like start on tying the patient's gown or whatever, right? You lose your LUCIS points for doing that. And then, don't forget to retire your patient's gowns, right?

Try to keep your patient's modesty, again, obvious things, things that make sense. And again, before you do sensitive things, like I said, ask for permission, they actually abbreviations that you can use in your note, right?

So like, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,

no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no I'm not going to do it.

I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it.

I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to do it. I'm not going to be afraid to reach out. As I mentioned, I started mentioning at the end of my recent podcast, my dual-fer private tutoring for the USM. It's step one, step two CK, step two CS and step three exams. I guess the medicine in training exam for what it's worth. I also do application advising and also prepare people for interviews.

If you need to do any of these areas, please don't be afraid to reach out. I do hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I hope you're getting good use out of these podcasts. I wish you all the best. Have a wonderful Monday and a wonderful rest of the week and God bless. I'll see you next time. Thank you.

Spoken English proficiency, Communication Skills (CIS), and Information Gathering/Interpretation (ICE).

Using open-ended questions, demonstrating empathy (e.g., apologizing for their problem), and explaining the rationale ("why") behind physical exam maneuvers.

Immediately on the spot if the patient mentions smoking or drinking habits to prevent forgetting this crucial information later in the exam.

1) A summary at the end of the HPI (to confirm detailed history). 2) An overall summary (CC, PE findings, likely cause, plan, counseling) to establish rapport and reinforce key points.

Apologize for the difficulty of the situation ("I'm sorry you're going through this") and express hope that the encounter will lead to a diagnosis/improvement.

Use explicit transition statements, such as, "If you don't mind, I would like to transition to performing a physical exam."

Six to nine months in advance.

Questions about birth history/complications, and developmental history/vaccination status (e.g., "Are you up to date on your vaccinations?").

To create a consistent, repeatable structure or checklist that ensures no major steps are missed, allowing the exam process to feel rapid and smooth.

Copy and paste the vital signs rather than typing them out individually for efficiency.

Start open-ended ("Tell me more") to allow the patient to speak freely; avoid starting with closed-ended questions (e.g., "When did it start?") as this risks losing points.

Always ask for permission before touching or examining a patient, and always wash hands before and after the exam.

Six to nine months in advance.

Questions about birth history/complications, and developmental history/vaccination status (e.g., "Are you up to date on your vaccinations?").

To create a consistent, repeatable structure or checklist that ensures no major steps are missed, allowing the exam process to feel rapid and smooth.

Copy and paste the vital signs rather than typing them out individually for efficiency.

Start open-ended ("Tell me more") to allow the patient to speak freely; avoid starting with closed-ended questions (e.g., "When did it start?") as this risks losing points.

Always ask for permission before touching or examining a patient, and always wash hands before and after the exam.