USMLE Step 2 CS ( 6-3)/复习要点及中国考生复习重点

考生还需注意另外二个方面：

1.      标准病人：标准病人在美国医学教学中已存在30余年，所以每一个考生面临的标准病人具有相同和极为相式的临床病例。标准病人本人只具有普通医学知识常识，所以考生不必关注你所陈述和回答病人问题的严格性和正确性，但要注意对病人的尊重和职业同情心态。

2.      考生方面：考核过程重点在你的诊疗过程，不要把太多时间和工作用在“做出正确诊断”,而应做到整个病例的宏观思维和时间的合理安排。

对每个病例，考生将会得到一份病人的基本资料：描述病人的姓名，年龄、性别、就诊原因及生命体征。考核过程中，最困难的是保持正确的时间进度。 你必须在15分钟内完成整个病情的询问及检查，所以对应该进行的每一步骤应相当熟悉：

病史：

Step 2 CS Blueprint: Content Categories   - Common and Important Medical problem/Patient Presentation -Acuity -Age -Gender -Race/Ethnicity

 

 

 

 

 

 

 

 

 

 

• 介绍及问候：

“Hello, Mr./Ms. Smith, Good morning/Afternoon.”

“I am Dr XX. It’s nice to meet you. ” (握手)

然后问：

“What brings you to see me today?” or

“What brings you in to day”.

标准病人（SP）会告诉你主诉:（CC）

接下来的一个开放式问话：

“Could you please describe to me exactly what is going on or what were your problems (issues)?”

在SP答述后，你提醒式询问他是否有其他相关的重要情况还未讨论:

• 定位（Location）:

查问病症部位：

“Where is the problem?”或

“Could you please show me exactly where it hurts?”

• 发生时间及时程

为了解病症是急性, 亚急性或性慢性, 应询问：

“When did it first start?”或

“When did you first notice the problem / pain?”

然后了解发作情况：

“Was the onset all the sudden or progressive?” 接下来还要询问有关主诉的其他情况;

• 病症强度:

应记录病情的严重性及程度，如果是疼痛，你可询问疼痛程度：轻、中、重, 或用0-10来记录:

“On a scale of 0-10, with 0 being the least painful and 10 being the most painful, how would you scale your pain from 0 to 10?”

• 病症性质：

疼痛性质可能与疼痛原因有关，你可问：

“How do you describe your pain?”

• 发作频率：

总是询问发作的频率 如：

“Is it constant?”或

“Does it come and go?”

如是间断性的

“How often does if occur? How long does it last? How do you feel between attacks?”

• 症状放射性：

如果症状是疼痛，需问

 “Does the pain go somewhere?”

• 加重与减轻因素

询问有否意识到病重或减轻症状的因素有利于分析病和做出诊断，如食物的影响，运动的影响，体位的影响等等:

“what were you doing when it first began?”

“Have you ever found anything that makes your pain / problem worse?”

“Do you have any idea of what might have brought this out?”或“what brings it on?”

• 药物治疗及效果

了解是否进行过治疗及治疗效果，并注意治疗副作用.

• 过去史：

• 手术史：

• 家族史：

• 个人史：儿童应包括疫苗接种史; 妇女应有血经及生育史;

• 过敏史：

• 当前用药：

体检(PE):

体检前总是用肥皂洗手，为节约时间，洗手时仍然保持与标准病人谈话. 绝不要透过患者服装检查. 检查时仅暴露检查部分，其余部分应遮盖；对“女患者”检查心脏时不要表现出犹豫不决，保留胸罩，清SP推起自己的乳房以便听诊心尖部；不要检查乳房, 同时告诉“患者”你准备做的检查，可以这样开始：

“Ok. Mr/Ms. Smith, now I would like to do a physical examination on you. For that, I need to untie your gown. Is that OK with you?”

标准病人（SP）：“Yes, it’s ok.”

医生：“Thank you.”

如果SP表示不愿意：你应该解释其检查的重要性，比如：“Mr./Ms. Smith, I understand your feelings, but to clearly understand your problem. I have to do this examination. It won’t take more than 1 minute. Don’t worry, I am here to help you and I will let you know whatever I’m going to do. If you feel hurt, let me know. I’ll stop right away.”

SP可能以面部表情来表示病痛, 检查时要留意SP的表情;

体检时，由于时间关系，重点做与病史相关的检查.

小结

   在结束病情资料收集前，应向“SP”说明你的诊治计划和一些相关健康建议, 比如停止吸烟，参加运动或减少体重等等：

“All right, Mr./Ms. Smith, thank you so much  for your kind corporation.  Now, I’d like to sit down and talk about what I think. First, let me summarize:

·         You just told me that … and …. Also, you mentioned that … and …. Is that right?

·         According to the information I got from you and the examination, I am considering a couple of possibilities. It may be..(probable diagnosis) or possibly (differential diagnosis).

·         I need to run some tests in order to find out exactly what the problem is.

·         As soon as I get the results, let’s meet again to go over everything. At that time, I will explain the details and we will talk about your options for treatment. Does this sound OK?

 

  完成病情资料收集后，你有10分钟时间完成病情记录（patient note ）. 以下是在进一步检查（work-up）中可能考虑并应注意的治疗计划。 会诊咨询及转诊均不属(work-up).

 

头颈面部（HEENT）                     

• 头：X-ray, CT , MRI

• 眼：Snellen’s 表，视力

• 耳：分泌物培养，听力检测 ( audiometric, tympanometry)

• 中枢神经系统：（CNS）

     CBC + diff,  ESR

     X-ray, CT, NRI

     Lumbar Puncture

     Carotid Doppler Study

     EEG

     EMG and Nerve Conduction Studies

常用检测

• CBC（Complete Blood Count）/ Coags (PT、 PTT、 INR)

• Urinalysis

• Electrolytes

• Arterial Blood Gas

• EKG

• Chest x-ray

 

   前面已经讲过，Step 2 CS 相对较Step 1和Step 2 CK 容易。只是大多数中国医学生在学医过程中以自我消化知识为主，所以在以要求表达自我和交流能力为主的Setp 2 CS考核中多少有些吃亏。Step 2 CS 考试的重点并非医学知识，而是interpersonal communication方面，那么从现在起如果你注意培养这方面的能力. 当你把Step  1 和Step 2 CK 考完后，准备Step 2 CS 也就不成问题了。

 

 

 

 

临床考核许分以通过或未通过（Pass/Fail）为准考评内容及报告为

Step 2 CS Scoring

 

ICE	CIS	SEP
Data Gathering Hx Taking PE Patient Note	Communication Inter Personal Skills	Spoken English Proficiency

 

 

 

 

 

Sample Score Report

Examination Components	Decision
Integrated Clinical Encounter	Pass
Communication/Interpersonal Skills	Fail
Spoken English Proficiency	Pass

Examination Decision: Fail

 

 Next  三.赴美考试及旅行

[1hblshqt]

很感谢你给出了这么多有关医师考试的信息, 请问如果从医学院 毕业近20年,还有可能match上吗? 谢谢!