Doorway: Write all the five DD in abbreviated form before you enter the room. This will help you to ask atleast one pertinent history for each of the DD. This will serve you well and I did not do that and in the end I always had couple of minutes in hand when I concluded.
History: I did not use PAM HUG FOSS or LIQUORAAA but you got to ask these questions and I did. When asking about personal history make a note on your scrap paper, the number of cigs/day, alcohol intake and sexual practice. I would strongly advice to write the family history as well. I did not do it and I was not able to recollect when I was writing the patient notes. Also this will help, to remind yourself to councel the SP. So make a mark on any relevant personal history to remind yourself to councel in the end. I did not even councel a single patient regarding their personal habits and I was lucky becasue only two SPs gave history of smoking and for one I did not councel regarding alcohol.
Whilst washing hands: Ask SP if it is okay if you can talk to him whilst washing and ask if he was able to understand you properly. The bottom line is never stop talking even for a second.
Examination: After draping ask the SP, if they are comfortable and tell them what you are examining. If in one of your DDs, you need to exam pelvic/rectal/breast exam tell did them you will have to do these at a later time. I thought I will tell them before the conclusion part and only remembered it whilst writing the notes, when it was already too late. Be very apologetic when SP reveals signs of tenederness and be very gentle in your examination and remember the SPs are examined by 12 examinees. Remember to extend the table for abd examination. I always supported the SP’s shoulder when I made the lay down for the abdomen exam. These little things show empathy and that is very IMPORTATNT.
Conclusion: Always summarize the history, and check with the SP that if you have got it right, explain what you think, give two DD, and explain about the investigation, for example, if you are to mention CT scan, ask him does he/she understand what a CT scan means etc. Now before you go check your scrap paper for personal history and see if you need to councel re smoking, alcohol, safe sex practice and leave by asking if SP has any concerns or questions he/she needs clarification.
Notes: Always start from the DD and Inv. Then go back to history and examination. I wrote the notes and if you are to type, practice on the usmle webite. Practice patient notes at home and time yourself. Certain abbreviations are allowed and know it well since it will save time. So know all the abbreviations that are allowed. You have this in the first aid.
After the exam: Never come to any forums and see if anybody who have taken the exam with you or after you have got the results. This will stress you out. I did the mistake and somebody who took the exam with me passed in 4 weeks and mine took 7 weeks. DELAY DOES NOT MEAN FAILURE.
Materials: I used First Aid and USMLE WORLD. I read few pages in Kaplan CS book regarding how to explain to the patient the examination part and pschy history.
Preparation time: I studied for a week but in an ideal world you will need atleast two weeks becasue I thought in the end I could do with some more time. 3 weeks is more than enough. I prepared alone and if you are to practice with somebody it will be a big help.
About the exam: If you get uncopeartive patient or if you need to examine CNS you will have lot of time constraint so develop a strategy early whilst preparing. There is no time to think during the exam so practice well. YOU CAN DO IT. There is 80% pass rate, so you are more likely to pass. But, 20% do fail, so take the exam very seriously and I was told by somebody it is very easy and he studied for 2 days, well, I did’t agree after my experience.
Lastly: Just because you have passed does not make you a master of this exam. So what I have written so far is my humble experience and these are the things I will do to make myself very confident about this exam.