Profile image of Amjad Elmashala
Amjad Elmashala

This is the fifth article in a series which describes the USMLE Journey of three friends from Al-Quds University, Palestine. They are – Amjad Elmashala, Kinana Abu-Rayyan, and Mohammad Adawi. Below are the links to all the articles in this series –

  1. Amjad Elmashala (Step 1 Score 269)
  2. Kinana Abu-Rayyan (Step 1 Score – 257)
  3. Step 1 Success Story – Dr. Mohammad Adawi (Step 1 Score – 259)
  4. Step 2 CK 265 Plus – The Exam Experience of Three Friends (Combined Step 2 CK Experience)
  5. Step 2 CS Experience by Amjad Elmashala


Part 5

Step 2 CS Experience by Amjad Elmashala

Step 1 – 269

Step 2 CK – not yet

Step 2 CS – Pass

Preparation time: 2 weeks

Recommended preparation time: 4 weeks

Dear all,
Since I have been asked by some people from the step 1 group about what I studied and how I prepared for the step 2 CS exam, I decided to share my experience. First, I am a graduate from Al-Quds University and currently an intern doctor at a governmental hospital in Palestine. I registered for the exam in mid-January and decided to take it in Philadelphia on March 6th – 4 weeks after my step 1 exam, which was supposed to be on February 1st. However, my step 1 exam was delayed for one week and I took another 5 days off until I got back home from Jordan and settled things down. I started my preparation on February 12th, while I was doing my psychiatry internship. My main source was first aid. I studied for 2-4 hours per day for the whole two weeks. Two of my friends helped me with the preparation through Skype. I used to do 2-3 cases with each one of them (2 hours in the morning and 2 hours at night). In between, I really did not know what to do in the beginning!


Image - Quote for Step 2 CS


In the second week, I started watching the CSE videos, and they were really helpful. I also helped a friend who was taking the exam one week ahead of me, and this gave me the chance to review some of the cases. We would talk over Skype and I would give him about 5 minutes to read the case. Then I would start my encounter with knocking on the door, introducing myself and stating what my role here is. After that, I would go through the history and act the physical exam, and then I would give a closure and get asked one challenging question. After I am done with the case, I would type in the note while my friend is preparing the next case. We would have a little discussion after each case, about things I should have asked or had done. This was the most important part of the whole process as I was criticized a lot and was challenged to prove to my friend that I was improving. By February 26th, I had gone through all the cases in first aid at least once. Then I traveled to Jordan and stayed there for 2 days. I was in Philadelphia on March 1 st and stayed there with a host. My Step 1 exam result was out on that day, so I could not study for 2 days! Now, I had three days before the exam. I went through some of the notes I had taken while I was in the airport and on the plane, and I asked my friend to prepare three random cases on March 3rd and 4th. On the last day before the exam, I went for a walk in our neighborhood and bought some snacks for the exam. I did not feel the need to review anything at that moment. I had a shower and went to bed at 7 PM. Unfortunately, I was not able to sleep until 1 AM.


Image - Quote for Step 2 CS



On the next day, I woke up at 6 AM, made myself breakfast and headed toward the exam center. I was terrified at the beginning. They gave us numbers and an orientation session and allowed us to use the tools (ophthalmoscope, phone, bed … etc.) before going into the exam. These all were icebreakers. The exam was eight hours long that included twelve standardized patients (SP) encounters (25 minutes each). The first two cases were the toughest because I was nervous and was not able to think clearly. But after that, everything was fine. The SPs were very friendly.


Here is something that is very important to note. The cases on the exam are quite different from first aid. In each case in first aid, there are a lot of clues that will help you formulate a proper differential diagnosis, but on the real exam, there is only one piece of information which you have to rely on to formulate the differential. For example, a 40-year-old female c/o arm pain, and that’s it. No additional findings in the history or physical exam will help you determine the cause. Anyhow, regarding timing, fifteen minutes were enough for each encounter. I did not feel the need for extra time as I was able to do proper closure for all SPs. For the computer notes, I did not experience any problem with time either as I always had 1-2 minutes to go back and make sure that I filled in everything. I was so happy after the exam because it was such a relief.



Image - Step 2 CS Quote


The immediate feeling after the exam is the best predictor of your performance on the exam, since one becomes very suspicious of his performance with time while awaiting the results (which take forever).

Best of luck to you all,



Amjad Elmashala



This article was first posted on Facebook. It was later edited and republished here with the permission from the author.



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One Comment

  • Anonymous Reply

    Great! thank you so much bro…good luck with the next exams

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