hello. I am an IMG,I passed step 1 and 2 CK on first attempt with really good scores. However, I failed CS on my first attempt. I worked in Europe but have no US experience. I did much above average on SEP and ICE, but failed the ICS. I was devastated and as I did not know how to really improve, I decided to have some tutoring. I felt that studying with a SP who is an IMG like me was not really helpful. I found a tutor here on the Forum, met 5 times for 3 hrs with him. I don´t want to advertise for anybody, but for me it felt like a big help because he could tell me what I was doing wrong, more exactly how I had to ask and examine. I realized I asked everything in the exam, but some things in a way which, even though I was not aware of it, sounded rude to the SP or the formulation was not very elegant. My physical exam also needed some improvement, again, it was the small Details like in what order to examine, how to hold the otoscope, etc. I re-took the exam and passed on the second attempt. I am sorry I did not have the tutor for the first attempt, because now I have this failure on my record.... So my advice for IMGs is to practice with a tutor, it is worth the investment, cheaper then a second attempt by far, with focus on the questioning part and the physical exam especially, for me the notes were no problem at all. Or to find a study partner who studied/worked/shadowed in the US and who knows how they want to have it done. Or to do some shadowing in a US hospital.
Good luck!