I am in total shock right now (and so is my Dean).

I have no idea what to do or what the implications will be. Throughout med school, I've always gotten the highest marks for my interpersonal skills, but this is the exact area of Step 2CS that they failed me.

In typical Kubler-Ross fashion, I am in total denial right now. I just don't understand what happened, especially considering that my school has the largest standardized patient program in the country. And, we've been working with SPs since day one.

So far, no one in my school has failed either of the Step II exams this year (except, for me, of course). The school will still let me graduate, but I am not sure how I am going to tell the program I matched into (a top 3 optho program).

Well, as you can imagine, this has been a pretty crappy day. I am also a bit ticked off about the fact that there is nothing I or my school can do (The NBME gives essentially no feedback). I feel totally helpless, upset, extremely embarassed, and very much an outcast.

Did you read first aid for step 2 CS?

I am in total shock right now (and so is my Dean).

I have no idea what to do or what the implications will be. Throughout med school, I've always gotten the highest marks for my interpersonal skills, but this is the exact area of Step 2CS that they failed me.

In typical Kubler-Ross fashion, I am in total denial right now. I just don't understand what happened, especially considering that my school has the largest standardized patient program in the country. And, we've been working with SPs since day one.

So far, no one in my school has failed either of the Step II exams this year (except, for me, of course). The school will still let me graduate, but I am not sure how I am going to tell the program I matched into (a top 3 optho program).

Well, as you can imagine, this has been a pretty crappy day. I am also a bit ticked off about the fact that there is nothing I or my school can do (The NBME gives essentially no feedback). I feel totally helpless, upset, extremely embarassed, and very much an outcast.


Don't feel embarrassed.

Did you run back through each of the scenarios to see if maybe you missed something? Did you use First Aid for Step 2 CS? Did you always wash your hands and drape the patient? What about eye contact? Did you summarize the history and discuss the plan with the patient? Did you always come up with a reasonable differential? What about your diagnostic plan?

Most importantly, could you have pissed off any of the test center personnel? I got the feeling that if you were rude toward them that could affect your grade.

Also, I wouldn't be real upset over this. I have heard that future classes may not have to take this exam anyway. I don't know how we are to receive a refund though.

this is really not a big deal at all. the only thing is you'll have to fork over another grand for a retake. let's face it: your ophtho program won't care so long as you pass before you start (and you've got over a year for that); and your prelim program likely won't care either. just schedule a retake and get it over with asap. best of luck.

I'm sorry to hear this happened to you. That test seemed like a crap shoot, and hearing stories like this from good students like you scares the living out of me (took it last week). It is unfortunate that you received essentially no feedback regarding your performance and that you have to deal with the unnecessary stress (and $$) of taking this again. Don't feel embarassed or like an outcast, as i know plenty of people are failing this exam (it is set up that way). It certainly doesn't test your clinical abilities and i'm sure you will be a fine MD. Best of luck.

$hit happens!! Oh well, life goes on! Don't worry about it!

P.S. Just because you're top 25 and AOA, that means your never going to fail at anything???????

I am not trying to be mean but put some whipped cream on your slice of humble pie and eat it. Life will go on. I think by now PD's are taking notice that a suprising number of people are failing that test. It's new, its not a perfect test. You will probably still match into your top residency. So chin up, and re-take it!!

Sorry that you have to re-take the exam but try not to worry too much about it. Try and think of what could have gone wrong. The CS exam has nothing to do with how competent/smart you are. It's all about playing the game. With First Aid, you can learn to play the game. Good luck.

Don't feel embarrassed.

Did you run back through each of the scenarios to see if maybe you missed something? Did you use First Aid for Step 2 CS? Did you always wash your hands and drape the patient? What about eye contact? Did you summarize the history and discuss the plan with the patient? Did you always come up with a reasonable differential? What about your diagnostic plan?

Most importantly, could you have pissed off any of the test center personnel? I got the feeling that if you were rude toward them that could affect your grade.

Also, I wouldn't be real upset over this. I have heard that future classes may not have to take this exam anyway. I don't know how we are to receive a refund though.

Just to clarify, the NBME breaks your test down into three sections for those who fail: 1) Data gathering/Physical [my marks were so high they were almost off the chart] , 2) Patient Note [again, off the chart high], and 3) Communication and Interpersonal Skills [FAIL].

So, obviously I did all of the right things clinically, but somehow they found me lacking in these very basic but essential skills. As I said above, I am totally shocked because this is the exact area where I have always excelled. Its just so wierd. Although I honored almost every clerkship, my shelf exam scores were never all that high and my "fund of knowledge scores" were only slightly better than average. Instead, what got me honors in every single rotation was the subjective score my residents and facutly gave me, all of whom always gave me the highest marks for teamwork, communication, and interpersonal skills.


To make matters worst, much of the exam is actually based on our school's CSA, and we each had two full-day practice exams at the start of 4th year that were nearly identical to Step 2CS. I am just beside myself. As I mentioned before, my school has trained us from day one (for better or worse) how to conduct ourselves during such encounters, and I don't know what else I can do. After all, I've worked hard these past four years, supposedly "done all the right things," always tried to be nice and helpful, and now have this mark of shame tattooed on my forehead like some sort of interpersonal leper.

Anyway, to answer your specific questions:

1) Read First Aid for Step 2 CS cover to cover
2) Always washed my hands and draped the patient
3) Made eye contact and asked open ended questions
4 Told the patient exactly what I was doing and what I found (e.g. "I am now going to listen to your lungs with my stethescope......Excellent, your lungs sound nice and clear").
5) Summarized the history and discuss the plan with the patient?
6) Asked the patient if they had any other questions before I left.

Just to clarify, the NBME breaks your test down into three sections for those who fail: 1) Data gathering/Physical [my marks were so high they almost off the chart] , 2) Patient Note [again, off the chart high], and 3) Communication and Interpersonal Skills [FAIL].

So, obviously I did all of the right things clinically. but somehow they found me lacking in these very basic but essential skills. As I said above, I am totally shocked because this is the exact area where I have always excelled. Its just so wierd. Although I honored almost every clerkship, my shelf exam scores were never all that high and my "fund of knowledge scores" were only slightly better than average. Instead, what got me honors in every single rotation was the subjective score my residents and facutly gave me, all of whom always gave me the highest marks for teamwork, communication, and interpersonal skills.


To make matters worst, much of the exam is actually based on our school's CSA, and we each had two full-day practice exams at the start of 4th year that were nearly identical to Step 2CS. I am just beside myself. As I mentioned before, my school has trained us from day one (for better or worse) how to conduct ourselves during such encounters, and I don't know what else I can do. After all, I've worked hard these past four years, supposedly "done all the right things," always tried to be nice and helpful, and now have this mark of shame tattooed on my forehead like some sort of interpersonal leper.

Anyway, to answer your specific questions:

1) Read First Aid for Step 2 CS cover to cover
2) Always washed my hands and draped the patient
3) Made eye contact and asked open ended questions
4 Told the patient exactly what I was doing and what I found (e.g. "I am now going to listen to your lungs with my stethescope......Excellent, your lungs sound nice and clear).
5) Summarized the history and discuss the plan with the patient?
6) Asked the patient if they had any other questions before I left.

Are you questioning 5) or is the "?" a mistake? (just curious)

Sounds like you did everything right. I would ask for a rescore (not sure of the procedure). Someone is screwing with you regarding the subjectivity of the exam.

Are you questioning 5) or is the "?" a mistake? (just curious)

Sounds like you did everything right. I would ask for a rescore (not sure of the procedure). Someone is screwing with you regarding the subjectivity of the exam.


Sorry for the confusion. It was a typo (of the cut and paste variety). Hope it doesn't reflect poorly on my communication skills.

Hmm...just curious...do you speak with an accent or is English not your first language? I've heard that that accounts for a good portion of the people who fail in the communication skills area.

Hmm...just curious...do you speak with an accent or is English not your first language? I've heard that that accounts for a good portion of the people who fail in the communication skills area.

English is my first language. I was actually an English Lit/Histoy double major in college (again, Ivy League, blah, blah, blah), and was even runner-up as student speaker for our graduation.

As for the above post regarding my mentioning the fact that I was AOA at a top 25 school (and similarly, the Ivy League business), my aim was not to be self-congratulatory. After all, this is not that type of thread. To a certain extent, I was trying to dispell the notion that only non-native English speakers from off-shore, no name medical schools fail Step 2 CS.

On a similar note, my feelings (and self-esteem) have not been helped by the numerous posts on this site that say something like "I thinks it's impossible to fail that thing. I bet you have to be retarded or something." At least at my school, all other 120 students have passed. Talking to my dean, he was also shocked because he was one of my staunchest supporters when I applied for residency. Basically, the way he put it, this means that students at my school paid aproximately $130,000 to weed out a single student (ie, me), who, at least according to my school's standards, has quite good patient skills.

Two possibilities:

1) Clerical error (it happens)
2) You truly had awful communication or interpersonal skills

I don't know you, so I cannot attest to whether 2) is a possibility, but I would sure as hell contact whomever I could to figure out if 1) is the answer. Pay to have your test re-graded. They should offer this option.

To me, it seems implausible that someone could fail on the communication skills section, especially given your preparation and background. From the school averages I have seen, this is the section which most medical students score highest in. I hate to say it, but sometimes it is hard to swallow all of the information posted on internet forums, especially from new accounts.

Welcome to SDN, btw. I hope things go well for the retest.

Just a thought. If you do request a re-grade, make sure you are really nice and sincere to the people you talk to because if you are a jerk about it, it will not help you convince them that you truely do have great interpersonal skills.

I hate to say it, but sometimes it is hard to swallow all of the information posted on internet forums, especially from new accounts.

Welcome to SDN, btw. I hope things go well for the retest.
I can explain the new account. I have a previous very active account which contains information that would allow people at my school and future residency to easily figure out who I was. In all honesty, I am embarassed enough as it is, and am having a good deal of trouble dealing with my own internal shame without having to worry about the consequences of a more public humiliation.

Dude, thats funny.

I understand, freefall. I like scholes' idea, about talking with them about it in a nice way. It is in their own interests to make sure that students are passing/failing for the right reasons..and at this point you don't have much to lose by requesting a regrading, working through your deans, etc. Can't your school complain to the board that they think this is an anomaly, etc? It seems like your school should be able to exercise some influence since you have a good reputation.

Yes, I suspect that cursing them out over the phone while trying to explain how good my interpersonal skills are may not be the best strategy.

(Though, it certainly would feel good and it would be cathartic in a way).

If you don't mind me asking, when and where did you take the test?

Also, the USMLE website has a bulletin about how to request a score re-check. Best of luck to you.

If you don't mind me asking, when and where did you take the test?

Took the exam in early January in the City of Brotherly Love.

perhaps introducing yourself as an AOA student of a top 25 in your pt interviews & referring to your ivy league pedigree while taking your social history may have put the SPs off. ;)

perhaps introducing yourself as an AOA student of a top 25 in your pt interviews & referring to your ivy league pedigree while taking your social history may have put the SPs off. ;)


Furball, I understand your point in mentioning your credentials. It is one of the few times on this forum that it has its legitimate place. It frames your situation in terms most will understand. It is funny to me how many people are reacting to it. Jealousy?? Probably. I know I would love to have those credentials but I don't. No big deal for me! :D
The worst is over and it was not that bad. You have your match, you are going into your specialty. You will have to retake this blasted test again but 5-10 years from now, this won't matter at all (does not matter now either though I understand your embarrassment).

Be honest with yourself (not on this forum surrounded by sharks) as to why you may have failed and fix it.

Ego blows can be tough but in the end you will prevail and be wiser for it.

Did you show empathy for fake pain? Or give fake comfort to those who faked crying? This test is such BS. :mad:

Sorry about what happened to you. Realize the fact that this test doesn't necessarily test how well you interact with patients. My interactions with the SP don't look anywhere close to how I interact with real patients. There's still alot of kinks with this exam that my school doesn't require us to pass it before graduation but only to take it before graduation.

For all the AOA haters out there..don't. Each school have their own way of figuring out who gets AOA so it doesn't mean that freefall is superior than you on the shelf exams, USMLE exams, OSCE, etc.

you know what that IS such BS becuase you know what that means? Your particular SP didn't like you. i recently got feedback ( in a nongraded practice thankfully) that i wasn't very empathetic and that i put the patient on the defensive ( which IF that was the case- his acting skills are lacking). This is always the area that i not only excel in but that the sp always compliments me on so I hate to say it but it was THAT SP's problem with me i guess. i hope that I don't get that particular SP for a graded practical and it sucks that you got that particular one for your boards but really THAT's all that means. if you take it again and get someone who gels with you then you'll pass. and you're probably like me- i basically have gelled with every other SP except for that one SP.
i do know of people who don't have any interpersonal skills but usually and espeiclaly by 4th year it is enough for them to pass but i haste to say for some reason that SP didn't like you. hmmm i wonder if it's the same one i had... ( since my school farms them out for the boards and all).

perhaps introducing yourself as an AOA student of a top 25 in your pt interviews & referring to your ivy league pedigree while taking your social history may have put the SPs off. ;)

having difficulty understanding the validity of that one myself.
study hard, and take it again. Remember what you do have, and not what you dont and then make the best of it. You will definitely pass it, just dont let this inconvenience get to you.

Just to clarify, the NBME breaks your test down into three sections for those who fail: 1) Data gathering/Physical [my marks were so high they were almost off the chart] , 2) Patient Note [again, off the chart high], and 3) Communication and Interpersonal Skills [FAIL].

There is a formal policy for contesting your STEP II BS score. You can find it on the NBME website.

Furball, I understand your point in mentioning your credentials. It is one of the few times on this forum that it has its legitimate place.

Umm, typo I think. I'm Furrball and I didn't post anything about credientials. :eek:

Contacting the good folks at step 2 "BS" (I like that) reminds me of the scene in office space when John C. McGinley (scrubs fame) is interviewing that dude who doesn't actually answer the phone to take orders, and doesn't physically take the orders to the engineers "because they don't have people skills".

"So what do ya do?"

"I'VE GOT PEOPLE SKILLS DAMN IT!"

Why does everyone get so bent out of shape when people post credentials on this anonymous forum? I don't think anyone would have been upset if his credentials were mediocre. People, this is an anonymous forum. If he would have said his first and last name, his school, and posted a picture of himself, I would recognize the OP's conceit. But why would someone post their credentials in order to glorify a clever SDN code name, a funny avatar, and an obscure quote in the signature line? It just doesn't make sense. People need to relax a bit and realize that there is always someone out there with better scores and achievements.

perhaps introducing yourself as an AOA student of a top 25 in your pt interviews & referring to your ivy league pedigree while taking your social history may have put the SPs off. ;)
Scootad, you ornery rascal, I thought you might post something like this. In fact, I clicked on the post to see if I knew you as well as I thought I did. Man, you always crack me up. :laugh:

To the OP, I feel for you. I feel like the same thing could happen to me, with the exception that I'm not AOA, am not from a top 25 school, do not have good interpersonal skills, did not go to an Ivy for undergrad., and am not an excellent speaker.

I've heard some interesting anecdotal info from a dean at my school - appartently a lot of people who fail this test tend to be white men with imposing physiques. Some deans at other schools have noticed the same thing. Weird.

I've heard some interesting anecdotal info from a dean at my school - appartently a lot of people who fail this test tend to be white men with imposing physiques. Some deans at other schools have noticed the same thing. Weird.

It's actually not weird. I can see where the SPs could harbor certain prejudices and resentments. What if an SP had been treated poorly by a certain physician type in real life? Step 2 CS would be a great opportunity for revenge.

It's actually not weird. I can see where the SPs could harbor certain prejudices and resentments. What if an SP had been treated poorly by a certain physician type in real life? Step 2 CS would be a great opportunity for revenge.

Oh, the irony. It seems this test is better at identifying the poor interpersonal skills, prejudices, and incompetancy of standardized patients while failing to accomplish its mission of identifying poor students.

I find this amusing because after I scored below average on my first 3rd year OSCE, my professor gave me some advice and explained to me how "acting" does indeed contribute to your performance. I was more dramatic with my empathy for my next OSCE and scored among the highest in the class. I find it concerning that the socially manipulative are the ones who will do the best on this exam. The people who are the most insincere are the people that will be able to fake their emapthy the best. These people are at the biggest risk for being a jerk later. In all honesty, I do not really understand why the NBME feels as if they need to identify these jerks. If someone wants to be apathetic in their practice, that is their prerogative. I am not condoning this behavior, but I do not think it should be necessary to graduate medical school. Medicine is still a business and if people cannot behave in a manner that appeals to their patients, then they will fail in this business because they will not attract patients. And when it comes down to it, I think I would rather have a brilliant *****hole surgeon operate on me than the sweet moron who barely got through residency without killing someone.

hey uh, may be it's just me, but there's no way to determine that you did "off the chart high" on the grade score sheets that they send. so how were you able to figure that one out?

is this some experiment you got going on ?

I may be wrong, but I've heard that if you didn't pass Step 2 CS, they include feedback on the results sheet. If you passed, all you see is a "PASS" for each section, and an overall "PASS."

Umm, typo I think. I'm Furrball and I didn't post anything about credientials. :eek:

Furrball?!?!?! I MEANT FREEBALL... oh... no I did not mean freeballin, I meant FREEFALL

Glad we got that straight! :D

One of my very good friends did not pass the test either (also took it in phili). However, our school said that if his scores do not come back by graduation they will not let him walk with us. He also has to retake the test on Match day. (how unfair is that) This is the only test date that was open before March 31st-when our school wanted him to retake the test by.

My question is: Does anyone have any ideas on how we can convience the school that he should get to walk with us at graduation. I was thinking something on the lines of a petition.

Freefall, is your school not giving you any trouble about graduating? I may pm you as it gets closer to graduation. Maybe we can use you as an example if you don't mind. (this school is letting their students walk, etc). Thanks. Also let us know how your re-scoring goes. I hope it works out for you.

One of my very good friends did not pass the test either (also took it in phili). However, our school said that if his scores do not come back by graduation they will not let him walk with us. He also has to retake the test on Match day. (how unfair is that) This is the only test date that was open before March 31st-when our school wanted him to retake the test by.

My question is: Does anyone have any ideas on how we can convience the school that he should get to walk with us at graduation. I was thinking something on the lines of a petition.

Freefall, is your school not giving you any trouble about graduating? I may pm you as it gets closer to graduation. Maybe we can use you as an example if you don't mind. (this school is letting their students walk, etc). Thanks. Also let us know how your re-scoring goes. I hope it works out for you.

i met with my dean last week (expecting the guillotine), and asked what the fallout from failing 2 cs would be. he chuckled, and said there would be none except for the blow to my ego. the other advice he gave me was this -- tell no one. he doubts any residency program will request 2 cs scores this year, so there is no reason to "bear your soul." besides an ego blow and another coupla thousands bucks down the toilet, he thinks the issue will not follow any of us.

as for my school, the requirement is merely to take the exam before graduation; there is no requirement to pass it. as for your friend's situation, i would urge your school to reconsider for several reasons: 1) it's highly unlikely that residencies will require passage this year, 2) most top schools are not requiring students to pass, 3) not letting a student march after 4 years of hard work is not consistent with a medical school that really supports its students, and is a bit vindictive.

If you don't mind me asking, when and where did you take the test?

Also, the USMLE website has a bulletin about how to request a score re-check. Best of luck to you.
I'd like to say best of luck on this. I had the same thing happen last month. I had to have it in time for deadlines so I unfortunately cannot enjoy my match day since right after I have to leave to go retake this exam half way around the country. It was a horrible experience I was numb for a while had the "talk" with my school and no I am not ever reporting that score to my residency program. It's a horrible radiculous exam. I too did very well in all my clerkships and failed it. That stupid exam is a piece of crap and has cost me so much money since now I am in further debt because of it. Lots of luck and I am sure youll do better the second time. Next time just go in on a mission and ask every possible thing you can think of and smile and just look like you give a crap. I feel your pain.

what is the best study guide out there for this stupid test? also, do you need to bring your own supplies (i.e. stethoscope, reflex hammer, etc?)

also, freefall and annoyances... i am sorry to hear about your situations. hope everything works out for you both

Only need a stethoscope...i used FA for step 2 CS--pretty good book IMHO. good luck.

What a nightmare of a story! Seriously- how can this test be "valid" with so many stories of people who passed an OSCE at accredited US medical institutions, and then failed the CS? One could argue that OSCE's are variable, but they seem to have served the purpose up until now. I sincerely hope that the NBME gets hit with a massive lawsuit.

Freefall, don't sweat the test- just rock the next one. It sounds like you just got a bad rap to me. It may take longer to request a "rescore" than to just go do the damn thing again. If you retake ASAP, you'll have your score (in theory) before intern year begins.

You all have to realize WHY we have to take this test to begin with. It is approximately 1% to weed out IMG's who can't speak English but 99% as a political move to soothe the lay public who are fed up with doctors who are short with them and only give them like 2 seconds of face time. This is abolutely verified becaue there were several articles in the lay press commending the NBME for now making new doctors "pass the test of bedside manner" before graduation.

When dealing with stupid liberal $hit like this, you really have to go out of your way to play the game (as other posters have already mentioned). You have to coddle the patient like they're a friggin 2 year old, ask them like 5 times if they need pain medication, ask them what they think is wrong with them or what they feel they want done, keep yes/no questions to a minimum, and try to unearth the patient's "dirty secret" (e.g. business exec with CP is actually a cocaine user).

I am convinced that the SP's are trained to detect cockiness, standoffishness, and arrogance in an examinee and that's really what this test is about. And by the way, they are the WORST actors and interpreting physical findings is very unclear. This test blows, will not improve health care, and underscores the fact that liberals suck.

freefall,

does your school video tape you for osce's and their graduation CSA??

i also did well in clerkships for the same subjective reasons that you did, but i was shocked when i failed an osce after a rotation (i thought i aced it!)

me and a couple docs went over the taped encounters (painful by the way to watch yourself, especially when people are watching it with you with a critical eye!), but it really helped me see some stuff that i didn't know i was doing (kind of like those axis 2 personality disorders where you don't see the problem cause you lack insight). If you do have taped encounters; i suggest you go over all of them with some older docs even though you passed them. i'm sure they'd be more than willing/

also, it is impossible to not have transferrence rxn's in such an artificial environment. with different actors, you would have likely passed.

i agree with posters on each side of the argument with the posting of credentials. I think that if i had your credentials it would be extremely difficult to not develop a little bit of pride/ego and i think that the fact that you mentioned them in your origianl post does say something. a slight sliver of ego could lead to a failed encounter (the public is very fed up with Minor Deity syndrome, and borderline comments that could go either way will be interpretted as egotistical).

i also agree that a white male with a good physique is highest risk for failing (other than the 1% or so who cant speak english). i also would like to add that attractive people are more likely to fail ( do you understand why?? )

the actor advice that your dean gave you is dead on too. couple of my favorite tips to sway the transference rxns in your favor:

1) use sir and ma'am with every patient (classic southernplayalistic trick) - a lot of northerners don't do this (culture thing) picked it up in undergrad when i noticed that southerners use it ruthlessly, get what they want, but often have no respect for who they are addressing as sir/ma'am.

2) validation: awesome and underused. get brief initial CC and a few details of the history and then say "first of all, I think that it's great that you took the initiative to come in! it shows that you really care about your health and I'm looking forward to assisting you with your situation!" HA! i also like, "LOTS of people would feel the way you feel if they were in your position!"

3) showing humbleness and modesty by admitting that you don't know something. we had a guy who thought his son had ADHD. in this encounter, i was instructed to be a primary care pediatrician. i didn't happen to know all of the criteria and if i did, i'm not sure i would have gotten too much into it. instead i told him that although i know about the condition, it is not my specialty so i will be referring you to a child psychiatrist and WE will all be working on this as a team with follow-up from both of us. People who knew the 7/7/7 criteria did not do as well and came off robotic by just firing out q after q rather than sympathizing.


just a few tips. you seem really bright, so you probably used all 3 of those. just a few of my personal favs & trying to help others who may not know them. i'm sure you kicked ass in the match too,.. so congrats.

in conclusion, i think it's great that you took the initiative to post and ask for help. lots of people would feel the way you feel and i'm looking forward to assisting you in your situation. see that?? I'm actually ASPD (king of axis 2!) and don't give a crap about you!!!!

later doc.



You all have to realize WHY we have to take this test to begin with. It is approximately 1% to weed out IMG's who can't speak English but 99% as a political move to soothe the lay public who are fed up with doctors who are short with them and only give them like 2 seconds of face time. This is abolutely verified becaue there were several articles in the lay press commending the NBME for now making new doctors "pass the test of bedside manner" before graduation.

When dealing with stupid liberal $hit like this, you really have to go out of your way to play the game (as other posters have already mentioned). You have to coddle the patient like they're a friggin 2 year old, ask them like 5 times if they need pain medication, ask them what they think is wrong with them or what they feel they want done, keep yes/no questions to a minimum, and try to unearth the patient's "dirty secret" (e.g. business exec with CP is actually a cocaine user).

I am convinced that the SP's are trained to detect cockiness, standoffishness, and arrogance in an examinee and that's really what this test is about. And by the way, they are the WORST actors and interpreting physical findings is very unclear. This test blows, will not improve health care, and underscores the fact that liberals suck.

I failed the cs as well. I'm in the top 20% of my class, over 230 on step 1, 250 on step 2 CK. I had passed a standardized patient assessment for 3rd year med students last year at Mt Sinai. I also passed my patient H&P required of me durign my medicine clerkship with honors. I really don't know what happened during my CS exam.
Perhaps I was a little nervous due to the magnitude of the exam, and the artificialness of the entire situation, but I felt that I communicated well with my actor patients. I smiled, made eye contact, was courteous and always left time for them to ask me questions. I always explained to them whatever it was that I was doing, why I was asking a particular question and why I was performing a certain exam. I told them my differential diagnosis with reasoning, and gave them reassurance with the serious diagnoses which were unlikely.
I felt that I had a good rapport with most of the actor patients with the exception of 1 or 2 of them, who seemed to give me the evil eye from the beginning of the encounter and one of them just stared at me when I said "it was nice meeting you" as we parted ways.
For some reason, they still failed me, and worst of all, the results came back in the middle of my interview season. I am very grateful to the residency program I ended up matching at, for giving me a chance, especially since it is a very good program and they could have easily cast me aside. Still, I can't believe how evil this exam is... first year its ever been given, no chance for remediation or anyone to review the videotapes with you, no real explanation on why you failed or what you did wrong, just a big fat F in the mail due to "poor communication skills". The funny thing is several weeks later during my subinternship, one of my fellow subIs was yelling at a peds patient for not letting her stick him for the 3rd time. I was the one who eased the situation and convinced him to let us draw it by explaining in a calm manner that it was important for us to order the blood tests that we needed. Somehow, she passed the CS, I didn't. There are people going thru much worse than I, such as the sick people in the hospital obviously, but for them to try and crush my life-long dream like that... I feel wronged.

I failed the cs as well. I'm in the top 20% of my class, over 230 on step 1, 250 on step 2 CK. I had passed a standardized patient assessment for 3rd year med students last year at Mt Sinai. I also passed my patient H&P required of me durign my medicine clerkship with honors. I really don't know what happened during my CS exam.
Perhaps I was a little nervous due to the magnitude of the exam, and the artificialness of the entire situation, but I felt that I communicated well with my actor patients. I smiled, made eye contact, was courteous and always left time for them to ask me questions. I always explained to them whatever it was that I was doing, why I was asking a particular question and why I was performing a certain exam. I told them my differential diagnosis with reasoning, and gave them reassurance with the serious diagnoses which were unlikely.
I felt that I had a good rapport with most of the actor patients with the exception of 1 or 2 of them, who seemed to give me the evil eye from the beginning of the encounter and one of them just stared at me when I said "it was nice meeting you" as we parted ways.
For some reason, they still failed me, and worst of all, the results came back in the middle of my interview season. I am very grateful to the residency program I ended up matching at, for giving me a chance, especially since it is a very good program and they could have easily cast me aside. Still, I can't believe how evil this exam is... first year its ever been given, no chance for remediation or anyone to review the videotapes with you, no real explanation on why you failed or what you did wrong, just a big fat F in the mail due to "poor communication skills". The funny thing is several weeks later during my subinternship, one of my fellow subIs was yelling at a peds patient for not letting her stick him for the 3rd time. I was the one who eased the situation and convinced him to let us draw it by explaining in a calm manner that it was important for us to order the blood tests that we needed. Somehow, she passed the CS, I didn't. There are people going thru much worse than I, such as the sick people in the hospital obviously, but for them to try and crush my life-long dream like that... I feel wronged.

I would write a letter of complaint to the NBME. It is ridiculous that so many excellent students are failing. I truly believe that the examiners are trying to knock the "top notch" students down a notch.

Wow, that really sucks. If I were you guys I would threaten them with a lawsuit unless they can justify why you were failed on this exam. Do they provide criteria for the examination? Are you allowed to see what they marked you off for? This just seems so f-ing arbitrary. I hope that your dean will fight on your behalf to find out what happened. This is just totally unacceptable. I wish you luck with all this.

Also, knowing that if you ask an SP a string of symptoms in a single question they only answer to the last thing in the string is also important (So for example, if you ask, "Do you have nausea, vomiting, diarrhea or constipation?" They only answer to the last thing you asked.

Where did you hear this? It never said this in FA. I'm afraid I did this for every single one of my pts. Who has the time to ask about each individual symptom in a ROS and pause after each one when you have such a short amt of time for the H&P??!

Where did you hear this? It never said this in FA. I'm afraid I did this for every single one of my pts. Who has the time to ask about each individual symptom in a ROS and pause after each one when you have such a short amt of time for the H&P??!

You only ask the obvious questions and in the ROS state: as per HPI above. It states something like that in FA for Step 2 CS.

You all have to realize WHY we have to take this test to begin with. It is approximately 1% to weed out IMG's who can't speak English but 99% as a political move to soothe the lay public who are fed up with doctors who are short with them and only give them like 2 seconds of face time. This is abolutely verified becaue there were several articles in the lay press commending the NBME for now making new doctors "pass the test of bedside manner" before graduation.

When dealing with stupid liberal $hit like this, you really have to go out of your way to play the game (as other posters have already mentioned). You have to coddle the patient like they're a friggin 2 year old, ask them like 5 times if they need pain medication, ask them what they think is wrong with them or what they feel they want done, keep yes/no questions to a minimum, and try to unearth the patient's "dirty secret" (e.g. business exec with CP is actually a cocaine user).

Could we please keep the name calling out of this? By referring to this exam as stupid and liberal you just lost at least half of your audience. I met the guy who is repsonsible for this. I do not know if he is liberal or neo-con, what I do know is that he is all politician. You are right though, the NBME conducted a survey in which the majority of respondents said they thought an exam such as BS would be good. Guess what we get to take BS.

Another point, the FMGs have had to take this exam or something like it for a while now. The exam has just been expanded to include those of us who are graduating from US and Canadian LCME schools. The exam as it is now has less to do with catching FMGs who can't communicate adequately in English, than it does with testing the 30 % of US grads who never had a physical exam witnessed by an attending.

Does this exam bite big donkey bars? Yes. Is it here to stay? Yes. Will I ever volunteer to do anything for the benefit of the NBME or volunteer to sit on my state's board after this? Hell no!

Please let us know how this works out for you and how you handled the situation.

i also agree that a white male with a good physique is highest risk for failing (other than the 1% or so who cant speak english). i also would like to add that attractive people are more likely to fail ( do you understand why?? )

Okay, you got my attention. I'm a blonde-haired, blue-eyed, 6-foot tall former Marine Sergeant - I'm 225 pounds of solid muscle (a former-nationally-ranked powerlifter) - and my wife (and my mom) think I'm good looking ;)

I haven't gotten my results back yet. Should I be scared?

Seriously, though....what's your reasoning behind this statement?

Could we please keep the name calling out of this? By referring to this exam as stupid and liberal you just lost at least half of your audience. I met the guy who is repsonsible for this. I do not know if he is liberal or neo-con, what I do know is that he is all politician. You are right though, the NBME conducted a survey in which the majority of respondents said they thought an exam such as BS would be good. Guess what we get to take BS.

Another point, the FMGs have had to take this exam or something like it for a while now. The exam has just been expanded to include those of us who are graduating from US and Canadian LCME schools. The exam as it is now has less to do with catching FMGs who can't communicate adequately in English, than it does with testing the 30 % of US grads who never had a physical exam witnessed by an attending.

Does this exam bite big donkey bars? Yes. Is it here to stay? Yes. Will I ever volunteer to do anything for the benefit of the NBME or volunteer to sit on my state's board after this? Hell no!

I agree with you about the liberal part losing an audience, but I doubt anywhere near half of people reading posts here are offended by the test being called stupid.

Just thought I'd give this thread a bump - my story is exactly the same as Freefall's (and the others on this thread). If you'd feel like giving me a PM or anything regarding how you got on with your lives after your CS debacle I would be very grateful.

Thanks!

Hello there,

I was in a similar situation. I had to retake it and thankfully passed it the second time. I did not get to enjoy my match day (though met some people in same situation). I think it's a bogus retarded exam and feel they randomly fail people. No real reasoning behind it. I hate that exam. Anyhow, after getting in more debt I traveled half way around the country and took it in order to have the score by graduation time and in time for intern year. Thankfully it all worked out. I was so upset after failing it. I had always done well with patients and was so shocked when I got a failing score. Horrible feeling. Felt numb and then just plain horrible. I ended rereading Step2 CS 3 times and the kaplan clinical skills book too (I went all out the second time) and thankfully must have done "something" differently or else they decided this time to fail someone else after making an extra thousand out of me. Don't worry about it just study very hard this time and go take that piece of crap exam again.

I like that name... Step 2 BS...

As for the SP's... at the Houston center, they have a Rick's Cabaret in the same building (adjoining). I could swear at least two of my patients were strippers.

We're being evaluated by strippers.

just wanted to bump this topic because the identical situation happened to me. my question is -- would it cost so much more for the NBME to pay physicians to sit behind those glass windows and grade us instead of using strippers (as somebody :) hysterically pointed out) and homeless people from the streets to grade us? this makes me feel like this test is nothing more than extortion.

does anybody feel like getting together and writing a joint letter to JAMA or something to complain about this? if so, email me endstep2cs@yahoo.com

(i'm mad b/c i've to pay $~900 x2 to take this invalid test twice...)

would it cost so much more for the NBME to pay physicians to sit behind those glass windows and grade us instead of using strippers (as somebody :) hysterically pointed out)
that was me... and it was true...
next door to the Houston center was a Rick's cabaret...
my Trichomonas counselling case was definitely a stripper...
and plus... her eyes were so red...
so either she took the acting too seriously and somehow infected her eyes with Trich too, or she was stoned...

I just took step 1 so I don't know how true any of this is or if it's common knowledge from FA, but I was talking to an IMG from Brazil who is studying for step 2 CS and he told me that you get marked down for saying "good" while nodding and talking to a patient, you're supposed to use more neutral phrases like "alright" etc. Also, he said you're never supposed to shake a patient's hand unless they offer you their hand first-- that's another deduction.

Needless to say I was shocked, none of this really seems intuitive, and behaviors that seem to come naturally to those of us who like people and enjoy talking with patients are some of the same behaviors that can cause great students to fail.

Seems like CS is just a mine field, and you have to avoid the "booby traps" to pass.

I just took step 1 so I don't know how true any of this is or if it's common knowledge from FA, but I was talking to an IMG from Brazil who is studying for step 2 CS and he told me that you get marked down for saying "good" while nodding and talking to a patient, you're supposed to use more neutral phrases like "alright" etc. Also, he said you're never supposed to shake a patient's hand unless they offer you their hand first-- that's another deduction.

I am willing to bet that your Brazilian friend is full of poop.

I am willing to bet that your Brazilian friend is full of poop.

I don't know one way or the other, but I'm curious as to why you think he'd lie?

I don't know one way or the other, but I'm curious as to why you think he'd lie?

I am in no way saying he is lying. I am saying that he either has no idea what he is talking about or he is misinformed. I am willing to bet that the majority of US medical student test takers either consistently shook the hands of their patients firmly without any invitation to do so (as recommended by First Aid) or used the word "good" while talking to their patients. And the bottom line is 96% of US/Candian medical students pass this exam. I would bet that a lot more than 4% of test takers do the things your Brazilian friend warned against.

There are all these rumors about the test of things you cannot do and a lot of them seem rather silly. It is just my opinion. When you are in the exam room, the more you start worrying about things like "Oh crap, did the patient offer their hand before I shook it?" the more likely you are to lose site of what is important, like taking a good history and physical. So if you want to believe several of these things, then believe them. I am going to go ahead and trust the opinons of those who teach clinical skills and Step 2 CS preparation at my medical school and the physicians who write the books such as First Aid for Step 2 CS instead of giving much attention to seemingly silly advice from a Brazilian IMG. But hey, to each their own.

agree with scholes here. This Brazilian guy has no clue how the test is graded.

agree with scholes here. This Brazilian guy has no clue how the test is graded.


Good to know-- I figured it was hearsay, but it would seem to explain how some solid students fail this exam, which was the original issue at hand

I am a US med student, over 230 on step I, AOA, and I just failed step II CS. I studied hard for a week for this test, reading all of first aid, and practicing on my wife, plus our school had us practice with some standardized patients, which I got in the 90th percentile on. So this F makes absolutely no sense. I had heard horror stories (especially about white, good-looking boys like me), and I did everything possible to avoid failing. The possible things I did wrong: I forgot to re-tie one of the patients gowns, one SP seemed annoyed at me when I asked her if she used drugs (she was black), I ran out of time once and had to end before giving a full explanation of the diagnostic steps, and one of the SP’s coughed and I forgot to get her water (a- it wasn’t a bad cough, b-I did remember to turn lights off for someone with headache and never repeated painful maneuvers). My clinical notes and knowledge were excellent. I am a very humble person, and I am very nice and easy-going in actuality, and tried to be even more so in this exam. I have no idea how this is even possible. So I am forced to come to a couple conclusions.

1) This test was totally unfair—I took it in LA, and it was filled with black and Hispanic women (two who weren’t even very good at English!!), and one elderly white lady. It was interesting too that I was one of only three or four US med students, and the rest were actually full doctors, mainly from Korea and India. Anyway, the SP’s could have any vendetta they want against me for being a white kid, no matter how perfect I performed (and competing against actual doctors). The NBME hides this by not releasing any sort of evaluation that would help you improve. And just for the information of my stupid graders, I am not a rich white boy—I grew up in the ghetto and ate old bread out of the dumpster of the neighborhood bakery for two years. I came out of hell just as much as any black person in the ghetto. I gave my life to study and service, and this is how I am rewarded, by being told that after excelling in all my training thus far, I’m not good enough to be an MD. If I weren’t in so much debt I would quit med school right now, just because I don’t want to be a part of the kind of people who are running this show. I wish I could expose what a screwed up little prep club it is, having nothing to do with skill, smarts, or compassion.

2) The NBME says that the purpose of this exam is to help us improve bed-side manners. Then why are we supposed to rush in and rush out without even doing a thorough H&P, or talking about all the patient’s concerns, or figuring out if we’re missing anything? This exam taught me that I am not curt enough with my patients and I took too long finding out about their problems. Therefore, as soon as I pass this exam for real, I will make sure to take no longer than 15 minutes with each patient. If I ever have a doctor for a patient, I will ask him if he or she has ever been on the NBME, and if so, I will make sure he is in as much pain as possible. Why? Because the NMBE thinks I’m not a nice doctor, so I guess I’ll just live up to that.

3) The NBME made up a test that eliminates any smart people from finishing medical school and, what’s worse, embarrasses the specialty of medicine. I have not always been a super social person, but I am very nice and pretty smart. I wouldn’t say I’m quirky at all, but either way, this exam must be testing all the wrong things. I have also accomplished a lot of significant research, but that doesn’t matter. This is why the NBME has just embarrassed the entire specialty of medicine-- it no longer makes any difference how much you have contributed to science or medicine, or how talented or brilliant you are, or what you have overcome in your life. An MD just means you can talk to people about their sex life (good for psychiatrists and family medicine).

4) This test was made up by a bunch of old fart doctors who never had to go through nearly this much to become doctors. Back in their day, they didn’t have nearly the competition that exists today. They didn’t have to do research to get into med school or competitive residencies, and they didn’t have to even study for step I, much less dedicate months of grueling study to it. Apparently they got tired of molesting little kids and decided to molest all of the US medical students instead. So for the new generation of med students, let's just remember this test is worthless and indicates nothing. Just as they have actors, this exam only tests the students ability to be an actor and find the random pieces of info that the SP's are looking for. Furthermore, it doesn't matter how good you are-- they have said they are going to fail 1 out of every 25 US med students (4%). Don't respect it for a second.

5) Since the NBME thinks it is essential that every MD have all these family medicine skills, why not make a step II for research skills, and another for surgical skills to be even more broad and balanced? (Sarcasm)

So… do you think there are any countries that would be willing to accept an AOA, excellent scientific researcher, and budding US doctor who is not compassionate enough? I think so. The US can take all these foreign graduates who are apparently more compassionate than me. Maybe the public thinks it is "good" that doctors are "learning bedside manners," but when people realize that the only doctors available are from India and no one from their own culture, I think the NBME will have some explaining to do.

I am a US med student, over 230 on step I, senior AOA (in a top 25 school for clinical and research), and I just failed step II CS. I studied hard for a week for this test, reading all of first aid, and practicing on my wife, plus our school had us do 4 hours of standardized patients, which I got in the 90th percentile on. So this F makes absolutely no sense. I had heard horror stories (especially about white, good-looking boys like me), and I did everything possible to avoid failing. The possible things I did wrong: I forgot to re-tie one of the patients gowns, one SP seemed annoyed at me when I asked her if she used drugs (she was black), I ran out of time once and had to end before giving a full explanation of the diagnostic steps, and one of the SP’s coughed and I forgot to get her water (a- it wasn’t a bad cough, b-I did remember to turn lights off for someone with headache and never repeated painful maneuvers). My clinical notes and knowledge were excellent. I am a very humble person, and I am very nice and easy-going in actuality, and tried to be even more so in this exam. I have no idea how this is even possible. So I am forced to come to a couple conclusions.

1) This test was totally unfair—I took it in LA, and it was filled with black and Hispanic women (who weren’t even very good at English!!), and one elderly white lady. It was interesting too that I was one of only three or four US med students, and the rest were actually full doctors, mainly from Korea and India. Anyway, the SP’s could have any vendetta they want against me for being a white kid, no matter how perfect I performed (and competing against actual doctors). The NBME hides this by not releasing any sort of evaluation that would help you improve. And just for the information of my stupid graders, I am not a rich white boy—I grew up in the ghetto and ate old bread out of the dumpster of the neighborhood bakery for two years. I came out of hell just as much as any black person in the ghetto. I gave my life to study and service, and this is how I am rewarded, by being told that after excelling in all my training thus far, I’m not good enough to be an MD. If I weren’t in so much debt I would quit med school right now, just because I don’t want to be a part of the kind of people who are running this show. I wish I could expose what a screwed up little prep club it is, having nothing to do with skill, smarts, or compassion.

2) The NBME says that the purpose of this exam is to help us improve bed-side manners. Then why are we supposed to rush in and rush out without even doing a thorough H&P, or talking about all the patient’s concerns, or figuring out if we’re missing anything? This exam taught me that I am not curt enough with my patients and I took too long finding out about their problems. Therefore, as soon as I pass this exam for real, I will make sure to take no longer than 15 minutes with each patient. If I ever have a doctor for a patient, I will ask him if he or she has ever been on the NBME, and if so, I will make sure he is in as much pain as possible and I will wipe my ass with my hand and stick it into his incisions. Why? Because the NMBE thinks I’m not a nice doctor, so I guess I’ll just live up to that.

3) The NBME made up a test that eliminates any smart people from finishing medical school and, what’s worse, embarrasses the specialty of medicine. I have not always been a super social person, but I am very nice and pretty smart. I wouldn’t say I’m quirky at all, but either way, this exam must be testing all the wrong things. I have also accomplished a lot of significant research, but that doesn’t matter. This is why the NBME has just embarrassed the entire specialty of medicine-- it no longer makes any difference how much you have contributed to science or medicine, or how talented or brilliant you are, or what you have overcome in your life. An MD just means you can talk to people about their sex life (good for psychiatrists and family medicine).

4) This test was made up by a bunch of old fart doctors who never had to go through nearly this much to become doctors. Back in their day, they didn’t have nearly the competition that exists today. They didn’t have to do research to get into med school or competitive residencies, and they didn’t have to even study for step I, much less dedicate months of grueling study to it. Apparently they got tired of molesting little kids and decided to molest all of the US medical students instead. So for the new generation of med students, let's just remember this test is worthless and indicates nothing. Just as they have actors, this exam only tests the students ability to be an actor and find the random pieces of info that the SP's are looking for. Furthermore, it doesn't matter how good you are-- they have said they are going to fail 1 out of every 25 med students. Don't respect it for a second.

5) Since the NBME thinks it is essential that every MD have all these family medicine skills, why not make a step II for research skills, and another for surgical skills to be even more broad and balanced? You only can pass by cutting of the ****s of the NBME board members and shoving it down their throats. Since I suspect that the step II CS exam is largely the result of women being on the NBME board, "****" can refer to more than one thing.

So… do you think there are any countries that would be willing to accept an AOA, excellent scientific researcher, and budding US doctor who is not compassionate enough? I think so. The US can take all these crappy foreign graduates who are apparently more compassionate than me. Maybe the public thinks it is "good" that doctors are learning bedside manners, but when people realize that the only doctors available are from India and no one from their own culture, I think the NBME will have some explaining to do.

advertising isnt allowed here on SDN, but blatant racism is? That is just a disgusting comment.

"The US can take all these crappy foreign graduates who are apparently more compassionate than me. When people realize that the only doctors available are from India and no one from their own culture, I think the NBME will have some explaining to do."

With that horrible attitude, it would be a blessing if you never got licensed in the US to practice medicine in the first place.

"I had heard horror stories (especially about white, good-looking boys like me), and I did everything possible to avoid failing."

this HAS to be a troll, nobody in their correct mind is crazy enough to actually post something absurd like this. It is insane.

I am a very humble person, and I am very nice and easy-going in actuality, and tried to be even more so in this exam. I have no idea how this is even possible. So I am forced to come to a couple conclusions.

you are moreso a completely inappropriate that has no business at all being in the medical profession in the first place, not as a nurse, or occupational therapist, NOTHING.

I took it in LA, and it was filled with black and Hispanic women (who weren’t even very good at English!!),

your one post ever explains it all though, you are a TROLL

2) The NBME says that the purpose of this exam is to help us improve bed-side manners.

or screen crazy individuals like you completely out of the system

If I ever have a doctor for a patient, I will ask him if he or she has ever been on the NBME, and if so, I will make sure he is in as much pain as possible and I will wipe my ass with my hand and stick it into his incisions. Why? Because the NMBE thinks I’m not a nice doctor, so I guess I’ll just live up to that.

completely crazy troll, you are not even probably done with high school.

The NBME made up a test that eliminates any smart people from finishing medical school and, what’s worse, embarrasses the specialty of medicine

well you are held back, now how would that be at all a bad thing?

So for the new generation of med students, let's just remember this test is worthless and indicates nothing.

I actually used to teach for Kaplan and dedicated time to teaching the cs portion of the examination. This examination reflects upon whether or not you are competent enough to practice medicine in the US. Thanks for showing everyone that it is accurate.

I am a US med student, over 230 on step I, senior AOA (in a top 25 school for clinical and research), and I just failed step II CS.

What element did you fail? I think it should be on the score report.

wow dude,
i can understand your frustration, but those are pretty heavy comments. i hope others understand the need to vent at times like this without flaming you terribly.
my completely unsolicited advice:
just LET IT GO, retake it, and mark it up as a small slice of humility which, lets face it, we all need sometimes.
in the big scheme, its a thousand bucks and 8 hours of your life. dont make it more than it REALLY is.
after all, you are in the best profession in the world, about to gradute (i assume) and will probably get the residency of your choice based on your step one score. its a bump in the road.

Ok, I admit I am pissed off, and I apologize for being rude. Thanks for the advice to just let it go. That's the only reasonable thing I can do. But to the idiot "andwhat"-- these are not racist comments, but I am accusing the SP's of being racist. If the NBME wants to prove otherwise, let them release the comments on my performance. And it was a complete fact that their English was not very good, one of them had a very Spanish accent and the other a very black accent. I don't have anything against that, but I just think it's ironic since we are being graded on English as well. I think people like you are the ones who should be taken out of medicine (You-- "Oh, I'm so righteous and glorified, I used to teach for Kaplan, so how dare you say something mean or have emotions after working your ass out of a hell-hole to achieve something.")

Ok, I admit I am pissed off. Thanks for the advice to just let it go. That's the only reasonable thing I can do. But to the idiot "andwhat"-- these are not racist comments, but I am accusing the SP's of being racist. If the NBME wants to prove otherwise, let them release the comments on my performance. And it was a complete fact that their English was not very good, one of them had a very Spanish accent and the other a very black accent. I don't have anything against that, but I just think it's ironic since we are being graded on English as well. I think people like you are the ones who should be taken out of medicine (You-- "Oh, I'm so righteous and glorified, I used to teach for Kaplan, so how dare you say something mean or have emotions after working your ass out of a hell-hole to achieve something.")

I never knew "black," was a language.

Plus, lots of patients will have accents in real life, so maybe you should get used to how they pronounce words now.

Black is not a language (although they tried to create ebonics I guess), but it is an accent. Maybe you should meet a black person sometime instead of living in prep-ville at Princeton. Accents and slang and whatever are fine, but while being graded on my English is just ironic, that's all. I don't see what's so offensive about that.

Black is not a language (although they tried to create ebonics I guess), but it is an accent. Maybe you should meet a black person sometime instead of living in prep-ville at Princeton. Accents and slang and whatever are fine, but while being graded on my English is just ironic, that's all. I don't see what's so offensive about that.

That's pretty funny, considering you are the one that obviously lacks the ability to comprehend the accent. That would imply you have less experience living in a minority-filled area, not me. MD/PhD, huh?

I grew up in an area with over 60% minorities; so maybe I'm at an advantage for being able to understand people from black and hispanic families. Still, I doubt it. Unless you are the one who has lived with a silver spoon in your mouth your whole life atop a castle on the coast of Whitey McWhiteville, I find it hard to believe you can't understand black people.

I can't wait for The Force Unleashed to come out!!! I scheduled vacation time just so I could play the game.

Ok, I admit I am pissed off, and I apologize for being rude. Thanks for the advice to just let it go. That's the only reasonable thing I can do. But to the idiot "andwhat"-- these are not racist comments, but I am accusing the SP's of being racist. If the NBME wants to prove otherwise, let them release the comments on my performance. And it was a complete fact that their English was not very good, one of them had a very Spanish accent and the other a very black accent. I don't have anything against that, but I just think it's ironic since we are being graded on English as well. I think people like you are the ones who should be taken out of medicine (You-- "Oh, I'm so righteous and glorified, I used to teach for Kaplan, so how dare you say something mean or have emotions after working your ass out of a hell-hole to achieve something.")

very black accent
So now black is an accent?

I seriously thought that this was some high school kid, but this is actually somebody who somehow got admitted into medical school, and is allowed to take the step 2 cs?
I am waiting for the sdn moderators to hopefully intervene in this terrible slew of racist insults.
Again let me reiterate,
this is the
student DOCTOR network, yes DOCTOR.
Your not being rude, no need to apologize to me. You are just inappropriate -- plain and simple.
You cannot pronounce English properly, or you are just plain not presentable -- in other words you do not smell all that great possibly. I wouldnt want a doctor with minimal language skills and body odor around me either. I will have to agree with NBME in their assessment of you Rugbyman.
You have to act like you know how to present yourself as a physician, before you can actually become one. That rule also applies to you.
You lack any sort of professionalism in your language here.

Ok, I admit I am pissed off, and I apologize for being rude. Thanks for the advice to just let it go. That's the only reasonable thing I can do. But to the idiot "andwhat"-- these are not racist comments, but I am accusing the SP's of being racist. If the NBME wants to prove otherwise, let them release the comments on my performance. And it was a complete fact that their English was not very good, one of them had a very Spanish accent and the other a very black accent. I don't have anything against that, but I just think it's ironic since we are being graded on English as well. I think people like you are the ones who should be taken out of medicine (You-- "Oh, I'm so righteous and glorified, I used to teach for Kaplan, so how dare you say something mean or have emotions after working your ass out of a hell-hole to achieve something.")

these are not racist comments

The US can take all these crappy foreign graduates who are apparently more compassionate than me. Maybe the public thinks it is "good" that doctors are "learning bedside manners," but when people realize that the only doctors available are from India and no one from their own culture, I think the NBME will have some explaining to do.

you contradict yourself mr. Rugby man. Try again.:laugh: :laugh: :laugh:

Alright children, everyone just chill. Rugbynerd obviously is pissed and took a cheap shot at the NBME. And that makes it really easy to take cheapshots right back about how you're so much better, and how he's racist, blah, blah. It is a frustrating and random exam, everyone knows that. Just roll with the punches. I passed, but I know I made mistakes too. And no matter how much you study and can perform perfect physical exams and come up with awesome diagnoses, there were a lot of cases where the SP just seemed weird and did not react like a normal person... and I wasn't sure if I was supposed to keep pressing for some underlying depression they were having, or if I was suppose to resolve some concern, or if I was supposed to do a heart, thyroid, lung, and abd exam for their complaints of fatigue, or if there was something in the history they weren't letting me know at first... and so I tried to do all of these things in the short 15 min, and it left no time to finish any of them (especially if you are pursuing one and then realize it's a dead end). I just have no idea what they happened to be looking for, and I think that kind of exam is ridiculous.

put yourself in the guys shoes, andwhat... i bet you would be frustrated too.
honestly, i find your use of "Jesus" in your post as slang just as offensive as you seem to find him saying "black accent"..
but so what if it offends me? nothing was meant by it right? its just a figure of speech to you, vernacular..
and to many a "black accent" is just that, his own vernacular describing someones accent. i dont think the op meant anything by it, just the fact that the guy had an accent..
i have a somewhat "country accent" because i am from sticksville and grew up on a farm.. i dont take offense, its just my accent..
and many black people from downtown l.a. might have a "black accent' or whatever you call it. who cares? its just an accent!
all the guy meant was it was ironic that people that didnt seem to use proper english or whatever you want to call it were failing him in that exact area.
i am not taking sides, but lets keep it fair.
did you never fail at anything you worked hard for? its a terrible feeling..
all i am saying is cut the guy some slack.

put yourself in the guys shoes, andwhat... i bet you would be frustrated too.
honestly, i find your use of "Jesus" in your post as slang just as offensive as you seem to find him saying "black accent"..
but so what if it offends me? nothing was meant by it right? its just a figure of speech to you, vernacular..
and to many a "black accent" is just that, his own vernacular describing someones accent. i dont think the op meant anything by it, just the fact that the guy had an accent..
i have a somewhat "country accent" because i am from sticksville and grew up on a farm.. i dont take offense, its just my accent..
and many black people from downtown l.a. might have a "black accent' or whatever you call it. who cares? its just an accent!
all the guy meant was it was ironic that people that didnt seem to use proper english or whatever you want to call it were failing him in that exact area.
i am not taking sides, but lets keep it fair.
did you never fail at anything you worked hard for? its a terrible feeling..
all i am saying is cut the guy some slack.


The US can take all these crappy foreign graduates who are apparently more compassionate than me. Maybe the public thinks it is "good" that doctors are "learning bedside manners," but when people realize that the only doctors available are from India and no one from their own culture, I think the NBME will have some explaining to do.

cut the guy some slack after saying some stuff like this?
Yeah ok, apparently the moderators must agree with this sort of behavior and language. It is ok to state racist remarks, but its not ok to say anything about it. That is unreal and uncalled for, but I am not the judge, it is the moderators and users of SDN.
Well you know what? Even though I am a US grad, I at one time attended an international school also. I do have connections with USMLE World, and help from time to time for a little extra loot. Its funny, because YOU RUGBY BOY, will be paying FOREIGN GRADS FROM INDIA in order to pass your step 2 ck and step 3.
Oh and by the way, the best prep for step 2 cs, it comes from USMLE World, which is run by foreign grads from India. Nice huh? Maybe we can teach you a thing or three.

Racism is clearly allowed here, however speaking up against it most definitely is not, so I will leave this thread.
For the record, no I have never failed anything of this magnitude -- and if I did, then I wouldnt blame the system, NBME, and graders of my test. I would suck it up, move on and learn from my mistakes.
I have however failed to understand how the moderators of SDN allow blatant racist remarks to stay on a forum, however it is outlawed to say anything against it. So yes you are correct, I definitely have failed to make the connection there.

I am accusing the SP's of being racist

So it is the system right? Wrong. Get over it and move on with your life, instead of blaming each and every single person besides yourself.

Dude, the guy says that foreign grads must have shown more compassion than him, so I hardly see how that's racist. Unless you think saying "crappy foreign grad" is racist. It may be rude, but I hardly see how it's racist. Why are you so intent to make this a racist issue? Same for you rugbynerd-- i think you probably failed for some random reasons which no one will ever know, but likely not for racism.

You never failed at anything andwhat? Soooo that's why you're in family medicine? You must have been the guy that pulled down the curve for all those "failures" who rocked step I. Thanks bro. You may have been at the bottom of the pack all your life, but you never failed, so keep on ripping everyone else down, real mature. I'm glad you're not my PCP.

And I highly doubt you will leave this thread as you state.

I just have no idea what they happened to be looking for, and I think that kind of exam is ridiculous.

i passed as well, and truly, i had no idea what they were looking for either.
i just tried to be polite and empathetic, and genuine. and respectful..and hurry as quick as i could w/o seeming rushed!
for the record, i am a "typical white guy" whatever that means who came to medicine as a second career after 10 good years owning a construction company.. i had an brachial plexus injury and was so impressed by the surgeon that fixed me that i had to go for it.
i WISH i were a US grad good grief, but at the end of the day, we are all the same. repeat, we are all the same.
that may ruffle some feathers, but its true. ask yourself..
did you get a better education than i did from a US school? yes, i am sure thats the case..
does this translate into higher board scores? yes... most often..
does this translate into "better" residency positions? yes.. again usually..
however.. does where you went to residency mean anything to 99% of your patients? do they even know what residency is?
the bottom line, for me and for anyone i think that truly is being honest with themselves..
we all took the same steps to get here.. we all went to med school, we took the same usmles, we all go to residency..
and then.. guess what? when its done its done.. the sign in front of your office says dr so and so MD just like mine, all that matters then is how you treat your patients.. at THAT point you can throw grades out the window... where you went to school..board scores. its all out.
because at THAT point, do you care about your credentials, or do you care about your patients?
if you are a caring, empathetic, repectful, skilled doctor, then 99% of the time, you will have more patients than you can handle. and thats what cs to me is trying to determine. not how smart you are, but.. do you know how to treat someone as a human being? (on a side note, those who treat their patients well, have many more patients, thus tend to make more $$, which oddly is the ultimate barometer for most in terms if ultimate success, NOT the degree hanging on your wall)
how many of you look down your nose at the guys on the next rung down.. american grads looking down on fmg's. fmg's looking down on img's, img's looking down on do's (this is not my personal hierachy, just a general theme)..
an ivy league grad can care as much about his patient as a carribean grad..
an indian doc can care as much about his patient as an american doc.
it doesnt matter how you get there, just THAT you get there do your best with what God (or Allah or Buddah or...) gave you. be thankful. all of you, that you get the honor to practice medicine.
everyone should be so lucky.

one more thing..
people can fail a test for any number of reasons..
some people get flustered..
some lose focus
some dont prepare..
sometimes there is miscommunication or true clerical error..
but my all time favorite for cs, are the cocky guys that walk in with an attitude of superiority because they are the big DOCTOR and the patient is just a silly actor, so far beneath them... those guys deserve to fail imho.
future cs takers take note..
those actors, the ones that are so far beneath some of you? they are GRADING YOU!
so be polite, be respectful, fake empathy even if you dont have it!
this is what you are being tested on. is it fair? maybe, maybe not...
i am just glad to be past it.
good luck to all.

Dude, the guy says that foreign grads must have shown more compassion than him, so I hardly see how that's racist. Unless you think saying "crappy foreign grad" is racist. It may be rude, but I hardly see how it's racist. Why are you so intent to make this a racist issue? Same for you rugbynerd-- i think you probably failed for some random reasons which no one will ever know, but likely not for racism.

You never failed at anything andwhat? Soooo that's why you're in family medicine? You must have been the guy that pulled down the curve for all those "failures" who rocked step I. Thanks bro. You may have been at the bottom of the pack all your life, but you never failed, so keep on ripping everyone else down, real mature. I'm glad you're not my PCP.

And I highly doubt you will leave this thread as you state.

my scores? 230s, with the exception of step 3 which I took during residency -- granted I STILL managed a good score on step 3 also. The fact that I am an international grad? Nope. I am a US grad. No I can say that I havent failed at anything, other than to see why this stuff is allowed to be posted. As for pulling the curve down? Thats why I am now in the specialty of my choice, could have easily bailed out of my current situation, but I fulfilled my obligatory commitment. Ok so now its a mudslinging contest? Thats not my style. Bottom of the pack? No actually I can send you my FM in service examination, upper 75th percentile. Board scores also.
I can start working and pocket $200 K a year, but chose to pursue the career of my choice.
So let me get this straight, just because your a Family Medicine resident means that you have low board scores?! That is the most absurd thing that I have ever heard. What the hell kind of concept is that???? Granted I was not at all in the top whatever percentile of my medical school (couldnt care less mostly kiss as+ people), albeit do have great LORs and board scores......
are you serious???


HOLD ON WAIT WAIT WAIT

Today, 07:10 PM #82
Superbad
New Member


Join Date: Sep 2007
Posts: 4

Superbad is Rugbynerd, the only person crazy enough to post that stuff above, is Rugbynerd himself. Yes you are exposed, somebody that has registered as a new user only to post in this thread, GEE WHAT A COINCIDENCE -- get a life dude.
So your too busy registering as a new user with multiple different user names to defend yourself. Truly sad.
Somebody that cannot even clear step 2 cs, insulting a specialty Family Medicine??? pretty pathetic.
You have very very twisted and convoluted ideas. Perhaps that is why you cannot focus and pass. I do not know why, but you are one amazing individual, you have racist ideas, and you think that family medicine is full of people that didnt fulfill some curve??? wow ur one amazing individual.
I think that you have so much anger built up inside of you, that you cannot focus on tasks at hand. You are frustrated with the world, and you cannot do anything about it. Truth is, you will not be able to start rotations without passing your cs in some medical schools, so better get studying Superbad aka Rugbynerd. What names are next buddy?
For note, I am not ripping anybody "down" I agree with all of the rest of the intelligent and respectful posts. Somebody that dogs family medicine, and International grads, and doctors from India, is a troll. Let us remember this guy has a grand total of 3 to 4 posts, and all here on this thread, and changing his name rapidly to agree with himself.
Truth is, I know people with low board scores AND attempts, in Radiology and Anesthesiology, as well as General Surgery -- agree this is not the norm, and majority of individuals in my residency program happen to have excellent board scores. So what exactly does this prove? Absolutely nothing.
This thread proves that Superbad is Rugbynerd, and possibly more multiple personalities. Actually same personality, different names.

[QUOTE=andwhat;5638658]
So let me get this straight, just because your a Family Medicine resident means that you have low board scores?! QUOTE]


i dont mean this sarcastically, but yes, it usually does mean just that.
there are exceptions of course, to anything. and with a 230, you are WAY high for a fm step one.
its sort of like saying, just because i have a dog, doesnt mean i buy dog food..
well, again there are exceptions, but most dog owners buy dog food, and most family residents have lower scores than their peers in other specialties.
check the match stats for 07 for avg scores among specialties.
family was the lowest. kind of stinks, as it is also my specialty.
i am guessing its less attractive because of lower avg $$, but there are always exceptions. maybe you will add ob, or derm, or whatver. its a free country, so go for it :)
all the best.

[QUOTE=andwhat;5638658]
So let me get this straight, just because your a Family Medicine resident means that you have low board scores?! QUOTE]


i dont mean this sarcastically, but yes, it usually does mean just that.
there are exceptions of course, to anything. and with a 230, you are WAY high for a fm step one.
its sort of like saying, just because i have a dog, doesnt mean i buy dog food..
well, again there are exceptions, but most dog owners buy dog food, and most family residents have lower scores than their peers in other specialties.
check the match stats for 07 for avg scores among specialties.
family was the lowest. kind of stinks, as it is also my specialty.
i am guessing its less attractive because of lower avg $$, but there are always exceptions. maybe you will add ob, or derm, or whatver. its a free country, so go for it :)
all the best.


yeah that is true actually, havent considered that in a while...... I am not the only one above 230 in my program on step I definitely, albeit I do not know how to formulate D.O. results -- D.O.s are higher than average also in my program.
Those going for the match, apply early and apply broadly. Apply to both community and university programs. I was arrogant, disorganized, and messed up during match season, albeit definitely happy with my result. God willing worked out. By all means not saying that I am perfect, far from it in my opinion. Luck has been on my side for sure.

Dude, I'm not rugbynerd. I just registered to comment 'cause I felt like saying something. Sheesh. You just say arrogant things and then group everyone who disagrees with you together. Just chill bro.

I’m not ripping on doctors from India-- I’m sure they’re just as competent as anyone. I apologize for saying "crappy foreign grads"-- I was just throwing in angry words, and did not mean to say foreign grads are in any way inferior. I know two excellent foreign grads myself. They just come from a different culture and language, and I was mad that they all can pass this test on "English and American mannerisms," and yet I did not. It would be the same if I came down to India and passed a test on Indian language and mannerisms, and yet someone who grew up in India did not… naturally it would be frustrating, and if someone from India were mad about not passing an exam in their own culture and language, I would understand. Thanks superbad and jdig for defending me, but I know that what I said was out of frustration and probably offended some people. I know I probably failed not due to racism, but there’s really no way to know. I just thought it’d raise some controversy to bring that up. Like you say jdig, we are all the same in the end. I was only trying to rip on the NBME, and accidentally brought in a can of worms I guess, and I apologize. (But I still think this exam is stupid.)

I’m not ripping on doctors from India-- I’m sure they’re just as competent as anyone. I apologize for saying "crappy foreign grads"-- I was just throwing in angry words, and did not mean to say foreign grads are in any way inferior. I know two excellent foreign grads myself. They just come from a different culture and language, and I was mad that they all can pass this test on "English and American mannerisms," and yet I did not. It would be the same if I came down to India and passed a test on Indian language and mannerisms, and yet someone who grew up in India did not… naturally it would be frustrating, and if someone from India were mad about not passing an exam in their own culture and language, I would understand. Thanks superbad and jdig for defending me, but I know that what I said was out of frustration and probably offended some people. I know I probably failed not due to racism, but there’s really no way to know. I just thought it’d raise some controversy to bring that up. Like you say jdig, we are all the same in the end. I was only trying to rip on the NBME, and accidentally brought in a can of worms I guess, and I apologize. (But I still think this exam is stupid.)

Much more lucid, respectful, and cogent. In which case best of luck, man, I hope this thing gets sorted out for you ASAP.

I actually took the PIPE years back, and didnt do well at all on it. It was a mock practice test, just before the actual CS was implemented. I was so panicked that I took a course, and that helped to an extent, but USMLE World had all of the weird cases in there. Its not a tough test, its just you have to know what to do and how to study. All or most of the cases that you will get are in First Aid, but it doesnt cover nearly the depth that you have to go into.
For instance the childhood visits. When I took my test, a lady walked out of the room, and asked "so wheres the kid?" I knew that her test didnt go well.
There is no actual kid on the test. Its a weird test, that is a bit unfair honestly, because theres no information out there provided by NBME that will help you necessarily. Thats where the commercial review courses get rich quick. Also the other agonizing thing was the telephone visit, I was so freaked out by that during the PIPE examination, that I almost just walked out because I had no clue what to do. Its an examination of nerves at times.
USMLE World was ok, but a bit disorganized, Kaplan is more organized, but not nearly comprehensive enough, as they are with step I. Actually Step 3 Kaplan is straight up horrible, as they teach incorrect things.
Would go personally with all of the USMLE World cases, you can print out the majority of them, you need to finetune some of them though because they are not organized well enough.
Kaplan course is ok, I mean they grill you during the extended course, its expensive but almost worth it. You get to practice on the dummies, and they give you feedback right away. Its pretty decent in my opinion. I went in blank, but there were people that had practiced for weeks. Its not a bad course, way too expensive.

Black is not a language (although they tried to create ebonics I guess), but it is an accent. Maybe you should meet a black person sometime instead of living in prep-ville at Princeton. Accents and slang and whatever are fine, but while being graded on my English is just ironic, that's all. I don't see what's so offensive about that.

Dude, I initially felt bad for you and was cutting you a little bit of slack on your previously unacceptable comments (chalking it up to trauma of failing CS)...but black accent?!? Come on man! That is the most ignorant statement on this board right now! It sucks that you failed, but you probably exuded the exact attitudes that you are displaying here...and patients can definitely pick up on that. It's great that you are an excellent student, but your prejudices are poisoning your bedside manner. There's no such thing as a black accent and I have met a black person, quite a few to be exact. Many people in America black, white, hispanic, whatever, are not as fortunate as you or me to be blessed with an extensive or quality education, but that makes them no less a person and they deserve to be treated with the respect that you would want. Regardless of the way your patients spoke, the raters were probably a little turned off by your upturned nose.

I am a US med student, over 230 on step I, AOA, and I just failed step II CS. I studied hard for a week for this test, reading all of first aid, and practicing on my wife, plus our school had us practice with some standardized patients, which I got in the 90th percentile on. So this F makes absolutely no sense. I had heard horror stories (especially about white, good-looking boys like me), and I did everything possible to avoid failing. The possible things I did wrong: I forgot to re-tie one of the patients gowns, one SP seemed annoyed at me when I asked her if she used drugs (she was black), I ran out of time once and had to end before giving a full explanation of the diagnostic steps, and one of the SP’s coughed and I forgot to get her water (a- it wasn’t a bad cough, b-I did remember to turn lights off for someone with headache and never repeated painful maneuvers). My clinical notes and knowledge were excellent. I am a very humble person, and I am very nice and easy-going in actuality, and tried to be even more so in this exam. I have no idea how this is even possible. So I am forced to come to a couple conclusions.

1) This test was totally unfair—I took it in LA, and it was filled with black and Hispanic women (two who weren’t even very good at English!!), and one elderly white lady. It was interesting too that I was one of only three or four US med students, and the rest were actually full doctors, mainly from Korea and India. Anyway, the SP’s could have any vendetta they want against me for being a white kid, no matter how perfect I performed (and competing against actual doctors). The NBME hides this by not releasing any sort of evaluation that would help you improve. And just for the information of my stupid graders, I am not a rich white boy—I grew up in the ghetto and ate old bread out of the dumpster of the neighborhood bakery for two years. I came out of hell just as much as any black person in the ghetto. I gave my life to study and service, and this is how I am rewarded, by being told that after excelling in all my training thus far, I’m not good enough to be an MD. If I weren’t in so much debt I would quit med school right now, just because I don’t want to be a part of the kind of people who are running this show. I wish I could expose what a screwed up little prep club it is, having nothing to do with skill, smarts, or compassion.

2) The NBME says that the purpose of this exam is to help us improve bed-side manners. Then why are we supposed to rush in and rush out without even doing a thorough H&P, or talking about all the patient’s concerns, or figuring out if we’re missing anything? This exam taught me that I am not curt enough with my patients and I took too long finding out about their problems. Therefore, as soon as I pass this exam for real, I will make sure to take no longer than 15 minutes with each patient. If I ever have a doctor for a patient, I will ask him if he or she has ever been on the NBME, and if so, I will make sure he is in as much pain as possible. Why? Because the NMBE thinks I’m not a nice doctor, so I guess I’ll just live up to that.

3) The NBME made up a test that eliminates any smart people from finishing medical school and, what’s worse, embarrasses the specialty of medicine. I have not always been a super social person, but I am very nice and pretty smart. I wouldn’t say I’m quirky at all, but either way, this exam must be testing all the wrong things. I have also accomplished a lot of significant research, but that doesn’t matter. This is why the NBME has just embarrassed the entire specialty of medicine-- it no longer makes any difference how much you have contributed to science or medicine, or how talented or brilliant you are, or what you have overcome in your life. An MD just means you can talk to people about their sex life (good for psychiatrists and family medicine).

4) This test was made up by a bunch of old fart doctors who never had to go through nearly this much to become doctors. Back in their day, they didn’t have nearly the competition that exists today. They didn’t have to do research to get into med school or competitive residencies, and they didn’t have to even study for step I, much less dedicate months of grueling study to it. Apparently they got tired of molesting little kids and decided to molest all of the US medical students instead. So for the new generation of med students, let's just remember this test is worthless and indicates nothing. Just as they have actors, this exam only tests the students ability to be an actor and find the random pieces of info that the SP's are looking for. Furthermore, it doesn't matter how good you are-- they have said they are going to fail 1 out of every 25 US med students (4%). Don't respect it for a second.

5) Since the NBME thinks it is essential that every MD have all these family medicine skills, why not make a step II for research skills, and another for surgical skills to be even more broad and balanced? (Sarcasm)

So… do you think there are any countries that would be willing to accept an AOA, excellent scientific researcher, and budding US doctor who is not compassionate enough? I think so. The US can take all these foreign graduates who are apparently more compassionate than me. Maybe the public thinks it is "good" that doctors are "learning bedside manners," but when people realize that the only doctors available are from India and no one from their own culture, I think the NBME will have some explaining to do.

I'm not surprised IN THE LEAST that you failed this exam.

Patients ARE gonna "seem annoyed" that you ask them if they take drugs. If you can't handle that (or maybe you just can't handle black or hispanic patients) then you DO NEED to choose another profession.

Dude, I initially felt bad for you and was cutting you a little bit of slack on your previously unacceptable comments (chalking it up to trauma of failing CS)...but black accent?!? Come on man! That is the most ignorant statement on this board right now! It sucks that you failed, but you probably exuded the exact attitudes that you are displaying here...and patients can definitely pick up on that. It's great that you are an excellent student, but your prejudices are poisoning your bedside manner. There's no such thing as a black accent and I have met a black person, quite a few to be exact. Many people in America black, white, hispanic, whatever, are not as fortunate as you or me to be blessed with an extensive or quality education, but that makes them no less a person and they deserve to be treated with the respect that you would want. Regardless of the way your patients spoke, the raters were probably a little turned off by your upturned nose.

LOL, you are cracking me up with your desperate attempts to be politically correct. Thanks for a good laugh in this stressful time. I'm not sure where you came up with the idea, however, that I look down on others because of my education. I guess it helps you be more pissed off though, so just make up whatever ideas you want. Anyway... I hang with all my black bros all the time (I played football and rugby in college, and I have tons of black friends), so I don't think you need to be lecturing me. Any black person will not only admit if they have an accent, but also make fun of it... but apparently it's immoral and racist for a white person to point that out.

LOL, you are cracking me up with your desperate attempts to be politically correct. Thanks for a good laugh in this stressful time. I'm not sure where you came up with the idea, however, that I look down on others because of my education. I guess it helps you be more pissed off though, so just make up whatever ideas you want. Anyway... I hang with all my black bros all the time (I played football and rugby in college, and I have tons of black friends), so I don't think you need to be lecturing me. Any black person will not only admit if they have an accent, but also make fun of it... but apparently it's immoral and racist for a white person to point that out.

Ooops I'm sorry...you have black friends...why didn't you say so in the first place? That makes it all ok then...:laugh:

Dude, I initially felt bad for you and was cutting you a little bit of slack on your previously unacceptable comments (chalking it up to trauma of failing CS)...but black accent?!? Come on man! That is the most ignorant statement on this board right now! It sucks that you failed, but you probably exuded the exact attitudes that you are displaying here...and patients can definitely pick up on that. It's great that you are an excellent student, but your prejudices are poisoning your bedside manner. There's no such thing as a black accent and I have met a black person, quite a few to be exact. Many people in America black, white, hispanic, whatever, are not as fortunate as you or me to be blessed with an extensive or quality education, but that makes them no less a person and they deserve to be treated with the respect that you would want. Regardless of the way your patients spoke, the raters were probably a little turned off by your upturned nose.

Even if many refuse to see it or appreciate it--Good comment...
I find that a "sheltered or semisheltered middle class life or better" is a COMPLETELY different world from "charming", real life, real time, proper Oslerian bedside manner!

Even if many refuse to see it or appreciate it--Good comment...
I find that a "sheltered or semisheltered middle class life or better" is a COMPLETELY different world from "charming", real life, real time, proper Oslerian bedside manner!

how about "lowlife" bedside manner :laugh:


Any black person will not only admit if they have an accent

so an African American individual, will clearly point out that he or she has a "black" accent? ha ha ha ha ....

Ugh, seeing how some people react after failing gives a lot of insight into why they didn't do so well. Seriously, I think these things aren't as much isolated rants as you think - they're more like little glimpses into your personality.

I just feel sorry for some people. It seems that some people who fail just get angry and blame the test instead of assuming that they might actually have a weakness and trying to figure out how to fix it. It's more probable that you have an area of weakness then it is that these "black and hispanic" actors at the testing center are racist and failing more white students then the rest of the country. Assuming that's the case right from the start because of only your anecdotal evidence is racist. I wish you could see that.

Ugh, seeing how some people react after failing gives a lot of insight into why they didn't do so well. Seriously, I think these things aren't as much isolated rants as you think - they're more like little glimpses into your personality.

I just feel sorry for some people. It seems that some people who fail just get angry and blame the test instead of assuming that they might actually have a weakness and trying to figure out how to fix it. It's more probable that you have an area of weakness then it is that these "black and hispanic" actors at the testing center are racist and failing more white students then the rest of the country. Assuming that's the case right from the start because of only your anecdotal evidence is racist. I wish you could see that.

Assuming that's the case right from the start because of only your anecdotal evidence is racist. I wish you could see that.

rugbynerd aka superbad will never ever learn that. Gets the award -- :hardy:

My only hope is that someday I can be as exalted as you all are. Maybe by congratulating myself, and patting each other on the back, and telling anyone who dissents or fails how bad they are... maybe then I will be as glorified as Sage880... AKA andwhat... AKA mjl1717.

And my point is not so much that people were biased against me for being white... my point is that clearly I didn't "jive" with the actors, but I have no idea how... so maybe the NBME could release some data to help me improve. I think it is lame that this test is supposed to help us learn bedside manners, and yet we get absolutely no feedback, except, essentially, that "you suck." I'm more than willing to learn. If I had an arrogant attitude (which I really don't think I did... I really am a nice guy and got honors in almost all my rotations with tons of notes saying how I had excellent interaction with patients and families), then tell me, and I'll change it. If I wasn't compassionate enough, then tell me. If I didn't explain things well enough, then tell me. But how can I improve if I don't even know what I did wrong????

my point is that clearly I didn't "jive" with the actors,

maybe you just dont jive with being a doctor in the first place. Every time that you defend yourself, you look worse and worse.
Stop blaming everyone in the world except yourself. Lets look into your mistakes

SPs (standardized patients) are not cared about
SPs are mocked

SPs are stereotyped by you, and that truly shows your lack of compassion.
SPs needs are not acknowledged
and not taken seriously


all of the above, including your medical knowledge probably, is what probably set you up for failure Mr. Superbad Rugbynerd. You basically do not care at all about others, and model yourself far above anybody else. You make fun of people from India, FMGs, African Americans. You truly have no compassion whatsoever.

maybe you just dont jive with being a doctor in the first place. Every time that you defend yourself, you look worse and worse.
Stop blaming everyone in the world except yourself.

Your medical knowledge probably, is what probably set you up for failure Mr. Superbad Rugbynerd. You basically do not care at all about others, and model yourself far above anybody else. You make fun of people from India, FMGs, African Americans.

LOL, I look worse and worse? Just keep talking bro.:sleep:

And why are you so determined to make it sound like Indians and African-Americans are inferior? You are clearly the racist here. Every race and nationality is just as worthy as you to be a doctor, so maybe you need a little attitude adjustment "andwhat."

And thanks for repeating exactly what I said above, i.e., maybe I can improve, but the NBME gives no info on how. And are you even a doctor?? How do you have time as a "resident" to sit on here all day insulting people?

LOL, I look worse and worse? Just keep talking bro.:sleep:

And why are you so determined to make it sound like Indians and African-Americans are inferior? You are clearly the racist here. Every race and nationality is just as worthy as you to be a doctor, so maybe you need a little attitude adjustment "andwhat."

And thanks for repeating exactly what I said above, i.e., maybe I can improve, but the NBME gives no info on how. And are you even a doctor?? How do you have time as a "resident" to sit on here all day insulting people?

ha ha calm down Rugbynerd aka Superbad.
Nobody is insulting you, you are somewhat actually insulting yourself, I am just trying to help you out. Cummon dont be so hard on the environment, just try and maintain a low profile, you know, actually pretend to care about other people. You are not helping your cause, with your venomous insults towards other races and specialties.

So heres a tip for you Superbad aka Rugbynerd.
Stop blaming the whole world that you failed, figure out your mistakes, and take the test again.

Certainly I was not coming off as being superior, just saying that you should maintain as low a profile as possible. I have seen Physician Assistant students with very similar mentality, and they were not treated very nicely in the end. It is somehow - actually believe it or not -an inferiority complex.

My only hope is that someday I can be as exalted as you all are. Maybe by congratulating myself, and patting each other on the back, and telling anyone who dissents or fails how bad they are... maybe then I will be as glorified as Sage880... AKA andwhat... AKA mjl1717.
I wasn't trying to come off as superior. I'm not saying I'm the exact model you should follow. I fight the urge to make assumptions based on age, sex, race, and socio-economic status all the time and it annoys me when I realize I've made some kind of snap judgement. I think not having prejudice takes a constant effort. It's easy enough when things are going well but on this forum it seems when people are down they lash out and kick whatever visible target they can find. I just think we should all be careful not to do this in any situation.

Everyone;

Let's keep this civilized and refrain from name-calling and personal insults.

Thanks,
SoCuteMD

Some of my deeper thoughts:
I use to think that step 1 had questions on it where someone could tell if one was racist.. But I could see step 2 csa which I havent taken yet might be better at eliciting someones GUT instinct that they have LITTLE control of... Because it forces intimate social interreaction, (which not everyone is good at-no matter how brilliant you are) and partially has to do with a persons etiquette, conscientiousness, meticulous order, compassion, and how well a person does socially......{ and believe it or not (Im not trying to offend anyone) a persons upbring, real time life experience and what did his mama teach him, tell him and expose him to. Id say all this plays a role in the karma one exudes in human interreaction.. I think step 2csa is more then how smart you are..[you actually have to prove you can fake being a good human being even if you are not] Just my 2 cents..

Some of my deeper thoughts:
I use to think that step 1 had questions on it where someone could tell if one was racist.. But I could see step 2 csa which I havent taken yet might be better at eliciting someones GUT instinct that they have LITTLE control of... Because it forces intimate social interreaction, (which not everyone is good at-no matter how brilliant you are) and partially has to do with a persons etiquette, conscientiousness, meticulous order, compassion, and how well a person does socially......{ and believe it or not (Im not trying to offend anyone) a persons upbring, real time life experience and what did his mama teach him, tell him and expose him to. Id say all this plays a role in the karma one exudes in human interreaction.. I think step 2csa is more then how smart you are..[you actually have to prove you can fake being a good human being even if you are not] Just my 2 cents..


agree completely, how good or bad of a person you are.... truly...

Wow, I started reading this thread and became immediately infuriated...even more so when I actually read people coming to your defense, as if failing a freakin' test and being frustrated justifies the comments you made!! I mean SuperBad if you HONESTLY couldn't pick up on the sarcasm in his saying the foreign grads were "more compassionate" than he, then either you are ridiculously naive or you really sucked at English Lit in school. So, naturally I became more and more upset as I read on, but then I read the apology. And while it doesn't excuse the comments, it was still a respectable apology. But you just keep digging yourself in deeper. Personally, it's not like I, as an African American male, mind the phrase "black accent" so much. What I mind is the racist connotation behind it, as if A.) all black people talk alike B.) No black person can speak "proper" English (whatever the hell that means...I mean didn't I read that they are adding Will Ferrel's "ginormous" to the dictionary???) C.) black people haven't been in this country for HUNDREDS of years; I mean you say "black accent" like black people just walked off the boat yesterday! The problem with what you said and the way that you said it is that it implies YOUR accent is THE "American" accent and everyone else is an outsider...as if white people didn't walk off a boat themselves! Furthermore, given the vastly growing minority population (esp Hispanic) and the fact that the USMLE is supposed to test you on current conditions it hardly seems "unfair" that you would see SP's who will likely comprise a significant portion of the patient base (even if not necessarily YOUR pt base).

my point is that clearly I didn't "jive" with the actors, but I have no idea how...
You see, it's snide remarks like this that hint to the closet biggot! I think that's what Sage was pointing to when he said maybe you should take a look into your personality.
....And by the way, another sign of the closet biggot is the "knee jerk" reaction to try to indicate how many black friends you have...just FYI for future reference.
Personally, I hope you are the "really nice guy" (albeit self-proclaimed....:rolleyes:) that you have repeatedly reported. And I don't even care if you are racist, it's your right to be. But you can't honestly expect to say the things that you said (typed) and not expect a ferrocious retort. If you had only approached the situation the way you did your apology and your last comment (save the "jive" comment obviously) then no one would've been outraged and thought you a racist *****...whether you are or aren't.

My only hope is that someday I can be as exalted as you all are. Maybe by congratulating myself, and patting each other on the back, and telling anyone who dissents or fails how bad they are... maybe then I will be as glorified as Sage880... AKA andwhat... AKA mjl1717.

And my point is not so much that people were biased against me for being white... my point is that clearly I didn't "jive" with the actors, but I have no idea how... so maybe the NBME could release some data to help me improve. I think it is lame that this test is supposed to help us learn bedside manners, and yet we get absolutely no feedback, except, essentially, that "you suck." I'm more than willing to learn. If I had an arrogant attitude (which I really don't think I did... I really am a nice guy and got honors in almost all my rotations with tons of notes saying how I had excellent interaction with patients and families), then tell me, and I'll change it. If I wasn't compassionate enough, then tell me. If I didn't explain things well enough, then tell me. But how can I improve if I don't even know what I did wrong????

you know, i don't think you are trying to be racist, but you are succeeding anyway. i think you are ignorant of the subtle racism in your comments. "black accent" doesn't really mean anything....some blacks have South African accents, some have Carribean accents, some have Southern drawls, and yes, some may say there is a characteristic African American accent too. But the truth is, we all have accents. There is the Suburbian accent, the Brooklyn accent, the Austrailian accent, the Midwest accent, the Valleygirl accent, the British accent, etc.

However, the language is the same. English.

You are upset because you think the SP was unqualified to assess your communication in English. Would you have felt the same way if the SP had a British accent?

The bottom line is, you felt the SP was unqualified based on her "black accent" and not her command of the actual language. This is discrimination, as you assume that "black accent" = "inferior language skills."

You said nothing about whether her english was BROKEN or not, which wouldn't have spoken to accent.

And at the end of the day, how do you know that the SP's weren't simply acting?

you know, i don't think you are trying to be racist, but you are succeeding anyway. i think you are ignorant of the subtle racism in your comments. "black accent" doesn't really mean anything....some blacks have South African accents, some have Carribean accents, some have Southern drawls, and yes, some may say there is a characteristic African American accent too. But the truth is, we all have accents. There is the Suburbian accent, the Brooklyn accent, the Austrailian accent, the Midwest accent, the Valleygirl accent, the British accent, etc.

However, the language is the same. English.

You are upset because you think the SP was unqualified to assess your communication in English. Would you have felt the same way if the SP had a British accent?

The bottom line is, you felt the SP was unqualified based on her "black accent" and not her command of the actual language. This is discrimination, as you assume that "black accent" = "inferior language skills."

You said nothing about whether her english was BROKEN or not, which wouldn't have spoken to accent.

And at the end of the day, how do you know that the SP's weren't simply acting?



of note, Kaplan standardized patients are actual actors, and did change their accents frequently. I found out that the actors in the CS examination get pretty decent pay. And yes they "act" accents several times. Its cool to get an insight into the process sometimes.

hey there,

I'm a new member. In fact, I found out about this forum after I failed my step 2 CS. I felt so bad that I have to search online to see if I'm the only one who failed this f. test.

As for a few of you here in this forum, I got very good scores for step 1 (242) and step 2 ck (250). Just got the official result yesterday, failed CS at the most surprising part- communication and interpersonal skills!!!!!!!

My med school in NY organized a special course for us related to the change in passing requirement. I got 4 days course and studied for 2 weeks then took the Mock exam with 8 SPs in my school.
Everything was prepared as in real exam. After that I got feedback by faculty members, etc. I passed the simulated exam at my school with very high performance on communication skills. In fact, SPs rated me as "a good communicator in nature"!!!!!

As for with real life rotations, I always got high pass or honor....and patients loved me. So I have no idea about why I mess up my real exam.

Perhaps I got jet lag and a bit tired on the test day...but I think I did apply most major requirements....
Probably, i let the anxiety took control over me....
But I think to pass CS, you need some lucks as well as your destiny is determined by SPs....you gotta make them love you....not easy when you're nervous.....

I feel really down.....and I risk not to be able to graduate on time and miss the Match this year....
My failure already has been sent to residency programs!!

Everybody is shocked.

I read several posts. Some students were thinking of the possibilities of bias in certain testing centers. I'm not sure if it's true. Some guys failed in Atlanta, one failed in Chicago, I failed in LA. So it's all over the places......

I took the exam after the passing rate was raising.

I was planning to match into competitive programs...now not just miss this year but have bad record as well. Some nice programs don't accept any failure in any steps.

I could not sleep for 2 nights already.....still have to work long hours at my hospital.....

Anyway, somehow I feel taking CS is just like taking driving test...you never know for sure why you pass or fail.

Still remember that I failed 5 times for my driving license long time ago at the same damn DMV in CA where all the examiners were Hispanics. They even used rulers to measure the distance between the curve and my car's wheels when I pulled over.
Then I moved to another DMV and immediately passed my test..something I should have done earlier.

Maybe it has something to be done with the testing center too. Some SPs in my testing center (LA) had very thick accent but for them, my NJ accent is considered as strong too!!!

I could not find a spot in PA to take my exam at the time....It's closer to my home and my med school.

all in all.....I'm not the only one who failed and the fact that I failed does not mean I'm a bad or stupid student.

Just a pity.

Good lucks to you all.
/Minerva

add me to the crowd of those who have failed Step 2 CS solely for the ill-defined "Communication and Interpersonal Skills" criterion. (i passed all the other sections, and did just fine on my highly-ranked school's OSCEs along with step 1 and 2 CK.)

so what went wrong? well, i DID ask all patients if they smoke, drink, or do other drugs. is this racist? if you think so, then you're on crack yourself -- i ask this of every patient. (and if you think being on crack is some racist joke then you need to rethink your own assumptions.)

another thing that might have hurt me in retrospect is that i am quick, and was out of the room before the bell in every case save for maybe one. despite being quick, did i wash my hands and drape the patients? yes. did i ask them if they had any other concerns? yes. did i summarize my findings and the next step? yes.

given all of this, why did i fail?! it's beyond me.

for what it's worth i've been informed that 3 other people in my (large) graduating class also failed CS this round. i think this is ridiculous, yet i am forced to jump through this hoop so will pony up the $1k and dance like a marionette once again.

Hello everyone,

I haven't taken the test yet and am trying to figure out when to schedule the exam. I would like to take it right before I graduate because I have an ER rotation that month and think that would be good practice for it. But, I don't want to take it right before graduation and then happen to fail it because then I might not be able to partake in residency activities depending on where I match. Do you have any recommendations for the latest that a person can take the exam and still leave comfortable room to retake the exam in case of a failure?

I was looking at the NMBE and USMLE websites and saw that there is 60 days that must pass after finding out a person failed til you can register again. So, if you find out 2 months after taking the exam and then leave 2 weeks for additional review then additional 2 months til getting the 2nd set of results, that's like a total of 4.5 months before graduation/starting residency.... which would be in January...

Am I overthinking this thing or does it make sense that I should schedule it in Jan? I am not extremely worried about passing, but if I did not pass, it would be horrible for me not to be able to start residency with the rest of the class. So the potential badness of not passing to me sort of weigh heavy.

Thank you!

Ok now this thread is scaring me. I just took the CS last week. I've been doing relatively well at my school, with good grades on my OSCE's...yet I was nervous/anxious and forgot to ask about family hx once, forgot to ask meds/allergies once, forgot to tell the pt i wanted to do a rectal/pelvic though I put it in the patient note.

All my friends minus one passed...now I'm scared.

Interesting. I did marginal on step 1 and step 2 CK (failed ck the first time), but thought CS was probably the easiest test I had ever taken since undergrad school. I mean it seemed like a joke, just something NBME did to make some extra money from med students. I really cannot imagine anyone failing it - so I have to admit, if what you tell us is true (AOA, etc etc) is true, then I am amazed.

After I took it (I am an IMG) I told many of my classmates to get boards for wards and study for a day or so, practice with a family member. Our student body president the year before I took it told me she read boards for wards and then practiced with a stuffed bear. She is in her last year of residency. As far as I know nobody in my class failed cs - it just seems like such a cakewalk : the cases are very obvious, and other than that you need to smile, demonstrate basic politeness and thoughtfulness, and enunciate well.

Anyway, several thoughts come to mind. First is something I was taught yeaers ago, and was reitered by a doctor I did a pain management rotation with. He is one of the smartest people I know - from Switzerland (he is a FMG), first did a surgery residency - did not like that so then he did a anesthesiology residency - did not like that, and then did a pain fellowship and likes that. He said something to the effect that its a shame that the medical education process is so heavily weighted on memorizing things from books (like the Krebs cycle) - when it ought to be more about developing people skills. Many students when they get to medical school are very good at memorizing junk, and spend alot of time in the books - but are also good candidates for the reality TV show BEAUTY AND THE GEEK, just a wee bit awkward with people.

William Osler knew this. For those of you who do not recognize the name, he was the doctor who started the first residency programs, and the tradition of having medical students shadow doctors in a hospital - believing that patient interaction was more important than spending hours in a lecture hall. He said something to the effect of ; a medical student who does not study texts is like a sailor who does not have a map but a medical student who does not treat patients is like a sailor who never sets to sea. He recognized the important ingredient in medical training was interacting with people in a real way. Kind of like Bruce Lee who said martial artists who train but never get in real fights are like swimmers who only practice swimming on dry land.

Secondly, I am not sure medical school trains doctors to be very warm and fuzzy(except maybe pedes). It is a frequent comment from just plain ol' people I have spoken with is that the MD's they meet are rude, arrogant, and cold. I think, as far as personality goes, a good profession to emulate are : waitresses (a good one who gets tipped well knows how to establish rapport quickly).

The businesses I owned for years was a service oriented business that dealt with the general public. I took numerous courses that taught establishing common ground, negotiating, and basically manipulating their emotions - creating a sense of "we" instead of "me and you". I sold my last business 3 years ago, and still get occassional calls from customers who just want my opinion. Right now as I wait for residency, my job is nothing but managing average people all day long - and from my evaluations and comments I am well liked and successful - I recently got a sterling letter of recommendation from a district level manager. The courses helped me immensely - because more naturally I am a prick. Maybe it was all the years I worked as security in a bar before owning my own businesses that made me a prick - where I got to deal with the public by knocking them out - no, honestly I was a prick way before that. I love the internet because I can be myself (a prick), a privilege I am denied in my day to day life.

Its very hard for me to deal with the "general" public, because I often don't like them. But the techniques I learned in the seminars has made a huge difference in being able to make people "think" I like them - and that makes them want to do business with me.

Being an IMG/FMG I cannot say for certain, but I really don't think AMGs learn well how to be warm and fuzzy. I see my brother,graduated from one of the most competitive USA schools, well known surgeon,has invented procedures, president of a major medical association, dept chair at a major US medical school - and often struggles with sympathy for patients (as opposed to empathy). He has a bad temper (just like I do) which he has displayed at work too often (which I don't - even as a bouncer in a bar I learned not to show anger, becuase it warns people a beating is coming, you lose your element of surprise) - he never punches anyone out, its just the verbal wounds he creates with patients and staff.

While most MD's are not that bad, at the same time, I have only met two (one was a recent Med/Ped grad who was my primary care for a year before leaving, and the other was a DO who was my primary care 10 years ago) that I would chose as my doctor - most doctors I have are ones I am basically stuck with because of insurance. I have met a huge number I hate, and like many of my friends consider them rude, arrogant, jerks who I would not associate with if it was not for my insurance carrier essentially forcing me too. If insurance reimbursement continues to decline it may be that doctors have to develop more of the attitude like McDonalds in which the idea is to serve the customer, and not : treat their disease, give some orders, act the know-it-all big shot, and get paid big bucks.

Wow, that was alot to write. After all that I guess I just have to say : damn dude, how the heck can you fail such an easy test!!! hahahahahahahaha.

(i passed all the other sections, and did just fine on my highly-ranked school's OSCEs along with step 1 and 2 CK.)

for what it's worth i've been informed that 3 other people in my (large) graduating class also failed CS this round. i think this is ridiculous, yet i am forced to jump through this hoop so will pony up the $1k and dance like a marionette once again.

I seriously cannot understand this. Are you an AMG?

The foreign Caribbean school I attended is filled to a large degree by non-traditional students. I do think their years of experience in other fields makes a huge difference in their ability to deal with people. I doubt most of them can hold a candle in basic sciences with a grad of John's Hopkins or Yale medical school, but all of them that I know of for years have passed step 2 CS. Heck for years only FMG's had to take CS. I don't think I know of anyone from my school failing CS in the 4 years I attended, although I myself failed step 2 ck the first time and scored marginally on step 1.

I am shaking my head as I read this - it almost seems like a goof or a stunt, I really cannot imagine how anyone, let alone an AMG could fail this.

I mean I almost feel like I have to ask if you have Star Trek memorabilia, or operated the audiovisual equipment in high school classes.

I mean I almost feel like I have to ask if you have Star Trek memorabilia, or operated the audiovisual equipment in high school classes.

Totally out of line.

Being an IMG/FMG I cannot say for certain, but I really don't think AMGs learn well how to be warm and fuzzy.

I think developing such skills is up to the student, and if you don't choose to do so your school can't force it into you. I don't see a shortage of opportunities to practice and refine one's bedside manner in the US system.

As for 2CS, I think the main issue is that one cannot have genuine empathy for an actor (unless one is very gullible), so the patient interaction evaluation is not testing one's empathetic skills, but rather one's acting skills.

I think developing such skills is up to the student, and if you don't choose to do so your school can't force it into you. I don't see a shortage of opportunities to practice and refine one's bedside manner in the US system.

As for 2CS, I think the main issue is that one cannot have genuine empathy for an actor (unless one is very gullible), so the patient interaction evaluation is not testing one's empathetic skills, but rather one's acting skills.

The best thing to do is to pretend that YOU are an actor as well and that you actually care, even though you really don't give a rats behind. I went into my last 3 osce's with this mentality, being very fake and disingenuous, and i scored in the top 3 of my group on each one.

Totally out of line.

Yes you are right - totally unnecessary, as they are givens. I should have asked : have you ever kissed anyone and do you live in your parents basement?

Okay sort of kidding, I could not resist. That was uncalled for. I am sure you hang out with all the cool kids.

The best thing to do is to pretend that YOU are an actor as well and that you actually care, even though you really don't give a rats behind. I went into my last 3 osce's with this mentality, being very fake and disingenuous, and i scored in the top 3 of my group on each one.

I agree with you on this. Its somewhat a shame to gain guile, but faking it helps so much.

Yes you are right - totally unnecessary, as they are givens. I should have asked : have you ever kissed anyone and do you live in your parents basement?

You seriously need to be modded down.

You do realize as physicians, the world thinks we're a bunch of "nerds" anyways. No need to be an ass and look down on others via stereotypes.

Hey guys, Just a reminder this is a professional forum. Let's try to make our comments respectful of one another.

I seriously cannot understand this. Are you an AMG?

The foreign Caribbean school I attended is filled to a large degree by non-traditional students. I do think their years of experience in other fields makes a huge difference in their ability to deal with people. I doubt most of them can hold a candle in basic sciences with a grad of John's Hopkins or Yale medical school, but all of them that I know of for years have passed step 2 CS. Heck for years only FMG's had to take CS. I don't think I know of anyone from my school failing CS in the 4 years I attended, although I myself failed step 2 ck the first time and scored marginally on step 1.

I am shaking my head as I read this - it almost seems like a goof or a stunt, I really cannot imagine how anyone, let alone an AMG could fail this.

I mean I almost feel like I have to ask if you have Star Trek memorabilia, or operated the audiovisual equipment in high school classes.

yes, i'm an american medical grad (-to-be), top 10ish school depending on the year. i think the fact that i didn't have any problem with the knowledge components meant that i didn't take CS seriously enough -- i got in there, went through the motions (all info, drape, wash hands, etc. etc.), and got out when i figured out their game.

apparently that's not enough. and fwiw, i'm going into radiology, so i am unapologetic for not being warm and fuzzy. i'm not going to dance in a bear suit on the peds ward, for sure... :laugh:

I am in total shock right now (and so is my Dean).

I have no idea what to do or what the implications will be. Throughout med school, I've always gotten the highest marks for my interpersonal skills, but this is the exact area of Step 2CS that they failed me.

In typical Kubler-Ross fashion, I am in total denial right now. I just don't understand what happened, especially considering that my school has the largest standardized patient program in the country. And, we've been working with SPs since day one.

So far, no one in my school has failed either of the Step II exams this year (except, for me, of course). The school will still let me graduate, but I am not sure how I am going to tell the program I matched into (a top 3 optho program).

Well, as you can imagine, this has been a pretty crappy day. I am also a bit ticked off about the fact that there is nothing I or my school can do (The NBME gives essentially no feedback). I feel totally helpless, upset, extremely embarassed, and very much an outcast.

Personally I think this is a goof. You have 14 posts, all of them in this thread - there is no real benefit for you to post this - so I think this is a goof, maybe wanting to create a squabble between AMG's in top schools and those that are somewhat jealous of them (such as myself), by creating an opportunity to poke at a weak spot. Why would an AMG of a top school come and reveal such a weakness? I think this is a BS post. I know some AMG's fail, but don't believe this post is legit.

Regarding those that fail, its possible that it is a lack of the ability to be or at least pretend to be warm and fuzzy when needed - thankfully there is radiology et al, which requires less Dale Carnegie type skills.

i also agree that a white male with a good physique is highest risk for failing (other than the 1% or so who cant speak english). i also would like to add that attractive people are more likely to fail ( do you understand why?? )
.

:laugh: I would think this is more goof, except I am sure you are serious. That is funny.

Almost never a week goes by that someone does not comment on my physique. Today a girl interrupts (I teach school right now) and asks how much I work out. I had a website that had among other things pictures of my naked from the waist up posted (for a reason, it is an athletic oriented page) and I was amused when people suggested I had cut and pasted my face (or a models face) on the body of someone with a famous physique. I taught college level anatomy this summer and was told the students called me "Dr.Goodbody" behind my back.

I mean if I had to bet something it would be, you consider yourself attracticve and you failed.

So I took CS yesterday and what pain in the rear end it was. HOnestly, the cases werent that difficult and there were only two where I wasn't sure about the Diagnoses. I am afraid I might have failed b/c I forgot to ask some Key questions in a few cases(e.g patient with ED did not ask if he was still having nocturnal erections). Also in one instance I laugh a little b/c the patient told me he had chest discomfort and I kept telling/asking him about his pain so he corrected me and said "Dr. is discomfort not pain"...so I fond that funny and smile and chuckle!! .......Ouch!!! I don't know why I found that funny but I am sure it will hurt me :(. Also, for I've been reading anfd hearing most of the poeple that have failed finish the patient encounter with time to spare, which is my case. I Never took the entire 15 minutes. As you guys can tell I am concern. This is going to suck and I hope if I have to retake it I can do it before graduation.

Holy crap. I just found I failed the CS. I cant f***** believe it. Ive done fairly well in med school( am an AMG), was in the top half of my class, 230s in step I, got 88 percentile on my schools OSCE. I saw the score report and said I did well in everything but failed the communication and interpersonal skills part. My question is that I checked the box that automatically transmits by USMLE transcript to ERAS and how is this going to hurt me in the match. Im trying to do a competitive residency.

My condolences to you guys. That just really sucks. I got my score back today too but ended up okay. I was scared the whole time because of this thread.

I think if you go to the register site there are plenty of spaces still available before May so try to get on that fast!

Holy crap. I just found I failed the CS. I cant f***** believe it. Ive done fairly well in med school( am an AMG), was in the top half of my class, 230s in step I, got 88 percentile on my schools OSCE. I saw the score report and said I did well in everything but failed the communication and interpersonal skills part. My question is that I checked the box that automatically transmits by USMLE transcript to ERAS and how is this going to hurt me in the match. Im trying to do a competitive residency.

Hey medstudent5241, I sent you a pm. I feel your pain as I am in a similar predicament and don't quite know what to do either.

Here I go, unfortunately joining the club - good medical school, good Step 1, good grades, AOA, and FAILED STEP 2 CS b/c of poor communication/interaction. :(

Needless to say, I'm shocked and extremely bothered by the fact that it's the middle of interview season and I automatically released my scores to schools.

Does anyone know if my chances of matching will be affected?
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I think I am misunderstanding the purpose of the exam. I wish I could get some good feedback from the USMLE people, so that I could improve. All my feedback from my school clerkships have been outstanding, so it's not very useful in this situation.


Anyway, life has some interesting turns and I'll suck it up and go on. And I do think that the draping thing is kind of silly in the given situation.

What is the process like to reschedule CS, and how long does it take? For example, does it require reapplying again even if I'm still within my 1-year eligibility, and does it require getting a new scheduling permit? I'm in a bit of a time crunch, so if someone could please tell me how long it takes to reapply from the date you get your score to the date you schedule your exam, I'd greatly appreciate it. Thanks.

yes, i'm an american medical grad (-to-be), top 10ish school depending on the year. i think the fact that i didn't have any problem with the knowledge components meant that i didn't take CS seriously enough -- i got in there, went through the motions (all info, drape, wash hands, etc. etc.), and got out when i figured out their game.

apparently that's not enough. and fwiw, i'm going into radiology, so i am unapologetic for not being warm and fuzzy. i'm not going to dance in a bear suit on the peds ward, for sure... :laugh:

here's an update to my personal story of Step 2 CS failure:

- failed it in July 2007
- found this out in October (?) 2007, immediately tried to reschedule, but nothing was open until February 2008 (the email notifications were useless)
- scores after Dec 31 are NOT reported until after rank order list submission
- interviewed at 8 rads programs, ranked 8 rads programs
- retook CS in Feb 2008
- didn't match to anything
- scrambled into both rads and internship (worst week EVER, but it worked out)
- got my passing retake CS score reported on March 26, the first day that the post-Jan 1 scores may be reported

moral of the story: don't piss off the actors. failing for Communications and Interpersonal Skills is the dumbest way you can piss away a whole year, your match prospects, and multiple thousands of dollars (both in retake fees and in that my interview trail was all for naught without a passing CS in hand).

if you do happen to fail take an extra year, immediately, and go through the interview season the next year, fresh in spirit and with all passing scores lined up. i wouldn't wish trying to scramble into a competitive field, such as rads, on my worst enemy.

good match
bad boards
AMG-to-be
decent med school
thought i failed
found out i passed

exhale