AOA, top 25 school, Failed Step 2CS

Did you read first aid for step 2 CS?

freefall said:

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.

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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.

freefall said:

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.

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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.

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.

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.

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.

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. said:

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.

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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!
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.

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).

scootad. said:

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.

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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.

freefall said:

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].

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

Obedeli said:

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.

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

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!"

scootad. said:

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.

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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.

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.

monstermatch said:

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.

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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.

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 ?

Furrball said:

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

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

Glad we got that straight!

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.

Spiff said:

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.

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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.

Firion451 said:

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.

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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.

slunk said:

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.

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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.

yankeeh8r said:

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.

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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??!