Please Help: Failed CS

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blueyankee

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I just saw my score this morning and saw that I failed CS. I'm done with all my interviews. Match day is less than 2 months away. I'm freaking out. Will programs receive my scores? Will they push me down? I failed the Questioning skills / Professional subportions of communications and interpersonal skills.

This is completely out of left field. I felt like i did everything correctly. I'm freaking out right now. Everyone has always given me high marks in those categories during my clerkships. Can someone please help me...

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I just saw my score this morning and saw that I failed CS. I'm done with all my interviews. Match day is less than 2 months away. I'm freaking out. Will programs receive my scores? Will they push me down? I failed the Questioning skills / Professional subportions of communications and interpersonal skills.

This is completely out of left field. I felt like i did everything correctly. I'm freaking out right now. Everyone has always given me high marks in those categories during my clerkships. Can someone please help me...

Hi there, as someone who passed, I would think back to that day and wonder if you either asked too many leading questions, too many yes/no questions or did not drape the patient/wash hands/show empathy appropriately. I am sure you are more than able to obtain a history and physical, it's just that Step 2cs is more of a dog and pony show than a demonstration of thinking or judgement.

I think that some residency programs are stringent about passing Step 2cs on the FIRST try; I would check with each program though. I know that Stony Brook in New York will not consider your application even if you failed Step 2cs once.
 
I too am in your application cycle and failed CS back in August in the exact same components (questioning/infosharing) but with high performance and stars in ICE components. Retook it in November (doing full time research now) and passed on 2nd attempt with high performance in all CIS subcomponents (including star). I didn't know what metric they used for grading, but after the results I knew exactly where I went wrong the 1st time around.

1st time:
Questioning: asked leading questions and multiple questions ("Did you smoke OR drink", "one pack, two pack for how many years..." I rushed the patient. I didn't ask enough open-ended questions (such as "what do you think caused this?", "can you describe your pain?" "instead I asked is your pain sharp, dull, etc... I didn't use transition sentences before PMHx ("I like to ask some questions about your general health", "I need to ask about your social habits and practices", "I like to ask some questions about your sexual health/history, everything will be kept confidential" I didn't maintain 100% eye contact, around 40%, I was so concentrated taking accurate notes. 2nd time around paid around 100% attention (if they see you write notes, they look at your notes I think). I didn't address patient by their last name more than once.

Info sharing: I didn't summarize to ANY patient because I used an outdated prep book. I didn't paraphrase anything they told me (e.g "so this pain you described as sharp, does it also travel anywhere?") I didn't counsel to half of patients with smoking and drinking and any patients about necessary f/u. "Mr. XYZ if your condition worsens or experiencing symptoms of XYZ it may be a sign of something more serious and would to see your sooner." I didn't use say I was available if they needed me, "I'll leave my card with nurse, if you have any questions or concern please let me know"

Professionalism: I didn't ask "I'm so sorry you are in this condition, I'll try my best to help you". I didn't act confidently such as going from one exam to another quickly and with confidence. I didn't ask patient if I could make him/her more comfortable (e.g. if coughing a tissue, headache about lights) before exam and during exam. Didn't properly drape patient (I unfolded sometimes once not twice). I didn't ask patient how they felt with regards to their condition and if they needed any transportation/financial assistance (pediatrics/phone case). I didn't make small talk (2nd time around I made some jokes and asked about their job or upcoming vacation. They smiled when they did that and I smiled BACK.

Also if patient behaves in a certain way, they are doing it on a purpose and I picked up on that quickly and asked them politely why they are acting like that.

For 2nd time around, I passed after practicing 3 hours every weekday with skype friend and 6-8 hours everyweek in person (which I didn't do at all 1st time around).

I think for the match, if you didn't release your scores, schools may still keep you on rank list but some will drop you some spots. If you did auto release your scores, they may drop you off the list altogether. If in former, it is best to not tell schools and match and then pass with retake with results back in April.

I hope this helps, good luck.
 
I just saw my score this morning and saw that I failed CS. I'm done with all my interviews. Match day is less than 2 months away. I'm freaking out. Will programs receive my scores? Will they push me down? I failed the Questioning skills / Professional subportions of communications and interpersonal skills.

This is completely out of left field. I felt like i did everything correctly. I'm freaking out right now. Everyone has always given me high marks in those categories during my clerkships. Can someone please help me...

Are you a US student?
 
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Sorry to hear that you didn't pass. I'm not sure what programs do with a failed CS score...I'm curious myself as I had a really bad feeling after my exam. I would think that contacting programs to inform them that you are planning to retake the exam would be a good start and point out your clinical strengths via your clerkship grades. If u haven't reported yet, I would take it again and release your scores after the match. I doubt they would rescind their offer based on that...

Just curious, when did you take the exam? I took it early December I was hoping to get my report today.
 
Sorry to hear you failed. I also failed back in August with lower performances in question skills/professionalism and rapport and passed easily my 2nd attempt. It doesn't mean you won't be a good doctor but make sure you take it again before 3/24 to receive your score between 4/25 and 5/23, especially if your school requires it for graduation.

The 2nd time I really just read the USMLE website because it tells you exactly what they're looking for. For questioning skills, the only thing I could think that I didn't do was summarize for any of the 12 patients. The 2nd time I summarized between history and starting exam ("Now to summarize, you came in having...., is there anything else that I missed"). Just doing this change made me go from lower to higher performance. I'm sure I missed other stuff the first time but summarizing is definitely important.

For Professionalism/questioning skills), I made a dumb pneumonic CSI FEST for (concerns, summarization, impact of illness on life, facilitating statements, expectations, support systems for patient, and transition statement. I just addressed these with each patient and received higher performance the 2nd time in professionalism. Also, never leave a patient room early and spend a lot of timing closing/counseling. There was a study that showed amount of time spent correlated with a higher CIS component http://www.ncbi.nlm.nih.gov/pubmed/19907366.

As for the match, is there an adviser who has your interest in mind at your school you could talk to? Did you check the automatically release box? What specialty did you apply for? If you don't release the score and get a passing score before starting residency you probably will be fine but it's not something many people have experience with so it's tough to say.

I didn't release my step 2 score and have finished interviews without anyone asking about it. If I match in March I don't even know if the PD will see my failed attempt or not and if so I don't think it would matter that much because I passed my 2nd attempt and didn't break any rules by not releasing my score. Also, my adviser recommended I keep quiet about it.
 
Sorry to hear you failed. I also failed back in August with lower performances in question skills/professionalism and rapport and passed easily my 2nd attempt. It doesn't mean you won't be a good doctor but make sure you take it again before 3/24 to receive your score between 4/25 and 5/23, especially if your school requires it for graduation.

The 2nd time I really just read the USMLE website because it tells you exactly what they're looking for. For questioning skills, the only thing I could think that I didn't do was summarize for any of the 12 patients. The 2nd time I summarized between history and starting exam ("Now to summarize, you came in having...., is there anything else that I missed"). Just doing this change made me go from lower to higher performance. I'm sure I missed other stuff the first time but summarizing is definitely important.

For Professionalism/questioning skills), I made a dumb pneumonic CSI FEST for (concerns, summarization, impact of illness on life, facilitating statements, expectations, support systems for patient, and transition statement. I just addressed these with each patient and received higher performance the 2nd time in professionalism. Also, never leave a patient room early and spend a lot of timing closing/counseling. There was a study that showed amount of time spent correlated with a higher CIS component http://www.ncbi.nlm.nih.gov/pubmed/19907366.

As for the match, is there an adviser who has your interest in mind at your school you could talk to? Did you check the automatically release box? What specialty did you apply for? If you don't release the score and get a passing score before starting residency you probably will be fine but it's not something many people have experience with so it's tough to say.

I didn't release my step 2 score and have finished interviews without anyone asking about it. If I match in March I don't even know if the PD will see my failed attempt or not and if so I don't think it would matter that much because I passed my 2nd attempt and didn't break any rules by not releasing my score. Also, my adviser recommended I keep quiet about it.
I failed CS because of the PN. Data gathering was above borderline, but the PN was very low.
I did pretty high on the rest. What have you done in your PN to pass CS?
 
For patient note, make sure you type very fast (I was able to get all info down with 2 minutes to go). Make sure you follow FA's template for PE and HPI. Once you get good at writing the PE, you can write RRR, S1/S2, no murmurs for CV for like all your patients. Same with Pul: CTAB, no cough/wheezing, (no tactile fremitus), dullness to percussion. Same with abdomen: NT, non-distended, no tympany, no tenderness to palpation in 4 quadrants, +BS. Those 3 exams are the normal findings you can write for 80% of the patients.

Allergies, Pmhx, Social history, Meds vary depending on patient. Write only pertinent positives and negatives for ROS.

The differential and treatment I can't help you much since it is something you have to practice a lot.
 
As above, did you auto-release your score?

If so, I would think this would hurt you at many programs.
At the time they rank you, you will not have a passing score, and at many schools you can't graduate without a passing score.

I'm sure you can figure out how to improve on the retake, but why would programs want to take a chance?

If they are going to see your score, you need to talk to an advisor and get them to contact some programs on your behalf.

If they won't see the score, it won't impact your match.
Just make sure you prep like crazy and pass it on the retake.
And get moving so you have a passing score before graduation.
 
For patient note, make sure you type very fast (I was able to get all info down with 2 minutes to go). Make sure you follow FA's template for PE and HPI. Once you get good at writing the PE, you can write RRR, S1/S2, no murmurs for CV for like all your patients. Same with Pul: CTAB, no cough/wheezing, (no tactile fremitus), dullness to percussion. Same with abdomen: NT, non-distended, no tympany, no tenderness to palpation in 4 quadrants, +BS. Those 3 exams are the normal findings you can write for 80% of the patients.

Allergies, Pmhx, Social history, Meds vary depending on patient. Write only pertinent positives and negatives for ROS.

The differential and treatment I can't help you much since it is something you have to practice a lot.
Thank you very much!!!
 
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