Another 'failed step 2 cs'

[IH8NBME]

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So the purpose of this thread is to warn students about this stupid exam- don't take it too lightly. First off, a little about me, I have another screen name but created this one for the sake of being anonymous.

So, I go to a solid US Allopathic Medical School, 250+ step 1, AOA, amazing clinical evaluations (ie best medical student on several of my narratives/LORs), etc etc etc..

Outcome: Fail

ICE: PASS (Integrated Clinical Encounter)
CIS: FAIL (Communication and Interpersonal Skills)
SEP: PASS (Spoken English Proficiency)


Final results-
Integrated clinical encounter- higher performance, all the way to the right
Data gathering- ditto
Patient note- ditto
Communication and interpersonal skills- lower performance
Questioning skills- borderline performance
Information-sharing skills-higher performance
Professional manner and rapport-lower performance
Spoken english performance-higher performance, off the chart



So, I have a pretty decent number of friends and haven't had any problems interacting with people in general. I guess the NBME thinks I am a complete tool- one who is unable to interact with people. The problem is that I hate hate hate faking things, especially empathy. So be forewarned, make sure that you fake your empathy.

Damn you NBME, I just hope I can get this cleared up in time so I could start residency.....

 

[PhakeDoc]

Sorry to hear about your experience. From what I can tell from your descriptions, that should have been a pass, no? I saw another examinee's scorereport and he had 2 subareas going down well in to the lower performance area, but passed overall.

in time so I could start residency.....

Best of luck with this!

 

[IH8NBME]

Sorry to hear about your experience. From what I can tell from your descriptions, that should have been a pass, no? I saw another examinee's scorereport and he had 2 subareas going down well in to the lower performance area, but passed overall.



Best of luck with this!

It wasn't a pass- perhaps we were both borderline/threshold and I was that one point lower. This whole thing is pretty unreal- hit me earlier this evening. I may not be able to start my residency despite matching into a dream program in an uber competitive field...crap. I have no idea how I failed this test after hearing about some of the mistakes people got away with. I obviously made mistakes, but for some reason, mine were more serious. This really blows....

Well, to all those taking the test- be careful and don't just blow it off.

 

[ShyRem]

Look for the next test date and read your paperwork carefully to see if passing CS is a requirement for your residency position. Also make sure it's not a requirement to graduate from your school.

 

[IH8NBME]

It is a requirement for residency. I passed the required internal clinical skills exam.

 

[ShyRem]

In that case, check the website DAILY to figure out the next test date. Figure out how long it takes to get scores and check to when you need a passing score reported to your residency.

If you can not get a score back to your residency by the date due, you should call them as soon as possible to inform them of the situation. You may be able to work out a late start or some other accommodations for your situation. And if not, then you need to start working on getting a job, research, or prelim residency year for the one year you're behind. And you'll need to start working on a new ERAS application as well.

 

[deleted77919]

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[Dr.LeoSpaceman]

Thoughts of the above haunted me from match day until I got my score back. It was my own fault for not looking at the score report timeline before scheduling my exam
Advice to future applicants: take this test before Dec 31st to get your score back reasonably early!

This is very, very true. I'm rolling the dice, as I just recently took it, and won't get my scores back until a week before internship starts. Certainly my fault for not paying attention. Fortunately, the state in which I'm going does not require it for a training license, and the hospital I'm at has not mentioned it in any of the paperwork, etc. I do, however, blame my school a little bit for having an atrocious advising department. All they say is "You only have to take Step 2 to graduate". Not pass, just sit for it. What they don't say is "Even though you don't need it for us, it may cause you problems for residency, so take it early."

I think I did ok, but the subjective nature of it is just brutal. You can't ask "every question" because it felt like the patients had enough info to lead you down almost any pathway you wanted. Even so, if you have done a lot of H&Ps in med school, you should be able to ask enough questions and write a decent enough note to do well in the ICE part.

The CIS part is the real wildcard. Unless you've taken time to look at the things they score for this part (hand washing, draping, asking the patient if it's ok to do a physical, asking about removing the gown, doing the adequate summary/counseling at the end, etc.), there's certainly a chance you might get docked enough in those areas. That's the real issue...it's not about being a "normal person", it's about being a "normal person" the way in which the NBME defines it.

To the OP, that blows hard. Hope everything works out for you.

 

[Nellyakgo]

It is a requirement for residency. I passed the required internal clinical skills exam.

To the OP, sorry about this! I really hope you sort it out fast. I just signed up for the next available test date and gave myself only 2 weeks to prepare. So now I'm nervous!

I too, do find that described style that you also refer to, to be unrealistic. Who asks the patient before every single piece of PE, "can I do this, can I do this, can I do this"? If I were a patient it would make me nervous about the doctor.

So what happens in a situation like this? Is there a requirement for the department to allow you to re-take the test? Or can they (if they want) say that they won't take you anylonger, even though you matched in the match? I'm asking from a theoretical viewpoint in general.

 

[Dr.LeoSpaceman]

I too, do find that described style that you also refer to, to be unrealistic. Who asks the patient before every single piece of PE, "can I do this, can I do this, can I do this"? If I were a patient it would make me nervous about the doctor.

You don't have to ask permission for every part, just the big stuff. Like to start the exam, then to undo the gown. After that, you just have to make sure you tell them what you're doing. "I'm going to examine your eyes", "I'm just going to feel your neck for your thyroid", etc. At least that's my understanding, and what I did...don't know if I passed, so we'll see.

Also, two weeks is plenty of time. Just read First Aid for CS, get a pattern down for the history and know the differentials for each complaint. Also, practice (with a partner or by yourself) to get an idea for the timing. When it comes to the note (or even in the interview) I honestly don't think it's as much about getting "the right answer" as much as it is coming up with a an appropriate differential, even if the answer is obvious.

 

[PathMD2010]

If you take it before May 15, the score reporting date for that block starts June 16.

OP, I feel bad for you. It sounds like you are actually a good doctor rather than someone who failed only to jump through their "demeanor" hoops. I like the "i'm not good at faking empathy" line!

I think that the test should not be req'd of AMGs; its an anxiety provoking waste of our time and money. Most schoold do internal PE exams or SP exams that you must pass to graduate. if they are an accredited US school, they should be able to put forth residents who can do a basic H and P in a timely fashion. Otherwise, they should not be accredited. Idiotic hurtle it is, it must be jumped. Because we don't have the leverage to mass boycott the thing

Best of luck

 

[Nellyakgo]

It is a requirement for residency. I passed the required internal clinical skills exam.

So what happens in a situation like this? Is there a requirement for the department to allow you to re-take the test? Or can they (if they want) say that they won't take you anylonger, even though you matched in the match? I'm asking from a theoretical viewpoint in general.

 

[Law2Doc]

So what happens in a situation like this? Is there a requirement for the department to allow you to re-take the test? Or can they (if they want) say that they won't take you anylonger, even though you matched in the match? I'm asking from a theoretical viewpoint in general.

Your residency contract is usually conditional on completing your med school graduation and Steps 1-2 before the start date.

 

[Eta Carinae]

Dear prospective 2 CS examinees,
Take the friggin' exam early.
There's no regulation that requires you to have taken CK before you can take CS.
And the further removed you are from your introduction to physical exam skills and your school's OSCEs, the harder it can be to remember the fine points.

As soon after step 1 as possible would be my recommendation.

 

[IH8NBME]

Thank you everyone for the words- much appreciated.

So it took about 24 hrs for my application to get approved in order for me to take the exam again. I go to school in Manhattan so Philly would be the closest site- they are booked until next year! So the closest date is early next week but in LA. I just booked it and will pay the ridiculous costs to travel from the upper east side to los angeles....

Again, to warn future med students-let me be an example to you- study for this test.

I am so angry with myself for losing $2000, potentially losing a dream residency spot and now taking away from my vacation/freedom till the start of residency.

I am also wondering where I went wrong on this exam. I did all the basic steps, ie introduce, ask to touch pt, drape pt, repeat what they said, spend time counseling...yet I still got dinged somewhere. I go to a solid med school and we have had several OSCE type exams all throughout, never once had a problem. I passed the internal clinical skills exam with flying colors. What did the NBME want from me...ugh...

 

[Eta Carinae]

Thank you everyone for the words- much appreciated.

So it took about 24 hrs for my application to get approved in order for me to take the exam again. I go to school in Manhattan so Philly would be the closest site- they are booked until next year! So the closest date is early next week but in LA. I just booked it and will pay the ridiculous costs to travel from the upper east side to los angeles....

Again, to warn future med students-let me be an example to you- study for this test.

I am so angry with myself for losing $2000, potentially losing a dream residency spot and now taking away from my vacation/freedom till the start of residency.

I am also wondering where I went wrong on this exam. I did all the basic steps, ie introduce, ask to touch pt, drape pt, repeat what they said, spend time counseling...yet I still got dinged somewhere. I go to a solid med school and we have had several OSCE type exams all throughout, never once had a problem. I passed the internal clinical skills exam with flying colors. What did the NBME want from me...ugh...

An oscar-winning performance.

There are several skills I picked up in med school:

5. The art and practice of insomnia

4. Hieroglyphics

3. How to smooch a**

2. one-ups-man-ship

1. ACTING



In preparation for residency, I am unlearning #2.

 

[Perry Mason]

IH8NBME,

I also failed the damn thing the first time with similar feedback and for same reasons.

From my experience, cancellation slots appear in two peaks: two weeks before the date (the last opportunity for people to reschedule without incurring additional fees) and a couple of days before (when people freak out and don't actually care about paying those fees). I managed to grab a cancellation date two days before the exam so keep looking.

 

[Proverbs31]

Hey!
Did you get my PM? 2 spots opened up today in Philly...Keep checking them and leave your preferences open for those days. Worse case scenario, they usually will at least give you some credit for cancelled flights even if they are the nonrefundable ones and it would still save you money! I just got a closer ATL date (since Im now going to be taking both patient encounter exams - COMLEX/USMLE). Keep your chin up! A spot will open for you!
Best of luck!! 🙂

 

[IH8NBME]

^Hey, thanks for the PM

I completed the exam and think I did worse when it came to arriving at the final diagnosis/obtaining information. This was partially because I spent time 'establishing rapport, expressing empathy' among other things I feel just shouldn't be forced.

I don't feel too good about this exam as I missed quite a bit-
the first time around went much smoother for me because I was focused on getting the pertinent info/diagnosis right. This time around, I spent a lot more mental effort on trying to fake a connection with the patient- I felt I had many holes in my data gathering.

This exam has been nothing short of a nightmare for me. The first time pass rate is 97% with <1% of students failing in the CIS section. The second time pass rate is 93% and the third time pass rate drops down to the 80s.

If I fail this exam again (very possible), I am in deep crap, ie I can't start residency.

 

[Proverbs31]

No more of this talk!! I will say a big prayer for you tonight and I am certain you did fine and PASSED! Relax, try..."try" to think only positive good things. There is no sense in worrying now because you can not do anything about this until you get your results...So just trust..Trust that You were meant to be a doctor. You will be a doctor. This is just another stepping stone...just another task to finish in order to get where you are going. Im sure you did great! You always do better than you think you did! They don't expect you to know everything and every differential. They want to know you''re on the right track to a diagnosis and wont miss something life threatening. Im sure your rapport was great with the patients! Best of luck!! Stay positive and keep your chin up! Keeping my fingers crossed for you!!

^Hey, thanks for the PM

I completed the exam and think I did worse when it came to arriving at the final diagnosis/obtaining information. This was partially because I spent time 'establishing rapport, expressing empathy' among other things I feel just shouldn't be forced.

I don't feel too good about this exam as I missed quite a bit-
the first time around went much smoother for me because I was focused on getting the pertinent info/diagnosis right. This time around, I spent a lot more mental effort on trying to fake a connection with the patient- I felt I had many holes in my data gathering.

This exam has been nothing short of a nightmare for me. The first time pass rate is 97% with <1% of students failing in the CIS section. The second time pass rate is 93% and the third time pass rate drops down to the 80s.

If I fail this exam again (very possible), I am in deep crap, ie I can't start residency.

 

[life_saver]

Hey!
Did you get my PM? 2 spots opened up today in Philly...Keep checking them and leave your preferences open for those days. Worse case scenario, they usually will at least give you some credit for cancelled flights even if they are the nonrefundable ones and it would still save you money! I just got a closer ATL date (since Im now going to be taking both patient encounter exams - COMLEX/USMLE). Keep your chin up! A spot will open for you!
Best of luck!! 🙂

3rd year DO here and I see you're taking CS after completing PE. Curious as to what advantage this would provide? Do any ACGME programs require this? Sorry for being nosy!

 

[Proverbs31]

3rd year DO here and I see you're taking CS after completing PE. Curious as to what advantage this would provide? Do any ACGME programs require this? Sorry for being nosy!

No problem....I dont mind you asking. So, I matched MD Urology. I took the USMLE Step 1. I did not take step 2. Upon my interview and consequent acceptance into the program I am starting, they stated that they would "recommend I had taken Step 2 CK", so.....I decided I would. They are also paying for it. I'm guessing they just want to have me at an even keel all around. For justification -This program really does love me and I have not ever felt any bias towards being a DO in this field or program, in fact, another DO that graduated from their program a few years ago, honestly probably paved the way for me. SO....I know that they want to position me in the best place possible. I know that they understand that very unfairly and unfortunately so, at least in the Urology world, it is not so even and equal for a DO to match into an MD urology spot. They have told me this in person and told me that they feel this leaves a lot of great applicants from matching and that its a shame. They also know that I want to go into academic medicine, aka do a fellowship as well and they want to be able to help me get the fellowship of my choice. SO.....I figured if they were paying for step 2 CK....in my mind I see no reason not to go ahead and just take it all ( Step 2 CE and Step 3) and be double boarded.

So to answer your questions....1. Some people take it because they can then take USMLE step 3 and NOT have to take COMLEX step 3 AND BECOME BOARDED AND LICENSED AND PRACTICE in whatever state they are in. Some states allow this, however certain states have both an osteopathic and an allopathic board so that would not suffice. They would require you to be osteopathic licensed in order to practice in that state. I am taking both COMLEX step 3 and USMLE step 3...my own decision....so that wouldn't apply to me and 2. There are a "FEW" countries that still do not recognize the Osteopathic DO licensure and I love doing mission work. Being double boarded by both NBME and NBOME, I will have practicing priviledges in any country an MD has, to practice medicine and do missionary work. These are small things, but to me important. Lastly, 3. Like I mentioned, I want to do a fellowship and stay in academic medicine. Having taken USMLE step 3 will allow me to be just as competitive for any spot I want. Now please dont misunderstand me, MANY DOs do AMAZING fellowships without having USMLE scores. I personally "Me, Myself, and I" have decided with my situation and current recommendations from my program, decided to just go ahead and take all of them. SO....thats what I am doing. 🙂
Hope that helped clarify some things. But no...NO PROGRAM requires it. 🙂

 

[life_saver]

No problem....I dont mind you asking. So, I matched MD Urology. I took the USMLE Step 1. I did not take step 2. Upon my interview and consequent acceptance into the program I am starting, they stated that they would "recommend I had taken Step 2 CK", so.....I decided I would. They are also paying for it. I'm guessing they just want to have me at an even keel all around. For justification -This program really does love me and I have not ever felt any bias towards being a DO in this field or program, in fact, another DO that graduated from their program a few years ago, honestly probably paved the way for me. SO....I know that they want to position me in the best place possible. I know that they understand that very unfairly and unfortunately so, at least in the Urology world, it is not so even and equal for a DO to match into an MD urology spot. They have told me this in person and told me that they feel this leaves a lot of great applicants from matching and that its a shame. They also know that I want to go into academic medicine, aka do a fellowship as well and they want to be able to help me get the fellowship of my choice. SO.....I figured if they were paying for step 2 CK....in my mind I see no reason not to go ahead and just take it all ( Step 2 CE and Step 3) and be double boarded.

So to answer your questions....1. Some people take it because they can then take USMLE step 3 and NOT have to take COMLEX step 3 AND BECOME BOARDED AND LICENSED AND PRACTICE in whatever state they are in. Some states allow this, however certain states have both an osteopathic and an allopathic board so that would not suffice. They would require you to be osteopathic licensed in order to practice in that state. I am taking both COMLEX step 3 and USMLE step 3...my own decision....so that wouldn't apply to me and 2. There are a "FEW" countries that still do not recognize the Osteopathic DO licensure and I love doing mission work. Being double boarded by both NBME and NBOME, I will have practicing priviledges in any country an MD has, to practice medicine and do missionary work. These are small things, but to me important. Lastly, 3. Like I mentioned, I want to do a fellowship and stay in academic medicine. Having taken USMLE step 3 will allow me to be just as competitive for any spot I want. Now please dont misunderstand me, MANY DOs do AMAZING fellowships without having USMLE scores. I personally "Me, Myself, and I" have decided with my situation and current recommendations from my program, decided to just go ahead and take all of them. SO....thats what I am doing. 🙂
Hope that helped clarify some things. But no...NO PROGRAM requires it. 🙂

That makes sense. Thanks for the reply, and congrats on your Urology match! No small feat!

 

[Proverbs31]

That makes sense. Thanks for the reply, and congrats on your Urology match! No small feat!

Thank you very much! Just took USMLE CS today! Phew! Done! 🙂

 

[Knicks]

btw, not that any of us can know for sure but do you think that the survey @ the end might "factor in" to your grade?

 

[interprimos]

One thing I must say..... Do not underestimate the exam. That was the mistake I made and I ended up failing it. Prior to taking the exam, everyone I spoke with told me that it was the easiest of all the steps, that once I got thru Step I and step II CK I'll be fine. I took that advice to heart and was sloppy in my prep for CS. I took my CS in Houston and I was slaughtered. I forgot lots of questions to ask, I did not do some neccessary physical examinations and missed quite a bit of work up and differentials. Like I said, I ended up failing.
Now I'm here again, preparing to take it a second time. Now I'm a whole lot wiser; it may be easier compared to the other steps but that doesn't mean I shouldn't be diligent in my preps. I take it in about 3 weeks and I'm believing that I'll ace it this time around.

 

[GAPCOM student]

INTERPRIMOS-

GOOD LUCK!! Youll do great!

 

[pocketknife52]

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