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Hey guys,
I know there are already an infinite number of these types of posts on SDN, but I can't help myself. It's been 2 weeks since I took CS and I'm freaking out still. I don't want to get into trouble by giving too much away, so here are the very basics:
1. I did horrible PEs. Very short. Very abbreviated. I listened to heart and lungs on almost every patient, and then just a few maneuvers related to the CC. That's seriously it. My neuro exams (when required) were pretty crappy--incomplete and poorly executed. My MSK exams (when required) were almost non-existent (just "inspection" and palpation really). There was just no time...IDK maybe I have horrible time management skills. I left out at least one required PE maneuver or entire system that might have been required for at least 3 or 4 cases.
2. On almost every case I forgot to ask AT LEAST one relevant hx question related to the CC. On a few cases these were MAJOR omissions...really important things I should have asked and didn't.
3. Differentials on at least 2 cases were bad/completely wrong. The rest were ok but not perfect. Probably spelled a lot of things wrong too.
4. 2 cases I just had no idea what was going on with the patient at all. AT ALL!
I always washed my hands...except one case I forgot and did it during the exam. I always asked HPI, FH, SH, PMH, PSH, Allergies, meds.
I counselled on every case, which I think went OK. Got cut off counselling a few times. I always shook hands, smiled, was nice, said I'm sorry, asked how this is affecting your life, said that must be difficult...blah, blah, blah.
Anyway, my biggest concern is the ICE portion, especially the PE. Anyone else have trouble with this? Anyone have downright terrible PEs and still pass?
Sorry and thank you.
Edit: I swear I will let you all know my results. Should get them in Dec.
EDIT #2: I PASSED. For those of you who are reading this and worrying about your performance on this exam, I hope this gives you some reassurance. I thought I did terrible on ICE and OK on CIS...turns out both were above the borderline area, but ICE was MUCH higher than CIS (with CIS almost touching the borderline area). I'd suggest (as many others before me have suggested) to stay off SDN when worrying about things like this. It has been said before in other threads, but I want to reiterate: people are horrible at judging how they did on this exam (I think the same goes for the other steps, but this is ESPECIALLY true for CS).
Also, I just want to point out something that worried me quite a bit while reading SDN obsessively over the past 2 months-
I know I'm at risk here for sounding like a complete jerk and someone who, now that they passed, can get up on their high horse and try to critique those who failed. I really don't want to come off that way (even though I probably will). I just need to get this off my chest a little bit.
First-- I know I could have had a really bad day and easily failed this exam. Failing this exam happens all the time, and it sucks cause this exam is stupid. I don't want to criticize people who failed this exam in general. It's a certain kind of post on SDN and other sites that I want to lightly criticize here.
It's this kind of thing: "I asked all of the relevant HPI questions" "I knew every diagnosis" "I thought the test was really easy"
Reading these posts really freaked me out for the past few months because 2 scenarios went through my head depending on whether this person passed or failed:
#1: if this person passed, I definitely DID NOT know every diagnosis/think the test was easy. OMG I MUST HAVE FAILED.
#2: if this person failed...HOW DID THEY FAIL?...THIS MEANS I DEFINITELY FAILED...AHHHH!
Going through these two scenarios is a lose-lose situation. You think you're gonna fail no matter what. Not very reassuring. Then I thought about this a little more.
"It was obvious what the patient had. I thought all of the diagnoses were really easy" --I'm sorry, but REALLY? I'm not saying I know how this test works, but my guess is that the patients do not have one specific diagnosis that you're supposed to "get". MY GUESS is that the patients are supposed to have somewhat vague symptoms with a MOST LIKELY diagnosis, but not just one specific diagnosis. That's because this test isn't just about getting the diagnosis right. In fact, I think that's a pretty minor part of it (especially given the fact that I likely missed the most likely diagnosis of 3-4 patients). I think you can get into big trouble on this exam by--for example--assuming your patient has GERD and not considering that they could be having an MI or angina (and therefore, not asking about cardiac symptoms at all). If you thought you "nailed" the diagnoses, 12/12, you might be making this mistake repeatedly.
Think of a clinician mentor that you have. Some rockstar resident or faculty that you know. Think of the best family medicine doctor you can think of, and then imagine them taking this test. Imagine them seeing a 12 patients with 20 mins for the hx and PE and then writing a note in 10 mins. Did they do everything perfectly???...NO FREAKIN' WAY. Even with "straightforward CCs." That's why it bothers me a little bit when people think "ACED" this exam. What 4th year medical student walks out of this kind of test feeling like they did perfectly or "nailed all 12 diagnoses" or "asked all relevant HPI questions"???
Bottom line is this: It's NORMAL/EXPECTED to feel like you did horrible on this exam. I think it's unusual/suspicious when people say they feel like they did really well on it, or especially when people say things like "I got 11/12 or all the diagnoses/asked all relevant HPI questions" (I mean, how would you even know that??)
TL;DR: People are pretty bad at judging how they did on this exam. If you are really worried, I think you probably have better self-awareness than someone who thought they aced it. You probably passed. Try to stop worrying (I know, it's really hard!!! I should speak for myself). Stay off SDN if you can!!!
I know there are already an infinite number of these types of posts on SDN, but I can't help myself. It's been 2 weeks since I took CS and I'm freaking out still. I don't want to get into trouble by giving too much away, so here are the very basics:
1. I did horrible PEs. Very short. Very abbreviated. I listened to heart and lungs on almost every patient, and then just a few maneuvers related to the CC. That's seriously it. My neuro exams (when required) were pretty crappy--incomplete and poorly executed. My MSK exams (when required) were almost non-existent (just "inspection" and palpation really). There was just no time...IDK maybe I have horrible time management skills. I left out at least one required PE maneuver or entire system that might have been required for at least 3 or 4 cases.
2. On almost every case I forgot to ask AT LEAST one relevant hx question related to the CC. On a few cases these were MAJOR omissions...really important things I should have asked and didn't.
3. Differentials on at least 2 cases were bad/completely wrong. The rest were ok but not perfect. Probably spelled a lot of things wrong too.
4. 2 cases I just had no idea what was going on with the patient at all. AT ALL!
I always washed my hands...except one case I forgot and did it during the exam. I always asked HPI, FH, SH, PMH, PSH, Allergies, meds.
I counselled on every case, which I think went OK. Got cut off counselling a few times. I always shook hands, smiled, was nice, said I'm sorry, asked how this is affecting your life, said that must be difficult...blah, blah, blah.
Anyway, my biggest concern is the ICE portion, especially the PE. Anyone else have trouble with this? Anyone have downright terrible PEs and still pass?
Sorry and thank you.
Edit: I swear I will let you all know my results. Should get them in Dec.
EDIT #2: I PASSED. For those of you who are reading this and worrying about your performance on this exam, I hope this gives you some reassurance. I thought I did terrible on ICE and OK on CIS...turns out both were above the borderline area, but ICE was MUCH higher than CIS (with CIS almost touching the borderline area). I'd suggest (as many others before me have suggested) to stay off SDN when worrying about things like this. It has been said before in other threads, but I want to reiterate: people are horrible at judging how they did on this exam (I think the same goes for the other steps, but this is ESPECIALLY true for CS).
Also, I just want to point out something that worried me quite a bit while reading SDN obsessively over the past 2 months-
I know I'm at risk here for sounding like a complete jerk and someone who, now that they passed, can get up on their high horse and try to critique those who failed. I really don't want to come off that way (even though I probably will). I just need to get this off my chest a little bit.
First-- I know I could have had a really bad day and easily failed this exam. Failing this exam happens all the time, and it sucks cause this exam is stupid. I don't want to criticize people who failed this exam in general. It's a certain kind of post on SDN and other sites that I want to lightly criticize here.
It's this kind of thing: "I asked all of the relevant HPI questions" "I knew every diagnosis" "I thought the test was really easy"
Reading these posts really freaked me out for the past few months because 2 scenarios went through my head depending on whether this person passed or failed:
#1: if this person passed, I definitely DID NOT know every diagnosis/think the test was easy. OMG I MUST HAVE FAILED.
#2: if this person failed...HOW DID THEY FAIL?...THIS MEANS I DEFINITELY FAILED...AHHHH!
Going through these two scenarios is a lose-lose situation. You think you're gonna fail no matter what. Not very reassuring. Then I thought about this a little more.
"It was obvious what the patient had. I thought all of the diagnoses were really easy" --I'm sorry, but REALLY? I'm not saying I know how this test works, but my guess is that the patients do not have one specific diagnosis that you're supposed to "get". MY GUESS is that the patients are supposed to have somewhat vague symptoms with a MOST LIKELY diagnosis, but not just one specific diagnosis. That's because this test isn't just about getting the diagnosis right. In fact, I think that's a pretty minor part of it (especially given the fact that I likely missed the most likely diagnosis of 3-4 patients). I think you can get into big trouble on this exam by--for example--assuming your patient has GERD and not considering that they could be having an MI or angina (and therefore, not asking about cardiac symptoms at all). If you thought you "nailed" the diagnoses, 12/12, you might be making this mistake repeatedly.
Think of a clinician mentor that you have. Some rockstar resident or faculty that you know. Think of the best family medicine doctor you can think of, and then imagine them taking this test. Imagine them seeing a 12 patients with 20 mins for the hx and PE and then writing a note in 10 mins. Did they do everything perfectly???...NO FREAKIN' WAY. Even with "straightforward CCs." That's why it bothers me a little bit when people think "ACED" this exam. What 4th year medical student walks out of this kind of test feeling like they did perfectly or "nailed all 12 diagnoses" or "asked all relevant HPI questions"???
Bottom line is this: It's NORMAL/EXPECTED to feel like you did horrible on this exam. I think it's unusual/suspicious when people say they feel like they did really well on it, or especially when people say things like "I got 11/12 or all the diagnoses/asked all relevant HPI questions" (I mean, how would you even know that??)
TL;DR: People are pretty bad at judging how they did on this exam. If you are really worried, I think you probably have better self-awareness than someone who thought they aced it. You probably passed. Try to stop worrying (I know, it's really hard!!! I should speak for myself). Stay off SDN if you can!!!
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