Pursuing MD

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Starting July 16, 2006 the CS "Step 2 Committee has decided to raise the performance levels required to receive a passing outcome on two of the three Step 2 CS subcomponents" http://www.usmle.org/step2/Step2CS/Step2Indexes/Step2CSIndex.htm#change.

Has anyone takes the CS exam yet since July 16th? If yes, did you notice any changes that you thought were implemented to make the exam harder or trickier?
 

surgimg

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oh man!was planng to gve it on 21st,hw bad is ths gna be?
 

Discobolus

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I don't think it's that they are making the test any "harder" or "trickier" they are just raising what is considered a passing score. Kind of like changing the passing score on the CK from a 182 to a 186, the test doesn't change just the required performance to pass it.
 
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dfagod

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They didn't make the test harder, you just need a higher score to pass. If you can breathe, and went to an american medical school you will pass. Don't stress about it. I just took it a couple of days ago. It was a total waste of $1000 dollars and a couple days.
 

Shane2150

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I hate to sound like the dumb-dumb here (since everyone has been posting that the CS exam is so easy, you're guaranteed a pass if you can a) breathe and b) speak English), but I found the exam to be trickier than I'd expected. I usually ran short on time (in about 8/12 cases I was still finishing my wrap-up statements when time called), had a couple of cases where the diagnosis was far from apparent, and found several of the SP's to be such wooden actors that the whole interaction felt quite awkward. Also, felt like I made a number of large mistakes/omissions in my diagnoses/follow-up testing lists in the patient notes. I didn't anticipate being worried about passing, but I am. I prepared for the exam with FA as well as a "run-through" offerred by my medical school. Am I totally alone in feeling like this was an awkward, rather tricky testing experience?
 

dfagod

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You didn't have to know the diagnosis for any patient, you just had to know the differential, and what tests to order/perform. I'm sure you did fine
 

LostTommyGuns

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I expect that you did fine, my understanding is that a number of the cases have no clear-cut diagnosis, which probably makes coming up with a differential that much easier.

It does irritate me how little information they give about the grading in CS. I saw that little post they put up about changing the grading - but what does that mean? I still haven't found anything much about how they grade it to begin with. I know you have to pass 3 parts: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). That says nothing about how the parts are graded.

I know that SPs have a checklist that identifies items that you should have done. I know that a physician reads your PN and grades it based on certain criteria but I still have questions. For instance: if you put something on your "Workup" that isn't on their list do you lose a point, not get a point? Is it worth cramming as many tests into the Workup as possible to try to get more points or do you lose points for having too many tests.

What are their goals by raising the bar? Increase failure rates? That said, I'm not particularly worried about it, but I think that when the institute a new test the test-takers should know what to expect and how scores are determined. The "black box" philosophy doesn't amuse me.
 

Medical123

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What are their goals by raising the bar? Increase failure rates? That said, I'm not particularly worried about it, but I think that when the institute a new test the test-takers should know what to expect and how scores are determined. The "black box" philosophy doesn't amuse me.[/QUOTE]


They probably decided that they weren't getting enough money out of the thing. So, by failing more people,they can add several hundred thousand dollars to their greedy little pockets! Seriously though, they do need to explain how grading works so that we know what we are expected to do. Though everyone says that this test is easy and that a monkey could pass it, people do fail it and I don't want to be one of them!
 

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Medical123 said:
What are their goals by raising the bar? Increase failure rates? That said, I'm not particularly worried about it, but I think that when the institute a new test the test-takers should know what to expect and how scores are determined. The "black box" philosophy doesn't amuse me.

They probably decided that they weren't getting enough money out of the thing. So, by failing more people,they can add several hundred thousand dollars to their greedy little pockets! Seriously though, they do need to explain how grading works so that we know what we are expected to do. Though everyone says that this test is easy and that a monkey could pass it, people do fail it and I don't want to be one of them![/QUOTE]


Majority of the students this will effect are foreign grads....not US students...
 

LostTommyGuns

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I think that one might be up for debate:

I see your point that making the test harder will make it more difficult for FMGs. You can make the argument that higher fail rates among FMGs means that if the test is graded more stringently, their fail rates will increase all the more.

On the other hand I think that by changing the grading on the other two parts (Not the spoken english grading part) you could argue that it won't be significantly more difficult for FMGs, who usually fail on the Spoken English portion. They do well on the other two portions because they frequently have years of clinical training under their belt. It will be disproportionately harder for US med students who have limited clinical experience, and therefore will be more prone to failing if you increase the difficulty of the sections they have the most trouble with.
 

cjw0918

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The most important thing to keep in mind is that the pts aren't supposed to have just one dx. They are trained to respond with yes to many different lines of questioning for the differentials. That's why I think the best approach is to make a mental differential before you go in just from the door info. That way you can remind yourself what key questions to ask about ALL the possible dxs and not just one based on the first yes you get. The USMLE doesn't expect you to know what to do with the information you get, they care more about whether or not you know what important questions to ask. That's what step 2 CS is about- eg) Do you know what questions to ask someone with abdominal pain and what to examine??? Almost anything is ok for the workup as long as its somewhat reasonable and it's not contraindicated.
Don't go into the test with the mindset with you're supposed to "figure out" what dx these pts have, it's not about that from the USMLE standpoint. Just know the differentials for the chief complaints and ask all the appropriate questions. Good luck to all.
 
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Pursuing MD

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cjw0918 said:
The most important thing to keep in mind is that the pts aren't supposed to have just one dx. They are trained to respond with yes to many different lines of questioning for the differentials. That's why I think the best approach is to make a mental differential before you go in just from the door info. That way you can remind yourself what key questions to ask about ALL the possible dxs and not just one based on the first yes you get. The USMLE doesn't expect you to know what to do with the information you get, they care more about whether or not you know what important questions to ask. That's what step 2 CS is about- eg) Do you know what questions to ask someone with abdominal pain and what to examine??? Almost anything is ok for the workup as long as its somewhat reasonable and it's not contraindicated.
Don't go into the test with the mindset with you're supposed to "figure out" what dx these pts have, it's not about that from the USMLE standpoint. Just know the differentials for the chief complaints and ask all the appropriate questions. Good luck to all.
Some good advice to keep in mind.
 

LostTommyGuns

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After recently taking CS, I think that FA is great preparation. The only thing I didn't like was the fact that in the FA cases, there seemed to be more potential positives. By that I mean that in FA there might be five potential things that could be contributing to this problem, but on CS (unless I blew it) there was usually only a few.

For instance: An FA headache case might have answers to questions that involved increased job anxiety, family problems, associated symptoms, HTN, and occurence at the same time each day. Whereas CS would have HA with a couple associated symptoms and mild HTN...

I guess it doesn't really change anything, but it's a nice feeling when the patient says something and you know that it was a line they were supposed to tell you when you asked the question.
 
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trkd

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LostTommyGuns said:
After recently taking CS, I think that FA is great preparation. The only thing I didn't like was the fact that in the FA cases, there seemed to be more potential positives. By that I mean that in FA there might be five potential things that could be contributing to this problem, but on CS (unless I blew it) there was usually only a few.

For instance: An FA headache case might have answers to questions that involved increased job anxiety, family problems, associated symptoms, HTN, and occurence at the same time each day. Whereas CS would have HA with a couple associated symptoms and mild HTN...

I guess it doesn't really change anything, but it's a nice feeling when the patient says something and you know that it was a line they were supposed to tell you when you asked the question.
Thanks for chiming in. What did you think about the cases they gave you? Similar to the generic FA ones?
 

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longtime lurker here, took CS last friday. Aside from being slow out of the gate(not able to finish 1st encounter - pt was pretty difficult to get along with), I felt the rest of the exam was pretty straight-forward. Thought the cases were similar to Kaplan Step 2 CS examples. Hope this helps
 

LostTommyGuns

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I would say that if you review FA you're pretty much good.

The challenge questions were pretty much verbatim from the section in First Aid though about half my patients had two challenge questions. If you need help coming with with the differentials/tests the quick cases part is pretty reasonable. I totally blanked out a couple of times and wished I had gone over it more. The longer cases were pretty representative of what you'll experience in the test itself though I think I had one more "Urgent" care situation that wasn't really covered by FA.

All in all if you relax, have good interpersonal skills, are able to come up with a diff diagnosis and ask pertinent questions as well as do a decent physical exam I think everything will be fine.

If it helps the following rules came into play in my exam that I remembered reading about in FA:

Don't listen through the gowns.
Always ask before you do PE manuevers.
Wash your hands.
Don't repeat painful manuevers.
Utilize "social workers" and their apparent infinite capabilities when asked challenge questions.

Just a few thoughts. It's all in FA though.
 
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Pursuing MD

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and 1st Aid CS cases are pretty good, but the cases were not too balanced on the real thing. Got too many musculoskeletal cases. The 1st few cases u may get lost a little, but by the 3rd one, u feel more comfortable.

But, 1st Aid CS book was not bad. I wished I wrote out my H&P cause my typing skills were absent that day.

I wish all those who are gonna take the exam the best!
 

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Shane2150 said:
I hate to sound like the dumb-dumb here (since everyone has been posting that the CS exam is so easy, you're guaranteed a pass if you can a) breathe and b) speak English), but I found the exam to be trickier than I'd expected. I usually ran short on time (in about 8/12 cases I was still finishing my wrap-up statements when time called), had a couple of cases where the diagnosis was far from apparent, and found several of the SP's to be such wooden actors that the whole interaction felt quite awkward. Also, felt like I made a number of large mistakes/omissions in my diagnoses/follow-up testing lists in the patient notes. I didn't anticipate being worried about passing, but I am. I prepared for the exam with FA as well as a "run-through" offerred by my medical school. Am I totally alone in feeling like this was an awkward, rather tricky testing experience?
I totally felt totally the same! I took it today. I walked out of a couple thinking "damn..... did I just forget to....." or "why didn't I ask about....". I am actually pretty scared too. But I can think of a few key things I didn't ask in 3-4 cases. I figured it out when I was writing the note but too little too late. Sucky feeling especially since I have to wait til mid-Oct for the result. Its going to be a loooong 2 months. I don't know how many you have to pass but one girl said 8/10 (and 2 of the 12 don't count anyway). Anyone know this info? I couldn't find it on the site.
 

leorl

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I think everyone who takes the test feels the same way. For nearly each patient encounter (even those that you think you did well on), you realize later "Oh damn, I should have asked that! or DARNIT I forgot to write suchandsuch finding in my patient note!" Everyone in my group felt like that anyway. And many people screw up their first couple anyway. I hope markers realize this because you are only given 15 minutes... There are some cases where I couldn't really think of 5 differentials for their complaint either...so do they want to see 5 for each case, or just that you're thinking along the right lines?
 

trkd

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leorl said:
I think everyone who takes the test feels the same way. For nearly each patient encounter (even those that you think you did well on), you realize later "Oh damn, I should have asked that! or DARNIT I forgot to write suchandsuch finding in my patient note!" Everyone in my group felt like that anyway. And many people screw up their first couple anyway. I hope markers realize this because you are only given 15 minutes... There are some cases where I couldn't really think of 5 differentials for their complaint either...so do they want to see 5 for each case, or just that you're thinking along the right lines?
Thanks. I know that is what everyone says. Everyone makes mistakes, I should not worry about it. But I actually am a bit concerned. I missed a HUGE important question for one of the hx and thought of it after I walked out so I put the correct answer as my top DDx though I didn't even ask about it. I also missed a HUGE part of the PE for one and realized it when I walked out. Couldn't fix that much. So I am thinking that if these are "critical mistakes" that leaves me with little leaway for the other encounters. That said, I think most everything was fine except that you are not supposed to ask more than one question at a time and I always say " do you have nausea or vomiting" or " do you have a runny nose or sore throat" or whatever. Apart from these, I think it generally went great. These things eat at you though. Not a good feeling to have for 2 months, particularly since they decided to make the mysterious grading "harder". But thanks for the encouragement. Makes me feel a little better. :oops:
 

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I took CS today. I would say that, while the test is not extremely difficult, is is not quite as easy as some of the earlier posts indicated (the ones about English fluency and breathing being the only requirements to pass). As mentioned, there was more Musculoskeletal/Rheumatology than anticipated. Also as mentioned, the cases were not that obvious, so there were not too many cases where one could say (for certain) this patient has this conditions and needs this workup. FA is a very good resource. I would agree with LostTommyGuns, who emphasized how FA had some non-technical tips that were quite useful (wash nyour hands, always ask permission before starting the Physical, etc).
 

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I would agree with LostTommyGuns too but that's not the point . :D

I'm still waiting for my score but have had a few weeks to reflect upon my experiences. Consider: how many times have you seen residents be asked a question by faculty and say "hmmm, I'm not sure". These people have had years more training than us and are still making these mistakes. True, they aren't as common as what I do but that comes as no surprise.

I think that CS is here like many other things - a hoop to jump through. You should read through the "trick" questions and learn how to dodge the questions. You read through the cases and practice your DDx skills. Like much of medicine the test isn't there to test you as much as it is to force you to review and possibly learn something. It's more of a tool to teach than it is to measure. That said I'll rest easier when I pass :rolleyes:
 

azzarah

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They didn't make the test harder, you just need a higher score to pass. If you can breathe, and went to an american medical school you will pass. Don't stress about it. I just took it a couple of days ago. It was a total waste of $1000 dollars and a couple days.
Actually, I heard a few people at my school failed because they totally blew it off....you should still study for it, especially since you're paying all this money to take the freaking test....
 

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I took it the other day; all my patients seemed incredibly straightfoward. I just asked a few basic ROS questions relevant to their complaint, did a minimal physical exam on most of them, and left. I had like ten minutes between cases to doodle. Maybe I missed some huge trick, but I figure I passed the English part, passed the "be nice to your patients" part, and I probably had at least 80% of the info I needed on most patients.

Unless they had secret agendas, and if 95% are targeted to pass, I would be really, really surprised if I failed. There were a couple people I didn't know exactly what they had, or precisely what work-up to do, but I can't imagine that's fail-worthy.
 
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