Convinced I failed CS...I PASSED!!!!!

[SamusLives]

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PASSED!!!

I really can't believe it. I messed up so much throughout the day, that I was sure I failed. I made a lot of small mistakes, and a couple of what I thought were big ones (eg. didn't ask permission to untie gown, patient says "ohh!!") I thought that was the kiss of death. I forgot to ask all sorts of ROS questions; heck, I forgot to ask some basic questions even (b/c I didn't use mneumonics).

I've been freaking out for the past ~2 months about this. Especially after I matched to the program I wanted. I was afraid I would not graduate, and be unable to start my residency. I realize that virtually everyone passes, but that didn't stop me from worrying about it, and shaving a few years off my life.

Anyway, I've been reading other CS posts, and I thought the info was pretty helpful (wish I knew about SDN before taking the CS). I hope everyone reading this does well on their CS. BTW, score reports are posted at midnight EST (just in case your freaking out and want your score ASAP).

In case your wondering, I used the First Aid to study. I browsed through it for a few weeks, then really focused for about 4 days before the test. I probably should have spent more time on the CIS, since I'm an AMG I mostly studied for the ICE, but ended up stressing about the CIS. So don't neglect the CIS.

Definitely take the exam seriously and study hard. Nobody wants to shell out another grand to retake this thing.

Good luck to all!!!!!

 

[PrincetonRocks]

I recently matched in derm which was a big high for me. But then I was scared that I may have to give up my position or something since I probably failed CS. To be honest, I was very sick and lost my voice the day before the exam. My physical exam sucked and I honestly did it so fast that it looked like quackery.

I think the key to passing the exam is efficiency, not perfection. You don't want to run out of time on any of the stations because it will mess with your head on the next station. If I passed that exam with a graspy voice that was hardly comprehensible....anyone can pass the exam. Oh by the way, I studied all of 3 hours for the exam (read FA cases once the night before) and got my results today...I PASSED!

The CS is totally unnecessary and a big waste of money. I hope that no one from an accredited AMS will have to go through that exam by 2010.

 

[bocaburger]

all the posts here have been helpful so I want to post my experience to hopefully allay some fear/stress.
I made big mistakes such as not washing my hands on one patient and not doind a cv exam on a syncope patient. I performed a babinski without warning the patient and tickled him. I finished most my encounters early. I believed I failed the test nevertheless I passed. Like a previous post said...I think the key is efficiency and hitting many of the required techniques or questions. The test clearly does not require perfection. Everyone I know missed big and small things here and there and most passed.
One final point..smile and be compassionate throughout the entire exam even if you know you messed up. That is a must.
I studied First Aid for 2 weeks and this helped me nail the notes and develop good differentials.
Good luck to all and thanks for the helpful posts.

 

[gleep and gloop]

To the people who thought they failed but didn't - was it close? i.e. if you look at the score report that they gave you, were you borderline or were you well within the passing range?

I have about a month to wait for my score, and while I think I probably passed just based on the stats, I could definitely see how it could go either way.

 

[medblazer21]

To the people who thought they failed but didn't - was it close? i.e. if you look at the score report that they gave you, were you borderline or were you well within the passing range?

I have about a month to wait for my score, and while I think I probably passed just based on the stats, I could definitely see how it could go either way.

I would love to know that info too, because I failed. However, if you passed I dont think it gives you the score breakdowns, its just a one page report that says PASS in each category.

It sucks because I'd love to know how well you have to do to pass the exam, but the way they report the scores its a total mystery.

Bastards! 😡

 

[165808]

Nope, they give you no breakdown of your performance if you pass. There's a blank page at the end of your score report that says since you passed, you get no breakdown 🙁

On the other hand, I was super freaked out after reading these boards. SO happy to have passed today!! I know I probably missed a ton of things. There's hope!! Good luck to you all!!

 

[keeping-it-real]

hey, did you guys do thorough exams on the SPs? For instance, if the complaint focused around abdominal pain, did you listen to CV and lungs in addition to the abdominal exam?

 

[165808]

hey, did you guys do thorough exams on the SPs? For instance, if the complaint focused around abdominal pain, did you listen to CV and lungs in addition to the abdominal exam?

Eh, I tried to do heart and lungs on everyone, but sometimes I just didn't have the time (or didn't feel like it). If I had failed, I was pretty sure it was because my physical exam skills during CS were totally sub-par. They were crap. I never did anything close to a neuro exam, never really did anything except for heart, lungs, abdomen, and faking an ophthalmologic exam on a guy. I really never did anything else. If I felt orthostatics were needed, I put it in my plan. No way was I going to even try to waste time doing that.

Time is such an issue with each encounter, I was too worried/hurried to do any sort of complete exam. Or even an appropriate one. And I had no idea if there were grading on technique or just the general idea that you thought about doing that portion of the exam. Who knows?

I feel fortunate to have passed. I feel like such a slacker writing this!! It's such a random test, and anything can happen, but....the odds are in your favor. If all else fails, do a heart/lung exam and use that small amount of time to figure out what else you should examine afterward. 😀

 

[SamusLives]

I did a heart, lung, and abdominal on everyone; mostly b/c FA seemed to want that for almost every case. In addition, I also did a joint exam once, a poor neuro exam 1-2 times, never did eye exam (I knew I should have for DM or HTN), and never took any vitals. The fanciest things I did were a psoas sign and an obturator sign. I tried my best to do all the exams in a certain order, so as not to forget and to maximize efficiency (ie. did all the exams I could think of while the patient was sitting, then all I could think of while pt lying down, instead of having them sit/laydown/sit/laydown).

I would recommend looking the patient over once when you meet them. I almost missed LE edema, b/c I was so concerned with eye contact. Besides that though, I didn't find any real findings (except simulated "pain").

Be sure to look over the "tough" questions in FA. At least half my pts asked me a tough question (always right before I washed my hands for some reason--to make me forget to wash hands? to make sure I didn't talk with my back turned? I'm not sure).

Good luck.

 

[babycatcher08]

I was almost CERTAIN that I failed, and I passed. For the past two months, all I could do was remember things I forgot. But now its time to cruise on to graduation! Best of luck to everyone who is waiting to hear!

 

[Skills of House]

I would recommend looking the patient over once when you meet them. I almost missed LE edema, b/c I was so concerned with eye contact. Besides that though, I didn't find any real findings (except simulated "pain").

I'm trying to take this thing in Aug and it already has me freaked out b/c I don't see how you all are able to get through the whole H&P in 15min!!! I've been looking through the first aid for cs book and I see how it's focused and everything but still to get through all of that and still explain your plan and counsel the patient...I feel like I'll end up fighting the clock on every case (except maybe the phone calls)! And how are they able to simulate LE edema???

 

[SamusLives]

The LE edema was real. It was the only real finding I encountered. Besides that everything else was simulated.

Yes, 15 minutes isn't alot of time, but you can do it. Have you taken an OSCE at your school? That is about as close to the real thing as you can get. I took the OSCE everytime my school offered it (3 times) and it is set up the same way as CS--15 for H&P, 10 for note. It gives you a good idea about how to manage your time. Thanks to the paranoid people at the USMLE you can't bring your watch in, but they do have a clock on the wall. You can also try practicing with a partner if you're really worried about time.

Also, remember that the SPs are not like real pts b/c they answer questions more directly. You don't have to tease out the information. In this way, you can gather a lot of info quickly. They actually know the answers to your questions.

The PE I did was pretty basic, and you just have to go through the motions (the correct motions). Make sure you place the stethoscope on all the right places, and tell the patient what your doing as you go along.

Counsel the patient as you go along, should something come up. Don't rush the patient.

You don't need alot of time to close. Just say I think it could be X, Y, or Z. We're going to do "some x-rays, blood tests, etc." (plus any forbidden exams pelvic/rectal). You don't have to be super specific, b/c you want to avoid jargon anyway (don't say "we're going to check your complement levels", say "we're going to do some blood test"). Ask if they have questions/concerns.

Good luck! The odds are in your favor.

 

[owl]

Yesterday I found out I passed Step 2 CS, too! Just wanted to share the news in this forum which has been so helpful to me.

I was pretty nervous about this exam and spent the past few weeks worrying about things I forgot. As others have suggested, it does seem like what they're looking for is not perfection but consistently hitting certain main points over and over.

My experience: I used the LIQORAAA and PAM HUGS FOSS mnemonics on everybody and added open questions at the beginning and end, too. Did heart and lung exams every time as well as other little random maneuvers depending on the complaint. (Did not do any neuro exams at all. Was worried my weak physical exam performance would fail me. I also forgot to counsel to lose weight and quit smoking, later realized I should have done that several times.) Made sure to always sit while interviewing, drape and wash hands. Certainly smiled a lot and tried to seem compassionate and reassuring. I typed all my notes and would definitely recommend that over handwritten.

FA is a great resource - I practiced several cases with my mom playing the SP and then writing up notes, and it felt like a good preparation for the real thing.

Best wishes to everyone and thanks for all the support and advice in this forum!

 

[NuMD97]

I'm trying to take this thing in Aug and it already has me freaked out b/c I don't see how you all are able to get through the whole H&P in 15min!!! I've been looking through the first aid for cs book and I see how it's focused and everything but still to get through all of that and still explain your plan and counsel the patient...I feel like I'll end up fighting the clock on every case (except maybe the phone calls)! And how are they able to simulate LE edema???

I completely understand your panic, but you have to keep things in perspective. You are not doing a "whole H&P in 15 minutes." You're doing a focused exam. For me, I think the most serious issue was the lack of a watch. Two books I read mentioned time frames for each portion of the exam. Except I spent so much time with the door information, I lost track of time. When the announcement came (each time for 11 of the 12 patients) telling us we had five minutes left, I raced and did the physical. But like the previous poster noted, I, too, combined steps, washing my hands and talking to the patient at the same time. Eye contact is important, which was done throughout the rest of the exam, but without combining things it was impossible, for me, to do all that I wanted to do.

Also noted above, the standardized patients are very well trained in their responses. I had one patient close her eyes (talk about conditioned responses!) as she saw I was about to do a neuro exam, even before I told her to close her eyes!

Keep in mind, too, that with the time constraints, you will not repeat BP measurements and the like, but having said that, I put things in the orders to reflect that I knew things like orthostatics were important. It shows that you knew what you needed to do, and included it as part of the workup. That gets around some of the issues of time constraints.

I'm writing of my experience because, I, too, found out that I passed this miserable experience yesterday, and I also found a lot of the postings here extremely helpful. If you're in a medical school that has standardized patient testing as part of your curriculum, all the better. For those of you, especially IMGs, the FA is the best resource, I believe. It gives you every possible scenario that you can imagine. Plus it gives you an idea of how certain signs are simulated (that was a real eye-opener).

I believe the key to this test is to practice, practice, practice. This helps for two reasons: it keeps your nervousness to a minimum, and it allows the test to be just another practice session: you do it automatically using whatever you were using while studying. Be systematic, be consistent, use the mnemonics recommended, so you are thorough; be kind to the SPs, show compassion, address them as you would any clinic patient you have, and you should be okay.

Just do not underestimate this exam. You really do not want to pay over $1,000 to do it again.

Again, my thanks to all previous posters. Now to get in gear for Step 3!

Nu

 

[jpro]

Found out I passed CS


What a freaking relief. I was leaving the room with 5min left just so I could write a good note. There was barely any eye contact going on. I was all business. I once performed DTRs on a guy in 10sec. What a joke.

 

[Thomas123]

I too was convinced that I failed. I took the test in the end of feb. I didn't really study for the test since everyone who I talked to said the test was a joke. I briefly read through about half of the first aid the evening before and morning of the exam.

I did not write vitals down for 11 patients (even though was normal), had a patient with a red knee and just focused on arthritis differential diagnoses after barely touching the knee since I forgot how to do a knee exam, and was missed more than one diagnosis. I also caged everyone even if they only said they drank once/year (that got some funny looks from sp's) and put too much time into washing my hands, and listening to the whole back for resp exam. My physical exams also only consisted of CV, lung, abd exams (after I spent too much time with draping and proper positioning. I finished everything on time, but was rushed on most. My notes were all handwritten and I sometimes can not read my own writing. Most of the time I ran out of space and had to start new columns.

I also had not seen a patient for about 4 months before the test so I was a little rusty. My school had a lot of SP's for the first 2 years and I guess that and luck helped because I passed. I really do not think I did a good job on test day and was expecting to fail. I probably was more happy that I found out I passed CS than on match day!

If I passed many of the people who think they failed must have passed! I think that the people grading the tests are MDs and they know it is very expensive and are trying to pass us (or at least I would). Good luck to everyone!

 

[Thomas123]

I too was convinced that I failed. I took the test in the end of feb. I didn't really study for the test since everyone who I talked to said the test was a joke. I briefly read through about half of the first aid the evening before and morning of the exam.

I did not write vitals down for 11 patients (even though was normal), had a patient with a red knee and just focused on arthritis differential diagnoses after barely touching the knee since I forgot how to do a knee exam, and missed more than one diagnosis. I also caged everyone even if they only said they drank once/year (that got some funny looks from sp's) and put too much time into washing my hands, and listening to the whole back for resp exam. My physical exams also only consisted of CV, lung, abd exams (after I spent too much time with draping and proper positioning. I finished everything on time, but was rushed on most. My notes were all handwritten and I sometimes can not read my own writing. Most of the time I ran out of space and had to start new columns.

I also had not seen a patient for about 4 months before the test so I was a little rusty. My school had a lot of SP's for the first 2 years and I guess that and luck helped because I passed. I really do not think I did a good job on test day and was expecting to fail. I probably was more happy that I found out I passed CS than on match day!

If I passed many of the people who think they failed must have passed! I think that the people grading the tests are MDs and they know it is very expensive and are trying to pass us (or at least I would). Good luck to everyone!

 

[SamusLives]

It seems you can make quite a few mistakes and still pass. The pass rate is something like 98% for AMGs according to the USMLE website.

What I don't like is that the advice I got about the exam was: its easy, if you speak english you'll pass, just remember to wash your hands. Even if this were true, I don't think you should encourage anyone to take this exam lightly. Its expensive, and some schools (like mine) require it for graduation. The fact that it takes long to schedule, and get scores back, makes it potentially dangerous to students.

When I say I messed up alot and still passed, I don't mean to suggest folks take this test lightly. Definitely study and give it your best.

 

[165808]

It seems you can make quite a few mistakes and still pass. The pass rate is something like 98% for AMGs according to the USMLE website.

What I don't like is that the advice I got about the exam was: its easy, if you speak english you'll pass, just remember to wash your hands. Even if this were true, I don't think you should encourage anyone to take this exam lightly. Its expensive, and some schools (like mine) require it for graduation. The fact that it takes long to schedule, and get scores back, makes it potentially dangerous to students.

When I say I messed up alot and still passed, I don't mean to suggest folks take this test lightly. Definitely study and give it your best.

I definitely agree with that, SamusLives!!

 

[Incandescent]

i remember being worried about passing as well (i am an american graduate) but passed anyway 🙂 one thing that helped me was i asked every patient, "do you have any further questions?" "or is there anything that i missed?" (not test wise - history wise - i always ask this of my real patients as well).

that usually opened the door to one of their "super secret tough questions" that i could answer. just one more box they could check off, i guess.

 

[Eddie]

Congrats Samus. 🙂

 

[superoxide]

Took CS on Thursday in Philadelphia. Definitely think I failed this thing.

-Forgot to ungown/drape a few times
-listened through the gown on a few pts. 😳😱
-totally bombed the telephone encounter ("Are you still there Doctor?" is what the SP said). Couldn't answer her challenge question.
-Totally forgot to do a lung/heart exam on one pt who came in with hearing difficulties.
-in some cases, didn't type the physical exam findings in the note, even though I did them during the encounter
-sometimes I didn't know what else to ask, so I just stood there like an idiot looking at my notes.
-didn't check lymph nodes on pt with sore throat and fever.
-asked CAGE questions to pts who "only" drank 1-2 drinks/week and got a weird look from the SP ("No, it's not THAT bad") 😳

....and the above is just what I can remember. It's going to be a looooooooooong summer for me.👎

 

[NuMD97]

Took CS on Thursday in Philadelphia. Definitely think I failed this thing.

-Forgot to ungown/drape a few times
-listened through the gown on a few pts. 😳😱
-totally bombed the telephone encounter ("Are you still there Doctor?" is what the SP said). Couldn't answer her challenge question.
-Totally forgot to do a lung/heart exam on one pt who came in with hearing difficulties.
-in some cases, didn't type the physical exam findings in the note, even though I did them during the encounter
-sometimes I didn't know what else to ask, so I just stood there like an idiot looking at my notes.
-didn't check lymph nodes on pt with sore throat and fever.
-asked CAGE questions to pts who "only" drank 1-2 drinks/week and got a weird look from the SP ("No, it's not THAT bad") 😳

....and the above is just what I can remember. It's going to be a looooooooooong summer for me.👎

Superoxide, I think it's safe to say we all had the same post mortem experience as you expressed here. I also "CAGEd" folks who only drank 1-2 drinks a week just to be on the safe side, and show what I "know". In the real world keep in mind that alcoholics downplay what they drink, so you won't lose points for "extra" questions like the one you mentioned. I also remember the alcoholic I had in real life who "only drank" 1-2 beers, until his friend interjected that each beer is the 32-oz size. That was quite an eye-opener for me, and after that I made sure to ask the size of the bottle to better assess the level of drinking.

Trust me, we all left out a lot (or seemingly so) on that miserable exam. I, too, kicked myself for all the maneuvers I performed that I didn't mention in my note.

You took it, now try to put it past you and don't waste the summer fretting about it. Otherwise you're going to have a very long two-month wait.

All the best,

Nu

 

[superoxide]

Superoxide, I think it's safe to say we all had the same post mortem experience as you expressed here. I also "CAGEd" folks who only drank 1-2 drinks a week just to be on the safe side, and show what I "know". In the real world keep in mind that alcoholics downplay what they drink, so you won't lose points for "extra" questions like the one you mentioned. I also remember the alcoholic I had in real life who "only drank" 1-2 beers, until his friend interjected that each beer is the 32-oz size. That was quite an eye-opener for me, and after that I made sure to ask the size of the bottle to better assess the level of drinking.

Trust me, we all left out a lot (or seemingly so) on that miserable exam. I, too, kicked myself for all the maneuvers I performed that I didn't mention in my note.

You took it, now try to put it past you and don't waste the summer fretting about it. Otherwise you're going to have a very long two-month wait.

All the best,

Nu

Thanks for the reply. I hope it works out for me! What is going to make the wait worse is that I am now preparing for CK, which I am scheduled to take on July 31st. I hope the waiting and getting neurotic about the CS result is not going to affect my CK prep! Everyday I can't help but open my First Aid CS and find out more and more things where I screwed up. Maybe I could use it to feed a nice fire.

Just got to try to forget about it and move on.

 

[keeping-it-real]

just wanted to toss my hat in... I was thoroughly convinced I failed but just found out I passed.

My test day went horribly, I was sick and my nose wouldn't stop running. I forgot to do basic exams on many of the patients; I'm talking not doing heart/lung exams on people with breathing problems. I forgot differentials, I misspelled easy words... literally, I was all over the place on test day.

What I will say, though, is that while my physical exam skills lacked, I took a lot of time doing my histories and did them thoroughly. I also tried to be very personable and honest. If I couldn't answer their questions, I told them that I didn't know but would find out the answer and get back with them immediately.

I really can't describe this test or what the criteria are for this. All I know is that statistics are on your side. I'm an AMG with english as first language, so maybe that was all I needed... I'm not sure.

The bottom line is this, though: Don't freak out about the results of this test. I don't think I could've screwed up more stuff, yet I passed. I'm not saying that this will be the case for everyone, but I am saying that there is no use in worrying since there's absolutely know way to gauge how you did. Believe me, I was 100% convinced I failed and ready to re-sign up for this damn test.

 

[davey]

like a lot of you here, i made my fair share of mistakes adn managed to pass....i'm not sure how, but i definitely did not create rapport with most of the patients, left the rooms early and had weak physical exams...did not counsel most patients....i did manage to summarize on every patient, and was respectful.....this test is a mystery to me i was convinced i failed.

 

[NuMD97]

know way

Nice pun. 🙂

(Sorry I just couldn't resist.)

 

[bioguy]

supposed to receive my results today, but didn't. called them up, they said my results are pending. what does that mean? did i screw up so bad that they are taking time to decide whether to fail me or not ??

 

[guynextdoor79]

congrats to all the guys who passed the exam even after they thought the had botched it up.as for me,i failed cs even though i did all that was considered necessary like washing hands,asking permission,counselling and so on.its time the sp`s stand answerable for failing a candidate unjustly,if they fail you coz you are a not so good looking but a competent doctor. even if they get caught,they probably are just gonna lose a side job,the doc stands to lose his career.
Its time the nbme puts and end to playing russian roulette on physicians.
Let attendings examine students,its not super lotto,its sombody`s entire life.
there is a lot of awful things i wanna say about the exam,but i wont be justified now that i have failed and it wud look like a cheap arguement.
anyway good luck to the ones who passed.
i hope some of you will take the initiative to end this expensive unavoidable nonsense that we all have to go through.