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Critical mistakes on Step 2CS

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Hermione_Granger

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Guys, I'm not kidding. This isn't a situation where I forgot Fam Hx in a few cases. I made some next level, embarrassing, ridiculous mistakes that will haunt me for the next 3 months. I'm an IMG who got 240+ on Step 1, English is my native language, and I want to go into Psych. Haven't taken CK yet (maybe a mistake?). Anyways, took the exam in Philly a few days ago and have been steadily losing my mind since then.

IF Y'ALL ARE FEELING BAD ABOUT DOING BADLY, TAKE A LOOK AT HOW BADLY I ****ED UP, AND YOU'LL PROBABLY FEEL A LOT BETTER ABOUT YOURSELF.

I would appreciate an HONEST opinion of what you think. The nerves hit me and I probably had approx. 2 panic attacks per patient lol. Naturally as soon as I left the room, I knew exactly what was incorrect. I won't write anything that violates NBME rules.

1. Palpated PMI while patient was laying down in one case (like an idiot)
2. All abdominal exam patient had legs STRAIGHT instead of flexed (also like an idiot)
3. Performed a whisper test incorrectly (like a huge idiot)
4. Forgot Weber, Rinne, and cranial nerves for a case that warranted it (ughhh)
5. Did really half-assed lung/heart exams (unbelievably idiotic x1000)
6. Ran out of time on one case and completely didn't close (ended after PE)
7. Forgot to check oropharynx in a case that probably warranted it
8. Answered 2-3 difficult questions really awkwardly
9. Forgot to wash hands once (all other times I used gloves instead)
10. Checked oropharynx with fundoscope ... can I even do that?? (there wasn't a pen light)??
11. Completely missed an easy case, I didn't even have the correct diagnosis in Ddx. Just completely botched. Couldn't elicit DTRs so recorded the patient as having hyporeflexia.... FML.
12. Didn't counsel 2x smokers
13. Forgot fam history in 2-3 cases.
14. Forgot to ask age of menarche in female patient, although might not have been THAT important.
15. Some of the Ddxs were iffy I felt...
16. One patient was kind of rude and it flustered me so I did the entire HPI/physical exam/closure OUT OF ORDER (PE interspersed between HPI and closure).
17. Miss-spelt Zantac as Xantac... haaaaaaaa
18. Didn't know American brand name Afimex or something... I thought they'd only be using generic names.
19. Didn't counsel on one incidence of noncompliance
20. Forgot to write patient's general appearance/state in ALL PE areas of PN. sdkfhsldkjfhslkjdfhlskdjhflsdkjhf
21. OMG the list probably goes on.

What I did do:
I was super polite and energetic. I asked the patients how their disease was affecting their lives, I CAGE'd everyone who drinks, I closed on every case except one (although a few closures were awkward/stupid), I shook hands, made eye contact, asked everyone if it's okay that I write while we speak, told everyone "I'm sorry to hear that" about chief complaint, congratulated any successes, pulled out the leg thing for abdominal exams, asked if patients needed help, explained rectal and pelvic exams, NEVER left a patient note blank (filled everything), always asked if any questions/concerns/is everything clear, and I was gentle with the physical exam.
 
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sazerac

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I did the first 12 items for sure. I did probably 18 or 19 total from your list.

Result: pass (first time). I think my ICE was in the gray borderline area.

Don't worry so much.

I specifically remember pointing out to the patient that "oops I forgot to pull out the foot tray for the abdominal exam", apologized, and moved on with the interview.
 

Hermione_Granger

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I did the first 12 items for sure. I did probably 18 or 19 total from your list.

Result: pass (first time). I think my ICE was in the gray borderline area.

Don't worry so much.

I specifically remember pointing out to the patient that "oops I forgot to pull out the foot tray for the abdominal exam", apologized, and moved on with the interview.



Thanks for your reply. Still having PTSD over this. Remembering more things I got wrong- I wrote down some patients as having lymphadenopathy because I probably was kind of hallucinating from the stress. FML.
 
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vomeronasal

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My friend, I wish I only had your mistakes. AMG here. I 100% failed this test on the CIS portion. If I could go back in time I would change so many things...

1) I failed to completely close on TWO cases. One ran out just as I finished the physical examination, one immediately after the patient asked a challenge question (VERY WORRIED ABOUT THIS)
2) I did not get the patient to ask a challenge question on many of the cases (EXTREMELY WORRIED ABOUT THIS). I think I may have forgotten to ask if they have any questions at the end or I just ran out of time. Maybe only 5-6 cases did I completely close, most others I ran out of time after giving differential + treatment plan
3) Did not ask how patient's problem is affecting their life in every case
4) Wrote lots of notes and looked down to do so, asked permission prior to doing this, but somewhat poor eye contact on my part
5) Poor rapport building, overall very robotic with question asking
6) Many just plain CIS mistakes: accidentally doing physical exam maneuvers that caused the patient pain, occasionally forgetting to express empathy at appropriate points, did not explore patients feelings well, occasionally asked leading or stacked questions

I did a few things right:
1) Always introduced myself with a big smile, said "Mr./Ms. X?", gave a handshake when appropriate, and asked if I could take notes
2) Always started with open ended questions
3) Proactively responded to patients with obvious signs
4) Always summarized HPI and asked if patient had anything else concerning
5) Always washed hands and stethoscope and asked permission prior to beginning the physical. Always pulled out the foot extension, generally tried to be extremely gentle when patients had pain
6) Counseled patient on any bad habits using nonjudgmental language, assessed their willingness to change, commended on good habits
7) Always used laymen language and explained any possibly confusing terms, usually tried to check for understanding/agreement with plan

Has anyone with this amount of HUGE mistakes passed the CIS portion? Please pray to God for me, these recurring thoughts of failing have been awful.
 

Hermione_Granger

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My friend, I wish I only had your mistakes. AMG here. I 100% failed this test on the CIS portion. If I could go back in time I would change so many things...

1) I failed to completely close on TWO cases. One ran out just as I finished the physical examination, one immediately after the patient asked a challenge question (VERY WORRIED ABOUT THIS)
2) I did not get the patient to ask a challenge question on many of the cases (EXTREMELY WORRIED ABOUT THIS). I think I may have forgotten to ask if they have any questions at the end or I just ran out of time. Maybe only 5-6 cases did I completely close, most others I ran out of time after giving differential + treatment plan
3) Did not ask how patient's problem is affecting their life in every case
4) Wrote lots of notes and looked down to do so, asked permission prior to doing this, but somewhat poor eye contact on my part
5) Poor rapport building, overall very robotic with question asking
6) Many just plain CIS mistakes: accidentally doing physical exam maneuvers that caused the patient pain, occasionally forgetting to express empathy at appropriate points, did not explore patients feelings well, occasionally asked leading or stacked questions

I did a few things right:
1) Always introduced myself with a big smile, said "Mr./Ms. X?", gave a handshake when appropriate, and asked if I could take notes
2) Always started with open ended questions
3) Proactively responded to patients with obvious signs
4) Always summarized HPI and asked if patient had anything else concerning
5) Always washed hands and stethoscope and asked permission prior to beginning the physical. Always pulled out the foot extension, generally tried to be extremely gentle when patients had pain
6) Counseled patient on any bad habits using nonjudgmental language, assessed their willingness to change, commended on good habits
7) Always used laymen language and explained any possibly confusing terms, usually tried to check for understanding/agreement with plan

Has anyone with this amount of HUGE mistakes passed the CIS portion? Please pray to God for me, these recurring thoughts of failing have been awful.


To be honest, it sounds like you had fewer mistakes than I did >.< Additionally, since you're an AMG I'd guess you're in better shape than I am by default. Where did you write it?
 

vomeronasal

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To be honest, it sounds like you had fewer mistakes than I did >.< Additionally, since you're an AMG I'd guess you're in better shape than I am by default. Where did you write it?

I took it in Chicago. From your post, it sounds like you did fine! If I can pass CIS by a single star I will be the most grateful person in the world, it will truly take a miracle :(
 

Hermione_Granger

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I took it in Chicago. From your post, it sounds like you did fine! If I can pass CIS by a single star I will be the most grateful person in the world, it will truly take a miracle :(
My concern is more ICE rather than CIS, although a few SPs did seem pretty pissed with me... ugh. So what exactly is your concern about the CIS portion? The few closures that were messed up?
 

vomeronasal

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My concern is more ICE rather than CIS, although a few SPs did seem pretty pissed with me... ugh. So what exactly is your concern about the CIS portion? The few closures that were messed up?
Yes, I feel that not only did I screw up a few closures, but overall it was not a "patient-centered" interview like they wanted it to be. I tried to offer empathy when I thought of it but overall it was a lot of me talking and the patient listening, when I should have made it more equitable.

From what I've read about the ICE thing, plenty of people have forgotten to include something on the physical of every note (i.e., some people did not put vitals on anything). Also it appears the majority of people really skimp on the physical examination, so in that regard I think you did just fine. Your worries seem to be mostly about physical exam minutiae which I really think aren't going to hurt you at all :)
 

yrmd

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I've also been having nightmares about the exam. I've talked to people and searched all the posts I could find about mistakes and outcomes. I felt a bit better after a week or so, but I still have trouble sleeping every other day and nightmares about the leg rest I didn't pull out. I made so many silly mistakes and some mistakes that I just pray to god won't do so much damage. It's going to be a long wait for the scores and I'm probably going to have a heart attack before I see my report. Hang in there guys, and I know it's not easy, in fact it's quite difficult, but try to focus on exams comping up/rotations. Hopefully it will be good news for all of us. I can't pinpoint if I'm worried more about CIS or ICE. I feel like I was iffy on a few DDx in terms of order and maybe not having enough pertinent negatives and not doing 2 important physical exams. CIS well the leg rest and not closing (giving DDx and work up but not asking if there's any questions or how they feel about what I just said) in like 3 cases. Also some awkward situation when palpating for PMI, I honestly took five seconds thinking "what are you doing" to myself before I realized I gotta move along and pt was probably like so confused. Blurting out things I forgot to counsel pt about after thee encounter was over on my last case was the cherry on top. Encounter was over and I was like oh and avoid this! Smh. :smack:
 
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deleted500612

Dude... you think you did bad, I made most of the same mistake as you plus more.

I didn't counsel any patients on smoking, alcohol consumption, or safe sex practices. Didn't ask about scheduled screening tests at all. I skimped HORRIBLY on some of the PE exams and while writing the note immediately afterward I quickly realized what I had done and wanted to just crawl into a hole and die. Resp case I literally just auscultated the posterior chest wall and the heart. Didn't percuss, check fremitus or anything else. Immediately afterward I was like what the f uck was I thinking? The majority of the stations I neglected to do at least a couple physical exam maneuvers that would be considered fairly important. Probably only about half the cases I remembered to ask if the patient had any questions. I completely forgot to fill in the PE box for the note on one patient. I had time to do it too, but skipped over it to fill in the ddx and investigations first and then forgot to come back to it. Realized I hadn't filled it in with 10 seconds left and then wrote one line and ran out of time. There was one case that seemed absurdly vague and I had absolutely no clue what the dx was. Pulled a couple differentials out of my ass to put down even though I'm 90% sure they were both wrong. Couple of the brand name meds the patient mentioned I had no idea what they were or how to spell them so didn't even try to write them down in the note. Considering we are taught strictly generic names in medical school and on the step I and 2CK, I think it's a bit unfair they are using brand names for the 2CS.

Couple things I think I did well, showed good empathy and concern for all patients, had very good systematic history taking. Closed with all patients and told them what I would like to order and what my differentials and reasoning were and if they were ok with my plan. Included a quality summarizing statement for all cases. Overall the patient interactions felt natural and comfortable.

Given how HORRIBLY I skimped on PEs and completely neglected to counsel any patients about social stuff I came out of the exam feeling like absolute sh|t. I have a 240+ step I and almost 260 on the 2CK and I feel like all of my effort in those exams was for nothing and that my future is now ruined because nerves got the best of me in the 2CS and there is a good chance I failed it. Have never failed an exam in my life and I am terrified. Coming out of step I and 2CK I was extremely confident that I would score at least average, but not so on the 2CS. I have always struggled with nerves in oral/clinical examinations and I feel like this one bad day is going to ruin my career. This is going to be the most anxiety-inducing 2 month wait. Sigh.
 
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yrmd

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Dude... you think you did bad, I made most of the same mistake as you plus more.

I didn't counsel any patients on smoking, alcohol consumption, or safe sex practices. Didn't ask about scheduled screening tests at all. I skimped HORRIBLY on some of the PE exams and while writing the note immediately afterward I quickly realized what I had done and wanted to just crawl into a hole and die. Resp case I literally just auscultated the posterior chest wall and the heart. Didn't percuss, check fremitus or anything else. Immediately afterward I was like what the f uck was I thinking? The majority of the stations I neglected to do at least a couple physical exam maneuvers that would be considered fairly important. Probably only about half the cases I remembered to ask if the patient had any questions. I completely forgot to fill in the PE box for the note on one patient. I had time to do it too, but skipped over it to fill in the ddx and investigations first and then forgot to come back to it. Realized I hadn't filled it in with 10 seconds left and then wrote one line and ran out of time. There was one case that seemed absurdly vague and I had absolutely no clue what the dx was. Pulled a couple differentials out of my ass to put down even though I'm 90% sure they were both wrong. Couple of the brand name meds the patient mentioned I had no idea what they were or how to spell them so didn't even try to write them down in the note. Considering we are taught strictly generic names in medical school and on the step I and 2CK, I think it's a bit unfair they are using brand names for the 2CS.

Couple things I think I did well, showed good empathy and concern for all patients, had very good systematic history taking. Closed with all patients and told them what I would like to order and what my differentials and reasoning were and if they were ok with my plan. Included a quality summarizing statement for all cases. Overall the patient interactions felt natural and comfortable.

Given how HORRIBLY I skimped on PEs and completely neglected to counsel any patients about social stuff I came out of the exam feeling like absolute sh|t. I have a 240+ step I and almost 260 on the 2CK and I feel like all of my effort in those exams was for nothing and that my future is now ruined because nerves got the best of me in the 2CS and there is a good chance I failed it. Have never failed an exam in my life and I am terrified. Coming out of step I and 2CK I was extremely confident that I would score at least average, but not so on the 2CS. I have always struggled with nerves in oral/clinical examinations and I feel like this one bad day is going to ruin my career. This is going to be the most anxiety-inducing 2 month wait. Sigh.

Well now that you mention it, I also forgot to ask pts about screening exams other than one that I asked because it was related to her CC.

It's really hard to wait for this score. I'm so scared that I messed up enough to fail. It seems like you've had a good experience with the patients though so that's good. Most of mine seemed happy at the end, except the first one where I just froze for a few seconds when the encounter was over and I wasn't done with closure and just said thank you, and one where I yelled out something to the pt after encounter was over.. Let's just say pt was confused. It was my last case and it went well but knowing me I have to add that cherry on top and goof it up a bit.. it was all part of the plan ;)
and well I for one will ALWAYS pull the leg rest for all my patients from now on and until I retire.

Either way, I freak out at least once a day also, but if you just took the exam I understand how it can be really tough to not think about it 24/7.. in a week or two it will get better I promise. You realize that all you can do is pray, and hope for the best. I'll pray for all of us to pass. The wait is long, so whenever you feel like venting and discover other mistakes like we all are, just post here and I'll try to reply as soon as I can.
 

Hermione_Granger

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Dude... you think you did bad, I made most of the same mistake as you plus more.

I didn't counsel any patients on smoking, alcohol consumption, or safe sex practices. Didn't ask about scheduled screening tests at all. I skimped HORRIBLY on some of the PE exams and while writing the note immediately afterward I quickly realized what I had done and wanted to just crawl into a hole and die. Resp case I literally just auscultated the posterior chest wall and the heart. Didn't percuss, check fremitus or anything else. Immediately afterward I was like what the f uck was I thinking? The majority of the stations I neglected to do at least a couple physical exam maneuvers that would be considered fairly important. Probably only about half the cases I remembered to ask if the patient had any questions. I completely forgot to fill in the PE box for the note on one patient. I had time to do it too, but skipped over it to fill in the ddx and investigations first and then forgot to come back to it. Realized I hadn't filled it in with 10 seconds left and then wrote one line and ran out of time. There was one case that seemed absurdly vague and I had absolutely no clue what the dx was. Pulled a couple differentials out of my ass to put down even though I'm 90% sure they were both wrong. Couple of the brand name meds the patient mentioned I had no idea what they were or how to spell them so didn't even try to write them down in the note. Considering we are taught strictly generic names in medical school and on the step I and 2CK, I think it's a bit unfair they are using brand names for the 2CS.

Couple things I think I did well, showed good empathy and concern for all patients, had very good systematic history taking. Closed with all patients and told them what I would like to order and what my differentials and reasoning were and if they were ok with my plan. Included a quality summarizing statement for all cases. Overall the patient interactions felt natural and comfortable.

Given how HORRIBLY I skimped on PEs and completely neglected to counsel any patients about social stuff I came out of the exam feeling like absolute sh|t. I have a 240+ step I and almost 260 on the 2CK and I feel like all of my effort in those exams was for nothing and that my future is now ruined because nerves got the best of me in the 2CS and there is a good chance I failed it. Have never failed an exam in my life and I am terrified. Coming out of step I and 2CK I was extremely confident that I would score at least average, but not so on the 2CS. I have always struggled with nerves in oral/clinical examinations and I feel like this one bad day is going to ruin my career. This is going to be the most anxiety-inducing 2 month wait. Sigh.


Are you an IMG or AMG? Where did you write it? Congrats on the killer scores. I still find your mistakes less critical than mine... however, I'm sure most people feel their mistakes are worse than others'. What do you mean when you say you "skimped" on PE? I think the worst thing that happened for me was thinking a few patients had lymphadenopathy when they actually probably didn't. FML.
 
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deleted500612

Are you an IMG or AMG? Where did you write it? Congrats on the killer scores. I still find your mistakes less critical than mine... however, I'm sure most people feel their mistakes are worse than others'. What do you mean when you say you "skimped" on PE? I think the worst thing that happened for me was thinking a few patients had lymphadenopathy when they actually probably didn't. FML.

I guess we do tend to amplify our own perceived shortcomings. By "skimped" I mean I did very basic/superficial physical exams and missed a lot of relevant maneuvers for the patient's given presentation. This happened on almost every patient, and I would always realize what I had missed while writing the note afterward. Realizing I had missed something significant made me feel panicked and anxious for the next encounter, kind of perpetuating the state of relative disarray for the entire exam. My cardio exams consisted of simply auscultating the standard valvular areas, no auscultation with advanced maneuvers, no palpating for heaves or thrills, etc. My resp exam was auscultating the posterior lung fields, didn't percuss, didn't check fremitus, didn't check tracheal tug/deviation or anything else even on an obvious resp case. Head trauma case I just checked cranial nerves and did not do any upper/lower limb neuro. Like just horrendous stuff that is super frustrating looking back because it is all fairly straightforward and imporant things I would easily know to do on a real patient but the nerves just got the best of me. I can only hope for a miracle that I somehow passed this test. The only thing that gives me hope is that some other people have described fairly bad experiences with missing a significant number of things and still ended up passing the exam.
 
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Hermione_Granger

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I guess we do tend to amplify our own perceived shortcomings. By "skimped" I mean I did very basic/superficial physical exams and missed a lot of relevant maneuvers for the patient's given presentation. This happened on almost every patient, and I would always realize what I had missed while writing the note afterward. Realizing I had missed something significant made me feel panicked and anxious for the next encounter, kind of perpetuating the state of relative disarray for the entire exam.

I did pretty basic/superficial PEs too. Seems like a lot of people did. I don't think that you would ruin your entire career IF you happen to fail this. Your step scores are certainly high enough to compensate for such circumstances, if they should occur.
 
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deleted500612

I did pretty basic/superficial PEs too. Seems like a lot of people did. I don't think that you would ruin your entire career IF you happen to fail this. Your step scores are certainly high enough to compensate for such circumstances, if they should occur.

A lot of the more competitive/desirable residencies will just toss your application in the trash if they see you have a failed attempt at any step exam. I could still get something somewhere, but a failure in 2CS would undoubtedly close a hell of a lot of doors that I worked hard to open for myself all throughout previous years of med school which would be pretty devastating. I guess I can't change anything now though, just have to try and not go insane while waiting to get my result back.
 

yrmd

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A lot of the more competitive/desirable residencies will just toss your application in the trash if they see you have a failed attempt at any step exam. I could still get something somewhere, but a failure in 2CS would undoubtedly close a hell of a lot of doors that I worked hard to open for myself all throughout previous years of med school which would be pretty devastating. I guess I can't change anything now though, just have to try and not go insane while waiting to get my result back.

I was trying not to go insane too. This test plays a big part in our future, and the exams we've taken thus far have been very lengthy exams that required long days and nights of studying none stop, so I do believe it's completely ok to be freaking out right now.
However, if we let this get in the way of performing well on rotations, and doing well on future exams, we will only be burrying ourselves in a deeper hole. Don't forget that we are going to be future physicians, a career that requires a tremendous amount of patience, this is a great time to develop that patience and work on it.

I will be very heart broken if I fail, and will probably take a few days to get back on my feet again, and I'm getting nauseous just thinking about it right now, but will let you guys know of the outcome either way. I wish you all the best!

Btw I also put pale conjunctiva for two patients because I guess I was also hallucinating during the exam so you're not alone with that LAD. What were we thinking !
 

Elevencents

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Are you an IMG or AMG? Where did you write it? Congrats on the killer scores. I still find your mistakes less critical than mine... however, I'm sure most people feel their mistakes are worse than others'. What do you mean when you say you "skimped" on PE? I think the worst thing that happened for me was thinking a few patients had lymphadenopathy when they actually probably didn't. FML.

You are focusing on very minor mistakes in the grand scheme of things. EVERYONE makes mistakes and I would assume what you listed is around the norm, nowhere near failing. When you add them all up it appears like a lot but if you wrote out every single positive in such a detailed manner it would FAR outweigh your negatives. Please try to relax - I have spoken with people with extremely glaring mistakes that passed.
 

memelig

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Guys how do you do light touch PE? I feel like an idiot because i did light touch exam by using my hands instead of using cotton swap. Do you think this is acceptable?
 
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Ismet

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Guys how do you do light touch PE? I feel like an idiot because i did light touch exam by using my hands instead of using cotton swat. Do you think this is acceptable?

I always do light touch with my hands. If you're testing sharp vs dull then you use the q-tip.
 
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memelig

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I have another question about counseling guys. I am freaked out because more than half of my patients did not have a single thing in their SHx that I could counsel them on. I did not counsel on colonoscopy, pap smear etc. Is this a critical mistake?
 

Hermione_Granger

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I have another question about counseling guys. I am freaked out because more than half of my patients did not have a single thing in their SHx that I could counsel them on. I did not counsel on colonoscopy, pap smear etc. Is this a critical mistake?
definitely not a critical mistake.
 
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humerus12

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Dude... you think you did bad, I made most of the same mistake as you plus more.

I didn't counsel any patients on smoking, alcohol consumption, or safe sex practices. Didn't ask about scheduled screening tests at all.

I also did not counsel most of my patients so kind of in the same boat and super worried. I found the below checklist from the USMLE site while googling for the checklist they use. I'm not sure what to make of it really, but "helping patients with behavior changes" kind of sounds like the counseling part to me and I'm not sure if it means anything that it's italicized. Maybe, hopefully, it's not actually on the checklist or it's not as big of a deal as everyone makes it out to be.

www.usmle.org/pdfs/cru/CISFunctionsandSubfunctions.pdf
 

Hermione_Granger

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I also did not counsel most of my patients so kind of in the same boat and super worried. I found the below checklist from the USMLE site while googling for the checklist they use. I'm not sure what to make of it really, but "helping patients with behavior changes" kind of sounds like the counseling part to me and I'm not sure if it means anything that it's italicized. Maybe, hopefully, it's not actually on the checklist or it's not as big of a deal as everyone makes it out to be.

www.usmle.org/pdfs/cru/CISFunctionsandSubfunctions.pdf

Thanks for the info. There are so many things that I messed up royally during this exam that I've more or less given up speculating which mistake is more likely to lead to a fail. I've been able to suppress my CS experience relatively well up until now. I feel like the release date is creeping up (starting June 28th??) so I'm starting to get uncomfortable intrusions again. Everyone holding up ok?
 
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FreakinOutMD

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Dude, I'm trippin so hard right now.

I'm an American IMG, so english isn't a problem. I greeted everyone, counceled everyone yada yada all that easy stuff. However, THE ICE IS KILLING ME. All my examinations were SUPER CONCISE due to time and i realized that doing a cardiac examination on everyone who didn't really need it is a waste of time. I didn't do special tests for lets say a shoulder exam, but I know the diagnosis because it was classic. To be honest, all my cases were classic cases, except maybe 1.
Oh on my first case, I had soap left over on my hand so when i shook the dudes hand for goodbye, i must have gave him some soap lmaoxD. But it only got better from there.
I always started with differentials and tests first when it came to my PN, then i wrote up my history and physical. My physical lacked a bit.
I also did one mistake thats sort of worrying me, I accidentally added a finding that I didn't do (normal DTR), i thought i did when writing the note only realizing later that night that i didn't.

I took my exam in Philly, people told me that was a stupid idea, but the cases were rather easy for me. IDK.
 

Hermione_Granger

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Dude, I'm trippin so hard right now.

I'm an American IMG, so english isn't a problem. I greeted everyone, counceled everyone yada yada all that easy stuff. However, THE ICE IS KILLING ME. All my examinations were SUPER CONCISE due to time and i realized that doing a cardiac examination on everyone who didn't really need it is a waste of time. I didn't do special tests for lets say a shoulder exam, but I know the diagnosis because it was classic. To be honest, all my cases were classic cases, except maybe 1.
Oh on my first case, I had soap left over on my hand so when i shook the dudes hand for goodbye, i must have gave him some soap lmaoxD. But it only got better from there.
I always started with differentials and tests first when it came to my PN, then i wrote up my history and physical. My physical lacked a bit.
I also did one mistake thats sort of worrying me, I accidentally added a finding that I didn't do (normal DTR), i thought i did when writing the note only realizing later that night that i didn't.

I took my exam in Philly, people told me that was a stupid idea, but the cases were rather easy for me. IDK.
Dude why are you freaking out? It seems to me like you did fine...
 

FreakinOutMD

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Dude why are you freaking out? It seems to me like you did fine...

Sometimes I tell myself that, then sometimes I don't. My examinations and PN is the only thing that freaks me out for line an hour then I'm fine for the rest of the day. I'm not losing sleep about it. I left alot of things out when I do my examinations, its because when i take history i usually know what to look for and go straight to the examinations i need that will be positive. I read some stories where they do worse than in my case and pass, and people that look like they did really well and fail. You can never walk out of the exam knowing you will pass for sure lol. And failing isn't really exciting either.
 

Hermione_Granger

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Hey guys, today is the first day of the release period... I'm not too hopeful for results today, but I'm still a bit anxious! Does anyone know when during the release period people generally get their results?
 

vomeronasal

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I PASSED!!!! Refer above to see how much of a neurotic mess I was. I passed and I did not come anywhere close to failing. God is good.
 
D

deleted500612

Dude... you think you did bad, I made most of the same mistake as you plus more.

I didn't counsel any patients on smoking, alcohol consumption, or safe sex practices. Didn't ask about scheduled screening tests at all. I skimped HORRIBLY on some of the PE exams and while writing the note immediately afterward I quickly realized what I had done and wanted to just crawl into a hole and die. Resp case I literally just auscultated the posterior chest wall and the heart. Didn't percuss, check fremitus or anything else. Immediately afterward I was like what the f uck was I thinking? The majority of the stations I neglected to do at least a couple physical exam maneuvers that would be considered fairly important. Probably only about half the cases I remembered to ask if the patient had any questions. I completely forgot to fill in the PE box for the note on one patient. I had time to do it too, but skipped over it to fill in the ddx and investigations first and then forgot to come back to it. Realized I hadn't filled it in with 10 seconds left and then wrote one line and ran out of time. There was one case that seemed absurdly vague and I had absolutely no clue what the dx was. Pulled a couple differentials out of my ass to put down even though I'm 90% sure they were both wrong. Couple of the brand name meds the patient mentioned I had no idea what they were or how to spell them so didn't even try to write them down in the note. Considering we are taught strictly generic names in medical school and on the step I and 2CK, I think it's a bit unfair they are using brand names for the 2CS.

Couple things I think I did well, showed good empathy and concern for all patients, had very good systematic history taking. Closed with all patients and told them what I would like to order and what my differentials and reasoning were and if they were ok with my plan. Included a quality summarizing statement for all cases. Overall the patient interactions felt natural and comfortable.

Given how HORRIBLY I skimped on PEs and completely neglected to counsel any patients about social stuff I came out of the exam feeling like absolute sh|t. I have a 240+ step I and almost 260 on the 2CK and I feel like all of my effort in those exams was for nothing and that my future is now ruined because nerves got the best of me in the 2CS and there is a good chance I failed it. Have never failed an exam in my life and I am terrified. Coming out of step I and 2CK I was extremely confident that I would score at least average, but not so on the 2CS. I have always struggled with nerves in oral/clinical examinations and I feel like this one bad day is going to ruin my career. This is going to be the most anxiety-inducing 2 month wait. Sigh.

Somehow by the grace of god and all things holy I passed this thing. I felt like I just got jabbed with a 1mg epi bolus as I waited for my score report to load. Holy, wow! Ironically enough my ICE was actually good, not even in the borderline range and instead my CIS was borderline. I was only worried about ICE and was very confident with the CIS portion. No idea how they grade this test, doesn't seem logical to me. Only thing I can come up with to improve my CIS would have been to counsel patients with lifestyle stuff like smoking/drinking as I did not do that and also forgot to ask a few patients if they had any additional questions at the end of the encounter. Other than that I thought I basically had ideal encounters that couldn't have been improved in the CIS area at all. Oh well, still passed so that's what matters!!

My advice is that they apparently mark this very leniently and unpredictably. I know many people who were sure they failed and passed. I also know people who thought they did fine and failed. Even if you made multiple seemingly critical errors there is a good chance you still passed and there's not really any way to predict as the marking criteria seems pretty nebulous. Good luck to those still waiting!
 
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LandoftheJ

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Congrats all for passing!!!
I too had similar mistakes to you all, but I feel that you guys all had decent ddx... Mine were completely brutal I think. Is this a huge determining factor?
 
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CanuckApp

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Hi Everyone,

I also have a question (sorry if this was already asked):

Reading step 2 cs to get a sense of the test. For patients w headaches, the book advised head CT, MRI brain on most of them. Isn't that overkill unless they have red flag signs like weight loss, morning headache etc? esp if it sounds more like migraine, tension headache or cluster headache? In clinic, wouldn't one start with analgesics? Perhaps they mean the potential tests in the future as well as next test? Another example is a women with sinusitis where they recommended CT sinus and xray sinus. Unless the duration was long/not getting better, that seems like overkill? I read that they dock points for unlikely ddx, will it be similar for unnecessary tests?

Thank you in advance!
 

Reefs

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I just took mine -and I coudlnt complete the hpi for one case - only got the description in for the chief complaint - which sucks because i had supporting evidence from the history for my ddx :/ and for another -i had 3 ddx listed but only had time to type in the supporting evidence for the first one. I feel like i wasnt very good with my counselling - and with the recent changes in performance standards i feel like i wont pass this exam. Any insight on what to expect willl be appreciated .
 

DrKoala27

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I also did not counsel most of my patients so kind of in the same boat and super worried. I found the below checklist from the USMLE site while googling for the checklist they use. I'm not sure what to make of it really, but "helping patients with behavior changes" kind of sounds like the counseling part to me and I'm not sure if it means anything that it's italicized. Maybe, hopefully, it's not actually on the checklist or it's not as big of a deal as everyone makes it out to be.

www.usmle.org/pdfs/cru/CISFunctionsandSubfunctions.pdf
Hey! I just took CS and also forgot to counsel patients :/ did you end up passing? How was your CIS score?
 

quincyfuturemd

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So if you fall in the borderline region for a section you can still pass?

Yes, you need a certain amount of stars in the “lower performance” section to fail. I’ve seen multiple score results with a few stars (one with almost half the stars) in the lower performance and still pass
 
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Amygdala23

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I just took mine -and I coudlnt complete the hpi for one case - only got the description in for the chief complaint - which sucks because i had supporting evidence from the history for my ddx :/ and for another -i had 3 ddx listed but only had time to type in the supporting evidence for the first one. I feel like i wasnt very good with my counselling - and with the recent changes in performance standards i feel like i wont pass this exam. Any insight on what to expect willl be appreciated .

Hi, did you end up passing?
 

IMResApplicant

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I remember I left the plan/diagnostics section for one encounter completely blank and forgot to order a male genital exam for a urinary issue. Completely missed a cancer diagnosis, am i doomed?? :( Physicals were probably average, but I did good h&ps, always counselled and washed my hands, made good rapport, answered questions, etc. Just patiently freaking out over here!
 

futuredoc937

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Hey guys! Congrats on passing the exam everyone! I am starting off my CS studying, any advice for it?
Also does anyone know which CS course is best to take?
 

Flamingo477

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I just took mine -and I coudlnt complete the hpi for one case - only got the description in for the chief complaint - which sucks because i had supporting evidence from the history for my ddx :/ and for another -i had 3 ddx listed but only had time to type in the supporting evidence for the first one. I feel like i wasnt very good with my counselling - and with the recent changes in performance standards i feel like i wont pass this exam. Any insight on what to expect willl be appreciated .
Hey, did you pass in the end? Please share your experience!
 

Philosopher Jagger

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So I took mine somewhat recently and am not sure how to feel.

The Bad:
- I had 1-2 cases where time ran out in the middle of closure
- I had 2 DDx's on the majority of the PN's, I'd say most of the time each DDx had 2+ history items
- I palpated PMI with the patient lying down in 1 case
- I did not bend knees for any abdominal exam
- ***I keep feeling like there were other physical exams I could have done, mostly because for only 4-5 cases I had any pertinent positives to put into physical exam findings for a DDx. This has me especially worried that I did not do enough physical exam for certain cases. But at the same time I did not catch myself wishing I had done other exams for any of the cases...as in I felt confident in the diagnosis I listed first without any more exams.
- I missed counseling maybe 2 on smoking and 1 on drinking
- Forgot ROS in 3-4 cases
- Probably forgot to counsel a couple on noncompliance
-Did not perform the following once because they did not feel warranted by the chief complaints: Cranial Nerve Exam, Mini-mental status exam (Overall I felt like the set of chief complaints I had were very much history-dependent and did not rely much on physical exam...this too has me worried because like....was my whole frame of mind wrong? Should I have been doing exams even if I thought they were marginally relevant?)


The Good:
- introduced, shook hands, washed hands like clockwork for every case
- was appropriately empathetic and felt like I handled the challenge questions well, putting them at ease with their concerns
- Always covered HPI, PMH, PSHx, FMH, SMH
- noticed when patients had a cane or crutch in the room and asked about it
- Always asked if the patient had questions
- never gave a definitive diagnosis and had a couple options for each case
- Closure for every case (completed in 10/12) was this: summary and re-check for accuracy of history, summary of physical, discussion of at least 2 DDx's, possible tests, asked about questions
- wrote easy to follow history and physical exam sections
- PN strategy: always did in this order: Investigations/Testing (easy points) --> DDx's --> History --> Physical --> copy/paste H&P info into DDx slots

It will be a bit more time to wait...just keep second guessing myself. I know I did a fair amount of things well...but some of the things I didn't do well have me worried.
 

ogaust

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Just took mine recently as well...been having a real bad feeling about it (specifically the ICE section)

Mistakes:
1. Two easy cases I completely missed the primary DDx for (the ones I put instead were backed with evidence though...)
2. Three cases where I put a 3rd unlikely DDx with just one piece of supporting evidence (not sure why I did that...maybe nerves?)
3. Forgot a key physical exam in two cases
4. One or two cases where I should have switched the 2nd and 3rd DDx
5. Definitely missed asking some relevant HPI/ROS for a few cases
6. Forgot to write down some important things in the patient note that I asked (parts of history, etc.)
7. Couple vague DDx terms
8. Used layman terms at times in the note
9. Maybe overdid it with a couple diagnostic orders
10. Forgot to put in vitals as supporting evidence but did list them in my PE section
11. Might have written down something I did not ask/find by accident (minimal though)

I would say otherwise I felt pretty good for 6-7 cases as a whole.
It really seems like I made quite a few major mistakes though so fingers crossed for a borderline pass. Ugh...this is going to be a long wait...
 

PinusEldarica

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Just took mine recently as well...been having a real bad feeling about it (specifically the ICE section)

Mistakes:
1. Two easy cases I completely missed the primary DDx for (the ones I put instead were backed with evidence though...)
2. Three cases where I put a 3rd unlikely DDx with just one piece of supporting evidence (not sure why I did that...maybe nerves?)
3. Forgot a key physical exam in two cases
4. One or two cases where I should have switched the 2nd and 3rd DDx
5. Definitely missed asking some relevant HPI/ROS for a few cases
6. Forgot to write down some important things in the patient note that I asked (parts of history, etc.)
7. Couple vague DDx terms
8. Used layman terms at times in the note
9. Maybe overdid it with a couple diagnostic orders
10. Forgot to put in vitals as supporting evidence but did list them in my PE section
11. Might have written down something I did not ask/find by accident (minimal though)

I would say otherwise I felt pretty good for 6-7 cases as a whole.
It really seems like I made quite a few major mistakes though so fingers crossed for a borderline pass. Ugh...this is going to be a long wait...
Hey, did you get your score yet? My experience is pretty similar to yours
 

Philosopher Jagger

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So I took mine somewhat recently and am not sure how to feel.

The Bad:
- I had 1-2 cases where time ran out in the middle of closure
- I had 2 DDx's on the majority of the PN's, I'd say most of the time each DDx had 2+ history items
- I palpated PMI with the patient lying down in 1 case
- I did not bend knees for any abdominal exam
- ***I keep feeling like there were other physical exams I could have done, mostly because for only 4-5 cases I had any pertinent positives to put into physical exam findings for a DDx. This has me especially worried that I did not do enough physical exam for certain cases. But at the same time I did not catch myself wishing I had done other exams for any of the cases...as in I felt confident in the diagnosis I listed first without any more exams.
- I missed counseling maybe 2 on smoking and 1 on drinking
- Forgot ROS in 3-4 cases
- Probably forgot to counsel a couple on noncompliance
-Did not perform the following once because they did not feel warranted by the chief complaints: Cranial Nerve Exam, Mini-mental status exam (Overall I felt like the set of chief complaints I had were very much history-dependent and did not rely much on physical exam...this too has me worried because like....was my whole frame of mind wrong? Should I have been doing exams even if I thought they were marginally relevant?)


The Good:
- introduced, shook hands, washed hands like clockwork for every case
- was appropriately empathetic and felt like I handled the challenge questions well, putting them at ease with their concerns
- Always covered HPI, PMH, PSHx, FMH, SMH
- noticed when patients had a cane or crutch in the room and asked about it
- Always asked if the patient had questions
- never gave a definitive diagnosis and had a couple options for each case
- Closure for every case (completed in 10/12) was this: summary and re-check for accuracy of history, summary of physical, discussion of at least 2 DDx's, possible tests, asked about questions
- wrote easy to follow history and physical exam sections
- PN strategy: always did in this order: Investigations/Testing (easy points) --> DDx's --> History --> Physical --> copy/paste H&P info into DDx slots

It will be a bit more time to wait...just keep second guessing myself. I know I did a fair amount of things well...but some of the things I didn't do well have me worried.


EDIT: I passed...none of you should worry lol
 
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