CS Blunders

[direimpetus]

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Hi Everyone,
It is my first time posting here - I am looking for some honest advice

I took CS in Chicago a few days ago and I keep rehearsing in my head all the little blunders I made. Can everyone give me their opinion on my Sitch...

1) I did not write down vitals on any of my patient notes (will I be penalized??)

2) I wrote reallly small so that I could fit everything on the page (do the graders have the ability to enlarge my handwriting so they can more easily read it??)

3) I wrote a little bit on the rush/slightly illegible side (how persistent are the graders in trying their best to understand a testtaker's handwriting??)

4) I did not have time to close on my first case (will I be penalized)

5) I did not warm the stethoscope for any of my SP's (will I be penalized?)

-As a background I am an American citizen graduating from a Caribbean school
-My DDX and workup were quite legible and of normal size print
-I was super super COURTEOUS & EMPATHETIC - will this be be noted in my favor by the SP's?

Thanks in advance for your help -as this is consuming me and I reallly need to be focusing on Step 2CK but alas.... CS still lingering

 

[anyaking486]

Hi Everyone,
It is my first time posting here - I am looking for some honest advice

I took CS in Chicago a few days ago and I keep rehearsing in my head all the little blunders I made. Can everyone give me their opinion on my Sitch...

1) I did not write down vitals on any of my patient notes (will I be penalized??)

2) I wrote reallly small so that I could fit everything on the page (do the graders have the ability to enlarge my handwriting so they can more easily read it??)

3) I wrote a little bit on the rush/slightly illegible side (how persistent are the graders in trying their best to understand a testtaker's handwriting??)

4) I did not have time to close on my first case (will I be penalized)

5) I did not warm the stethoscope for any of my SP's (will I be penalized?)

-As a background I am an American citizen graduating from a Caribbean school
-My DDX and workup were quite legible and of normal size print
-I was super super COURTEOUS & EMPATHETIC - will this be be noted in my favor by the SP's?

Thanks in advance for your help -as this is consuming me and I reallly need to be focusing on Step 2CK but alas.... CS still lingering

Wow that is some list bro and unfortunately I am in the same boat you are...
Well almost - I am actually an American medical student. (some of you may remember me - but this is a new user name i am using)

I also made quite a few of your mistakes and a handful more:

-> I did the heart exam on a few patients while they were still sitting down - i forgot to make them lie down (arghh!!!)
--> I forgot the physical exam on 1 patient
--> i forgot TWO Closures
--> I forg to include pertinent history on a few patient notes
--> I DID Performn the heart, lung, abdomen exam on most ofthe cases.
--> May have forgotten to tell a 16 yr old I needed his mom's permission to do tests, etc

OKAY SO Bearing in mind I also just took CS a few days ago -
am i justified in being totally FREAKED OUT about this>?????

 

[joecole]

no need to worry guys. you'll do fine. i just got my result and had no x's in the gray areas (lol i couldnt believe it either) - was freakin that i failed.

here are the things i forgot:
- first station was all bad. did PE, counselling, and wrap up in 4 minutes
- I forgot to wash my hands on the first two stations
- forgot smoking counselling in 3-4 stations
- did deep palpation on a guy w/ pancreatitis...twice lol
- PE overall was a joke, absolutely mindless.
- barely did the revision part of the history (as in reiterate what patients said)
- in some stations at the end use to ask the SP's for a minute to let me revise and see if i has forgotten anything
- counselling overall was good but not superb. i would let them know what i think, show empathy. but i didnt bother with teh whole medical lingo/lay man crap. everyone these days know what an xray and a ct scan is.

the wait is the worst thing...believe me i really thought i was done (esp b/c i didnt wash my hands). but apparently i got stellar marks. just shut it out of ur mind and enjoy the next two months

 

[TTPHUS]

Hi Everyone,
It is my first time posting here - I am looking for some honest advice

I took CS in Chicago a few days ago and I keep rehearsing in my head all the little blunders I made. Can everyone give me their opinion on my Sitch...

1) I did not write down vitals on any of my patient notes (will I be penalized??)

2) I wrote reallly small so that I could fit everything on the page (do the graders have the ability to enlarge my handwriting so they can more easily read it??)

3) I wrote a little bit on the rush/slightly illegible side (how persistent are the graders in trying their best to understand a testtaker's handwriting??)

4) I did not have time to close on my first case (will I be penalized)

5) I did not warm the stethoscope for any of my SP's (will I be penalized?)

-As a background I am an American citizen graduating from a Caribbean school
-My DDX and workup were quite legible and of normal size print
-I was super super COURTEOUS & EMPATHETIC - will this be be noted in my favor by the SP's?

Thanks in advance for your help -as this is consuming me and I reallly need to be focusing on Step 2CK but alas.... CS still lingering

These sound like some of the mistakes I made . Add to this list not summarizing the history and missing the physical exam on two patients . Wow , amazing what exam stress can do !!

 

[Kimka83]

Having just received a passing score today and spending the last few months fretting over this test, I have come to realize that it is not designed to fail students for isolated mistakes. Rather, it appears that CS is designed to rule out those with consistent inadequacy in a particular area. It is all about check boxes. You just need to rack up enough points in each area. Making one error (even if you think it is a "bad" error) will not cause failure. For example, not asking patient if chest pain radiates = minus one point, not auscultating heart on patient with chest pain = minus one point, not including PE as DDx in patient with chest pain = minus one point. I think a lot of folks on here focus on making some "huge" mistake like not listening to the heart on a patient with chest pain (which would be very bad indeed in clinical practice) but it is really only one point on CS.

Forgetting to wash hands, forgetting to ask several questions, forgetting to do PE maneuvers etc. on an given encounter will not cost you the exam. What you want to ensure is that you don't have pervasive problems with history taking, PE, or communicating.

My advice to future test takers would be to look at the criteria that CS grades upon (http://www.usmle.org/Examinations/step2/cs/content/scoring.html) and try to do adequately address all of these areas consistently throughout your exam. Warming your stethoscope is not a grading criteria, you'll be fine.

 

[LifetimeDoc]

I forgot to retie two patient's gowns, I was awkward with one patient, failed to drape a patient or two until just after starting the physical exam, and I still passed with high marks. The only area I was weak on was data gathering, which I'm not sure what they are referring to exactly since they don't go into greater detail than that.

Like has been said before, ad nauseum, is to READ First Aid Step 2 CS, and PRACTICE a few or all of the cases in the book (or use another similar book or resource). If your first language isn't English, then you will need to prepare more since you are being graded on your ability to effectively communicate with patients. Other than that, the test is not hard as long as you take it seriously. A gaffe here and there isn't the end...it's a PASS/FAIL exam. Nobody knows if you did the best out of everyone that day or just barely passed.

 

[babycapybara]

Just got my PASS today after fretting for several months as well. Some things I remember doing wrong - forgot to ask about smoking when it was an obvious reason for a cough. Forgot closure on several patients. Draped awkardly. Handwrote first 2 notes before switching to computer - sure they were illegible. Didn't do a neuro exam a single time. Didn't look in ears or eyes at all. Didn't shake hands.

Anyhow..my best section was the English!!! Wish all my scores were that high🙄

 

[DrKnowLittle]

Background: Trip report is as follows. Missed my connecting flight to Houston due to delays. Landed in ATL at 11:00 PM. Miraculously found an evening slot in Atlanta for the next day. Flustered about that. Computers break down 3 times - wrote 6, typed 6. Flustered! It definitely threw me off on my patient encounters, as I do not write very legibly after I write for a while and it's all I could think about when I was seeing patients. Spent the greater part of 3 months freaking out - this was definitely the test I was most worried about of the 3, even with the excessive amount of standardized patients my school subjects us to.

End result - passed. So here is what they score you on and some areas I think I botched things up during the exam (and thought would cost me)

ICE:
Data gathering - Performed no PE outside of mental status and 'general' on 2 patients. Did wash my hands though x 12...
Patient note - Nothing really here that I feel I did poorly on. Just write and write and write what you gathered.
CIS:
Questioning skills - Felt in some ways as if I was fumbling around when asking questions. I definitely didn't feel as focused as in practice encounters or with real patients.
Information-sharing skills - There were a few encounters where I felt as if I didn't reiterate the plan or summarize the patient's account to the patient.
Professional manner and rapport - Just be really nice, be really courteous, be really apologetic if warranted, and make good non-verbal communication (or at the very least, avoid bad non-verbal communication)
SEP:
Either you have it or you don't, I guess

Bottomline, my impression is that this isn't an exam where they are expecting you to do everything perfectly. Even seasoned physicians mishandle aspects of an encounter or even an entire encounter on a given day in the real world. Just show them what you are capable of at whatever level you are at in your training and that ought to be sufficient. Barring a really bad day, an allopathic grad should be comfortable tackling these cases. Don't get so bogged down in pinpointing the absolute diagnosis because they're made to be vague to the point where you can sufficiently ask a good deal of different questions to the patient and gather information. Get the gist of First Aid for Step II CS and the patterns that emerge from the quick cases and more lengthy cases and you ought to be fine determining differentials and immediate plans/labs. Be humble. This isn't you trying to prove you are the almighty doc who can solve everyone's problem in a 15 minute encounter. This is just you going in there to glean information, show empathy, touch the patient, and compile it in a documented form.

 

[Golding]

My honest thoughts...

1) I did not write down vitals on any of my patient notes (will I be penalized??)

Not penalized, but you just won't be awarded points for any irregular vitals. Unfortunate, because those are points they literally handed to you.

2) I wrote reallly small so that I could fit everything on the page (do the graders have the ability to enlarge my handwriting so they can more easily read it??)

The note graders seem to be pretty generous, but I don't think they will do any special approaches to reading what you wrote. They'll make an honest attempt at reading the writing, and if it just isn't legible they probably won't award points.

3) I wrote a little bit on the rush/slightly illegible side (how persistent are the graders in trying their best to understand a testtaker's handwriting??)

You're not the first person to take the exam who had bad handwriting. As long as it's reasonably readable it should be okay. These graders know the terms and abbreviations they're looking for, so that might help assist them read otherwise difficult writing.

But it's a good idea to clean up your writing for the sake of real patients you're going to have, to ensure your orders have no reason to be misinterpreted.

4) I did not have time to close on my first case (will I be penalized)

Again, not penalized. But not awarded points for doing so. You're also not the first to run out of time on a case. It shouldn't be a dealbreaker.

5) I did not warm the stethoscope for any of my SP's (will I be penalized?)

Neither did I. I almost doubt that's really even something they look for. More like style points.

My DDX and workup were quite legible and of normal size print

That's good, but remember that most of your points come from the H&P portion. The DDX and workup are actually scraps in comparison.

I was super super COURTEOUS & EMPATHETIC - will this be be noted in my favor by the SP's?

You'll get the checkbox marked off next to "Showed empathy" on the patient grading. It's part of the exam, but I think people overestimate its worth.

My assessment:
Most people come out of the exam kicking themselves over what they did wrong. It's normal. Most people also pass the CS.
You may pass, you may fail. The CS is sort of unpredictable. Odds are in your favor, but no one here can realistically say how you're going to wind up. It's just something you'll have to wait for and see.

 

[Osteoimperfecta]

Hi Everyone,
It is my first time posting here - I am looking for some honest advice

I took CS in Chicago a few days ago and I keep rehearsing in my head all the little blunders I made. Can everyone give me their opinion on my Sitch...

1) I did not write down vitals on any of my patient notes (will I be penalized??)

2) I wrote reallly small so that I could fit everything on the page (do the graders have the ability to enlarge my handwriting so they can more easily read it??)

3) I wrote a little bit on the rush/slightly illegible side (how persistent are the graders in trying their best to understand a testtaker's handwriting??)

4) I did not have time to close on my first case (will I be penalized)

5) I did not warm the stethoscope for any of my SP's (will I be penalized?)

-As a background I am an American citizen graduating from a Caribbean school
-My DDX and workup were quite legible and of normal size print
-I was super super COURTEOUS & EMPATHETIC - will this be be noted in my favor by the SP's?

Thanks in advance for your help -as this is consuming me and I reallly need to be focusing on Step 2CK but alas.... CS still lingering

If these are your only mistakes then I am 98% sure you passed