Did I pass Step 2 CS?

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endoffouryears

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Hello,
Hope you are all well.

Took CS in the end of December. Hoping I'll see the result next week on Wednesday but as I tend to overthink things, I'd love to hear people's thoughts on whether or not my performance would be considered passing.

Prepared by taking a Kaplan CS course. Took a full length Kaplan practice test and was told by the professor "I'm not worried about you. I think you'll do fine." Scored above 80% in CIS (Kaplan considers above 70% passing for their tests) and scored 45% in ICE (Kaplan considers above 40% passing for their tests.) Studied and practiced all the mini cases and full length cases in First Aid. Also practiced all the full length cases in the Kaplan study guide. Worked one on one with 6 Standardized Patients via skype for two hour sessions each. Practiced writing notes for all the cases I mentioned above, and perfected it to fit them into ten minutes. Took another half length practice test with Becker which I scored 10-20 points above the group averages for ICE and CIS in each case.

On the actual test:
I used the following pneumonics (LIQORAAA (for HPI), THENFRCS PUBSAWED (for ROS), PAMHitsFOSS (for PMI)) and usually asked every question from them, along with some others concerning associated s/s that I assumed would be important given the chief complaint. Child cases got full prenatal and developmental history as well. Patients with Mood or Psych related complaints also got SIGECAPS and a five pint MMSE. All of these things were adressed in the written notes as well, and I used a + and - system to list positive and negative assoc s/s which was easy to cut and paste in order to support each diagnosis. I usually finished all the patient interractions with a few seconds remaining, and I usually finished all the notes on time. A few exceptions below:

There was only one patient interraction I ran short on time for. I did not get a chance to fully summarize, give a plan, and solicit follow up questions, but got through the majority of it. There was one patient interraction that I had to start summarizing for during the PE inorder to fit it all in.

There were two notes where I remember running out of time while writing the PE. I always left PE until the end of the note. All the notest used the same format and were written with the content in the same order. I practiced this alot...

There were two patient interractions where I know I forgot a few PE components that should have been done. There was one patient note that I know I neglected to include some PE components for in the note, which I had performed. Every patient got a brief auscultation of the lungs and heart, as well as a more significant focused exam given the chief complaint.

There were two patient interractions that I felt uncertain about with regard to the diagnoses. During these patient interractions it seemed like nearly everything asked was negative, and the patient was very difficult to build repore with. I assume these were intended to be difficult patients.

There was one patient interraction, a child case, that I misread the patient age for, and did not realize this until a few minutes into the patient interraction. I know this may have made for some confusion during the patient interraction, but I still feel like the questions were asked and answered in a relevant manner.

In retrospect I worry I did not summarize enough for each patient, although I know I did summarize for each patient, give clear plans which they agreed with, and allowed time for followup questions in nearly every case.

Can't remember anything else that I know I messed up on. I'm sure there was more.

Given what I said above, is there truly any good reason for me to fail?

Thanks for your time.
 
Sounds like a borderline performance, at best. Good luck OP.

Thank you for your comment.

It is interesting that you say this because I do not feel like my performance on this test was much different than on the two practice tests I passed.

Why do you think that what I described here is "...borderline performance, at best."? Keep in mind, I'm not saying you are wrong, I would simply like to better understand your perspective.

Thanks again.
 
it is difficult for someone to comment on how your test has gone based on a description ... you can only wait for the results...most people think they have failed ,but end up passing..
 
Thank you as well for your comment. I know what you mean.

In much the same way that we think of passing a few NBME Comps as a measure of our capacity to pass CK, I perceive of passing the Kaplan and Becker test as a measure of my capacity to pass CS. For that reason I feel some degree of confidence. However, the consequences of failure are severe enough that they are impossible to dismiss, so like many other students I am tormented by the thought...

I knew when posting this that by doing so, I was submitting to my insecurities. In some ways the post is simply a representation of my state of anxiety. Failing this test would ruin any chance of matching this year, so the anxiety is doubled. Even though your comment was largely neutral on the issue, thank you for indulging me by giving a response. 🙂
 
Thank you, Dave.
I appreciate that.

After he (assuming male) commented, I looked into his history a bit on this site, and became a bit suspicious of that myself.

However, I didn't want to crudely dismiss his opinion. Life has surprised me in many ways, so why not consider that he might be accurate? I felt it was only fair to offer the opportunity for him to provide more feedback.

Cheers.
 
Thank you, Dave.
I appreciate that.

After he (assuming male) commented, I looked into his history a bit on this site, and became a bit suspicious of that myself.

However, I didn't want to crudely dismiss his opinion. Life has surprised me in many ways, so why not consider that he might be accurate? I felt it was only fair to offer the opportunity for him to provide more feedback.

Cheers.

Although I haven't given the exam, I'd like to say that you seem to have prepared the best you could and performed well. I have read a lot of other experiences on this forum, much worse (not saying yours was bad) and they've passed with good ratings. Those seem like pretty minor issues based on what I have seen other people panicking on. While I am not trying to assume you're exaggerating your experience to get assuring replies because this is normal to feel after giving any exam (and this is not just any exam) or before a major result. So, I think you should relax and hope for the best. My best wishes to you, mate.

Personally, I believe this exam is a load of c r a p. Being an IMG, studying for step 1 and now for CK has improved me so much personally and, of course, knowledge wise. I don't know whether so much bucks for this piece of thing called CS will add anything worthy of the cost. Anyways, got to do it to get a chance at the American dream!
 
Nabin,
Thanks for your comments.
I am also an IMG student. A US citizen from one of the big 4 Carib schools. It is one of the reasons I worked so hard to prepare for this test. Additionally, I am not at all exaggerating in my comments.

I would tend to agree with you that alot or all of the errors I made are not "deal breakers" for this test. I do not feel like these errors are blatant reasons to justify failure, however, the grading of this test is very very subjective. This is part of the reason I carry so much anxiety for the result. I do not trust this test to actually be standardized. Having worked so much with standardized patients via both Kaplan and the SP's I practiced with via Skype, I can tell you for certain they truly are not standardized, nor are they incapable of missing things and making mistakes. I can think of many instances during my preparations where SPs missed things I did or said, did not give me credit for them in the checklist, or presented the patient information one way to one student, and another way to another student.

Additionally, the physicians who grade the notes are not at all standardized themselves. The Physicians who were grading the Kaplan tests described for us how some of the people grading the actual exam will be very meticulous about things, and others will not. Here is a real example given to us from Kaplan:

If the cardiac component of your PE write up says "RRR, S1S1, no MGR, no thrills or heaves, PMI not displaced.", many physicians will find that to be perfectly adequate, and you will get the point for having written the cardiac component of a normal PE well. However, another physician, who may be a cardiologist perhaps, might see it and chose not to give you the point because you didn't write it in this format, "S1S1, RRR, no MGR, no thrills or heaves, PMI not displaced." This is not a randomized example. Some of the people grading the notes are that meticulous, and others are not. They were serious about this having been a real example, and the physician teaching the PE write up to us had actually worked for a time scoring the test.

For these reasons, and others, I agree with you that this test is not all that it advertises itself to be.

Since you have not taken this exam yet, Nabin, I'd like to give you a piece of advice. When you are preparing for this test, keep in mind that the physicians grading your notes do not see the things you do in the exam room with the patient. They do not see the checklist from the patient, neither for the PE or CIS. The only points you get for the note portion of ICE is from what you write on your note. So to maximize the points in ICE, you must practice a method that allows you to easily and accurately transfer information from the patient encounter to the note, and you must make sure you cover all the bases for all the key components of an HPI, PMH, and ROS in the note for each patient. If you want some more advice about this please send me a message. Happy to tell you about what Kaplan taught us.

Cheers.
 
Midwest Blot,
I'll be honest with you, I didn't even know what "OP" meant. 🙂 I'm assuming now, based on what you said, that it is an abbreviations you guys use here for "Over Prepared".

That aside, I'd still love to hear from you about why you believe my comment represent "...borderline performance, at best." Again, not saying you are wrong.

When I looked back at your comments on previous threads, it seemed that you are (or atleast are representing yourself as) a relatively high performing student. Attending a US medical school, claiming to have scored 250+ on CK, doing 200 questions a day in tutor mode of UW, wishing you could move through Pathoma at speeds faster than 1.7x, etc. I am not at all saying that you are exaggerating your capacity as a student, but perhaps that you are performing at a level slightly higher than many people. If all this is true, then I congratulate you for your success thus far. I hope you will be a great benefit to your patients. 🙂

I know that I could never get through 200 questions a day in UWorld on tutor mode. I would need to review more for most question than simply the information that UWorld gave me, which was often not thorough or complete in my opinion. A 250 on CK was a reach for me, as well as most students. I was fortunate to get slightly higher than 230. Since I am a Carib student, clearly a US medical school was outside of my reach as well, as was the case with many of my peers.

For these reasons, I wonder if your perception of what is "borderline performance" might not be in line with what actual borderline performance really is? Given that you wrote Step 1 in June of 2014, it is also possible you may not have even taken CS yet. I only base that on the dates, and that you have not stated whether you took it already or not.

Again, not trying to slight you or put you down.

Cheers.
 
I was not being serious. In fact, you probably outperformed me on CS. I just studied first aid cases for about a week. Our school prepares us well with OSCEs, however. Best of luck. I get my results back soon as well.
 
Best of luck to you as well. 🙂

I wish our school prepared us better. We had a "clinical medicine" course every semester that was meant to teach us skills which are applicable to clinical medicine in general, but it lacks training geared for CS in particular. That needs to be rectified in my opinion. Fast...
 
wow. OP should be fine. I think you passed, for sure. I didn't even study at all whatsoever.... My friend and I basically just spent our 4 or 5 hours drive (with me driving and him reading) going through first aid CS. Basically we just role-played with half the cases, then we got so tired of it we just skimmed the HPI and Ddx. To make it worse, I did not sleep at all the night before the exam (not a very good move) because I was hooked on some TV show. Urgh... Never again. On the exam, about half of the cases I was like WTF is the dx? And I also left quite a few of the cases with only two ddx because I couldn't think of a 3rd one. Overall my note was pretty terrible with very little info on the supporting evidence for ddx (I'm a slow typer and I don't cut-paste nor do I use abbreviations). I passed.

This test is mostly about how comfortable you are talking to patients, follow the question check-lists, and type them out. The ddx cases should be fairly easy. Anyhow, I know it's nerve-wrecking waiting for the result, but I'm pretty sure you passed.

p.s. To think about it, right after we took the exam, I drove us back home. I can't remember how many hours (or days?) I stayed up. Expresso helped a little.

Oh, and I just want to mention that I didn't study for it because our school made us do OSCE tests through out the years so I felt comfortable enough. And I did have a sub-I in EM about 2 months before the exam.
 
Thank you for the vote of confidence. 🙂

Sorry to hear your CS experience was so tumultuous. I am not at all happy with the way this test is designed and run, and personally I see absolutely no reason why this test couldn't be run in the real world using actual patients. It would be a major paradigm shift, with a return (in part) to the old system of clinical examinations, but it would be better overall than this improv theatre we are using now.

Hope your career is going great thus far!
 
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