Failed step 2 cs cis, what can I do better

[mangostrawberry]

Hi,

I failed the Cis part of step 2 cs, and have been racking my brain to see what I could do better. I've figured out some things I need to prove upon (counseling, remembering to ask if they have any questions...). What are pertinent things you need to do to pass Cis?

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[morbentfel]

Can you make a video of yourself and post what your interactions are like. Not even joking because I barely did anything that was recommended including counseling, summarizing, finishing on time, closing gowns, asking to make sure they understand and agree with plan, etc and yet still passed with higher performance. So it is quite unclear what they actually grade you on, possibly on you acting out your empathy?

 

[Ina2990]

Some of the questions for CIS in FA are outdated, you don't have to ask if they feel comfortable in the room and say things like I'm so sorry for this and that. First thing is to listen carefully to what they say, to prevent askign things twice; Enter the room with a smile and adjust your demeanor according to the patient's mood. Introduce yourself and ask the patient how they'll like to be adress, don't assume is always Ms, Miss or Mister. Take meaningful notes, but keep eye contact at the same time. Something that worked for me was asking: What is it that concerns you the most about what is going on? Always explain what maneuver you'll do on the PE, you don't need to ask for permission just state what you'll do. Practice draping techniques and be confident while using other instruments. Make sure you tell them the diagnosis that your thinking, and the workup up you plan on doing; don't be vague, if it's difficult to understand explain before they have a chance to ask.

 

[Light Yagami]

Isn't it amazing for this joke of an exam that the money hungry NBME does not even put out sample videos explaining and showing what exactly they are looking for? They grab so much money from us for this ($3k total for me considering airfare, rental car, $1500 registration fee). Simply outrageous.

 

[johnwalldance]

So USMLE is telling me I failed Step2 CS CIS too. With all but 2 * in the lower performance part of the scale. Utterly shocked how this could happen, and the more I think about it the more confused I am.

I have always more than passed - usually did about average in school OSCEs, and in many rotations have developed good relationships/rapport with pts. Not sure how this could make me be in the bottom 1% of people taking this test. Ran out of time often in the school pre step2 CS OSCE, got the class average (87%)

During the real exam I
- always made good eye contact
- made sure to ask pts if they had any questions (usually before phys exam)
- counseled pts (extensively remember that many pts didn't keep up with Pap smears/colonoscopies/mammograms despite saying they had a PCP)
- washed my hands and wore gloves (remember the gloves breaking on me quite often specifically)
- even asked the pts where they were from. Talked about the Cavs winning the champ with one pt, about Ben Simmons to another, about where she went to college and what her plans were to another
- always went through the plan, what condition they could have, what I was gonna order to rule in/rule out what
- treated everyone like a real pt; in fact I imagined that this was a family medicine clinic day with 10+ pts to see and write notes on
- pretty sure I asked pts how their condition affects their life
- got water for a pt with a cough

Stuff I didn't do
- never summarized
- maybe forgot the pt's name here and there but didn't think this was a big problem

One thing I did do was doing the survey at the end of the test, I said I thought that step2 CS was dumb and that doctors before 2004 that didn't take it are fine doctors. That's maybe the only thing I could point to that I did that was dumb cause everything else I did, I thought I should have earned the pass pretty handily. Felt very comfortable and not nervous during the test. In fact I felt like a real doctor.

I am still utterly confused, in denial with my score and looking for any answers or clues. I am applying IM this fall and am scared to death about not getting interviews where I would normally get because of this messed up score.

FML.

 

[SilverCat]

So USMLE is telling me I failed Step2 CS CIS too. With all but 2 * in the lower performance part of the scale. Utterly shocked how this could happen, and the more I think about it the more confused I am.

I have always more than passed - usually did about average in school OSCEs, and in many rotations have developed good relationships/rapport with pts. Not sure how this could make me be in the bottom 1% of people taking this test. Ran out of time often in the school pre step2 CS OSCE, got the class average (87%)

During the real exam I
- always made good eye contact
- made sure to ask pts if they had any questions (usually before phys exam)
- counseled pts (extensively remember that many pts didn't keep up with Pap smears/colonoscopies/mammograms despite saying they had a PCP)
- washed my hands and wore gloves (remember the gloves breaking on me quite often specifically)
- even asked the pts where they were from. Talked about the Cavs winning the champ with one pt, about Ben Simmons to another, about where she went to college and what her plans were to another
- always went through the plan, what condition they could have, what I was gonna order to rule in/rule out what
- treated everyone like a real pt; in fact I imagined that this was a family medicine clinic day with 10+ pts to see and write notes on
- pretty sure I asked pts how their condition affects their life
- got water for a pt with a cough

Stuff I didn't do
- never summarized
- maybe forgot the pt's name here and there but didn't think this was a big problem

One thing I did do was doing the survey at the end of the test, I said I thought that step2 CS was dumb and that doctors before 2004 that didn't take it are fine doctors. That's maybe the only thing I could point to that I did that was dumb cause everything else I did, I thought I should have earned the pass pretty handily. Felt very comfortable and not nervous during the test. In fact I felt like a real doctor.

I am still utterly confused, in denial with my score and looking for any answers or clues. I am applying IM this fall and am scared to death about not getting interviews where I would normally get because of this messed up score.

FML.

Can you meet with an attending from your med school faculty and have them observe you interact with a patient? They might be able to point out some mistakes that you are unaware of. Just for some hope, our class had 3% fail rate last year; all retook the exam, passed and matched--my school is not a top 20, either.

 

[johnwalldance]

^Yeah that's my plan. And that is actually really hopeful statement...3% failing is not a small number. Problem is I'm gonna submit my application with a failed CS score; I know others on this site who have failed did so after already submitting their USMLE transcript without taking CS yet. I've seen a bunch of residency websites say they won't consider an applicant with failure in any USMLE...very worried about this. Applying IM so it's not as competitive as other specialties but I still want to go to a decently competitive academic IM program in a medium to big city

 

[cabergoline2]

take some practice exam and ask them for opinion... Asking your attendings opinion is a good thought too...however they may not be able to point out exam specific stuff as the exam is a farce in any case...

 

[CSHATER]

I know this thread is a few months old, but seemed like a appropriate place to share my experience. I also failed the CIS portion, and my experience is similar to the above. I've been a long time follower of these threads, but first time poster. Going into the exam, I was most concerned about the ICE portion, but passed with a comfortable margin. Coming out of the exam, my biggest concern was that I skimped on a few PE's. I was completely floored that I failed the CIS portion.

What I did do in the exam:
-Knocked on door, smiled, introduced myself, confirmed patient name.. "You are Mr. Smith, correct? Very nice to see you."
- Asked if the patient was comfortable in the room (not sure if it was necessary)
- Stated "I see you are having trouble with "insert condition". Can you tell me about it" (open ended question)
- Tried to develop a rapport, I took exam in November, so asked about their family and Thanksgiving plans with some. Other pts, we talked about their job or whatever else.
- Washed hands before every exam
- Help the patient lie down, sit up, offered water when needed, tissue when needed, blah, blah
- Was able to summarize every patient, including what I recommended next with testing, prognosis, etc in layman's terms. I never gave an exact diagnosis even if I was 99% sure that I knew (that's what FA says to do)
- Counseled every patient when needed.... tobacco, alcohol, sexual habits, etc
- Asked if they were okay with the next steps and asked if they had any further questions or concerns.
- The only way that I could have been nicer would be to give them a massage, pay their house payment, and pick their kids up from school.

The only thing that I can think off where I may have lacked was eye contact and asking "How does this affect you?" I explained to the patient that I would be taking notes while getting their information if that was ok. I would make eye contact when asking a question and while they answered, then briefly looked down to jot down some notes.

I am not a big fan of test bashing, but this exam is complete BS and may cost me a residency position. Like many others, I am at a complete loss on how to improve in this area. I am sure that I made a few minor mistakes, but a failure in CIS is certainly unwarranted. It seems like they randomly pick names to fail to meet their financial quota.

 

[xffan624]

I know this thread is a few months old, but seemed like a appropriate place to share my experience. I also failed the CIS portion, and my experience is similar to the above. I've been a long time follower of these threads, but first time poster. Going into the exam, I was most concerned about the ICE portion, but passed with a comfortable margin. Coming out of the exam, my biggest concern was that I skimped on a few PE's. I was completely floored that I failed the CIS portion.

What I did do in the exam:
-Knocked on door, smiled, introduced myself, confirmed patient name.. "You are Mr. Smith, correct? Very nice to see you."
- Asked if the patient was comfortable in the room (not sure if it was necessary)
- Stated "I see you are having trouble with "insert condition". Can you tell me about it" (open ended question)
- Tried to develop a rapport, I took exam in November, so asked about their family and Thanksgiving plans with some. Other pts, we talked about their job or whatever else.
- Washed hands before every exam
- Help the patient lie down, sit up, offered water when needed, tissue when needed, blah, blah
- Was able to summarize every patient, including what I recommended next with testing, prognosis, etc in layman's terms. I never gave an exact diagnosis even if I was 99% sure that I knew (that's what FA says to do)
- Counseled every patient when needed.... tobacco, alcohol, sexual habits, etc
- Asked if they were okay with the next steps and asked if they had any further questions or concerns.
- The only way that I could have been nicer would be to give them a massage, pay their house payment, and pick their kids up from school.

The only thing that I can think off where I may have lacked was eye contact and asking "How does this affect you?" I explained to the patient that I would be taking notes while getting their information if that was ok. I would make eye contact when asking a question and while they answered, then briefly looked down to jot down some notes.

I am not a big fan of test bashing, but this exam is complete BS and may cost me a residency position. Like many others, I am at a complete loss on how to improve in this area. I am sure that I made a few minor mistakes, but a failure in CIS is certainly unwarranted. It seems like they randomly pick names to fail to meet their financial quota.

I'm so sorry this happened to you. Im not sure where you tripped up but I would say your experience is a cautionary tale for future takers to take the exam early to allow enough time for a retake pre match should lightning strike.

 

[mangostrawberry]

A friend of mine had said the Communication and Interpersonal Skills checklist from Kaplan's book was helpful in coming up with further things to do or say. I'll have to search for her prompts (one of them was how is this affecting your life, asking about if they had a support system). But another thing I had researched was to sit in the stool when talking to the patient. I guess so you don't seem domineering over them. And if you are a girl, to pull your hair back into a pony tail (I didn't know this one).

 

[CSHATER]

Thanks for the replies. I'm going to go ahead and retake immediately. In response to the above, I sat on the stool in front of them for every history. I'm not sure if we are supposed to sit or stand or if it even makes a difference. I'm a male, so no worries on the pony tail. I'll look into the Kaplan book. The frustrating part is how subjective the CIS section is. I know people who failed once, passed the second time and changed nothing in regards to their approach to CIS. Go figure. Thanks again, and I'll keep you updated.

 

[CSHATER]

UPDATE: Just wanted to update from my previous post...... I retook the exam and have been anxiously waiting on my results for many weeks. After a near mental breakdown, several episodes of alcohol poisoning, and a nervous twitch that I'm still trying to get rid of, I finally got my scores today. I passed with the highest possible CIS score (one star all the way to the right). Thanks to everyone for the replies and messages. If anyone has failed or is worried about the CIS portion, feel free to send me a message. I will be more than happy to help someone avoid the mistakes that I made. The take home message is this: Don't think that you will pass CIS simply because you skimmed over the CIS section in FA, or because you are a nice person and can communicate well. That means very little. The test is checklist formatted, if you don't get the check marks, you won't get the points.... even if you think that you and the SP are butt buddies walking out. It's worth mentioning that I have no idea what the "official" checklist is, as it seems to be more guarded than the shroud of Turin.

My advice, for what it's worth, would be this: As with ICE, make sure that you have a system/format for CIS. For my second attempt, I created a template for the patient questioning and counseling that is virtually unchanged no matter what the CC is. The most difficult part of this exam (at least for me) was time management. There were a couple of encounters that I ran out of time. I was able to close well, but was cut short on challenge questions. Apparently it did not hurt my score. Create a system, practice it, and stick with it. Hopefully my bad experience can benefit someone else. Also, congrats to the other guys that I spoke to who got their passing scores today. Cheers!

 

[sazerac]

UPDATE: Just wanted to update from my previous post...... I retook the exam and have been anxiously waiting on my results for many weeks. After a near mental breakdown, several episodes of alcohol poisoning, and a nervous twitch that I'm still trying to get rid of, I finally got my scores today. I passed with the highest possible CIS score (one star all the way to the right). Thanks to everyone for the replies and messages. If anyone has failed or is worried about the CIS portion, feel free to send me a message. I will be more than happy to help someone avoid the mistakes that I made. The take home message is this: Don't think that you will pass CIS simply because you skimmed over the CIS section in FA, or because you are a nice person and can communicate well. That means very little. The test is checklist formatted, if you don't get the check marks, you won't get the points.... even if you think that you and the SP are butt buddies walking out. It's worth mentioning that I have no idea what the "official" checklist is, as it seems to be more guarded than the shroud of Turin.

My advice, for what it's worth, would be this: As with ICE, make sure that you have a system/format for CIS. For my second attempt, I created a template for the patient questioning and counseling that is virtually unchanged no matter what the CC is. The most difficult part of this exam (at least for me) was time management. There were a couple of encounters that I ran out of time. I was able to close well, but was cut short on challenge questions. Apparently it did not hurt my score. Create a system, practice it, and stick with it. Hopefully my bad experience can benefit someone else. Also, congrats to the other guys that I spoke to who got their passing scores today. Cheers!

Congratulations! Any chance you would be willing to share your CIS template? SDN, personal blogs, and even YouTube are littered with ICE templates, but CIS advice that actually works would be greatly appreciated around here.

Maybe even create a new post (with appropriate title) so other people can easily search and find it.

 

[CSHATER]

Thanks. Sorry about the delayed response. I would be glad to post my template, but explaining it would be difficult in a forum setting. Creating an easy-to-memorize template is pretty easy, and CIS is not difficult to pass, provided you know what you are getting into. The first time I took the exam, clearly I didn't know what I was getting into. I may create a new YouTube video if people think it would be helpful.

 

[zeevee]

Thanks. Sorry about the delayed response. I would be glad to post my template, but explaining it would be difficult in a forum setting. Creating an easy-to-memorize template is pretty easy, and CIS is not difficult to pass, provided you know what you are getting into. The first time I took the exam, clearly I didn't know what I was getting into. I may create a new YouTube video if people think it would be helpful.

Are you working on the youtube video? I am quite eager to go through the template you created. Please and thank you

 

[lucasrinconr]

Thanks. Sorry about the delayed response. I would be glad to post my template, but explaining it would be difficult in a forum setting. Creating an easy-to-memorize template is pretty easy, and CIS is not difficult to pass, provided you know what you are getting into. The first time I took the exam, clearly I didn't know what I was getting into. I may create a new YouTube video if people think it would be helpful.

Please help us!

 

[jac22]

Is anyone on here wrongfully failed for cis looking to pursue a law suit ? Strength in numbers

 

[futuredoc937]

Thanks. Sorry about the delayed response. I would be glad to post my template, but explaining it would be difficult in a forum setting. Creating an easy-to-memorize template is pretty easy, and CIS is not difficult to pass, provided you know what you are getting into. The first time I took the exam, clearly I didn't know what I was getting into. I may create a new YouTube video if people think it would be helpful.

Hey I was wondering if you ever made a youtube video on the CIS template. If you did I would love to get the link to the video. Thanks!