Retake it. You will pass without doing anything really different.
Failed step 2 CS, help!!
- Thread starter vbgal41
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Retake it. You will pass without doing anything really different.
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Go find a date. I bet December 30th in Philly May still be available. My friend snagged one a few days back. That will get you a score before rank deadline. If you fail that or are unable to find the spot (you really should), send letters to places letting them know of the situation, your plan to retake, assure it’s a 1-time thing, and pray that they have mercy on you and keep you on their list.
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Sorry OP...
Per my dean... STEP 2 CS has become more difficult and the passing scale has increased to weed out some of the FMG's who barely speak English and match. I can understand the reasoning for that, but also, its a cry to significance. The exam has been largely ostracized by mostly med-students due to its insanely high cost relative to higher pass rates. They definitely showed us on that one... FOL
1. if they ask for it, don't lie. If they don't ask, just omit.
2. if your other scores are solid, don't even sweat it. Unless you're applying for something insanely competitive.
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This isn’t meant at you but the bolded is wrong. Older generations need to stop advising younger generations based on rumors of their time. Same goes for Step 1 2 months, Step 2 2 weeks, and Step 3 #2 pencil. These board exams are serious and we need to treat them as such.
Regarding Step 2 CS, even I’m worried I did poorly but the way to prepare is to first read the guide NBME puts out. It lists a few things generally not to do. Additionally, you need to get a gist of what First Aid is saying but not take it too seriously. For anyone who finds this, this is my take on CS (2017 edition) without giving away any testing hints to help future US grads reading this. The biggest problem is that NBME is kind of irresponsibly by not going into more depth about the actual “rules” for the exam. No one knows exactly how it’s graded, etc. but after experiencing and seeing who’s failed, I can tell you it’s more than a glorified English exam.
-There are three components. Spoken English Proficiency (SEP), Communication/Interpersonal Skills (CIS), and Integrated Clinical Encounter (ICE). You need to get a certain total score or atleast achieve a minimum on each section. Since I’m speaking to US grads I’m not going to touch SEP.
CIS: First, make sure you counsel each patient with however much you can especially if the situation indicates it, summarize their complaints, and solicit questions because like FA says, they’ll usually have a “challenge question” that you need to give a diplomatic to. If not, there are other things like preserving modesty with the drapes, not asking questions in awkward ways, etc. that count towards CIS. Plenty of very smart people have failed this section. Don’t be one of them. Practice the physical exam to preserve modesty. By the same token, don’t be deliberately conservative with women. One person I know told an SP he didn’t want to deal with draping in that sensitive area and he failed CIS). Also quickly read up on how you can counsel patients to give you some quick phrases to use on the exam. Not that hard. Also, I feel like First Aid Step 2 CS is kind of wrong about HOW to make the patient feel comfortable. The patient centered (repeat their complaint etc.) is all good.. but they mention stuff like if the patient coughs, offer a napkin/glass of water or if a patient is hard of hearing stand on the appropriate side. I think that’s a bunch of BS because I tried stuff along those lines (again not going into what) and all of it was rejected. They just want to know you’re listening, making eye contact, displaying some level of sympathy, and just make them feel comfortable (when you adjust the patient’s sitting angle take their weight so they’re not tensing their abs and don’t forget to pull out the leg rest for the same reason). One interesting thing I don’t think a lot of people talk about is assessing the patients mood (which they may very obvious) and I have a vibe that SPs were looking for us to do that. You should go in confident, enunciate loudly, and have a moderate to cheerful demeanor but if a patient is hunched over and not in the mood to talk, you should lower your voice and adopt a sympathetic tone if they’re acting really sick. It’s super stupid but they wanna see how you adapt to the SP’s fake emotions.
ICE: This is the hardest part IMO and I recommend you don’t take CK and CS far off from each other. Diagnoses need to be correct (this isn’t your high school English class where your justification matters, but substance doesn’t). They’re going to give you scenarios (some which are classic others not so much) and you’re going to have to come up with a differential. The weird thing is the cases are weirdly made to have contradicting symptoms/history/physical findings. This is odd for us as its coming after tests where we’re trained to sift thru distractora to pick one answer. In this case, you need to use all those positive symptoms and come up with multiple diagnoses and if one really sticks out, rank it the highest. You could be given chest pain radiating to their left hand but the entire rest of the script could point to GERD -normal EKG, spicy foods make it worse, night time coughing- (NOT ON MY TEST, just classic example) so you should put two diagnoses and rank GERD higher but also but MI up there even tho that’s not how things work on CK it real life. Also, you need to get the tests to order right. You shouldn’t write a CT to diagnose acute pancreatitis w/o complications (again just an example) but instead should write lipase levels . I.e Don’t Shotgun. If you get the right answers, you can probably get away with shotgunning, but it’ll probably do harm to your reasoning in real time and according then the NBME manual over aggressive tests can make you lose points but I wish some official statement was made to clarify how exactly that worked. The same exact thing can be said about the history and physical. This isn’t the time to robotically do a heart/lung/belly exam on every patient and have a head-to-toe ROS checklist. For H&P if you have someone who has unilateral isolated thumb pain after trauma (again not real) just focus on the thumb, no need to listen to the heart/lungs/belly.
Last thing I want to go into because I was most concerned about it was positive findings on the physical exam. Before the exam, I was always worried about how detailed I need to be with physical exam. Let me just say this isn’t a test of physical diagnosis technique. The positive findings are going to be very crude. First Aid is right about this and their examples are on par with the real deal. You may see a rash they want you to notice with obvious body paint or they may whistle when you listen to their lungs (again both not on my test but in First Aid and similar kind of thing on the real thing). Don’t worry about weird murmurs or seeing diabetic retinopathy in the eye. Finally if an SP seems upset, is trying to rush you, or gets impatient, it may be them trying to challenge you but if it’s not like super obvious (i.e subtle cues like terse answers to questions or giving you a slightly urgent look) they may actually be trying to HELP you by subtly indicating that you’re fixating on something irrelevant or you need to move onto the next thing.
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