Hey y'all,
I got a lot of help from the internet and only feels right to share and I hope it's helpful to someone, along with other similar stories on here. I'm a US MD, and my application was good before failing CS...a couple honors including IM clerkship, 230s Step 1, 240s Step 2 CK.
I matched a mid tier academic primary care track in IM, my top choice. I absolutely loved it and am so happy. I have unique, committed interests and experiences that helped a lot as well, but that probably isn't something you can change if you're someone at the point of looking for CS advice on the web like I was many months ago.
So the take aways:
1. Yeah, there are at least some people who know this test is an absurd game, and you can overcome fails, particularly for US MDs, who are given some benefit of the doubt throughout this process in a way that others are not. But at the same time, since I took it early and the fail was clearly on my app, almost every interview asked about it, and while it worked out for me, if interviews at my favorite program didn't go as well, perhaps I would have fallen much further or not matched. There's no way for me to know exactly how much people cared about the fails, which I always disclosed when asked, but for the most part people did seem to be "on my side" about it and wanting to interpret it as a fluke and not a red flag. There are programs that I had considered safeties prior to the failure that didn't interview me, and a couple low tier but solid programs interviewed me after a letter of interest, suggesting that I got screened initially but was saved by a closer look. So there's clearly lots of variation in who cares about this test and how much.
2. Take the test seriously, and if you read this, tell 3rd years to do the same. I found it helpful to treat it more like oral boards (like the kind I saw EM residents practicing for), for the sake of seeing it as valuable and learning how to play the game. Besides, it's an acting test that's graded subjectively, so there's not much to stop SPs from marking you down if you seem apathetic or "not bought-in." It's total b.s., but accept it temporarily so that you can move on with your life and get to treating real patients.
3. Since I took it so many times, and failed different parts, maybe my experience will help you prep. So I describe that below.
4. If you failed, yes, be frustrated because the test is opaque, expensive, and unvalidated, but then be a little hard on yourself to figure out what you *may* have done wrong, and bust your a** to make sure you crush it the next time. And while you're doing that, remember that these failures say more about this bizarre test than it does about any of us.
I failed on CIS, tried again immediately, and found out in Oct I failed again, on ICE.
First attempt I probably took too many notes and didn't fully appreciate the need to close in a structured way.
Second attempt I crushed CIS by asking every person a million counseling questions at the end (How is this complaint affecting your life? Any questions? Do you understand the plan? Do you agree with the plan? Anything important you want to share that I missed?), but apparently overcompensated, anchoring on the "obvious" dx and not being thorough enough to have good pertinent NEGATIVES to support 2nd and 3rd diagnostic possibilities. So I failed ICE.
Third attempt I did much of the same stuff, but practiced EVERY. SINGLE. case in the FA Step 2 CS book, timed, with a friend, even faking the physical exam. I hear IMGs do this by default. But getting to a point where some of these differentials and ROS's were close to memorized helped me go faster so that I could be thorough, grab all the ICE points, and still have time to do the CIS things. You don't need to have the perfectly right answer, it's better to have good evidence for 2, preferably 3 things than a perfect #1 and a sparse 2 and 3. Again PERTINENT NEGATIVES are the most important thing to learn in my opinion, that's the difference between feeling like you're grasping at straws and knowing exactly what you need. Maybe some people get this stuff down cold just from wards and step 2 ck, I passed ICE with minimal prep the first try. But in any case, better to be over-prepared.
I used the Kaplan online course videos for my third try...it was helpful to have that structure. I don't think it offers THAT much besides what's in the FA, perhaps the mention of unusual but allegedly high yield cases (pediatric nocturia, erectile dysfunction, new pregnancy), but even that stuff is in the book too. They maybe give a few extra tips but if you're really tight on money (because you know, you have to retake a $1300 test), I'm confident you can do that without this. But it was still helpful psychologically if nothing else.
Good luck! Hope that helped a little.
I got a lot of help from the internet and only feels right to share and I hope it's helpful to someone, along with other similar stories on here. I'm a US MD, and my application was good before failing CS...a couple honors including IM clerkship, 230s Step 1, 240s Step 2 CK.
I matched a mid tier academic primary care track in IM, my top choice. I absolutely loved it and am so happy. I have unique, committed interests and experiences that helped a lot as well, but that probably isn't something you can change if you're someone at the point of looking for CS advice on the web like I was many months ago.
So the take aways:
1. Yeah, there are at least some people who know this test is an absurd game, and you can overcome fails, particularly for US MDs, who are given some benefit of the doubt throughout this process in a way that others are not. But at the same time, since I took it early and the fail was clearly on my app, almost every interview asked about it, and while it worked out for me, if interviews at my favorite program didn't go as well, perhaps I would have fallen much further or not matched. There's no way for me to know exactly how much people cared about the fails, which I always disclosed when asked, but for the most part people did seem to be "on my side" about it and wanting to interpret it as a fluke and not a red flag. There are programs that I had considered safeties prior to the failure that didn't interview me, and a couple low tier but solid programs interviewed me after a letter of interest, suggesting that I got screened initially but was saved by a closer look. So there's clearly lots of variation in who cares about this test and how much.
2. Take the test seriously, and if you read this, tell 3rd years to do the same. I found it helpful to treat it more like oral boards (like the kind I saw EM residents practicing for), for the sake of seeing it as valuable and learning how to play the game. Besides, it's an acting test that's graded subjectively, so there's not much to stop SPs from marking you down if you seem apathetic or "not bought-in." It's total b.s., but accept it temporarily so that you can move on with your life and get to treating real patients.
3. Since I took it so many times, and failed different parts, maybe my experience will help you prep. So I describe that below.
4. If you failed, yes, be frustrated because the test is opaque, expensive, and unvalidated, but then be a little hard on yourself to figure out what you *may* have done wrong, and bust your a** to make sure you crush it the next time. And while you're doing that, remember that these failures say more about this bizarre test than it does about any of us.
I failed on CIS, tried again immediately, and found out in Oct I failed again, on ICE.
First attempt I probably took too many notes and didn't fully appreciate the need to close in a structured way.
Second attempt I crushed CIS by asking every person a million counseling questions at the end (How is this complaint affecting your life? Any questions? Do you understand the plan? Do you agree with the plan? Anything important you want to share that I missed?), but apparently overcompensated, anchoring on the "obvious" dx and not being thorough enough to have good pertinent NEGATIVES to support 2nd and 3rd diagnostic possibilities. So I failed ICE.
Third attempt I did much of the same stuff, but practiced EVERY. SINGLE. case in the FA Step 2 CS book, timed, with a friend, even faking the physical exam. I hear IMGs do this by default. But getting to a point where some of these differentials and ROS's were close to memorized helped me go faster so that I could be thorough, grab all the ICE points, and still have time to do the CIS things. You don't need to have the perfectly right answer, it's better to have good evidence for 2, preferably 3 things than a perfect #1 and a sparse 2 and 3. Again PERTINENT NEGATIVES are the most important thing to learn in my opinion, that's the difference between feeling like you're grasping at straws and knowing exactly what you need. Maybe some people get this stuff down cold just from wards and step 2 ck, I passed ICE with minimal prep the first try. But in any case, better to be over-prepared.
I used the Kaplan online course videos for my third try...it was helpful to have that structure. I don't think it offers THAT much besides what's in the FA, perhaps the mention of unusual but allegedly high yield cases (pediatric nocturia, erectile dysfunction, new pregnancy), but even that stuff is in the book too. They maybe give a few extra tips but if you're really tight on money (because you know, you have to retake a $1300 test), I'm confident you can do that without this. But it was still helpful psychologically if nothing else.
Good luck! Hope that helped a little.
