Failed Step 2 CS

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ovenpat

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Hello all, this is my first post onto sdn. I am an MS4 at a highly-regarded US medical school and I just found out that I failed Step 2 CS. I took the test in late January and I failed both the ICE and CIS portions of the exam. Honestly, I felt very rusty going in, because I hadn't seen a patient for almost a year (got a masters). Still, I didn't think I would fail because my classmates joked that I would pass since I speak English.
I am worried about the possibility of this affecting where I match for residency. These results came back After rank lists were finalized and locked (February 25th) for both applicants and programs. Is the rank list 100% binding? Could I lose my residency spot somewhere because I failed step 2 CS?
I'm also nervous because my Dean said I cannot graduate without passing Step 2 CS. If I do not pass Step 2 CS in time and thus do not graduate on time, would a residency program be able to revoke my residency spot? I am freaking out and nervous. Thank you in advance to anyone who might be able to answer any of my questions/concerns.

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If you take it before march 28th, the score will be back between april 29th and may 27th. Most likely it will be back before graduation. If by some unlikely chance it is not, then you'd get it back before residency starts and will just graduate a little after everyone else. No big deal as long as you don't fail again. Practice and you should be fine.
 
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You would need to get a passing score before graduate date to receive the diploma.

For people who failed CIS, they seem to benefit from taking Kaplan live-class. (you may want to take it from the one in Newark or Chicago). make sure you spend time counseling the patient (smoking cessation, healthy diet), inquire about their support system, and the impact of the disease on their quality of life. Allow patient to ask you question before you begin the physical exam. Help them with position change.
I highly recommend taking the Kaplan live class for CIS (I don't work for the Kaplan)

Now, the ICE, they grade based on two criteria, the Physical exam checklist by the Standardized Patient, and the accuracy of differential diagnosis and the workup.
to really nail ICE, you want to review the mini-case from FA, and and practice the big case with a study partner (this would help with your time management).

You read want to read the step 2 cs manual before you begin studying for your CS exam.

http://www.usmle.org/pdfs/step-2-cs/cs-info-manual.pdf
 
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What Choo said is spot on. The rank list is a binding contract, but does have some stipulations such as that residents must have a medical degree. Some institutions will also require CS passage before starting, but that isn't universal. Some hospitals even have policies that they will dismiss you if you test positive for nicotine at orientation. So the list is generally binding, but with some caveats.

Retake ASAP, pass, and put it behind you. Sorry you have to deal with this crap.
 
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Thank you very much. These responses have been very helpful and calmed my nerves a little bit. Clearly I have some work to do, but not all is lost.
 
For people who failed CIS, they seem to benefit from taking Kaplan live-class. (you may want to take it from the one in Newark or Chicago). make sure you spend time counseling the patient (smoking cessation, healthy diet), inquire about their support system, and the impact of the disease on their quality of life.

http://www.usmle.org/pdfs/step-2-cs/cs-info-manual.pdf

I did not counsel or even ask about diet or support system (unless it was a very elderly individual where I saw in impact in life). I think a lot of this is a waste of time.

Biggest thing is remember to be a person. Take 15 seconds when you're doing an exam to think if this was a real person, what would I be concerned with. IE thinking abuse, talk to them about guns within the house/ children present/ past abuse/ opportunities to report/ support programs. IE old dude with a hand injury, be worried about ADLs/IALD. Memorizing question sets for symptoms/complaints and all that jazz is a waste of time, and it is definitely unnecessary. At worst you miss some part of a history that probably won't impact your score in the slightest. If the person is a smoker, ask if they are interested in quitting. All mine said no, and I simply said something along the lines of 'if you're interested in the future, we can spend some more time talking about it'.

If you draw a blank in what to ask to 'develop your patient relationship', simply ask 'is there anything that concerns you.' Fake some sympathy (talk slow/ quietly, nod your head, and allow time between responses to fake it).

I think the biggest help is trying to be on a clinical rotation where you deal with patients on the daily basis. Learning how to adjust your history and physical based on the personality is a big thing that is hard to convey in any textbook. And finally, you should always ask 'any questions' (this is when you get the challenge question if it hasn't already come up) and then summarize what you think is occurring/how you will work it up (and if you want how you will manage it).

Anecdotal evidence based on my experience and friends. None of us had any categories close to borderline (lowest score had to buy a round).
 
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I would follow the advice that I took from someone and posted on another similar thread. If I can find that thread I'll link you to it. But basically you want to over empathize with the patients,

6-7 min to take a history
3-4 for focused physical exam
3-4 for summary

If you've memorized First aid step 2 CS cover to cover and make mneumonics to help remember key hx questions you'll do fine for ICE

For CIS
- Ask the patient how they want to be addressed
Hi mr/ms. xyz my name is Dr. So and so and I would like to ask you some questions and then perform your physical exam today. How would you like to be addressed? Is there anything we can do to make you feel more comfortable? (the last question ask if they look like they are in significant pain)

OPPQRRSTAA (onset, palliative (what makes it better), provocative (what makes t worse), quality of pain, region, radiation, seveity, temporal (worse at day or night or frequency and duration go in here too), associated sx (focused Review of sx) and what do they attribute it to. That's also a good point to ask about hidden concerns. Is there anything else specifically concerning to you? What most concerns you about your condition?

Then quick but short review of sx
Then Meds and allergies
Then PMH
Then FMH
Then Soc Hx (Alcohol, drugs, tobacco use, and what they do for a living and who they live with. if female ob/gyn hx may be pertinent here. sexual hx may be pertinent here)
or
OLD CARTS (see meded.ucsd.edu/clinicalmed)

In fam hx or during pmh or during main HPI (OPPQRRSTAA) you will want to show empathy when they say things like "my dad died of cancer". That's a good time to acknowledge it and say "i'm really sorry to hear" in an empathic tone of voice. Or ask if there's been other stressors in their life contibuting to things. Sound like you care even if it is fake.

If they are coughing offer a kleenex

If they are crying offer a kleenex and put your hand gently on their hand or shoulder for a few seconds.

Answer the challenge questions they ask

Ask after you summarize the history if there is anything else they'd like to add or if they have any concerns thus far.

Ask at the end if they have further questions or concerns whether or not it pertains to the primary problem or not.
 
I just wanted to post about my story only because people never close the loop when posting about failure. I am an AMG with avg board scores on Step 1 and Step 2CK, good grades on clinic rotations, who failed Step 2 CS. I took it in December and found out I failed about a month before the match (Failed the ICE portion). I retook it the week after I found out I failed and just found out I passed yesterday. Huge relief, I did not want to have to tell my residency program I failed and now it wont matter. Anyway to the advice:
1. Take this **** seriously - dont pinch it in between interviews, or fly in or drive in the day off, get to the testing city the night before, get a good night rest at a hotel. This test is 1.5k and a **** load of time and effort. You dont want to have to take it again cause you blew it off like a jackass (i.e. me)
2. For those who have failed Step 2CS, particularly in the ICE portion, retake the test as soon as possible. Go through the FA cases and just get the hang of what questions to ask when doing the interview. I
3. Most importantly do an Physical EXAM on everyone! Even if it does not seem to be readily apparent that an exam is necessary. For example, I got a counseling domestic abuse case, and I stupidly just talked the whole time and never did an exam. WTF was I thinking right? I have no clue.
4. Failed Step 2 CS and matching: I failed my Step 2 CS but it had not effect on matching. I never told any school about my failed step 2 cs. Mostly because I was done with interviews and schools did not reach out afterwards. I never released the failed score to my ERAS so schools never saw it. I matched into my first choice in Psych without issue.
5. Take some time to practice writing a Physical Exam on the SOAP note - just one with normal findings, get it down to 2 minutes. On the exam you write it out and plug in any of your abnormal findings. This will make writing the note quicker and easier.
If you fail Step 2 CS i know it sucks, but hang in there, take it again, slay the beast and move on!
 
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I know this is a fairly old thread but thought I would share my story as well to offer some encouragement to those that read it in the future.

Just like enoughsaid wrote: I am an AMG with fine scores on all my other Steps and good evals and grades from clinical rotations. Never thought I would fail CS. Had a pretty bad testing day though and when I got my scores back I had failed the ICE component with borderline scores. I was pretty angry, mostly with myself for not taking the exam seriously. I didn't even read the information guide that tells you how the CS is scored very thoroughly...

Anyway, I rescheduled a month later. Studied ONLY first aid (no practice with SPs) for two weeks and practiced writing notes some and passed with very high performance in all subcomponents. I had two interviewers ask me about my failed attempt and one was after I had passed (I even took my score report with me on interview day to prove I had passed lol). So all that to say you can and will get past this thing with a little effort and a run through first aid. It isn't as easy as it used to be, but it shouldn't be a huge deal. Good luck to any who read this and are having to suffer the torture of retaking that thing.
 
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