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FAILED STEP2 CS second time plz help

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tammy01

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I failed again CS this time in ICE last time I failed in CIS
I do not know why it is frustrating......this time however I didn't do detailed PE just sought of faked it (wanted to make sure I smiled, spend time to make SPs feel they are special because that is why I had failed 1st time) but documented everything in patient note as per the case history. Is that a problem do SPs access on PE the methods and techniques etc
Also on patient notes I followed PAMHUGSFOSS religiously one every single note......I think it could have been my mistake. In my opinion one has to summarize the history rather than sought of tabulate everything same way...any opinions?????????????
 

Dr McSteamy

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what do you mean you didnt' do detailed PE?

did you at least do cardio, pulm, and abd on everyone?
 

gonogo

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IMO, you don't need to do a "detailed PE". In my case, sometimes I heard heart sounds on 3 spots instead of 4, I did very quick neuro exams, even forgot to do things that were warranted in the case (i.e. CVA palpation in abdominal pain, fundoscopic exam in diabetic and hypertensive patient, etc... the list continues!).

If I were you I'd focus on following FA for data gathering. Then make sure you're nice to the patient, introduce yourself, wash your hands, etc... always summarize at some point, always ask if they have any questions. Good luck.
 

Dr McSteamy

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give us an idea how you interview a pt?

e.g

"Mr. xxx, hi there. how are you.
I see that you are having a problem with xxx....?"
 

tammy01

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Thank you for the post.
This how how i will start knock at the door, hi how are you MR XYZ, My name is Dr. XYZ. What brought you here today.
I am going to ask you few question about your condition and do a physical examinination on you .....is that OK
Then I will start with regular PAMHUGSBOSS and LIQORAAA
I will ask if it is OK to ask your PMH, it is OK to ask your family history.... lablablab, at social and sexual history I will say everything will be kept confidential do not hesitate, it will remain between you and me....
Then I will ask the pt if it is OK to examine him....drape at that point expose only part that is to be examined
While washing hands I will tell SP that I will go through everything that I am going to do... I will explain before I do anything to you ...keep the conversation going while washing hands.
The examine and focus examination.....like for dizziness complete neuro and will briefly listen to chest and heart more emphasis on sysytem involved.
By faking I meant do the whole chest and CVS but not little details
like in CVS they say you have do it sitting up and then lying down and end you with pt sitting up. for neuro I didn't check every cranial nerve one by one or for muscle strength or reflexes every sing isolated musle
for example upper extremity flexion and extension at elbow and wrist and the hand grip
same for lower extremity flexion at hip extension/flexion at knee and dorsiflexion and plantarflexion and babinski's
for sensory did touch, pain did not do vibration or proprioception
finish with giving a brief summary of History and PE what mostly like is going on few DDx did couseling and finish with say do you have any questions. thank you very much It was nice meeting you
 

Dr McSteamy

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hmm..

sounds like you did everything from First Aid. plenty of other students 'fake it' too, and they've all passed.

just curious, do you have a thick accent?
did the SP find it hard to understand what you were asking?
 

tammy01

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....i definitely do not have heavy accent. that is my strong point i speak very well. pts even sometmes compliment me on my english.
when I took the exam second time I knew what I didn't do right I took it only a week after I failed.
This time I have registered but do not know what to do what am I going to do different this time....no confidence at all
what should I do???????I do not wan to fail 3rd time.
It is so said that 3rd rate people are assessing your medical skills...these people cannot even find a proper job, do not have any education otherwise why would somebody go through this torture of examination at least 20 times a day maybe more
this is pathetic I think it is time that we should raise voice against this.
one SP that I had she was a character she was weird dressed like a gypsy.can you believe that.
 

Dr McSteamy

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it's hard to say what went wrong.

since you messed up the ICE this time, maybe your differentials and HPI weren't complete or reasonable. From everyone else's experience, It doesn't sound like a sloppy PE will fail you.

did you have trouble with the DDx? These are common everyday cases, and the most likely ddx should be a common ddx.
 

DarthNeurology

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....i definitely do not have heavy accent. that is my strong point i speak very well. pts even sometmes compliment me on my english.
when I took the exam second time I knew what I didn't do right I took it only a week after I failed.
This time I have registered but do not know what to do what am I going to do different this time....no confidence at all
what should I do???????I do not wan to fail 3rd time.
It is so said that 3rd rate people are assessing your medical skills...these people cannot even find a proper job, do not have any education otherwise why would somebody go through this torture of examination at least 20 times a day maybe more
this is pathetic I think it is time that we should raise voice against this.

one SP that I had she was a character she was weird dressed like a gypsy.can you believe that.

I think if you are being complimented on your english this means you are not a native speaker, I went to France and tried to order lunch and was "complimented" on my french by the waitress but this doesn't mean I am not noticeably un-French.

I find your assessment of the people who proctor the examination to be sad as these people have a job even if it isn't what you would consider to be "proper." I think it is wrong to assume that the people doing this work are uneducated, they seemed at least to be good actors to me. (And of course since I passed I would say they are excellent judges of clinical/personal skills).

Only the 3% of people who failed this examination once or maybe 1% who failed it twice would think that it is an unfair examination so those will be the only people with whom you could conceivably form a protest group. Everybody who passes just smiles and says it was easy.

Obviously to work as a doctor in this country you need to take care of patients who don't have "proper jobs" and those who don't have as much education as yourself. Realize that from your tone I would conclude that you might not have the right attitude to be a doctor in this country.
 

tammy01

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you are right in saying as a doctor I will face people from all walks of life educated uneducated but they will not assess my clinical skills and my knowledge they do not come with that attitude and above all they are actors fake people. After all there should be some way to standardize the exam……don’t tell me this exam is not subjective. it all depends on SPs mood and whether he/she likes you are not.
I have been in this country for 10 years and i am from a country where English is official language. if you speak an uncommon language as French is (compared to English)even broken you will be of course complimented. how many times u have complimented somebody who speaks broken English I would say only if somebody comes from different planet and tries to speak English.
You are right in terms of percentages only 1% fail twice or are upset like I am what do u think I should do sit, don't say anything????????
and it just my opinion.
and because I failed ICE I shouldn't practice in this country is not fair to say… that is the point I am trying to make. I was assessed in my medical school and did clear boards in United States and now somebody who doesn't have proper education and is an actor by profession is judging my clinical skills, my medical knowledge and style to practice medicine in this country it is absurd and high percentage of passing people doesn't make this exam a right exam. There are people like me even a small percentage that suffers.
 
N

njbmd

and it just my opinion .and because I failed ICE I shouldn't practice in this country is not fair to say… that is the point I am trying to make. I was assessed in my medical school and did clear boards in United States and now somebody who doesn't have proper education and is an actor by profession is judging my clinical skills, my medical knowledge and style to practice medicine in this country it is absurd and high percentage of passing people doesn't make this exam a right exam. There are people like me even a small percentage that suffers.


What happened in your country is moot, you want to practice in the United States, you play by the rules of the United States period. If I went to another country to practice, guess what? I have to meet their standards and play by their rules. What I think or what has happened to me in my country is pointless and I either meet or do not meet their requirements to practice.

Another thing that is pointless is what you think of the standardized patients. You are not getting the job done and it's you - not them- that is keeping you from passing that test. Figure out your problem, though I suspect that I know what your problem is by your post, and get the job done. With two failures, you are likely not going to find much success in getting what you want here.

Get your problems fixed and get this exam done. There are plenty of folks with accents who do NOT fail this exam. What every you are doing to prepare for this exam isn't working for you. You are not going to change this system and whining about how unfair it is to you isn't going to get you through this exam. Fix your problems. I will repeat, fix your problems. Approximately 99% of the folks who take this exam, pass it. You haven't passed it so do what you need to do and get the exam behind you.
 

tammy01

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njbmd please calm down
if you go to another country at least I am sure you will not be assessed by an ACTOR that is for sure
do not take me wrong I love this country and its value and what it stands for but no system is perfect and we should be able to accept our shortcomings if we want to evolve.
this the beauty of this country that we as a society are open to criticism and I think that is what make this county great.
I promise you I will abide by its rules because I am here by choice. I am working to fix my problem only if I know what the problem is that is why I am on SDN to figure it out. It would have been nice of you to see my earlier post to see what my problem is rather than jumping to conclusions
peace
 

DarthNeurology

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you are right in saying as a doctor I will face people from all walks of life educated uneducated but they will not assess my clinical skills and my knowledge they do not come with that attitude and above all they are actors fake people.

You are right in terms of percentages only 1% fail twice or are upset like I am what do u think I should do sit, don't say anything????????
and it just my opinion.
and because I failed ICE I shouldn't practice in this country is not fair to say… that is the point I am trying to make. There are people like me even a small percentage that suffers.

It is false that your patient won't assess your clinical skills (i.e. attitude) and clinical knowledge. I have met some very savy patients who have read up everything about their condition on the internet AND some will want to know very specifics things about their illness, it will be painfully clear if you try to tell them what you know and you don't really know what you are talking about.

In terms of clinical skills, if you look down on people for lack of education or a job at McDonalds (which is a real job, but not a "proper" job) then patients pick up on this even without an education THUS making you a less effective physician. If this is what your standardized patients picked up during your encounter then I am glad then they had a good reason and were doing their job. The exam is standardized as much as possible as it is recorded and reviewed for failure cases to make sure.

Then again, you must have done something wrong as you failed the examination twice in TWO different areas. You may have gotten the wrong differential diagnosis or not asked the right questions. All of my examinations were very straight forward and the diagnosis was simple. I did not use any PAMHUGGSFOSSY or whatever pheumonic as you have to ask the important questions. While a program director may look at one failure as a one time event, two failures on Step 2 CS looks bad.

Because you did fail Step 2 CS twice then many states say that you can never get a license there as an FMG. That is why Step 2 CS exists to try to weed out the really bad FMGs who can't relate to patients. Everybody knows that this is why this exam exists. I would say that the "actors" who are proctoring this examination do a good job as far as I can tell, i.e. they answer the HPI questions quickly. They ARE trained properly to do their job, i.e. basically just list what you did right and wrong and there are standards as everything is VIDEO TAPED.

If you really feel that you shouldn't have been graded so harshly they go protest it, but you know what? They have the video tape which shows you messing up, which you probably know you did.

Saying that the people doing the examination are not "properly" educated is just your excuse for not doing well twice and not taking responsibility for bad performances. It is a myth that the examination is all based on your reviewers. Let me guess, you had two different sites or group of patients and they failed you at both places? Doesn't sound like a subjective problem at all.
 

flumazenil

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haha- alright darthneurology im sure he/she gets your point. I agree with the point you are making but no need to call him/her a bad FMG and remind that him/her of licensure restrictions and whatnot.
What is done is done. Better advice would be to study with people that passed on their first try and are native speakers that go to US medical schools. Maybe make more eye contact, maybe learn to smile, or say " im sorry to hear that" when a patient mentions pain or tragedy. I do not think this exam is testing your "hard medical science" knowledge with obscure diagnosis such as LUPUS or mixed connective tissue disease or mixed psychotic disorder secondary to drug noncompliance with a general medical condition tertiary to adjustment disorder with psychotic features secondary to normal bereavement.

I think this exam tests the "little things" Did the doctor speak in clear sentences? Did the doctor explain what he is going to do with my body on physical exam? Did the doctor cut me off while I was talking? Did the doctor look down the entire time? Did the doctor look nervous or annoyed?

any one care to comment?
 
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njbmd

I am working to fix my problem only if I know what the problem is that is why I am on SDN to figure it out. It would have been nice of you to see my earlier post to see what my problem is rather than jumping to conclusions
peace

You STILL don't get it. Read the posts of people who have attempted to help you because you obviously didn't read them. FIX your problems. You have already placed yourself in a very poor situation. If you fail a third time, which you seem bent of doing by not following the advice of people who have tried to help you, you will likely not ever practice in this country. This isn't my problem, it's yours as I am practicing.

If you can't seem to understand the posts of the folks above, find one or two of your countrymen who have passed this exam and get some help from them in your own language. Duh!!!:eek:
 

smq123

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It is so said that 3rd rate people are assessing your medical skills...these people cannot even find a proper job, do not have any education otherwise why would somebody go through this torture of examination at least 20 times a day maybe more
this is pathetic I think it is time that we should raise voice against this.
one SP that I had she was a character she was weird dressed like a gypsy.can you believe that.

It's worrisome that you are so ready to dismiss the standardized patients as "pathetic actors." Whether or not you like it, they WILL be grading you. Your ability to practice medicine in the US lies in their hands. The only thing you can do is accept that fact gracefully.

98% of American students pass Step 2 CS, despite having these "3rd rate people" assess their medical skills....so there's no reason why you should blame the actors for your failure. Stop making excuses, and get to work!

READ FIRST AID FOR STEP 2 CS. If you read that carefully, and really study from it, you should pass Step 2 CS with no problem. It is a great resource for this test.

If you failed ICE - it might be because your notes were poorly written. Or your differential diagnosis was not very good. Like I said - READ FIRST AID FOR STEP 2 CS from cover to cover. Read it at least 3 times. THEN take the test. It's a great book that will tell you how the standardized patients and proctors will evaluate you and your notes, and it's a very helpful text.

Good luck. :luck:
 

silas2642

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....i definitely do not have heavy accent. that is my strong point i speak very well. pts even sometmes compliment me on my english.
when I took the exam second time I knew what I didn't do right I took it only a week after I failed.
This time I have registered but do not know what to do what am I going to do different this time....no confidence at all
what should I do???????I do not wan to fail 3rd time.
It is so said that 3rd rate people are assessing your medical skills...these people cannot even find a proper job, do not have any education otherwise why would somebody go through this torture of examination at least 20 times a day maybe more
this is pathetic I think it is time that we should raise voice against this.
one SP that I had she was a character she was weird dressed like a gypsy.can you believe that.

They may not win an Academy Award for their acting skills, but most of the standardized patients that I've encountered are actually pretty good at recognizing what goes into a decent physical exam-- they know what a physician is supposed to do with a patient. Your biggest problem isn't that you have "third rate people" assessing your medical skills because these people are very likely to know exactly what your shortcomings are. They may not know pathophysiology, or why we do what we do, but they know what goes into an H&P and how a doctor should behave with a patient. You would be well advised to take njbmd's advice, stop whining, understand that you flunked this exam twice because of YOU and not THEM, and get studying because you're already in deep enough trouble as it is as an FMG.
 

Dr McSteamy

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alright alright. chill

lets stop attacking the op.

the op said she was friendly enough to the pts. and the SP's let her pass this time.
she just got lazy on the PE this time around.


chit can happen.

Either she messed the PE this time, or her notes were marginal.
 

SteveMurphy

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are you guys all SPs by profession why have you taken this so personal. she admitted that she messed up PE.
Let us face it I know two people who scored high 90s in USMLE but failed the test. do not tell me SPs are not biased towards americans which explains high percentage of passing.
I think United States is the only country in the world who subjects their medical garduates to face actors to clear licensing process.
i suggest to read first aid at least twice and keep a BIG SMILE on your face and you have to be a GOOD ACTOR as well I think that will do the trick.
good luck
 

IFNgamma

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hi there, I know how much it sucks to fails this stupid test and I have the greatest sympathy in the world for you, but don't lose hope.

Did you take both exams at the same center? If so, I would suggest taking it somewhere else.

I know the center in LA has been a nightmare for myself and a bunch of my classmates and some other people. I re-took the exam in Atlanta and I felt I actually did worst the 2nd time, but somehow passed. So I would suggest taking the test at another center, it would at least help you psychologically since you don't have to face the same people that failed you once already.

Good luck!
 

Dr McSteamy

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hi there, I know how much it sucks to fails this stupid test and I have the greatest sympathy in the world for you, but don't lose hope.

Did you take both exams at the same center? If so, I would suggest taking it somewhere else.

I know the center in LA has been a nightmare for myself and a bunch of my classmates and some other people. I re-took the exam in Atlanta and I felt I actually did worst the 2nd time, but somehow passed. So I would suggest taking the test at another center, it would at least help you psychologically since you don't have to face the same people that failed you once already.

Good luck!



i doubt it has anything to do with what center you take it in.
the SP's are just average joes, and when you are done examining them, they fill out a survey on the computer inside the room.

i'm sure it's like this in the other 5 testing centers.
 

Skills of House

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i doubt it has anything to do with what center you take it in.
the SP's are just average joes, and when you are done examining them, they fill out a survey on the computer inside the room.

i'm sure it's like this in the other 5 testing centers.
There was a computer inside the room? I don't remember seeing any...great! Just further evidence that I'll probably have to shell out over a "G" to take this crazy test again!:mad:
 

docnizzi

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I failed again CS this time in ICE last time I failed in CIS
I do not know why it is frustrating......this time however I didn't do detailed PE just sought of faked it (wanted to make sure I smiled, spend time to make SPs feel they are special because that is why I had failed 1st time) but documented everything in patient note as per the case history. Is that a problem do SPs access on PE the methods and techniques etc
Also on patient notes I followed PAMHUGSFOSS religiously one every single note......I think it could have been my mistake. In my opinion one has to summarize the history rather than sought of tabulate everything same way...any opinions?????????????

Were time constraints an issue at all? It seems that you may have been too thorough in some aspects sacrificing others. I know you've already spent a butt load on this exam, but maybe it would be wise to invest in a one day prep course in addition to reading 1st Aid. It might have been less expensive to do that before. Point being, none of us can TYPE what really went wrong. I actually had friends who had taken CS before I did set up their places for practice (I didn't realize they were such great actors) with the opening scenarios on the doors and even had me on the cell phone speaking with a "parent". Nothing beats face to face feedback.

But you HAVE to get that "they're just actors" out of your head when you're in there, or you set yourself up. :thumbdown: I would also suggest going to another facility if for nothing else for a fresher feeling start.
Best of luck :luck:
 

winner123

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I failed again CS this time in ICE last time I failed in CIS
I do not know why it is frustrating......this time however I didn't do detailed PE just sought of faked it (wanted to make sure I smiled, spend time to make SPs feel they are special because that is why I had failed 1st time) but documented everything in patient note as per the case history. Is that a problem do SPs access on PE the methods and techniques etc
Also on patient notes I followed PAMHUGSFOSS religiously one every single note......I think it could have been my mistake. In my opinion one has to summarize the history rather than sought of tabulate everything same way...any opinions?????????????

I am really moved by your difficult situation and my sympathies are with you.
Please contact me in person.I can say with surety that I know this test better than everyone else.
I also failed the first time in all the three subcomponents ,but passed this test on my second attempt after a lot of hardwork.
First, let me tell you that it is not at all a test of english accent or fluency .
It is a test of your overall personality and communication.
No doubt,at least 30-35% IMG's are failing this test now.
I can offer you coaching if you want.
You can contact me if you are willing to do so.

Please do not take this test again without any perfect help.

I guarantee you that if you learn what I know you will definitely pass.
DON'T TAKE MY THESE words lightly .

And don't waste your time in accusing the SP's .It will no way help you.
Just acknowedge your mistakes.That is the only thing which will help you pass,dear.

Sincerely
Winner123
 
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