SilverCat

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Aug 17, 2012
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Hi,

I just need some advice/reassurance. I took the CS today and am about 95% certain that I failed it. I didn't make minor errors -- there were some pretty serious issues. I ran out of time on most of my encounters due to overly detailed history, and wound up cutting short the PE on almost every patient to get counseling fitted in. I could only pinpoint 1-2 possible Ddx on every patient, and only on one or two patients could list pertinent positive PE findings for the ddx--I ended up leaving this section blank on 75% of patient encounter notes. I didn't counsel on sex/alcohol/drugs on several patients, and had at least five or six diagnoses missed completely. Finally, my physical exam skills are terrible, and while I did heart and lungs for every patient, I missed the relevant exam for many patients, like forgetting to do the neuro exam on one patient when the main complaint was neuro -related. Trust me, this isn't a situation where I think I may have failed--I'm fairly confident that I did.

I am taking a year off for research, and want to know how much this will impact my residency application. I know most people who fail already have interviews lined up or have submitted a rank list; I want to know if I will even get interviews were I to retake the exam and pass, given this fail on my record. I'm applying IM, nothing too competitive, and am AMG. I just want to know if others have been in this situation and if they matched, because I feel like I've completely destroyed my chances at any residency, and feel completely crushed. Thanks.
 

morbentfel

7+ Year Member
Jul 7, 2010
24
13
Status
Pre-Medical
Bro I made even worse mistakes than you and ran out of time even on multiple cases. I am also applying this year to IM and also an AMG, supposed to get scores back next week. I know how it feels ; ;
 

trepon

2+ Year Member
Sep 22, 2014
18
12
I also made bigger mistakes and am terrified I didn't pass. I don't know why they would have a USMLE exam that could make or break your chances of matching that gives you a result AFTER you have already applied.
 
May 22, 2015
83
18
Status
Medical Student
My mistakes had a similar feel to yours. I think I am fairly good at the physical exam however, and I was pretty polite and asking to untie gown etc. I however often ran out of time to do a thorough counseling. I think most my patients asked me a challenging question because after my HPI I often asked if there was any other questions at this time and they usually had a doozie. I always summarized, but really didn't do a lot of substance counseling and no CAGE questions.

I find out next week, so I'll update. Again, nobody really knows the voodoo they use, but at least its some data for you. I also want to know the answer to your question because I will be getting my score 1 month before apps are submitted through ERAS and CS pass or fail will be sent to all my programs. I'm applying to all the community family programs in my state, so not sure if this is a bigger or lesser deal. Maybe its just best to take ownership of it in your personal statement, and potentially ask your school to include something in the Dean's letter about how you overcame it or that you're an excellent student clinically but this test is not representative (which I think would be my case).

I'm a member of the GHHS at my school, lots of volunteering with people, good clinical feedback. All signs point to a student that would exceed the CIS portion, but if I didnt have enough empathy in counseling a patient or say the right two word phrase 12 times, I might had failed it.
 
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SilverCat

SilverCat

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Aug 17, 2012
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Thanks for posting, guys. I hope you all pass.

I just wish I could reschedule now so I don't have to wait so long to retake. These two months are going to be miserable.
 
May 22, 2015
83
18
Status
Medical Student
SilverCat check this thread out:

http://www.usmle-forums.com/usmle-step-2-cs-forum/250354-no-idea-how-i-passed-step-2-cs-there-s-hope-all-here-s-my-story.html

It happened recently and I feel this person's mistakes are somewhat comparable to ours. So let's have some hope and I will report back next week to let you know if mistakes of our caliber are pass-worthy for this idiotic test.
That post gives me hope! Thanks for sharing.
Swearing? Not closing except for 8 cases? Fingers crossed everyone!

Still wanting to know what happens if you are applying with a failing CS - hope for the best, prepare for the worst.
 
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SilverCat

SilverCat

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Aug 17, 2012
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FWIW, I contacted my school today to ask about what happens when people fail the CS. We have roughly a 97% pass rate, and everyone who failed last year retook the exam, passed, and matched. My school made it seem as though the CS is more of formality-- a fail isn't going to prevent you from matching. I am applying IM, however, so I don't know if this still applies to people going for a more competitive specialty. Just thought I'd throw that out there as a small bit of hope to those waiting like me.
 

morbentfel

7+ Year Member
Jul 7, 2010
24
13
Status
Pre-Medical
Thanks for the update SilverCat. I too spoke with the program director at my school for IM and he said roughly the same as well. Given that the rest of our track record is quite good, he would not expect it to significantly hurt our chances of matching. So, best case scenario we pass this absurd test and move on or in the worst case we simply have to retake it down the line and match anyway. I been waiting nearly 80 days now, so I know what it's like to be in this spot. Hang in there bruh
 
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SilverCat

SilverCat

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Aug 17, 2012
1,223
122
One of the least sought- after postal codes
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Medical Student
My case mistakes:

Cases:
1.) forgot fmhx (relevant to dx) and major risk factor for dx in counsel. scared pt with possible cancer dx, and may have falsely reassured pt that it wasn't likely
2.) missed major dx--missed relevant HPI questions, second ddx not well supported
3.) missed major dx and relevant counseling, missed major lab tests
4.) missed major dx, forgot to do ROM testing
5.) missed major PE portion relevant to dx, missed major dx
6.) okay--probably mixed up 1st and second dx
7.) okay
8.) okay, might have missed relevant portion of PE
9.)okay, but bad PE--patient in pain and didn't want to cause more pain, so I did bare minimum for PE, missed several ddx
10.) okay--might have missed relevant ddx and sexual hx
11.) okay, but missed important counseling
12.) ok

Issues that worry me--never did mental status testing (one case I should have done so, I think), never took pulses, neuro exam was pathetic, no psych workup was ever done--but I didn't see any cases I thought were psych--I might have missed something important with regards to the dx. I also only counseled a couple of times--I don't recall if I did enough with this, or forgot in most cases. Was the last examinee out of the room almost in every case--when I came out, everyone was already writing their notes. I didn;t spellcheck any of my notes, and might have capitalized in my rush to finish the notes. Lab testing was slapdash--I didn't really think too deeply about dx testing because I was usually in a rush to finish the notes. I had two ddx for most cases, three for one or two, and they were pretty badly supported. I am terrible with anchoring bias--I usually hit one dx I think is correct and have difficulty coming up with anything else, especially when there's a time limit.

I'm pretty bad with physical exams in general, and consider myself lucky to hear heart and lung sounds, let alone dx heart murmurs, decreased breath sounds, etc. I can hear wheezes on lung exams, but that's pretty much it. Once it a great while I can hear a systolic or diastolic murmur, but it has to be very loud and obvious. If the SPs had any of this stuff simulated, I definitely missed it.

What I did do:
Draped 1st patient--everyone else already had drapes in place. Asked permission before I undid gown for every patient
Washed hands
Closure for every patient-asked if they had any questions until I ran out of time or they ran out of questions
Transitioned between HPI, ROS and PMhX
CAGEd everyone who took more than 1 drink in a lifetime (probably overkill)
Tried to be compassionate--explored reasons for anxiety, said "I'm sorry" a lot--don't know if I did enough in this area
Auscultated heart and lungs on skin for every patient
 
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Aug 5, 2016
13
2
Status
Medical Student
Hi,

I just need some advice/reassurance. I took the CS today and am about 95% certain that I failed it. I didn't make minor errors -- there were some pretty serious issues. I ran out of time on most of my encounters due to overly detailed history, and wound up cutting short the PE on almost every patient to get counseling fitted in. I could only pinpoint 1-2 possible Ddx on every patient, and only on one or two patients could list pertinent positive PE findings for the ddx--I ended up leaving this section blank on 75% of patient encounter notes. I didn't counsel on sex/alcohol/drugs on several patients, and had at least five or six diagnoses missed completely. Finally, my physical exam skills are terrible, and while I did heart and lungs for every patient, I missed the relevant exam for many patients, like forgetting to do the neuro exam on one patient when the main complaint was neuro -related. Trust me, this isn't a situation where I think I may have failed--I'm fairly confident that I did.

I am taking a year off for research, and want to know how much this will impact my residency application. I know most people who fail already have interviews lined up or have submitted a rank list; I want to know if I will even get interviews were I to retake the exam and pass, given this fail on my record. I'm applying IM, nothing too competitive, and am AMG. I just want to know if others have been in this situation and if they matched, because I feel like I've completely destroyed my chances at any residency, and feel completely crushed. Thanks.
Hey SilverCat!

I think failing CS is worse if you are an IMG because PDs feel like you can't work in american setting if you fail. And also CS is the only place they can see our interaction with patients (SPs!) :(For you AMGs I don't think it is a big deal since they can look at your performance in school and dean letter.

Having said all of that, based on what you said I don't think you did as bad as you think. I am an IMG and I did my exam last year. I put 2 ddx for almost all patients. I also did not do a complete PE. But like you, I asked patients if they have any questions and let them explain as much as they want and overall I was nice and polite! and I think that is what matters most. My patients notes were very basic. I was freaking out after the exam (did it last year) but passed and when I got my report I wasn't even close to failing!
 
Last edited:
Jul 13, 2016
112
60
Status
Medical Student
I just found out that I failed my CS Exam.... :( your mistakes sound very similar to how I performed. Hopefully you will do good man just hope for the best......
0/10 on trolling attempt.

You could have at least made your profile private so people couldn't see the rest of your posts.
 
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SilverCat

SilverCat

The Friendly Reapp Cat
5+ Year Member
Aug 17, 2012
1,223
122
One of the least sought- after postal codes
Status
Medical Student
Just out of curiosity, have people who took the exam in August still got the permit link? My permit link still opens to the full permit (took the CS 1 month ago), whereas my CK permit is gone (and I only took that two weeks ago). Just wondering if this may be a hint I didn't pass.
 

stepone2015

2+ Year Member
Oct 24, 2014
242
236
Status
Resident [Any Field]
Just out of curiosity, have people who took the exam in August still got the permit link? My permit link still opens to the full permit (took the CS 1 month ago), whereas my CK permit is gone (and I only took that two weeks ago). Just wondering if this may be a hint I didn't pass.
1) CS takes a long ass time to come back. Worrying about permits disappearing/not disappearing is a pointless way to to take a couple years off your life.

2) Everyone, myself included, thinks they may or probably failed CS. You really should stop obsessing about it because there's nothing you can do about it now anyway if you did fail.
 

lavenderflowers

2+ Year Member
May 19, 2015
54
28
My case mistakes:

Cases:
1.) forgot fmhx (relevant to dx) and major risk factor for dx in counsel. scared pt with possible cancer dx, and may have falsely reassured pt that it wasn't likely
2.) missed major dx--missed relevant HPI questions, second ddx not well supported
3.) missed major dx and relevant counseling, missed major lab tests
4.) missed major dx, forgot to do ROM testing
5.) missed major PE portion relevant to dx, missed major dx
6.) okay--probably mixed up 1st and second dx
7.) okay
8.) okay, might have missed relevant portion of PE
9.)okay, but bad PE--patient in pain and didn't want to cause more pain, so I did bare minimum for PE, missed several ddx
10.) okay--might have missed relevant ddx and sexual hx
11.) okay, but missed important counseling
12.) ok

Issues that worry me--never did mental status testing (one case I should have done so, I think), never took pulses, neuro exam was pathetic, no psych workup was ever done--but I didn't see any cases I thought were psych--I might have missed something important with regards to the dx. I also only counseled a couple of times--I don't recall if I did enough with this, or forgot in most cases. Was the last examinee out of the room almost in every case--when I came out, everyone was already writing their notes. I didn;t spellcheck any of my notes, and might have capitalized in my rush to finish the notes. Lab testing was slapdash--I didn't really think too deeply about dx testing because I was usually in a rush to finish the notes. I had two ddx for most cases, three for one or two, and they were pretty badly supported. I am terrible with anchoring bias--I usually hit one dx I think is correct and have difficulty coming up with anything else, especially when there's a time limit.

I'm pretty bad with physical exams in general, and consider myself lucky to hear heart and lung sounds, let alone dx heart murmurs, decreased breath sounds, etc. I can hear wheezes on lung exams, but that's pretty much it. Once it a great while I can hear a systolic or diastolic murmur, but it has to be very loud and obvious. If the SPs had any of this stuff simulated, I definitely missed it.

What I did do:
Draped 1st patient--everyone else already had drapes in place. Asked permission before I undid gown for every patient
Washed hands
Closure for every patient-asked if they had any questions until I ran out of time or they ran out of questions
Transitioned between HPI, ROS and PMhX
CAGEd everyone who took more than 1 drink in a lifetime (probably overkill)
Tried to be compassionate--explored reasons for anxiety, said "I'm sorry" a lot--don't know if I did enough in this area
Auscultated heart and lungs on skin for every patient
I made more mistakes than you did and still passed with high performance in ICE and a star in SEP. That too, I'm a US IMG who studied less than a week for the test.

I wouldn't worry about your result until the day it comes out, everyone feels like they failed. I went on SDN and looked for every thread on CS experiences and freaked myself out with the I failed CS posts.

Also, CS is only looked at carefully for non-Caribbean IMGs, who barely do any electives or hands on patient contact in the US. If you're an AMG I wouldnt worry much about it. Good luck!!
 
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wwom2000

5+ Year Member
Oct 8, 2012
6
2
Status
I'm worried about the CS as well and I made much more mistakes than you, I think you'll be fine.
I actually forgot to summarize in every case I think. I closed every case except one and addressed any concerns as well, but yeah I'm freaking out as well.
I also made a few other stupid mistakes in my nervousness...the wait has been killing me!
 
Aug 3, 2015
10
2
Status
Medical Student
does anybody know how important the summarizing part is? feels like there's not enough time to do everything
 
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SilverCat

SilverCat

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Aug 17, 2012
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Update: Passed.

Proves you can pretty much botch the dx and still come out OK.
 
Jul 13, 2016
112
60
Status
Medical Student
Update: Passed.

Proves you can pretty much botch the dx and still come out OK.
That's good to hear!! Thanks for the update... I was following this thread for more than a month. Do u mind sharing how you did on your ICE, SEP and CIS components separately? (High, middle or borderline)??

I feel like I made similar mistakes as you, but probably a bit more...so somewhat anxious :-/
 
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SilverCat

SilverCat

The Friendly Reapp Cat
5+ Year Member
Aug 17, 2012
1,223
122
One of the least sought- after postal codes
Status
Medical Student
That's good to hear!! Thanks for the update... I was following this thread for more than a month. Do u mind sharing how you did on your ICE, SEP and CIS components separately? (High, middle or borderline)??

I feel like I made similar mistakes as you, but probably a bit more...so somewhat anxious :-/
All components in higher performance end, with CIS just out of borderline range.

Just remember: 94% pass rate.
 
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