Fairly positive that I just failed Step 2 CS

[SierraMist14]

Just came from my exam and I feel like pure ****. I felt ok on about 6 of the cases and completely bombed like 3 of them. The rest were so-so. My mistakes:

1. Completely missed the diagnoses on two of the encounters. I figured them out once I had finished my note but didn't have enough time to change anything.

2. Draped the patient WRONG TWICE on 2 abdominal exams.

3. I Feel like my notes sucked.

4. Not all of my patients provided a challenging question, which is scaring me. Maybe I didn't elicit a good enough history?

Overall, I'm pretty sure that I just failed. I can't believe it. Is it a real deal-breaker to fail?

I'm at the point where I'm just so tired of all of this. I'm towards the end of third year and I'm feeling like I don't want to be a doctor anymore. It's just too much!!

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[Phloston]

left out at least 2-3 history questions, left out at least one physical maneuvers, forgot counseling on some, had 2-3 cases where ddx were vague, had 2 cases with only 1 ddx, forgot to wash hand for one, crappy notes.. but with the limited time, it is kinda ridiculous to do everything.. Anyhow now its a waiting game and by God's grace lets hope both of us passed...

Not sure how to interpret this. You forgot 2-3 questions out of the ~100 we could possibly ask a patient during an encounter? And by forgetting a maneuver, do you mean such as not doing Rovsing or psoas in a possible appendicitis?

I've just started going through FA 2CS (i.e., I've played doctor for the first 4 of 44 cases in the book) and I can already tell practicing is hugely important, and I probably would have failed had those four encounters been my real deal. The cases are easy, but it's definitely tough to remember to ask/do everything when under time pressure, and sometimes those questions/things are major.

 

[TraumaBlonde]

Ok, so can I add my thoughts? I think it sounds like you guys just need help getting all of the info into a study plan that can be absorbed by your brains. Bc you know you guys know it, it just sounds like you're drowning in info.

 

[medrocks1]

Edit

 

[Phloston]

I have my 2CS in a couple days so will probably be freaking out just like you. Because at the moment I still have a cool head, I can say outright that every person taking this exam forgets/is going to forget to ask/write up certain Hx and P/E findings; you know that. As far as what I can gather from what I've read from reviews by people who fail, it seems to be that not doing the closure is the most significantly adverse thing. Apparently the SPs have to check off certain things we've done/asked during the encounter, and the closure involves quite a few points. So bottom line is that if you're freaking out about not asking/writing up some random things, don't, because everyone's in the same boat. The only thing I'd worry about is not closing, although it only happened twice with you, and nothing you can do now. Like I said though, I'll be in your same exact situation in a couple days most likely just based on the nature of things. Definitely not looking forward to the 8-week wait (or however long it's supposed to be).

 

[medrocks1]

Welcome to my boat... I know exactly how you feel. Although I assure you you made the right choice by taking the test earlier than rest of your peers. I made the mistake of taking it late in my fourth year and failing it.. thankfully it didn't affect my match, but I recently took it in March and now I am waiting for the results. I tell you the waiting is worse than taking the test. The psychological stress is ridiculous. But according to all the people here it seems like its fairly normal to feel like you failed after you take the test. I am crossing my fingers too this time, and I made a ton of mistakes as well.. left out at least 2-3 history questions, left out at least one physical maneuvers, forgot counseling on some, had 2-3 cases where ddx were vague, had 2 cases with only 1 ddx, forgot to wash hand for one, crappy notes.. but with the limited time, it is kinda ridiculous to do everything.. Anyhow now its a waiting game and by God's grace lets hope both of us passed...

Pleaseeee. Let us know if you passed!!!! Did you????


Edit: Just realized you took your test in April... But let us know when you get the results....

 

[medrocks1]

Just came from my exam and I feel like pure ****. I felt ok on about 6 of the cases and completely bombed like 3 of them. The rest were so-so. My mistakes:

1. Completely missed the diagnoses on two of the encounters. I figured them out once I had finished my note but didn't have enough time to change anything.

2. Draped the patient WRONG TWICE on 2 abdominal exams.

3. I Feel like my notes sucked.

4. Not all of my patients provided a challenging question, which is scaring me. Maybe I didn't elicit a good enough history?

Overall, I'm pretty sure that I just failed. I can't believe it. Is it a real deal-breaker to fail?

I'm at the point where I'm just so tired of all of this. I'm towards the end of third year and I'm feeling like I don't want to be a doctor anymore. It's just too much!!

Did you pass? Pleaseeeeee say something! this wait is killing me!




Edit: Just realized you took your test in April... But let us know when you get the results....

 

[medrocks1]

.

 

[medrocks1]

Hey sorry you are going through the same pain I dealt with just few weeks back.
Yes I passed with significant improvement on both components, nothing close to borderline. That said, my ICE was a bit lower than my CIS since my CIS was literally off the charts near the top performance (no star though). Yes, the wait sucks and there is nothing you can do about it. The anxiety is painful, but always know if it is your first attempt, you can always shoot a second and literally everybody pass on the second attempt. That being said, looking at your errors, you are not going to fail period. The mistakes you made, if they are even considered to mistakes, are very minute and probably not going to affect too much. Especially the physical exam documentation, and the minutia details of the hpi are not considered to be important. Matter of fact they are probably barely worth any points since I had multiple friend forget the rest of the HPI except the main HPI and still pass with a comfortable margin. I heard physical exam and the physical exam documentation is worth very little compared to the differentials and the focused HPI about the ddx in mind.
Sympathy is also inherently subjective, you are never going to feel like you were sympathetic enough. I thought exactly the same but the fact that I was conscientious of it when I took it second time made my performance sympathetic. If you attempted to be somewhat humanistic, you will do fine on the CIS and I wouldn't worry about it.

I know its tough but try to relax. This reassurance you are going to receive from other people won't get you very far before the anxiety settles back in. The best thing to do is just relax and put your mind off to ease by doing something else - easier said than done, and something I am guilty of not doing. But the chances are, with almost a 99 percent guarantee if the mistakes are limited to the ones you've described above, you passed with a very comfortable margin.

Good luck and think about the next step in your career which is much more important - ERAS, match, and how to develop in to a good clinician in real life.

Thanks a lot! I know I am only looking for reassurance! but it helps a little when you are feeling like this. I've been trying to suppress and it is working, so I will wait for my results patiently! I'm happy for you!!!! I wish you the best. Thanks for answering my post! PD: can u edit your reply so my post won't show up anymore? Thanks!

 

[medrocks1]

Hey sorry you are going through the same pain I dealt with just few weeks back.
Yes I passed with significant improvement on both components, nothing close to borderline. That said, my ICE was a bit lower than my CIS since my CIS was literally off the charts near the top performance (no star though). Yes, the wait sucks and there is nothing you can do about it. The anxiety is painful, but always know if it is your first attempt, you can always shoot a second and literally everybody pass on the second attempt. That being said, looking at your errors, you are not going to fail period. The mistakes you made, if they are even considered to mistakes, are very minute and probably not going to affect too much. Especially the physical exam documentation, and the minutia details of the hpi are not considered to be important. Matter of fact they are probably barely worth any points since I had multiple friend forget the rest of the HPI except the main HPI and still pass with a comfortable margin. I heard physical exam and the physical exam documentation is worth very little compared to the differentials and the focused HPI about the ddx in mind.
Sympathy is also inherently subjective, you are never going to feel like you were sympathetic enough. I thought exactly the same but the fact that I was conscientious of it when I took it second time made my performance sympathetic. If you attempted to be somewhat humanistic, you will do fine on the CIS and I wouldn't worry about it.

I know its tough but try to relax. This reassurance you are going to receive from other people won't get you very far before the anxiety settles back in. The best thing to do is just relax and put your mind off to ease by doing something else - easier said than done, and something I am guilty of not doing. But the chances are, with almost a 99 percent guarantee if the mistakes are limited to the ones you've described above, you passed with a very comfortable margin.

Good luck and think about the next step in your career which is much more important - ERAS, match, and how to develop in to a good clinician in real life.

Hi, Please delete my quoted post in your previous post! pleaseeee Thanks!

 

[SierraMist14]

Well ladies and gents....I got my score report back and...


I PASSED!

All is well.

 

[ShenMeYiSi]

After waiting for 2.5mo, CS scores are in and mine look great! For prep, I went though FA 2x and Kaplan Core Cases once. Took a 3 day review course with a company (not kaplan) which included a mock test. I worked one-on-one with friends, family members and classmates over skype, which was helpful, and probably the secret to success. The more cases you practice, the better you get at the whole encounter/note process. My experience with a review course was great, especially because the mock test was so similar to the real test situation (timing, OSCE rooms, typing notes, etc). After each encounter, we got to spend time with the SPs and got individual feedback on our encounters as well as on the notes, and we were given pointers as to what to improve or where to focus our studying/practice in the time leading up to the real exam. I felt that solid prep for CK was what spear-headed me through a smooth prep for CS - once you are really good at your ddx and things you need to look for in the H&P, the rest of your prep is basically fine tuning, watching the clock/keeping things within the allotted time frame, and perfecting your note. Everyone is nervous on the day of the test, and it's especially evident in the first 1-3 encounters of the day, but in my experience, I got the hang of it quickly and the rest of my day went really smoothly.
Other things that helped me for the note: I had a script ready for myself to type the PEx (basically a template that I followed for all pts, and tweaked it every time to suit each pt encounter), I kind of have a format in my head as well for how a decent HPI should be written, so it flows like a story rather than seeming choppy. I tried to have the 3 ddx written up first before I moved on to write the H&P because I wanted my history to follow suit with what my ddx would be, so basically keeping the train of thought continuous. Being able to practice this time and time again before the test was helpful.
Good luck to everyone else awaiting results!

 

[Bronchiectasis]

Hey sorry you are going through the same pain I dealt with just few weeks back.
Yes I passed with significant improvement on both components, nothing close to borderline. That said, my ICE was a bit lower than my CIS since my CIS was literally off the charts near the top performance (no star though). Yes, the wait sucks and there is nothing you can do about it. The anxiety is painful, but always know if it is your first attempt, you can always shoot a second and literally everybody pass on the second attempt. That being said, looking at your errors, you are not going to fail period. The mistakes you made, if they are even considered to mistakes, are very minute and probably not going to affect too much. Especially the physical exam documentation, and the minutia details of the hpi are not considered to be important. Matter of fact they are probably barely worth any points since I had multiple friend forget the rest of the HPI except the main HPI and still pass with a comfortable margin. I heard physical exam and the physical exam documentation is worth very little compared to the differentials and the focused HPI about the ddx in mind.
Sympathy is also inherently subjective, you are never going to feel like you were sympathetic enough. I thought exactly the same but the fact that I was conscientious of it when I took it second time made my performance sympathetic. If you attempted to be somewhat humanistic, you will do fine on the CIS and I wouldn't worry about it.

I know its tough but try to relax. This reassurance you are going to receive from other people won't get you very far before the anxiety settles back in. The best thing to do is just relax and put your mind off to ease by doing something else - easier said than done, and something I am guilty of not doing. But the chances are, with almost a 99 percent guarantee if the mistakes are limited to the ones you've described above, you passed with a very comfortable margin.

And also, if I were you, I would erase the ddx you listed on this post since it could very well be case someone else may have on the real test.

Good luck and think about the next step in your career which is much more important - ERAS, match, and how to develop in to a good clinician in real life.

Hey don't know if your still helping people but I feel like I might be in the same shoes you were in the first time you took the exam. I didn't pull the footstools out on my 3 abdominal cases. I'm pretty sure I wasn't empathetic enough in a few cases, summarized wrongly on 2 cases and I didn't summarize at all on two cases. I felt like I awkwardly answered challenging questions at times (not to the satisfaction of SP). Not sure how much eye contact I made while I was writing on the blue sheet. Forgot to council on 2-3 cases. I would say maybe 3 sps actually seemed to like, 8 seemed neutral and 1 guy seemed like he didn't like me. I didn't do particularly great physicals, missed tests in my workup (tried to be conservative but as a result missed quite a few important tests). Missed multiple questions in probably all of my cases (some of them were extremely relevant to the chief complaint). I closed on all 12 cases but I felt as though at time I spent to much time explaining each ddx. Only used one open ended question at the beggining of each encounter. Forgot one ladies name on entry called her ma'am (had to look at sheet in room to get the name). Also didn't take a full OB/Gyn history on a case that definetly required it. So all in all I'm pretty sure I blew it. Not really sure why I made this post, I just felt like I could relate to your first experience and I wanted to vent. Waiting for results is straight up horrible.

 

[Da_1_2_N_V]

Hey don't know if your still helping people but I feel like I might be in the same shoes you were in the first time you took the exam. I didn't pull the footstools out on my 3 abdominal cases. I'm pretty sure I wasn't empathetic enough in a few cases, summarized wrongly on 2 cases and I didn't summarize at all on two cases. I felt like I awkwardly answered challenging questions at times (not to the satisfaction of SP). Not sure how much eye contact I made while I was writing on the blue sheet. Forgot to council on 2-3 cases. I would say maybe 3 sps actually seemed to like, 8 seemed neutral and 1 guy seemed like he didn't like me. I didn't do particularly great physicals, missed tests in my workup (tried to be conservative but as a result missed quite a few important tests). Missed multiple questions in probably all of my cases (some of them were extremely relevant to the chief complaint). I closed on all 12 cases but I felt as though at time I spent to much time explaining each ddx. Only used one open ended question at the beggining of each encounter. Forgot one ladies name on entry called her ma'am (had to look at sheet in room to get the name). Also didn't take a full OB/Gyn history on a case that definetly required it. So all in all I'm pretty sure I blew it. Not really sure why I made this post, I just felt like I could relate to your first experience and I wanted to vent. Waiting for results is straight up horrible.

Dude your not alone. I took cs in LA on June 25 and I made a ton of mistakes. I even did the lung auscultation wrong by listening to one lung first then listening to the other. I also hardly asked any questions related to the chief complaint.

I have been having nightmares and I wake up every morning with a nightmare I just had regarding the exam. Personally I don't know how I'm going to get through the next month and half without worrying about it. Just forget about it dude.

 

[Bronchiectasis]

Dude your not alone. I took cs in LA on June 25 and I made a ton of mistakes. I even did the lung auscultation wrong by listening to one lung first then listening to the other. I also hardly asked any questions related to the chief complaint.

I have been having nightmares and I wake up every morning with a nightmare I just had regarding the exam. Personally I don't know how I'm going to get through the next month and half without worrying about it. Just forget about it dude.

I totally understand how you feel. I'm here for you if you want to vent. I have the same thing, just wake up with a horrible sense of impending doom.

 

[Dactino]

Hey guys. I gave my exam may 28th and im trying not to think about it too much. But as much as im trying to push the anxiety away it keeps creeping back anyway i made some errors that are really haunting me.
-I made a patient walk even though she had pain in her ankle. I seriously dont know if that may have cost me the exam.
-I also made the stupid blunder of blurting out the childs name as the mothers name. Like got the two reversed. And the mom had to correct me that that was her daughters name not hers. I apologized but dont know if i did it profusely enough :/
- I messed up a diagnosis. I was thinking of a disease but wrote the name of another. I had only two diagnosis for that case. I think the first one was correct.
- for majority of the cases i had 2 D/Ds. For one case i had just one :/ my brain just froze!
- missed out a very imp diagnostic test in one of the cases
- forgot to councel a pt for alcohol.
- one pt was really rude and defensive and continued like that till the end. I also did the mistake of doing her HEENT exam with the otoscope light. Like i checked her pupils and all. She said why are u pointing that pointy thing at me. I apologized and just moved further back but still used it :/ It was just a habit i picked up doing a rotation with this doc in US. I didnt know it was wrong to do it with it.

What i did do:
Introduced my self to each pt and shook hands. Asked if it was ok if i wrote while i talked
Showed empathy whenever patient told me what was bothering them
Did good physical pertinent exams.
Talked to patients when i washing hands about their lives.
Told those who were in pain if there was anything i could do to make them more comfortable.
Closed every case except in one in which i had answered one question but in the process of answering another the annoucement happened and i just said sorry i have to answer this page. The patient though seemed to like me.
Summarized all cases and asked at the end if they had anymore concerns or questions.
Explained the work up and procedures in lay man terms

 

[DocDocResearch]

AMG; 3rd year. People around me said if I could speak English, I would breeze through this exam. I went through all the cases at the back of the FA book and just took it. After I took it, I felt so bad about it and think I might have failed it. Here are the mistakes I made:

ICE:
1. In one case, I was so nervous that the right diagnoses did not click to me. I got one non-primary diagnosis right for sure but not the other two.
2. In another case, again, I got one main diagnosis right, another one - acceptable and the last one - completely off. I should have not put it even.
3. In another case, I got the primary diagnosis wrong and the other two right.
4. Funduscope exam - wrong technique
5. Abdominal exam - did not have the patients fold up their legs
6. Accidentally wrote 'cystoscopy' instead of 'hysteroscopy'

CIS:
1. Did not counsel about sex/drug/smoking in most of the patients
2. Did not summarize HPI to all of the patients
3. Two cases where the patients addressed the concerns but did not feel like I addressed them sufficiently

SEP:
English is not my first language but I spoke fine. No worries.

What I did right
1. No conflict with the patients (some of them actually liked me)
2. Good introduction and closure (kept saying "anything else?" "any question?")
3. Washed my hands
4. Listened to heart and lung under the gown
5. Other cases were reasonably okay I think

I am so worried that I might fail this stupid exam. I underestimated this exam and now am regretting. Any thoughts?

 

[rotcod17]

I am made pretty much the same mistakes as you, including forgetting to ask A LOT of relevant HPI questions and not documenting well due to time pressure. This makes me feel like I completely messed up the ICE portion Is it an automatic fail based on these mistakes?

 

[DocDocResearch]

I am made pretty much the same mistakes as you, including forgetting to ask A LOT of relevant HPI questions and not documenting well due to time pressure. This makes me feel like I completely messed up the ICE portion Is it an automatic fail based on these mistakes?

Hopefully not, dude. Seriously, I don't know why I took this exam so early. It's been about 2 weeks I took this exam, and hell with it. If I failed it, then I failed it. Nothing I can change. Hopefully I can register fast, retake it with flying stars and show that I am competent. This is really a stupid exam and I regret breezing through. I just hope 1) my worst encounters are the experimental cases; 2) the graders are VERY lenient with my thought process and 3) the cases are averaged.

 

[rotcod17]

Hopefully not, dude. Seriously, I don't know why I took this exam so early. It's been about 2 weeks I took this exam, and hell with it. If I failed it, then I failed it. Nothing I can change. Hopefully I can register fast, retake it with flying stars and show that I am competent. This is really a stupid exam and I regret breezing through. I just hope 1) my worst encounters are the experimental cases; 2) the graders are VERY lenient with my thought process and 3) the cases are averaged.

I hope so too! It sucks to not know which cases will be dropped.
ugh 3 whole months of stress...and realizing a new mistake each day is pure torture..I took it just a few days ago so it's still always on my mind. Hopefully I will be able to put it behind me in the next 2 weeks.

 

[redcharger2904]

AMG; 3rd year. People around me said if I could speak English, I would breeze through this exam. I went through all the cases at the back of the FA book and just took it. After I took it, I felt so bad about it and think I might have failed it. Here are the mistakes I made:

ICE:
1. In one case, I was so nervous that the right diagnoses did not click to me. I got one non-primary diagnosis right for sure but not the other two.
2. In another case, again, I got one main diagnosis right, another one - acceptable and the last one - completely off. I should have not put it even.
3. In another case, I got the primary diagnosis wrong and the other two right.
4. Funduscope exam - wrong technique
5. Abdominal exam - did not have the patients fold up their legs
6. Accidentally wrote 'cystoscopy' instead of 'hysteroscopy'

CIS:
1. Did not counsel about sex/drug/smoking in most of the patients
2. Did not summarize HPI to all of the patients
3. Two cases where the patients addressed the concerns but did not feel like I addressed them sufficiently

SEP:
English is not my first language but I spoke fine. No worries.

What I did right
1. No conflict with the patients (some of them actually liked me)
2. Good introduction and closure (kept saying "anything else?" "any question?")
3. Washed my hands
4. Listened to heart and lung under the gown
5. Other cases were reasonably okay I think

I am so worried that I might fail this stupid exam. I underestimated this exam and now am regretting. Any thoughts?

I'm waiting result too, and I did exam about a month ago. Worrying sick as well.
For ICE concerns:
I don't doing PE wrongly is a big deal. Getting wrong diagnosis in few cases does not equate to automatic failure I think, as DDx is only part of ICE. As long as you provide good evidence support, you should at least get some points
For CIS:
Though recommended, I heard summarizing HPI is not on checklist anymore. I only did so in a few patients. I saw people who didn't do at all still passed comfortably.
I did more mistakes than you
ICE:
1. Didn't complete note in 2. One was missing entire SH, the other incomplete ROS(Wrote "Negative exc")
2. Felt time constrained. Can't ensure quality of my note. Tried my best but might still missed something(I'm sure I forgot to write some maneuvers I did)
3. Skipped some maneuvers in order to save time for closure. Skipped CV&lung in one for neuro.
4. Didn't get some brand names of drugs. I probably just didn't write them in note.
5. Sure I Screwed DDX in 2-3 cases. Wrote lumbar disc hernia as #1 in someone with negative straight leg. Wrote chronic gastritis #1 in someone with lower abdomen pain(though she had diffuse pain in PE). What brain farts.
6. Didn't write any negatives in DDx section.
CIS:
1. Didn't finish closure in 4. Always started though. I mostly missed the challenging question part, or didn't complete answering. I do ask about concerns sometimes when washing hands before PE.
2. I asked a chest pain pt lying down for abdominal exam even though I knew from hx his pain worsens by lying down. He was unwilling at first. I still asked him to do so. As soon as he lay down, he screamed. I tried to help him get up, in the meantime I readjusted the bed, but didn't do properly and the bed moved fast. I probably slammed the patient on back. I apologized. The pt said thank you somehow when I left the room.
3. Didn't offer water for thyroid exam.
4. In one case was so nervous and I dropped clipboard and pen, then stethoscope. Looked so goofy
5. I washed hand in strange timing for no reason in one case.
6. One lady when I was asking ROS, she seemed annoyed and said" are these question relevant?" I said I'm doing quick ROS to have better idea.
7. Had pause between conversation in one case.
8. Not sure if I answered questions properly
9. Tried to do funduscopuc exam in a photophobia pt. I did imply there's light, and I stopped doing as soon as she said it bothers her, with apology.
10. Missed counseling ibuprofen for a suspected ulcer, but counseled something else for that one. Remember 1-2 I didn't find anything to counsel.
11. Might forgot foot step once when asking pt to step off the bed.
12. Did abdominal exam by 2-hand. Wasn't forceful, didn't repeat. ( I saw on sample video she did once with 2-hands)
13. A back pain pt when I checked ROM, and she had pain in all directions(This means 6 times!) not sure if this is considered repeating painful maneuver.
What I did right:
1. Always knock, introduce myself and call pt by name. Always shook hands in beginning, always asked if they're comfortable in room. Always be as pleasant as possible in beginning.
2. Asked to offer water and tissues in cough patients.
3. Tried to be empathetic. Always said"I'm sorry xxx is bothering you"
4. Turned light off in photophobia case(It was HA case and I asked her if light bothers her at first)
5. Always washed hands by sanitizer before PE. Always waited until hands dry. Did counseling when waiting.
6. Pulled leg rest when pt lay down. Might forgot one but remedied in middle.
7. Always be ready to help them sit up. (Most patients sat up by themselves but I always stood aside as I'm ready to help them anytime)

Sorry for long post.

UPDATEASS

 

[yrmd]

I honestly don't know how I'm going to wait 2-3 months for the scores to come out. I did so many mistakes and I'm so scared. I remember a new mistake everyday and just start getting depressed all over again. Can someone please give me some feedback? Without sharing what I shouldn't here is what I did wrong

1) first case ended before I finished closure and before I could ask if pt had any questions I was just starting to say what I think the diagnosis is and pt didn't look so happy before I left. Pt note I think was ok for that one and differential was ok too

2) ok but I think I was confused about my DDx and which to put as primary

3)good

4) forgot to counsel but closed and primary differential was ok but secondary and tertiary idk honestly
now here is what I'm scared of on this one and please don't ask me why I decided to be dumb and imagine that this patient had a heart murmur so I included that in my PE in pt note!!! What was I thinking??? He probably didn't even have a murmur

5)forgot a very important PE and probably had the wrong order for DDx..
And did neuro exam but forgot if I did sensation but included it in my note!!

6) weirdest case ever. Also maybe wrong order for DDx and i reported X lbs weight loss in my note even though I could not for the life of me remember the exact number of lbs but was almost sure it was X so I hope they don't take that as lying if it wasn't that!!!!

7) forgot to counsel about something

8) THIS one I'm really scared of because I put the wrong physical exam finding next to my primary diagnosis. so basically that finding was NOT for that diagnosis it actually would be positive for another diagnosis (MY SECOND ONE) for example it would be like Murphys positive for pancreatitis(primary) and cholecystitis was my second. It was by mistake!!!!! what is that going to cost me?! Also pt looked unhappy

9) Missed a very clear DDx. And didn't have time to ask pt if she had any questions

10) put a symptom as my primary diagnosis like anxiety for example

11) good

12) did not completely counsel and when my time was up I practically yelled out to pt to avoid doing something and left, no nice to meet you no thank yous. What's wrong with me.

Other things I forgot : I forgot the foot rest or leg rest on ALL abdominal exam patients. No ones feet were hanging so I didn't even notice.
Forgot some pretty important PE in 3 cases.
Probably messed up DDx in 4 cases maybe more
Didn't counsel in 2 cases

Things I did
Introduced myself shook hands was very friendly helped with gown,comforted pt, summarized in all, answered challenging questions, wore gloves in all, pt notes were ok other than dumb mistakes above, especially the part where I put a completely off physical finding for one primary diagnosis

Sorry it's a long post!! Please any advice or input would really help me.

 

[yrmd]

Anyone? Any opinion about my mistakes please? I have no one to talk to about this and I can't even get my self to study for 5 minutes without worrying and thinking about my mistakes. It's been a week now.. does this get better ?

 

[redcharger2904]

I passe

 

[yrmd]

I passe

Congratulations !!!

 

[DocDocResearch]

I'm waiting result too, and I did exam about a month ago. Worrying sick as well.
For ICE concerns:
I don't doing PE wrongly is a big deal. Getting wrong diagnosis in few cases does not equate to automatic failure I think, as DDx is only part of ICE. As long as you provide good evidence support, you should at least get some points
For CIS:
Though recommended, I heard summarizing HPI is not on checklist anymore. I only did so in a few patients. I saw people who didn't do at all still passed comfortably.
I did more mistakes than you
ICE:
1. Didn't complete note in 2. One was missing entire SH, the other incomplete ROS(Wrote "Negative exc")
2. Felt time constrained. Can't ensure quality of my note. Tried my best but might still missed something(I'm sure I forgot to write some maneuvers I did)
3. Skipped some maneuvers in order to save time for closure. Skipped CV&lung in one for neuro.
4. Didn't get some brand names of drugs. I probably just didn't write them in note.
5. Sure I Screwed DDX in 2-3 cases. Wrote lumbar disc hernia as #1 in someone with negative straight leg. Wrote chronic gastritis #1 in someone with lower abdomen pain(though she had diffuse pain in PE). What brain farts.
6. Didn't write any negatives in DDx section.
CIS:
1. Didn't finish closure in 4. Always started though. I mostly missed the challenging question part, or didn't complete answering. I do ask about concerns sometimes when washing hands before PE.
2. I asked a chest pain pt lying down for abdominal exam even though I knew from hx his pain worsens by lying down. He was unwilling at first. I still asked him to do so. As soon as he lay down, he screamed. I tried to help him get up, in the meantime I readjusted the bed, but didn't do properly and the bed moved fast. I probably slammed the patient on back. I apologized. The pt said thank you somehow when I left the room.
3. Didn't offer water for thyroid exam.
4. In one case was so nervous and I dropped clipboard and pen, then stethoscope. Looked so goofy
5. I washed hand in strange timing for no reason in one case.
6. One lady when I was asking ROS, she seemed annoyed and said" are these question relevant?" I said I'm doing quick ROS to have better idea.
7. Had pause between conversation in one case.
8. Not sure if I answered questions properly
9. Tried to do funduscopuc exam in a photophobia pt. I did imply there's light, and I stopped doing as soon as she said it bothers her, with apology.
10. Missed counseling ibuprofen for a suspected ulcer, but counseled something else for that one. Remember 1-2 I didn't find anything to counsel.
11. Might forgot foot step once when asking pt to step off the bed.
12. Did abdominal exam by 2-hand. Wasn't forceful, didn't repeat. ( I saw on sample video she did once with 2-hands)
13. A back pain pt when I checked ROM, and she had pain in all directions(This means 6 times!) not sure if this is considered repeating painful maneuver.
What I did right:
1. Always knock, introduce myself and call pt by name. Always shook hands in beginning, always asked if they're comfortable in room. Always be as pleasant as possible in beginning.
2. Asked to offer water and tissues in cough patients.
3. Tried to be empathetic. Always said"I'm sorry xxx is bothering you"
4. Turned light off in photophobia case(It was HA case and I asked her if light bothers her at first)
5. Always washed hands by sanitizer before PE. Always waited until hands dry. Did counseling when waiting.
6. Pulled leg rest when pt lay down. Might forgot one but remedied in middle.
7. Always be ready to help them sit up. (Most patients sat up by themselves but I always stood aside as I'm ready to help them anytime)

Sorry for long post.

UPDATEASS

Did you pass comfortably? Congrats!!!!!

 

[redcharger2904]

Did you pass comfortably? Congrats!!!!!

Passed, but borderline ICE. I was most concerned about CIS, turned out it was nothing within borderline

 

[DocDocResearch]

Hi! Sorry for not following up on the result. It turns out I did an amazing job in the test! For those of you who are concerned about not passing the test, let me assure you, 99% of the cases you passed - nobody cares about how well you performed, trust me. I got matched at my #1 program and am doing well. Congratulations to those who passed!