I retook CS...

[moosepatrol77]

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Passed. US grad. Previous Step 1 and 2CK >240. Studied 1 wk for the first time. I hadn't seen patients for 5 mo prior to the test. I thought I had a similar experience to everyone else taking this test for the first time compared to the forums. I was livid when I found out I failed.



Observations

1. Los Angeles testing center people were much, much nicer than the Houston staff. I would definitely take it in LA again compared to Houston. Patients seemed less educated and poorer at Houston in general.

2. Patient cases were mildly different. What's common and on first aid will be on the test.

3. Data collection was my issue the first time. It reflected in both the physician assessment of my note as well as the sim-patient grading.

4. PAM HUGS FOSS seemed to get me a pass. Did a Cards, Lung, and Abdomen exam on pretty much everyone, plus any pertinent other exam.



5. CS is a big crock of crap that didn't really test any of my abilities. I'm pissed I lost $1000 just to learn PAM HUGS FOSS.

 

[Law2Doc]

...
4. PAM HUGS FOSS seemed to get me a pass. Did a Cards, Lung, and Abdomen exam on pretty much everyone, plus any pertinent other exam.
...

Over-reliance on mnemonics is actually a common reason people fail IMHO. You really have to treat it as a normal patient encounter, not a test of substantive material. Get away from looking at this as something you need to memorize things for, and look at it as being a clinician. Ask lots of questions -- especially the where does it hurt, describe the pain, when did it start, does it radiate, anything make it better or worse variety. Do the niceties like eye contact, handwashing and draping and not repeating painful maneuvers, use the patient's name and show some empathy when appropriate. Tell smokers to stop smoking, tell drinkers to stop drinking. Ask before you untie anything and talk your way through the exam so the SP knows what you are doing. Do a little counseling -- tell them what you think is wrong and what tests you need to get to confirm. And then write up a soap note with a few ddx and tests. Really the exact same thing you should be doing in any family med, community med or ED rotation. If you overthink this thing and try to memorize mnemonics you are going to come off wooden. This should flow like a regular conversation/patient encounter, not come off stiff like you are playing "check the box".

 

[moosepatrol77]

Over-reliance on mnemonics is actually a common reason people fail IMHO. You really have to treat it as a normal patient encounter, not a test of substantive material. Get away from looking at this as something you need to memorize things for, and look at it as being a clinician. Ask lots of questions -- especially the where does it hurt, describe the pain, when did it start, does it radiate, anything make it better or worse variety. Do the niceties like eye contact, handwashing and draping and not repeating painful maneuvers, use the patient's name and show some empathy when appropriate. Tell smokers to stop smoking, tell drinkers to stop drinking. Ask before you untie anything and talk your way through the exam so the SP knows what you are doing. Do a little counseling -- tell them what you think is wrong and what tests you need to get to confirm. And then write up a soap note with a few ddx and tests. Really the exact same thing you should be doing in any family med, community med or ED rotation. If you overthink this thing and try to memorize mnemonics you are going to come off wooden. This should flow like a regular conversation/patient encounter, not come off stiff like you are playing "check the box".

Unfortunately it's not like a real patient encounter. It seemed like I just didn't get enough boxes checked the first time around. You have to pump the 'patient' for responses that a normal patient would give you as a story. The sim-patient giving just simple 'yes' or 'no' answers was one of the most off-putting parts of the exam. Sure the information is there, but you don't have the chance to connect with the person. You are taking an exam and that's what it boils down to for both parties. Get enough boxes checked and you win the game.

 

[Law2Doc]

Unfortunately it's not like a real patient encounter. It seemed like I just didn't get enough boxes checked the first time around. You have to pump the 'patient' for responses that a normal patient would give you as a story. The sim-patient giving just simple 'yes' or 'no' answers was one of the most off-putting parts of the exam. Sure the information is there, but you don't have the chance to connect with the person. You are taking an exam and that's what it boils down to for both parties. Get enough boxes checked and you win the game.

I actually found the SPs to be varied and to be quite similar to the normal patient in terms of being difficult to provide a good cogent history. Some rambled and ate up your time, some didn't offer more than a few words to each question. Some were very upfront with the black letter disease symptoms. If you haven't had real patients who only give you yes/no answers and are hard to connect with, I suggest you haven't seen enough real patients in clinic settings. Some days they are ALL like that. You are in a rush to get through the list to get ot lunch, and they don't want to give you a quick response. Seriously, if you treat it like a real life experience rather than a check the box mnemonic, you do fine. Playing it like a game and you come off wooden and maybe don't.

 

[moosepatrol77]

I actually found the SPs to be varied and to be quite similar to the normal patient in terms of being difficult to provide a good cogent history. Some rambled and ate up your time, some didn't offer more than a few words to each question. Some were very upfront with the black letter disease symptoms. If you haven't had real patients who only give you yes/no answers and are hard to connect with, I suggest you haven't seen enough real patients in clinic settings. Some days they are ALL like that. You are in a rush to get through the list to get ot lunch, and they don't want to give you a quick response. Seriously, if you treat it like a real life experience rather than a check the box mnemonic, you do fine. Playing it like a game and you come off wooden and maybe don't.

I think the quality of patient may vary from center to center. I felt like LA had some better quality actors. I didn't really have any that rambled, it was fairly cut and dry in most circumstances. Of course there are real patients that are harder to connect with, but I don't believe that represents the majority of patients. There isn't a checkbox for "genuiness" on the test. If you follow the highlighted areas in the testing book closely, I think it becomes a less ambiguous, and beatable game.

 

[Law2Doc]

... Of course there are real patients that are harder to connect with, but I don't believe that represents the majority of patients. ...

I think we are just going to have to agree to disagree on this point.

 

[Scottish Chap]

Over-reliance on mnemonics is actually a common reason people fail IMHO. You really have to treat it as a normal patient encounter, not a test of substantive material. Get away from looking at this as something you need to memorize things for, and look at it as being a clinician. Ask lots of questions -- especially the where does it hurt, describe the pain, when did it start, does it radiate, anything make it better or worse variety. Do the niceties like eye contact, handwashing and draping and not repeating painful maneuvers, use the patient's name and show some empathy when appropriate. Tell smokers to stop smoking, tell drinkers to stop drinking. Ask before you untie anything and talk your way through the exam so the SP knows what you are doing. Do a little counseling -- tell them what you think is wrong and what tests you need to get to confirm. And then write up a soap note with a few ddx and tests. Really the exact same thing you should be doing in any family med, community med or ED rotation. If you overthink this thing and try to memorize mnemonics you are going to come off wooden. This should flow like a regular conversation/patient encounter, not come off stiff like you are playing "check the box".

Completely agree with this. Stay away from mnemonics, folks. CS tests your ability to think and act sensibly rather than your ability to memorize. It's pretty much what I did to get a passing score first time. I also felt that some of the test patients simulated real patients well (some yes/no, some aggressive, some passive), and I have never been a fan of standardized patients, so it takes a lot for me to admit that about CS. I had just finished a busy one-month outpatient block, though, so it was a comfortable exercise when I took the test.

 

[Samoa]

Frankly, I don't think there's any one thing you should or shouldn't do to study. For every person who says that reliance on mnemonics helped them, there's another who felt that it impeded their performance. And for every person who felt that treating it like a normal patient encounter is the right approach, there's another who felt that was the reason they failed.

All these people are good clinicians in a real patient encounter. Meanwhile people I know who are atrocious clinicians in real life pass with no problems.

IMHO, the need to have some people fail the test is the reason people fail it, not anything inherently wrong with the skills or habits the people taking it.

 

[Law2Doc]

...
IMHO, the need to have some people fail the test is the reason people fail it, not anything inherently wrong with the skills or habits the people taking it.

That's probably true to some extent but since most people pass and it's a small minority who don't, I still think what the folks who pass all three sections tend to have in common is a bit more polish in terms of dialoguing with patients. Being difficult to understand in english is a hurdle for folks. Not giving the SP a feeling that they are being seen by a real doctor who cares about their health (whether sincere or well faked) also makes a difference. The SPs really do seem to respond to you treating them as if they were the real deal, and certainly you need to do the nicities like handwashing and draping to pass this sucker. The folks running through mnemonics in their heads all too often won't come off polished -- they will come off wooden -- trying to remember things throughout the history and all too often won't come off as conversational -- and in actuality the showmanship is everything here IMHO.

You don't have to BE competent, you have to SEEM competent. I think you'd be better off with huge knowledge gaps (without the mnemonics) but make the SP think you were confidently treating them just like a real life patient. This test is not really about medical knowledge -- the CK is for that. This is to show how you are as a clinician -- it's mostly a test on form, not substance. Which I think is what infuriates med students -- you can't study for it so much you can only learn it by developing a style while practicing.

 

[Nuriko]

Passed. US grad. Previous Step 1 and 2CK >240. Studied 1 wk for the first time. I hadn't seen patients for 5 mo prior to the test. I thought I had a similar experience to everyone else taking this test for the first time compared to the forums. I was livid when I found out I failed.



Observations

1. Los Angeles testing center people were much, much nicer than the Houston staff. I would definitely take it in LA again compared to Houston. Patients seemed less educated and poorer at Houston in general.

2. Patient cases were mildly different. What's common and on first aid will be on the test.

3. Data collection was my issue the first time. It reflected in both the physician assessment of my note as well as the sim-patient grading.

4. PAM HUGS FOSS seemed to get me a pass. Did a Cards, Lung, and Abdomen exam on pretty much everyone, plus any pertinent other exam.



5. CS is a big crock of crap that didn't really test any of my abilities. I'm pissed I lost $1000 just to learn PAM HUGS FOSS.

Amen to number 5. I failed, and will have to blow another $1100 just to get my license. I honestly have no idea what I could do differently next time. I dont see how I did anything SO poorly that I couldnt even meet a bare minimum criteria to pass. This is BS. 😡

 

[Medstudentquest]

That's probably true to some extent but since most people pass and it's a small minority who don't, I still think what the folks who pass all three sections tend to have in common is a bit more polish in terms of dialoguing with patients. Being difficult to understand in english is a hurdle for folks. Not giving the SP a feeling that they are being seen by a real doctor who cares about their health (whether sincere or well faked) also makes a difference. The SPs really do seem to respond to you treating them as if they were the real deal, and certainly you need to do the nicities like handwashing and draping to pass this sucker. The folks running through mnemonics in their heads all too often won't come off polished -- they will come off wooden -- trying to remember things throughout the history and all too often won't come off as conversational -- and in actuality the showmanship is everything here IMHO.

You don't have to BE competent, you have to SEEM competent. I think you'd be better off with huge knowledge gaps (without the mnemonics) but make the SP think you were confidently treating them just like a real life patient. This test is not really about medical knowledge -- the CK is for that. This is to show how you are as a clinician -- it's mostly a test on form, not substance. Which I think is what infuriates med students -- you can't study for it so much you can only learn it by developing a style while practicing.

Now I am getting scared about passing this thing. I didn't do the mnemonics, but I did forget some things here and there. Also I draped all the patients. Does it matter if you draped them initially or before the physical exam?

In FA, it said to drape them right at the beginning, but it seemed a very odd thing to do. I did this for a few patients, but overall it seemed too odd. I draped all patients before the start of the physical exam though.

If you forget to ask something, do they take points off for that? And how do the patients grade you as far as doing the exam correctly? i mean they are not clinicians, so how do they know if it's correct or not?

Is there a way to get the results sooner?

 

[Law2Doc]

Now I am getting scared about passing this thing. I didn't do the mnemonics, but I did forget some things here and there. Also I draped all the patients. Does it matter if you draped them initially or before the physical exam?

In FA, it said to drape them right at the beginning, but it seemed a very odd thing to do. I did this for a few patients, but overall it seemed too odd. I draped all patients before the start of the physical exam though.

If you forget to ask something, do they take points off for that? And how do the patients grade you as far as doing the exam correctly? i mean they are not clinicians, so how do they know if it's correct or not?

Is there a way to get the results sooner?

draping at the beginning still counts. You reportedly get the points so long as they got draped during the exam. the SPs likely have lists of things you ought to be doin/exploring during the encounter. but they arent physicians, so doing things "right" is probably less important than letting them know what you are doing.

 

[Medstudentquest]

draping at the beginning still counts. You reportedly get the points so long as they got draped during the exam. the SPs likely have lists of things you ought to be doin/exploring during the encounter. but they arent physicians, so doing things "right" is probably less important than letting them know what you are doing.

Well I didn't do it at the beginning for all, some I did it prior to beginning the PE. I thought coming in and say, hi, I'm MSQ. Here let me drape you, was kind of odd. So I changed it up and just draped them prior to the PE for some. Also I didn't say I'm testing for x or y most times, since they said not state things in medical terms. For example I said I'd like to listen to your lungs or do a heart exam something like that.

Were we supposed to say, oh I'm testing for example, for splenomegaly or something of the sort? Wouldn't that be considered medical jargon?

 

[Law2Doc]

...
Were we supposed to say, oh I'm testing for example, for splenomegaly or something of the sort? Wouldn't that be considered medical jargon?

I'd say -- "I'm just going to tap your belly to make sure your liver/spleen are the right size. Yes they seem fine". Just like you might to with a real patient who isn't expected to know medical terms.

 

[Medstudentquest]

I'd say -- "I'm just going to tap your belly to make sure your liver/spleen are the right size. Yes they seem fine". Just like you might to with a real patient who isn't expected to know medical terms.

So if I didn't do that, will I lose points? I just told patients general things. I'd like to do a heart exam or I'd like to listen to your lungs, or I'm going to check your strength, things like that. I talked to them during each physical exam part-i.e., I'd like to examine X and Y, etc. and asked them to do this and that maneuver. I didn't necessarily go into full detail of why, especially for the more complex maneuvers. Is that incorrect?

 

[Antoni B]

MSQ, I hate to be blunt, but why don't you wait to see whether you passed before freaking out? People do fail, as witnessed by this thread and others, but they're 3-4% of the US med student population. It sounds like you were conscientious as you took the exam, which means you more than likely passed.

There's no sense in crying over milk that you don't even know whether you spilled or not.

 

[Medstudentquest]

MSQ, I hate to be blunt, but why don't you wait to see whether you passed before freaking out? People do fail, as witnessed by this thread and others, but they're 3-4% of the US med student population. It sounds like you were conscientious as you took the exam, which means you more than likely passed.

There's no sense in crying over milk that you don't even know whether you spilled or not.

Antoni,

We've discussed this before. 🙂 I am an anxious test taker! Waiting until June to get the results seems excessive. I'm also studying for CK, but I keep worrying about whether I passed CS, so it's making concentrating difficult. I guess that's why I keep asking questions. 🙁 I worry about stupid mistakes that I may have made and I keep wondering which cases they will score and which they won't. As time went by, I think I progressively did better and became more comfortable with the whole situation.

 

[Law2Doc]

So if I didn't do that, will I lose points? I just told patients general things. I'd like to do a heart exam or I'd like to listen to your lungs, or I'm going to check your strength, things like that. I talked to them during each physical exam part-i.e., I'd like to examine X and Y, etc. and asked them to do this and that maneuver. I didn't necessarily go into full detail of why, especially for the more complex maneuvers. Is that incorrect?

Again, they are going to give you points for doing what they have been told are the appropriate aspects of a targeted exam for the particular ailment. But they aren't physicians so you never know how much they know. So to be safe, the more you tell them about what you are doing, the easier it is for them to give you points for doing what they have on their checklist. If they think you are supposed to check their spleen and you tell them you are checking their spleen, they give you the points. If you don't tell them, maybe they know what you are doing, maybe they don't. So the goal, IMHO is to make it idiotproof. Because you really don't know what they know. that being said you may have still gotten points by doing a passable exam, and you are absolutely allowed to make a handful of mistakes throughout the day and still pass. So wait for the score before stressing.

 

[Medstudentquest]

Again, they are going to give you points for doing what they have been told are the appropriate aspects of a targeted exam for the particular ailment. But they aren't physicians so you never know how much they know. So to be safe, the more you tell them about what you are doing, the easier it is for them to give you points for doing what they have on their checklist. If they think you are supposed to check their spleen and you tell them you are checking their spleen, they give you the points. If you don't tell them, maybe they know what you are doing, maybe they don't. So the goal, IMHO is to make it idiotproof. Because you really don't know what they know. that being said you may have still gotten points by doing a passable exam, and you are absolutely allowed to make a handful of mistakes throughout the day and still pass. So wait for the score before stressing.

May? I honestly hope it's not just a "may" have gotten points. 🙁 I had no idea that we were supposed to tell them what we were testing for other than basic info, like i'm going to check your ears or something. I am assuming that they have an idea of what we are supposed to be testing for. so if someone has a certain complaint, and you say well i'm going to check your lungs and they have cough or chest pain or something, they should check it off their list.

by "handful of mistakes", do you mean that we are allowed to make very few mistakes? i wonder how many questions/check lists we are supposed to get right and what the criteria for the PN is.

also i read that they combine the scores and that 2 of the encounters are not graded. is there any way to know which ones are not graded?

 

[Law2Doc]

May? I honestly hope it's not just a "may" have gotten points. 🙁 I had no idea that we were supposed to tell them what we were testing for other than basic info, like i'm going to check your ears or something. I am assuming that they have an idea of what we are supposed to be testing for. so if someone has a certain complaint, and you say well i'm going to check your lungs and they have cough or chest pain or something, they should check it off their list.

by "handful of mistakes", do you mean that we are allowed to make very few mistakes? i wonder how many questions/check lists we are supposed to get right and what the criteria for the PN is.

also i read that they combine the scores and that 2 of the encounters are not graded. is there any way to know which ones are not graded?

There is no way to know which of the encounters is not graded -- treat them all the same.

Nobody knows how many mistakes you can make and still pass, but I know of nobody who passed who didn't feel they made a number of mistakes on a number of encounters.

You really need to chill out. If my use of the word "may" is stressing you out you are going to give yourself an ulcer when the real stresses in life happen. You can assume the SPs know what a good exam looks like, and you are probably right. I personally prefer not to assume anything of these actors (with no medical training), and so I told them exactly what I was doing.

 

[Antoni B]

Nobody knows how many mistakes you can make and still pass, but I know of nobody who passed who didn't feel they made a number of mistakes on a number of encounters.

MSQ,

I have the distinct feeling that no amount of reassurance is going to make you stop fretting, but on the off chance that I'm wrong, Law2Doc is absolutely right here. I remember doing a whole bunch of stupid stuff. On at least one encounter, I forgot to ask about medications when it was really important that I do so. I forgot to ask a teenager about drug use. I missed a couple of family histories. I know of at least one physical exam maneuver that I realized I should have done after the fact. I ran out of time on two cases. I forgot to wear gloves/wash hands on one case. And that's just what I can remember three months out. But yet, I passed and I really wasn't all that worried about it because my three classmates who took it with me the same day had made just as many dumb mistakes. There was no way that all of us were going to fail, especially since we go to a "top 25" med school.

So move on; if this is keeping you from concentrating on CK studying, may I suggest that you go get yourself a benzo prescription? I'm being serious.

 

[Medstudentquest]

MSQ,

I have the distinct feeling that no amount of reassurance is going to make you stop fretting, but on the off chance that I'm wrong, Law2Doc is absolutely right here. I remember doing a whole bunch of stupid stuff. On at least one encounter, I forgot to ask about medications when it was really important that I do so. I forgot to ask a teenager about drug use. I missed a couple of family histories. I know of at least one physical exam maneuver that I realized I should have done after the fact. I ran out of time on two cases. I forgot to wear gloves/wash hands on one case. And that's just what I can remember three months out. But yet, I passed and I really wasn't all that worried about it because my three classmates who took it with me the same day had made just as many dumb mistakes. There was no way that all of us were going to fail, especially since we go to a "top 25" med school.

So move on; if this is keeping you from concentrating on CK studying, may I suggest that you go get yourself a benzo prescription? I'm being serious.

Antoni,

You are right. No amount of reassurance is really going to help me feel that i passed until I actually get my grade. I guess I feel this way because I feel all of the things that have happened lately were unfortunate and I felt like the exception to everything-i.e.: most med students match, most AMG's do this or that, and I felt like I was the miniscule % who was left out in the cold. So I am worried that I'll be in the 3% who doesn't pass this thing, but I am hoping not.

Again you are right. I should try to move on and concentrate on CK. I had a pretty productive study day today and I should really stop looking at the Step 2 CS posts. It's not like I'm going to know who graded what and which encounters were graded or not and what the SP's thought or not.

Thanks.

 

[civic4982]

you're right. this is a valueless test and is really a shakedown.

they fail people so that they can legitimize this as an examination.

the accreditation folks should rely on the fact that if you're trained here in the US in a accredited residency program that when you're out practicing you will have these skillsets.

although I don't see a future where these faux skills based exams will dissappear for us I hope someone pisses in whatever guy or gal's cereal that came up with this idea to make tens of millions extra in revenue for the NBME powers that be. these jackasses clear 16 million USD just from the estimated 16K US seniors that graduate yearly. That doesn't include all the IMGs struggling to perhaps pay multiple times to pass this exam.

As the different fees and costs of medicine slowly come to light now that I'm finishing my time as a student and progressing to becoming a resident I see how much of a fleecing the supporting community in medicine truly is.

when all of you someday are on a committee of some sort as you'll eventually become the leaders of medicine. make sure you start shutting down these unnecessary licensing/ceritication/examination fees for things that do not add true value to our profession. cut the fat.

oh and congrats to the OP. now mail them a photo of you giving them the finger 😉

 

[Law2Doc]

...
when all of you someday are on a committee of some sort as you'll eventually become the leaders of medicine. make sure you start shutting down these unnecessary licensing/ceritication/examination fees for things that do not add true value to our profession. cut the fat.
...

As with everything in life, I don't think it matters too much to folks once they get past it -- the incentive to shut down these things disappears once you've passed the test. In fact, you probably have the attitude most folks have that if I had to do it, the next generation should too (note that this attitude vs change still persists in older docs about the 80 hour work week). So no, once we get past this, I think it seems more like fair play than unnecessary to make the next generation of doctors have to go over the same silly hurdles too. I sure see no advantage to making things easier for the next generation. If anything once many of us are in, we like to raise the fences around us, not lower them. Rather than see them eliminate CS, I'd rather they worked harder to actually make it a test that actually tests the important stuff, like actually doing a physical exam correctly.

 

[funshine]

Rather than see them eliminate CS, I'd rather they worked harder to actually make it a test that actually tests the important stuff, like actually doing a physical exam correctly.

but that would make too much sense, wouldn't it?

 

[abbaroodle]

MSQ - I didnt really tell pts what I was doing. If I went to examine the abdomen, I asked a pt to lift up their gown for me and said I was going to look at and poke their belly a bit. I simply told them I was going to check reflexes, listen to their heart and lungs, examine at their hip, etc. I didnt tell them when I was checking CN II-XII or feeling their spleen or testing ROM in their hip.

Dont worry about draping - I think you got credit for "respectful draping." I tended to hand them the sheet when I sat down and said I was going to cover their legs to make them a little more comfy or to help them stay warmer or something. But I really dont think it mattered!

BTW - I am a worrier after the fact about exams! I understand!!! But try not to let it get to ya.

 

[winner123]

Completely agree with this. Stay away from mnemonics, folks. CS tests your ability to think and act sensibly rather than your ability to memorize. It's pretty much what I did to get a passing score first time. I also felt that some of the test patients simulated real patients well (some yes/no, some aggressive, some passive), and I have never been a fan of standardized patients, so it takes a lot for me to admit that about CS. I had just finished a busy one-month outpatient block, though, so it was a comfortable exercise when I took the test.

I completely agree with the above statement.
CS is about being with the patient .It is about addressing patient's concerns.It is about speaking slowly,loudly using simple words.
It is about extracting information about the chief complaint and associated symptoms.

 

[Law2Doc]

MSQ - I didnt really tell pts what I was doing. If I went to examine the abdomen, I asked a pt to lift up their gown for me and said I was going to look at and poke their belly a bit. I simply told them I was going to check reflexes, listen to their heart and lungs, examine at their hip, etc. I didnt tell them when I was checking CN II-XII or feeling their spleen or testing ROM in their hip. ....

I'm not saying you have to do this to get the points, but I am saying it's smart to do this. The goal when working with people who are actors, not doctors, should be to make it as easy as possible for them to give you the points. You don't know for sure that they know what a good exam looks like. Most likely they were herded into a room and shown a good exam once. So if you talk them through what you are doing, they are going to KNOW you did it. Doesn't mean you can't get 100% without doing this. With a lot of SPs you probably will. But why risk it IMHO.