Just found out I failed CIS on Step 2 CS

[medstudent234]

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I would love some advice. I am pretty upset, especially because I'm not sure what I did wrong or how to study for next time. I was always very nice and friendly with patients, asked about how they were feeling, sympathized and showed concern, communicated the differential diagnosis and plan, and asked if they had any questions. All of my evaluations in 3rd year specifically say that I had a great bedside manner!

I have always been told in the past that I have great patient interaction skills and am a good communicator so I am just at a loss. The dean of my med school just emailed me he was very surprised that I failed. I have excellent Step 1 and Step 2 CK scores, am a US senior, native English speaker, etc. Anyway, I was just wondering what students who failed this particular portion of the test changed for next time. Is it possible to get any more of an explanation from the USMLE on what my deficiencies were? I had read First Aid before the exam and practiced with family members and am terrified to fail again. Thanks so much!

 

[Patho_logical]

Sounds like you did most of the major stuff for the CIS portion...I believe that section includes calling the patient by name, giving your full name and title (med student/dr whichever) as well as showing sympathy, asking if they understand/have any questions/concerns. I believe the counseling the patient at the end of the encounter falls into this section as well. Using gloves or washing hands I think is part of this too. Sounds like you did most of that....sorry that you failed. This test is WAY too subjective and i've read so many posts about great students failing. I just passed on my second attempt. But I had trouble with the ICE portion. Wish I could help more. Good luck!

 

[buonassezia]

Hey! I just got my score back and got surprisingly lower performance in the CIS area than usual or expected, and wanted to share my thoughts/reflections in case they are helpful. It does sound like you did the majority of things right, and I think you and I likely both had deficiencies at the end of the encounters, which are likely given very heavy weight in the scoring.

(Copied from my other post):

"I did receive borderline CIS score breakdown on the exam, although this has always been an area in which I have excelled in school OSCEs and patient interactions. I also thought I hit the interpersonal skills out of the park during the exam day, and left the test worrying that I had failed in terms of ICE score. (I thought I spent too much time empathizing with the patient and not figuring out accurately what was going on with them). I promise, I'm not one of those cold or clueless, non-empathic people who nonetheless thinks they're fine. I tend to have an intuitive and inherently warm and nurturing personality, and this domain is (usually) truly my main strength. I am much more frequently told I'm "too nice" and I really 1. would be a great Pediatrician, and/or 2. Should just be brusque and get on with the businessy tasks of medicine rather than spending time on patient reassurance and communication. No joke.

In my preparation, I practiced and practiced greetings, empathic phrases, challenge question responses, summarizing, briefly guiding patients through the physical exam, appropriate draping and asking permission, and hand washing; I replicated these habits on test day.

As I tended to run out of time on encounters, I likely did not answer allay all of the patients' concerns at the end of the encounters very well. I probably missed some of the key counseling and complete explanation of testing and diagnoses to the patient. I think the most lacking sections in my CIS performance occurred as I rushed to finish each encounter. I described my impressions, differentials, and briefly outlined the diagnostic tests (without using medical jargon) and the next steps, but often ran out of time to elicit questions, allay patients' concerns, and clarify any confusion about next steps. This is probably key. Also probably missed counseling opportunities. Be sure to leave enough time at the end of the encounters, as these pieces are likely significant."

 

[Patho_logical]

Hey! I just got my score back and got surprisingly lower performance in the CIS area than usual or expected, and wanted to share my thoughts/reflections in case they are helpful. It does sound like you did the majority of things right, and I think you and I likely both had deficiencies at the end of the encounters, which are likely given very heavy weight in the scoring.

(Copied from my other post):

"I did receive borderline CIS score breakdown on the exam, although this has always been an area in which I have excelled in school OSCEs and patient interactions. I also thought I hit the interpersonal skills out of the park during the exam day, and left the test worrying that I had failed in terms of ICE score. (I thought I spent too much time empathizing with the patient and not figuring out accurately what was going on with them). I promise, I'm not one of those cold or clueless, non-empathic people who nonetheless thinks they're fine. I tend to have an intuitive and inherently warm and nurturing personality, and this domain is (usually) truly my main strength. I am much more frequently told I'm "too nice" and I really 1. would be a great Pediatrician, and/or 2. Should just be brusque and get on with the businessy tasks of medicine rather than spending time on patient reassurance and communication. No joke.

In my preparation, I practiced and practiced greetings, empathic phrases, challenge question responses, summarizing, briefly guiding patients through the physical exam, appropriate draping and asking permission, and hand washing; I replicated these habits on test day.

As I tended to run out of time on encounters, I likely did not answer allay all of the patients' concerns at the end of the encounters very well. I probably missed some of the key counseling and complete explanation of testing and diagnoses to the patient. I think the most lacking sections in my CIS performance occurred as I rushed to finish each encounter. I described my impressions, differentials, and briefly outlined the diagnostic tests (without using medical jargon) and the next steps, but often ran out of time to elicit questions, allay patients' concerns, and clarify any confusion about next steps. This is probably key. Also probably missed counseling opportunities. Be sure to leave enough time at the end of the encounters, as these pieces are likely significant."

I like this advice. One more thing I thought of, be sure you aren't using medical jargon. I did this a lot until I intentionally thought about every word I was saying. Imagine the patient is a child. That sounds condescending, but it's pretty much how they seem to want you to talk to them.

 

[doc0610]

Firstly, sorry about what happened. But, the point is that this is too subjective an exam. People fail for random things and pass for the craziest mistakes like forgetting to do a PE. For CIS, i suggest you read the usmle website and understand what they were looking for. I was on the higher end and this is what I did,

1) knocked and entered with a smile.
2) shake hands, unless they are in absolute pain, i.e., acute. Then the first thing you do or say is, I am so sorry that you are in this situation, I will do my best to try and figure this out as soon as possible.
3) recently, i have heard that you need to confirm if the patient in the room is the same as that mentioned on the doorway, I didn't do it so i can't tell you how to do that
4) I followed the basic, "Good morning Mr.X I am DR.Y, resident/physician on call today, how would you like to be addressed as? Hope you are comfortable in the room, can i do anything to make you feel more comfortable? So, what brings you in the hospital today? then, after they mention that, say, that you are sorry and that it is unfortunate that they have to be in this situation, but you are glad that they have come in to get themselves check and you will do your best to figure out what is going on. This time also mention that you will be asking questions and will be doing a brief physical to get a better understanding.
5) ask open ended questions after that, finish with the HOPI, offer water when they cough, if they have headache offer to dim the light, you know that drill.
6) while as the ROS, i generally transitioned using, "now i would like to know a little bit about your over health"
7) for PAMHUGSFOSS i generally used, "these questions might seem irrelevant to you, but I just want to be through and I want to make sure I don't miss anything. Also, these questions might be related to you current condition"
8) then I would summarize after this and before the physical, ask if i missed anything and if they had any questions
9) before the PE I tell them what all i would examine, ask permission for the gown and talk through the Pe, i.e, I am look into your mouth.ear for lesions, feeling for lymph nodes, i will be listening to heart/lungs, I want to feel your belly, I am looking at your skin/nail etc etc. Just keep them in the loop
10) After the physical i would close with that i was thinking was going on and why, gave them the rundown of the test i was going to order and then asked them if they understood and they were ok with the plan. I also, counseled while i was asking the related questions. i didn't wait till the end. Once everything was over and I was about the leave, I would thank them for their time and patience, would mention that i am always here and they could call me for anything and I will come back and see them once all the tests were in and then take it from there.
11) would smile and shake their hand, say have a nice day and leave
12) also, tried to make small talk, but not always
13) helped them if they need it, i.e, when they needed to stand, sit, lie down,


finally, lately people have ben suggesting that you ask the patient after the physical what they think is going on with them. I didn't do that.

Hope this helps, this is what i did and it seemed to work. Don't worry, hang in there and this test doesn't determine how good/bad a physician you are, it is a formality. Let me know if you have questions.

All the best 🙂

 

[GOLDMARK]

Sorry I'm not helping, but adding that grading for CIS makes no sense. I passed with borderline performance though I think I did a lot of the stuff mentioned above. Best of luck.

 

[greatime]

I would love some advice. I am pretty upset, especially because I'm not sure what I did wrong or how to study for next time. I was always very nice and friendly with patients, asked about how they were feeling, sympathized and showed concern, communicated the differential diagnosis and plan, and asked if they had any questions. All of my evaluations in 3rd year specifically say that I had a great bedside manner!

I have always been told in the past that I have great patient interaction skills and am a good communicator so I am just at a loss. The dean of my med school just emailed me he was very surprised that I failed. I have excellent Step 1 and Step 2 CK scores, am a US senior, native English speaker, etc. Anyway, I was just wondering what students who failed this particular portion of the test changed for next time. Is it possible to get any more of an explanation from the USMLE on what my deficiencies were? I had read First Aid before the exam and practiced with family members and am terrified to fail again. Thanks so much!

I am having the same issue. I did very well on ICE and SEP but failed CIS. As far as I know I fulfilled all the requirements and I am in complete shock. I would like to know if you or anyone else would like to form a group to contest the scoring. I took the exam in Los Angeles in early October 2015.

 

[buonassezia]

Sorry I'm not helping, but adding that grading for CIS makes no sense. I passed with borderline performance though I think I did a lot of the stuff mentioned above. Best of luck.

Agreed.

 

[medstudent234]

Thanks so much for all of your feedback! I'm set to take the exam again in a month and hopefully it will go better next time with some small adjustments to my closure and trying not to take so many notes (I am starting to wonder if I wasn't docked for eye contact because I took a lot of notes).

 

[greatime]

I took a good amount of notes too. It wasn't like I was buried in the notes though. If this is what might cause a failure that is garbage. They are giving you a piece of note paper to use and then penalizing you for using it.

Still venting, sorry. But good luck, I think you are right with your adjustments.

 

[Plasmatron88]

Thanks so much for all of your feedback! I'm set to take the exam again in a month and hopefully it will go better next time with some small adjustments to my closure and trying not to take so many notes (I am starting to wonder if I wasn't docked for eye contact because I took a lot of notes).

That could be an issue, i looked at the clipboard too long as well on first unsuccessful attempt.