Likely Step 2 CS failure

[poopsock]

I just took step 2 CS and believe that I failed. I got sick with some sort of flu/GI virus the day before the exam and didn't sleep much and just felt terrible during the entire exam day. I was just out of it, I screwed up 1 pt interaction badly, and overall, I would be surprised if I passed. I will be meeting with someone at the med school next week to find out what to do next.

I would like to hear from people who failed step 2 CS and how they are dealing with it. Just a timeline of events would be nice - when you scheduled the exam retake, how it will affect your match, how it will affect graduation, etc. Any input would be appreciated.

I am at a US med school and applying to a competitive residency. I unfortunately checked the automatically release USMLE scores option on ERAS.

---

Members don't see this ad.

 

[ZekeMD]

Don't sweat it....everyone feels that way when the leave the exam. Wait until your scores come back. If you fail...take it again. Simple

 

[RugbyJC]

I left the exam thinking the same thing and am honestly more worried about this than then CK or Step I. In fact, if I actually passed Step II CS then there clearly is no validity to the exam. I totally sucked that day. I was healthy and don't have an excuse. I just wasn't on the ball and couldn't finish anything. My first case my Differential was blank. I was pleasent and polite and english is my first language, but for two of the cases I couldn't answer the "difficult to answer question" appropriately and I could tell the patient was upset, but I did what I would have done in real life. There's more too, but im sure you don't want to hear the 100 thousand reasons why I think I failed Step II.

I hear this feeling is not too abnormal, so maybe we pulled it together. I hear everything thinks they failed and we are horrible judges of ourselves.

 

[theCamel]

lol nice post rugby, i love "In fact, if I actually passed Step II CS then there clearly is no validity to the exam."


i hope you passed, you should both post when you get your results. i'm sure it will all work out as far as residency/match, the part that i think sucks most is the $1k fee twice.


apparently nobody's ever failed CS @ my school ever, and i don't want to be the first, i'm taking it in feb, maybe i should start studying a few weeks before and actually take it seriously...

 

[RugbyJC]

Im in the military, so I already matched. It is more the grand plus transportation fees and losing my dignity that I am concerned with. I think I would be the first at my school to fail step II CS if I do.

I really did suck that day though...at least I was nice? and I only made one fake patient fake cry?

 

[MeowMix]

I was convinced I failed CS. I didn't do any piece of a neuro exam on the patient who absolutely needed one. I utterly failed to connect with the patient with difficult social situation. I completely missed the differential on a couple of pts. Instead of my normal good interactions with pts, I couldn't seem to do well with any of them. I spent 2 months torturing myself thinking I had failed. I passed.

Do not torture yourself like I did. Go live your life and then deal with the results when you get them.

 

[Brickhouse]

Thanks for this you guys, I feel better - I take it tomorrow and for whatever reason (well maybe except that I didn't prepare for it) I am more nervous about this than step 2 CK! I am so afraid I'm going to blank out! I don't want to be that guy that doesn't pass it! But if it is true what above poster says, then I should be ok, right???

 

[Pervo]

Hello Everyone...

I recently took the Step2 CS. I heard this exam was "a joke", that "everybody" passes, and that if your first language is English, you should have no worries. So I focused 3 days of study on differentials, diagnostic tests, and practicing 5 cases on a friend. I didn't even THINK about the CIS component, especially since I'm (fairly) socially competent and empathetic.

However, I am now plagued by constant anxiety/terror over having failed the CIS component (due to my inattention to the beginning pages in 1st AID). I'm particularly concerned because I finished most encounters 5 minutes early, and (usually) before my fellow examinees. The issue is that I was so anxious about the written note/getting the right ddx, that I may not have been chatty enough during the encounter (although I did always addressed concerns, etc).

So -- based on the following omissions, you tell me if you think I've failed. Rather than itemizing specific mistakes for each case, I'll provide my MO in general for all cases.

Legend:
Black Font = Stuff I did
Red Font = Mistakes or Stuff I didn't do
Blue Font = 1st AID citations

FOR ALL ENCOUNTERS:.

1. Knocked on Door

2. Addressed SP by name

3. Introduced myself by name and stated my position

4. Told pt I was going to ask questions and perform a physical exam, and if that was ok.

5. Draped patient

6. Took a History -- BUT NEVER VERBALLY SUMMARIZED THE HISTORY TO THE PATIENT FOR CLARIFICATION
FROM 1st AID: “It is also critical to summarize what the patient has told you, not only to verify that you have understood him but also to ensure that you receive credit. You need to use this summary technique no more than once during the encounter in order to get credit”

7. Asked permission to perform physical exam

8. Washed hands (forgot to wash hands in the 1st case, but did for all others)

9. Asked permission to untie gown

10. Told patient that I was going to "feel their tummy", "listen to their chest", etc., did not repeat painful maneuvers, did not examine through gown"
HOWEVER, I didn't:
A) Explain WHY I was performing the particular exam
B) Comment on Exam Findings
C) Thank patient for letting me perform the exam
FROM 1st AID “When you have concluded a given procedure, remember to say thank you. Then explain the next step, and ask the patient for his permission to proceed. The patient should always be made to feel that he is in control of his body”
FROM 1st AID “During the physical exam, you may ask the patient any additional questions that you feel may be pertinent to the history. It is recommended, however, that you stop the physical exam while doing so in order to reestablish eye contact”

11. Assisted with putting gown back on (BUT DID NOT TIE GOWN in MOST CASES)

12. Closed the encounter

From 1st AID: "During the closure, you are expected to do several things:"
- make a transition to mark the end of your encounter (NO)
- summarize the chief complaint and the HPI if you have not already done so (NO)
- Summarize your findings from the physical exam (NO)
- Give your impression of the patient's clinical condition and the most likely diagnosis (YES)
- suggest a diagnostic workup (YES)
- answer any questions the patient might have (YES)
- address the patient's concerns (YES)
- Check to see if the patient has any more questions (YES)
- Leave room (YES!)

---- My biggest concern is that even though I offered an impression/ddx, suggested a diagnostic workup, and asked if the pt had other questions, I NEVER ONCE SUMMARIZED THE ENCOUNTER!!!



----Also, I only addressed smoking cessation in 1 patient (with COPD), and only asked about life stressors in 1 patient (with Fatigue).


----Because the SP has a checklist, I'm worried that I've lost a lot of points despite being a concerned and communicative person!

----Finally, you should know that I'm an FMG, and that if I fail this exam I will be withdrawn from the 2008 Match (we have until Dec 31st, 2007 to do Step2 CS in order to be ECFMG certified in time). Unlike US grads, I cannot simply make this up in the New Year.

Awaiting comments and suggestions. Don't say "there's nothing you can do now, just wait" --- WHY don't I want to hear this?... Because I DO have a backup plan in case of failure; however, I only want to put the backup plan into action if my feelings of failure are reasonable.

So tell me, do you think I failed Step2CS or am I being ridiculously neurotic/delusional?So mad at myself from not paying more attention to the first few pages of 1st AID!

thanks in advance for support and advise,
PERVO

 

[NDESTRUKT]

Just wait for your score. I, like you, felt I failed Step II CS. I didn't even ask family hx or meds/allergies once. No worries - let it come and you may not be so disappointed!

 

[poopsock]

Thanks for the input guys. I am now somewhat hopeful that I passed...but I remain (probably legitimately) worried. I will post my results when they get released, including a follow up on what happens to an unlucky soul who fails step 2 cs during match season should my fears be realized.

 

[karmudjun]

I'm floored. Just saw my results - sub-par data gathering. I was curioius after leaving atlanta, one patient I didn't wash my hands, (eleven I did), I was courteous to all, explained my next step (or so I believe), did a decent write-up and failed.

Did okay on my medical school clinical training, am doing okay in my internship year. Actually getting pretty high marks by my attendings and senior residents.

My DDx sucks - I'll admit that - I probably appear like a deer in the headlights when confronted with basic nebulous symptoms - but I do know pancreatitis is like cholecystitis is like retroperitoneal appendecitis is like duodenal ulcer....and so on. And can tease out the differences on PE and history.

But still, what a kick in the teeth. F.A. and review of USMLEWORLD CS did not guarantee anything. I guess I'll need a review course - after all, when has a resident time to do anything??? Study on my own? I've got presentations, my schedule changes every month, the only way I can lock in time is to plan a seminar while "vacationing".

Any good recommendations for a US grad that manages the CK's fine, and speaks the language well? I do take coaching well, I'm just out another $1K that I don't have and don't want to repeat my last performance.

Oh, any word on how we can get this financial drain off of our backs? If everyone needs to be an ER doc, then we should require this....but some of us will never see a patient with a new complaint in our lives. I'm not about to look for a pathology residency, but I don't want to moonlight in any doc-in-a-box. Or ER.

Thanks

 

[zer0el]

What is the process like to reschedule CS, and how long does it take? For example, does it require reapplying again even if I'm still within my 1-year eligibility, and does it require getting a new scheduling permit? I'm in a bit of a time crunch, so if someone could please tell me how long it takes to reapply from the date you get your score to the date you schedule your exam, I'd greatly appreciate it. Thanks.

 

[Pervo]

I did indeed pass (see post above on 12-18-2007). The waiting period caused much psychological distress.

Good luck to everyone.

 

[RugbyJC]

updatc: I passed. I don't know how but that's what my scorc rcport says.

I gucss it just goes to show that this cxam is a crap shoot. NO ONE but the NBME will be able to tell you what they are looking for. no one.

I feel bad posting about a P when I know there are random Fs givcn out, but I am beginning tc wcndcr if they rcally arc just random.

yeah...and thc 3 months of waiting sucked donkey balls.

 

[2008 EM Reviews]

I was in the same boat, and I wanted to share my story. I'm a normal american medical student in chicago, a normal "white guy medical student". I didn't really prep for CS much, i did read through step one once. The first patient I had was a parent discussing a problem with her child. It really through me for a second, i bumbled and stumbled through the questioning. The next patient had a joint complaint, and I asked so many questions that I didn't do ANY physical exam, didn't wash my hands, didn't "counsel" her. Needless to say, i panicked. I did settle down into a good CS rhythm after those first 2 patients, but I was convinced that I made enough other minor errors throughout the day (weak physical exam, not friendly enough to one patient, not asking about a sex history, not drapping one patient, etc etc) that I may have failed.

But I passed, despite really being nervous.

So for those students who are freaking out that they passed, I just wanted to say that there's agood chance you'll be ok. For those who are preparing for CS, make sure you take is seriously and prepare.

 

[Shinken]

Hello Everyone...

I recently took the Step2 CS. I heard this exam was "a joke", that "everybody" passes, and that if your first language is English, you should have no worries. So I focused 3 days of study on differentials, diagnostic tests, and practicing 5 cases on a friend. I didn't even THINK about the CIS component, especially since I'm (fairly) socially competent and empathetic.

However, I am now plagued by constant anxiety/terror over having failed the CIS component (due to my inattention to the beginning pages in 1st AID). I'm particularly concerned because I finished most encounters 5 minutes early, and (usually) before my fellow examinees. The issue is that I was so anxious about the written note/getting the right ddx, that I may not have been chatty enough during the encounter (although I did always addressed concerns, etc).

So -- based on the following omissions, you tell me if you think I've failed. Rather than itemizing specific mistakes for each case, I'll provide my MO in general for all cases.

Legend:
Black Font = Stuff I did
Red Font = Mistakes or Stuff I didn't do
Blue Font = 1st AID citations

FOR ALL ENCOUNTERS:.

1. Knocked on Door

2. Addressed SP by name

3. Introduced myself by name and stated my position

4. Told pt I was going to ask questions and perform a physical exam, and if that was ok.

5. Draped patient

6. Took a History -- BUT NEVER VERBALLY SUMMARIZED THE HISTORY TO THE PATIENT FOR CLARIFICATION
FROM 1st AID: “It is also critical to summarize what the patient has told you, not only to verify that you have understood him but also to ensure that you receive credit. You need to use this summary technique no more than once during the encounter in order to get credit”

7. Asked permission to perform physical exam

8. Washed hands (forgot to wash hands in the 1st case, but did for all others)

9. Asked permission to untie gown

10. Told patient that I was going to "feel their tummy", "listen to their chest", etc., did not repeat painful maneuvers, did not examine through gown"
HOWEVER, I didn't:
A) Explain WHY I was performing the particular exam
B) Comment on Exam Findings
C) Thank patient for letting me perform the exam
FROM 1st AID “When you have concluded a given procedure, remember to say thank you. Then explain the next step, and ask the patient for his permission to proceed. The patient should always be made to feel that he is in control of his body”
FROM 1st AID “During the physical exam, you may ask the patient any additional questions that you feel may be pertinent to the history. It is recommended, however, that you stop the physical exam while doing so in order to reestablish eye contact”

11. Assisted with putting gown back on (BUT DID NOT TIE GOWN in MOST CASES)

12. Closed the encounter

From 1st AID: "During the closure, you are expected to do several things:"
- make a transition to mark the end of your encounter (NO)
- summarize the chief complaint and the HPI if you have not already done so (NO)
- Summarize your findings from the physical exam (NO)
- Give your impression of the patient's clinical condition and the most likely diagnosis (YES)
- suggest a diagnostic workup (YES)
- answer any questions the patient might have (YES)
- address the patient's concerns (YES)
- Check to see if the patient has any more questions (YES)
- Leave room (YES!)

---- My biggest concern is that even though I offered an impression/ddx, suggested a diagnostic workup, and asked if the pt had other questions, I NEVER ONCE SUMMARIZED THE ENCOUNTER!!!



----Also, I only addressed smoking cessation in 1 patient (with COPD), and only asked about life stressors in 1 patient (with Fatigue).


----Because the SP has a checklist, I'm worried that I've lost a lot of points despite being a concerned and communicative person!

----Finally, you should know that I'm an FMG, and that if I fail this exam I will be withdrawn from the 2008 Match (we have until Dec 31st, 2007 to do Step2 CS in order to be ECFMG certified in time). Unlike US grads, I cannot simply make this up in the New Year.

Awaiting comments and suggestions. Don't say "there's nothing you can do now, just wait" --- WHY don't I want to hear this?... Because I DO have a backup plan in case of failure; however, I only want to put the backup plan into action if my feelings of failure are reasonable.

So tell me, do you think I failed Step2CS or am I being ridiculously neurotic/delusional?So mad at myself from not paying more attention to the first few pages of 1st AID!

thanks in advance for support and advise,
PERVO

I absolutely hate you (and envy you) for having so much free time on your hands.

 

[Brickhouse]

I absolutely hate you (and envy you) for having so much free time on your hands.

You're awesome.

I passed it too!

 

[Arsenic]

You're awesome.

I passed it too!

NICE

congrats brick, i took it around the same time you did and passed it too. *wipes sweat off brow*, that damn test seriously caused me way too much stress afterwards. so nice to not have to think about it anymore.

 

[Brickhouse]

NICE

congrats brick, i took it around the same time you did and passed it too. *wipes sweat off brow*, that damn test seriously caused me way too much stress afterwards. so nice to not have to think about it anymore.

Yay us! I think that I have jumped over all the hurdles and I don't see anything else potentially keeping me from walking across that stage to get my diploma! (besides maybe tripping along the way) What a great feeling!

 

[kaboodle]

Well, I just took CS a few days ago and am freeking out now because I can't stop thinking of the things I did wrong. All my encounters went ok, except 1, but believe it or not I think I may have written the FH, SH, PMH etc in the physical exam section during my 1st couple of encounters. I was so nervous, during the 1st one that I'm sure I did this. On my 2nd encounter, I ran out of space in my PN which cements my belief of my mistake.!!! I do know how to write a note, although I get really nervous in some situations.

On all my notes I had 5 DDx and 5 work up plans that were reasonable and wrote pretty descent notes in general. However, I can't help but think that "whoever" grades this will look at these 2 notes and put the smackdown on me. On top of that, my telephone encounter was a disaster because it was some off the wall concern that I never came across before. I was just waiting for the lady to start laughing during our conversation because I'm convinced that the USMLE will use my tape for their training seminars one day!!

All in all, my encounters were good (except the blooper listed above ) but I'm sure I forgot to do more than I'm remembering right now. Did all the usual stuff asking the questions, was nice, washed hands, asked to examine, re-draped, counseled, etc.

What I'm most worried about is...
1. About 2-3 notes which I may have written the wrong information in the wrong section, but filled out my DDx and Plan completely.
2. The 1 encounter in which I should have had a sign over my head which read: Sure, I can possibly get you another $1000 to give you if you want.

It's over and all I can do now is laugh about it and try to relax. Neither of those mistakes have ever happened to me before. I just hope that I don't have to take this over again just because I panicked and I don't have another $1000 to give anyone. Man....this is gonna be a long couple months!!

 

[Brickhouse]

Well, I just took CS a few days ago ...

Don't worry. I'm pretty sure they just pass everyone at this point. Honestly, step II CS should not keep you from graduating if you've come this far.

If it makes you feel better, I forgot to put CXR on my work up of a pt. with chronic cough and smoking hx. I think you can make quite a few mistakes and still pass!

 

[kaboodle]

Don't worry. I'm pretty sure they just pass everyone at this point. Honestly, step II CS should not keep you from graduating if you've come this far.

If it makes you feel better, I forgot to put CXR on my work up of a pt. with chronic cough and smoking hx. I think you can make quite a few mistakes and still pass!

Thanks for your post and I hope your right!!!!