My Step 2CS Experience

[California]

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I was wondering if I could get input from those who took Step 2 CS. Although I expected to become less neurotic with more and more years of education under my belt, medical school has made me more neurotic. I hate it.

Well, I took Step 2 CS today and I wish I could say I have no doubt I passed. I have this feeling, which I would like to describe as the 1% possibility of failing, because I know there are so many things I missed with each case. But, I was particularly *bummed* out because I was unable to provide any real counseling to my first patient. I was in the middle of my first sentence of counseling during this encounter and heard the infamous, "Your patient encounter is now over. Please leave the room." I am proud to say I didn't loose it after this particular case and, in all the other cases that followed, I think I did a pretty good job. I may have missed things here and there, but-for the most part-I was able to do everything I wanted. There was one more case where I was interrupted during my counseling, but I had already provided almost everything I wanted to at that point. So, hopefully, I passed. Any thoughts? I am sure the great majority of students on this website may have had similar experiences and felt the same way. I hope you passed because, if you didn't, I am sure I will be joining you to repeat this awful exam.

I just wanted to vent here. Also, I would like to add that many of the standardized patients (SP) were horrible actors. One SP, actually my first case, complained that I was pushing two hard on her belly. I can promise you that I barely was pressing and have applied much more pressure on real patients without complaints. I don't know what was wrong with the SP! Another SP said all of her statements like she was reading from a script and when I did the neurological exam on her I could not believe what an idiot she was. I was pricking her with a toothpick to test pain sensation after clearly explaining to her to tell me if she felt a pinprick (I know I provided clear instructions because the other SPs in which I did this were able to follow my instructions without problems), but did not say anything afer seven pricks. I finally pushed harder and she said, "Oh." I reminded her to tell me when she felt pinpricks. Another SP laughed a couple times (out of character) when I was speaking to him for no real reason.

Thanks for reading.

 

[upekkha]

I was wondering if I could get input from those who took Step 2 CS. Although I expected to become less neurotic with more and more years of education under my belt, medical school has made me more neurotic. I hate it.

Well, I took Step 2 CS today and I wish I could say I have no doubt I passed. I have this feeling, which I would like to describe as the 1% possibility of failing, because I know there are so many things I missed with each case. But, I was particularly *bummed* out because I was unable to provide any real counseling to my first patient. I was in the middle of my first sentence of counseling during this encounter and heard the infamous, "Your patient encounter is now over. Please leave the room." I am proud to say I didn't loose it after this particular case and, in all the other cases that followed, I think I did a pretty good job. I may have missed things here and there, but-for the most part-I was able to do everything I wanted. There was one more case where I was interrupted during my counseling, but I had already provided almost everything I wanted to at that point. So, hopefully, I passed. Any thoughts? I am sure the great majority of students on this website may have had similar experiences and felt the same way. I hope you passed because, if you didn't, I am sure I will be joining you to repeat this awful exam.

I just wanted to vent here. Also, I would like to add that many of the standardized patients (SP) were horrible actors. One SP, actually my first case, complained that I was pushing two hard on her belly. I can promise you that I barely was pressing and have applied much more pressure on real patients without complaints. I don't know what was wrong with the SP! Another SP said all of her statements like she was reading from a script and when I did the neurological exam on her I could not believe what an idiot she was. I was pricking her with a toothpick to test pain sensation after clearly explaining to her to tell me if she felt a pinprick (I know I provided clear instructions because the other SPs in which I did this were able to follow my instructions without problems), but did not say anything afer seven pricks. I finally pushed harder and she said, "Oh." I reminded her to tell me when she felt pinpricks. Another SP laughed a couple times (out of character) when I was speaking to him for no real reason.

Thanks for reading.

I'm sure you did fine -- it's impossible to be "perfect" during this exam. The reality is that there is just not enough time to do everything you would ideally want to do during a NEW PATIENT ENCOUNTER with some complex cases. My first patient encounter was a disaster. When I needed to do a neuro exam, I only had time to do the most rudimentary exam (maybe only strength or something) and when I was writing up a note for a case and listing my differential, I realized what the diagnosis and started to move my hands towards the computer to type it in when the annoucement ended that write up period (and as you know, you REALLY have to stop typing/writing when that happens). So I never recorded the correct diagnosis. I did pathetic exams on most patients -- ugh, it was just an ugly day by any of my standards or really any standards you've been used to.

And I passed.

As you noted, this isn't a true slice of hospital/outpatient life. HOWEVER, this is not to say that you should just blow off preparing or blow off trying to do a good job (for anyone yet to take the exam). I think it's better to arrive with an arsenal of good skills. And once it's said and done, like for this poster, to just try to let it go. It's hard/impossible to do the type of job you'd like to do. So it's then hard to feel confident that you passed. That's what can make the weeks following until you get your score report so stressful. All you can do, unfortunately, is wait. But assume that most likely you passed, as long as you were kind, listened to the patients, made them comfortable, and demonstrated some medical knowledge. If you didn't pass, then you'll deal with it. But statistically, you passed. So try to let go some of that anxiety which will most likely be for naught.

 

[djipopo]

I'm sure you did fine -- it's impossible to be "perfect" during this exam. The reality is that there is just not enough time to do everything you would ideally want to do during a NEW PATIENT ENCOUNTER with some complex cases. My first patient encounter was a disaster. When I needed to do a neuro exam, I only had time to do the most rudimentary exam (maybe only strength or something) and when I was writing up a note for a case and listing my differential, I realized what the diagnosis and started to move my hands towards the computer to type it in when the annoucement ended that write up period (and as you know, you REALLY have to stop typing/writing when that happens). So I never recorded the correct diagnosis. I did pathetic exams on most patients -- ugh, it was just an ugly day by any of my standards or really any standards you've been used to.

And I passed.

As you noted, this isn't a true slice of hospital/outpatient life. HOWEVER, this is not to say that you should just blow off preparing or blow off trying to do a good job (for anyone yet to take the exam). I think it's better to arrive with an arsenal of good skills. And once it's said and done, like for this poster, to just try to let it go. It's hard/impossible to do the type of job you'd like to do. So it's then hard to feel confident that you passed. That's what can make the weeks following until you get your score report so stressful. All you can do, unfortunately, is wait. But assume that most likely you passed, as long as you were kind, listened to the patients, made them comfortable, and demonstrated some medical knowledge. If you didn't pass, then you'll deal with it. But statistically, you passed. So try to let go some of that anxiety which will most likely be for naught.

Ditto.

I also had that nagging voice in my head after the exam, but i just found out a couple of weeks ago that I passed. I wasn't even able to finish the exam on my first patient and I have no idea what one other patient's disease was. So try not to worry and relax, the odds are overwhelmingly that you PASSED the exam!

 

[sacrament]

Well, I took Step 2 CS today and I wish I could say I have no doubt I passed. I have this feeling, which I would like to describe as the 1% possibility of failing, because I know there are so many things I missed with each case.

Everybody I know felt this way after the test.

But, I was particularly *bummed* out because I was unable to provide any real counseling to my first patient.

I didn't provide much in the way of counseling to about half the "patients" I saw. I either just totally forgot or I didn't feel like there was much to counsel about. And I passed. Also, in general, I performed a half-assed physical exam in almost every case. Listened to heart and lungs on every patient but very rarely did more than that.

I just wanted to vent here. Also, I would like to add that many of the standardized patients (SP) were horrible actors.

They're terrible. As I said in another thread, the generally robotic nature of the SPs led me to assume, in the first couple of patient encounters, that they were intentionally acting out a flat affect, maybe as part of a psychiatric condition.

...and when I was writing up a note for a case and listing my differential, I realized what the diagnosis and started to move my hands towards the computer to type it in when the annoucement ended that write up period (and as you know, you REALLY have to stop typing/writing when that happens). So I never recorded the correct diagnosis.

I just wanted to note that in the CS, there are no "correct diagnoses." Some of those rare folks who report failing the exam say that they quickly decided on a "correct" diagnosis, put only one or two things on the differential, and didn't explore the history further. There is no correct diagnosis. Always expand your thinking. Do not expect that your "patients" will have a classic presentation... if it seems that way, you probably didn't do a full history, because every patient will have multiple symptoms that lead to multiple diagnoses. For example, nobody who presents with substernal pain will be a slam-dunk GERD... maybe the pain will be predominantly post-prandial, but it'll also be exertional, or maybe a couple of days ago they lifted something heavy, or etc. etc. Do not feel like you need to "figure out" exactly what each patient has. Rather, you need to put together a differential, and the patients will always have enough different clues to put at least three things on your list. Personally, I very easily came up with five pathologies for every differential.

 

[Poety]

I just took this test, and I was horrified to realize what I put for a well known pediatric condition (peds which I haven't had in 2 years!!!!) was NOT what I put I just hope I passed, but everyone has this anxiety - and the exam is horrible all the way around, with that "YOU HAVE FIVE MINUTES LEFT" screaming in your ear, it sends people into panic mode!! ugg.

Congrats to all those that passed 🙂

 

[EctopicFetus]

Poety, I took this today as well. The test sucked! I only counseled like 1/2 of the patients, missed some major stuff including not even really exploring what I ended up putting as my #1 Differential. Anyways.. I hope I passed. Im not as dumb as I look! 🙂

 

[rheumo_gal]

Hey all,
New to the forum,
Just took CK (FREAKIN LONG). Any way, I have the stupid CS coming up in about 2 wks. Did any of you read the first aid for it? Thanks for any replies
😱

 

[EctopicFetus]

I did have it.. I skimmed it more than read it. IMO the most important (high yield) stuff is what is expected from each part of the exam. IMO you should know how to illicit a history. Also brush up on Peds History stuff. Also look over some of the cases near the back to get your mind in the right mode..

Lastly you can either type or handwrite your patient note.. I wasnt aware you could type. If you have other Qs PM me.

 

[Ice-1]

Are you saying that they actually have kids simulating pediatric patients? Or do the adults just say "pretend I'm a kid and I've got this"

 

[neilc]

Are you saying that they actually have kids simulating pediatric patients? Or do the adults just say "pretend I'm a kid and I've got this"

you may get an adult in the room asking about thier kid, or you could get a phone call. i heard about kids with fever and enuresis as possible cases.