Okay so I terribly fuffed up my CS exam!

[FuF]

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Took it a few days back and I majorly messed up! I used the otoscope to check for pupil reflex and even went towards the eye a few centimeters on both eyes before realizing my mistake! The otoscope had the speculum on it!

How much is that gonna cost me? Anyone did that dangerous a blunder in an exam in 2013 and still passed?


I'm feeling especially down because in addition to that I also did some crappy mistakes:

1. Asked one abdominal pain patient to lie down while I went to wash hands and did not pull out the footrest for her. Realized this while drying my hands, ran to the table and pulled it up. The patient remained grumpy through the entire encounter, and that threw me off.
2. Didn't address 1/12 patient by name!
3. Don't remember being empathetic / doing PEARLS for at least 4/12 cases!
4. Didn't have anything to counsel for in 10/12 cases!
5. Only did partial neuro exams in all 3/12 cases that required a neuro exam. I either missed checking cerebellar signs or sensory loss in each.
6. Literally stammered in 2/12 cases because I didn't have a clue about the diagnosis (and hence further history questions) in one and while trying to explain my differential of diverticulosis without medical terms in the other!
7. Had one grumpy/mean patient who was very curt with her replies no matter how I tried to reassure her, and had two patients who would answer in single words no matter how I asked to find out what is bothering them.
8. Didn't write any negative findings in the D/Ds! I can't believe I didn't read the changes more carefully.
9. Missed quite a bit of relevant history questions in at least 6/12 cases, forgot to document some relevant history that I obtained on the PNs in at least 6/12 cases, and probably missed the right diagnosis in at least 3/12 cases.
10. Somehow missed writing VS in at least 3/12 PNs.
11. And finally, I took the exam in Philadelphia which has gotten tons of bad press at SDN recently for having odd SPs: http://forums.studentdoctor.net/showthread.php?t=1000039

I mention 2013 because of the CIS and ICE cutoff revision this year that has pretty much doubled the failing rates.

Any input would be greatly appreciated. Really!
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[sephonly]

What do you mean by new ICE cutoff? Im terribly.worried about my ICE score as well... If it's anything like first aid im prolly gonna miss tons of checkmarks!

Quick question... What if we didn't ask specific history about something and didn't explain the right DD to the Px but realized it when typing up a note ? As long as I use relevant findings I did ask for.to support my diagnosis I should credit for the PN right? Since PN and Data together make the ice im hoping my PN score will lift my horrible data gathering

 

[FuF]

What do you mean by new ICE cutoff?

The Step 2 Committee decided to increase the performance levels required to receive a passing outcome on two of the three Step 2 CS subcomponents: Communication and Interpersonal Skills (CIS) and Integrated Clinical Encounter (ICE).

These changes will be applied to Step 2 CS examinees testing on or after January 1, 2013.

If the new minimum passing requirements were applied to the group of first-time examinees who recently tested under the new examination structure, the overall passing rate for examinees from US medical schools would be approximately three percent lower and the overall passing rate for examinees from international medical schools would be approximately eighteen percent lower.

So that is a predicted increase in failing rate from 3% to 6% for AMG and from 21% to 39% for IMG first-time test takers. Both are significant numbers.
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[Fenster]

So that is a predicted increase in failing rate from 3% to 6% for AMG and from 21% to 39% for IMG first-time test takers. Both are significant numbers.

Holy crap.

 

[Cecilia Imelda]

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[Fenster]

If those numbers are right, more than a thousand students from American schools are going to fail this year!

 

[CDI]

So that is a predicted increase in failing rate from 3% to 6% for AMG and from 21% to 39% for IMG first-time test takers. Both are significant numbers.
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Moar $$$.

There is something seriously wrong with the people on these committees.

 

[EaglesAllDay]

Those numbers are very speculative...if you read the actual article it says that those standards were applied to group of first time examinees....what the hell does that even mean? how big was the group? was it a group of 12? was it a group who all took the same test on the same day from the 5 different centers?

Honestly we wont know for sure about the new pass/fail rates until this year is over and theyve reported the data

(i take mine next week so lol hope its bs)

 

[Fenster]

Those numbers are very speculative...if you read the actual article it says that those standards were applied to group of first time examinees....what the hell does that even mean? how big was the group? was it a group of 12? was it a group who all took the same test on the same day from the 5 different centers?

Honestly we wont know for sure about the new pass/fail rates until this year is over and theyve reported the data

(i take mine next week so lol hope its bs)

If the "recent test takers" term used in Step 1 score report is any guide, it could mean a pool of candidates who took the exam in the 3 months prior to the introduction of the new cut-offs. Considering the history scoring only from PN change had been done back in June, it should be an accurate representation especially since they have boldly mentioned those numbers.

 

[CDI]

Those numbers are very speculative...if you read the actual article it says that those standards were applied to group of first time examinees....what the hell does that even mean? how big was the group? was it a group of 12? was it a group who all took the same test on the same day from the 5 different centers?

Honestly we wont know for sure about the new pass/fail rates until this year is over and theyve reported the data

(i take mine next week so lol hope its bs)

First time exam-takers...as in people who have never taken the exam previously.

They can score these retroactively. They already have a database with scores of people. They just use that old data of first time test takers and apply the new "passing scores" and then they get a new number of people who should fail from then on. They can keep doing this every year to filter people via this failure quota, keep the exam legitimate, and get more money.

 

[FuF]

Hi, i don't know how much this is going to cost, but you did no forbidden maneuver like a rectal exam. I guess you just won't get the points for the pupil reflex!

A friend of mine accidently exposed her female SP's breast during cardiac exam (the bra dislocated) and the patient went mad at her. But she comfortably passed!!

Take a deep breath!! You can't change anything anymore, so don't make yourself nervous about the exam!!

Good luck!!

Thanks, that was reassuring. But it is hard to stop thinking about it! Especially when I've realized ten other mistakes already!

 

[stitchie]

FuF--I know you don't know yet, but I'm dying to know if you passed. Please post when you find out!

I just took my test and feel very similarly to how you described, which is why I'm curious how it turned out for you. I totally messed up two of the cases (as in, I reached the end of the encounter and was like "I have no idea what they're getting at with this case" and probably did not have the correct things on the Ddx). On these same two cases, I missed big, important sections of the history (probably why I couldn't figure out what was going on!), and on one of them I did the world's most perfunctory physical exam (like, I sort of glanced at just one part of the body and then palpated it. Seriously. It was disgraceful). Obviously the closures did not go well since I didn't know what was happening. I also did not complete the note in time on one of these cases, and had an item on the Ddx with absolutely nothing listed in support of it.

I then had one other case where I forgot a very, very crucial piece of history until I was actually done with the closure, at which time I was like "Oh yeah, and what about this?" I then had to re-close and explain some new diagnostic tests to the patient. I guess it could have been worse--I could have walked out without asking and therefore missed what was obviously the top thing on the differential. But it was really awkward. The patient seemed to even roll his eyes at me when I finally got around to asking the obvious question.

The other nine cases went alright--some better than others. I can think of lots of mistakes--things I would ask given another chance, exam maneuvers I should have done, different things that probably should have been on the differential, tests I forgot to order, tests I ordered but were probably superfluous, more elegant ways to have dealt with the patients' "challenging questions," and on and on and on--but nothing so abysmal as in the other three cases that I felt I pretty much totally botched.

Does anyone know if the scores from all encounters are "averaged" together? Like, say two SPs fail you but two others say you did great, and all the rest give you a sort of average/passable rating. Do the two fails and the two greats cancel each other out? Or is it more of a "three strikes, you fail--regardless of performance on the rest of the exam" type of situation? I hate how mysterious this whole process is. And how expensive. And that I have to wait three months to know the outcome.

 

[B52]

I don't understand the big deal about using an otoscope for checking pupil reflex. All you are using it for is a light source.

 

[link2swim06]

I don't understand the big deal about using an otoscope for checking pupil reflex. All you are using it for is a light source.

+1

In the actual hospital I use the light on my iphone all the time. While I won't use my iphone's light on CS I don't think using the otoscope really matters.