Passed CS, but not in my normal way

[Gotti]

Hey guys,
Now I shouldn’t complain when I passed this thing but I did spend a while (>1month) studying for this thing and I noticed the way I passed was in categories that met their stupid checklist but that essentially sacrificed the categories I was usually rated by patients and attendings to be good at. I almost think I was better off not studying and approaching the patient the way I normally do it, meaning not doing thorough physicals and asking one or two questions pertinent to the patient’s symptoms. I don’t think I’ve auscultated heart, lungs, and abdomen ever on the wards, never heard a murmur or bruit, and did it only for this exam. Somehow the patient was too standardized to notice my physical exam was very superficial and I scored best under data gathering. However, my score breakdown had me borderline in Professional manner and rapport. Now I admit I am not clinically the strongest being a PhD student coming back to clinical rotations after years in the lab and also applying to a surgical subspecialty where I can just examine one area on the patient. But usually patients like me because I don’t force rapport when it isn’t there and don’t poke them in a million places and ask a million questions just to fill out all the boxes on the clinical form and present 20 minutes to the attending. So with that said, I’m almost convinced its impossible to get all of the things on the checklist without sacrificing rapport and friendly manner. I mean, if you have to ask all the standard PAMHUGSFOSS or other mnemonic, there is no way to have time to get those charm points. I mean, I felt like I asked my mnemonic questions with as much cheeriness as I could for fake patients and I’m not saying I’m the most charming guy neither, but I’ve specifically gotten good comments from attendings for interpersonal skills. I know, I know, there’s one or two of you out there as I’ve seen in my fellow students who are so freaking charming and clinically efficient who are going to tell me its possible to score well in all the categories, but I just want to know how many out there scored well in all categories, how much you tried to do the entire checklist, and how well rated you are clinically (please be honest, I know most of us tend to overrate ourselves being the egotistical overachievers we are)

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[tfom08]

Don't judge yourself at all by your evaluation from a few standardized patients during CS states. It's a ridiculous test to begin with. Just be glad you passed and forget about it.

 

[AFDuck]

Hey guys,
Now I shouldn’t complain when I passed this thing but I did spend a while (>1month) studying for this thing and I noticed the way I passed was in categories that met their stupid checklist but that essentially sacrificed the categories I was usually rated by patients and attendings to be good at. I almost think I was better off not studying and approaching the patient the way I normally do it, meaning not doing thorough physicals and asking one or two questions pertinent to the patient’s symptoms. I don’t think I’ve auscultated heart, lungs, and abdomen ever on the wards, never heard a murmur or bruit, and did it only for this exam. Somehow the patient was too standardized to notice my physical exam was very superficial and I scored best under data gathering. However, my score breakdown had me borderline in Professional manner and rapport. Now I admit I am not clinically the strongest being a PhD student coming back to clinical rotations after years in the lab and also applying to a surgical subspecialty where I can just examine one area on the patient. But usually patients like me because I don’t force rapport when it isn’t there and don’t poke them in a million places and ask a million questions just to fill out all the boxes on the clinical form and present 20 minutes to the attending. So with that said, I’m almost convinced its impossible to get all of the things on the checklist without sacrificing rapport and friendly manner. I mean, if you have to ask all the standard PAMHUGSFOSS or other mnemonic, there is no way to have time to get those charm points. I mean, I felt like I asked my mnemonic questions with as much cheeriness as I could for fake patients and I’m not saying I’m the most charming guy neither, but I’ve specifically gotten good comments from attendings for interpersonal skills. I know, I know, there’s one or two of you out there as I’ve seen in my fellow students who are so freaking charming and clinically efficient who are going to tell me its possible to score well in all the categories, but I just want to know how many out there scored well in all categories, how much you tried to do the entire checklist, and how well rated you are clinically (please be honest, I know most of us tend to overrate ourselves being the egotistical overachievers we are)

Reading this line made me question the amount of quality clinical experience you have had. Maybe you just haven't had enough experience with patients to develop efficient, thorough, and yet personable data gathering skills. I could be wrong, its just a guess based on your post.

 

[Gotti]

Look, I know myself we can go all day criticizing my clinical skills. I'm just trying to figure out how to help my foreign friends with foreign med degrees still working in my old lab who may struggle with this test. I mean, should people not study to get through the checklist of questions and exam stuff? I'm convinced now you don't need to do everything, but just work on rapport with the standardized patient. Also, I'm also venting probably because I'm just jaded from all the b.s. of med school, med students,stupid tests, and going to school at a county hospital with a crappy health care system. In any case, I should just be glad its over and not worry about it again like the guy up there said.

 

[Gotti]

Thinking about this some more, the reason I'm pissed is the idea that this test is trying to tell everyone what type of doctor they should be and at such a hefty price. There are patients who prefer no rapport with the doctor. I know of past classmates who are rated perfectly good doctors even though they aren't the most socialable doctors willing to chat on and on about trivial stuff. I know immigrants as well as Americans who prefer a straightforward doctor who just does his job.
I'm also pissed they made this test because several of my friends cannot become doctors because they were trained in foreign countries where they don't value all this nonsense chatter. They would be perfectly fine at least serving their own community. These foreign guys all rock the CK tests so they obviously know medicine, but they just had to make this CS test to keep these jobs away from them.

Also, they've shown no correlation between all of those stupid sounds we auscultate for and any degree of sickness and the fact that I could feign it through a top US med school and a national licensing exam shows you how much dumber this test is.

 

[synapse lapse]

Thinking about this some more, the reason I'm pissed is the idea that this test is trying to tell everyone what type of doctor they should be and at such a hefty price. There are patients who prefer no rapport with the doctor. I know of past classmates who are rated perfectly good doctors even though they aren't the most socialable doctors willing to chat on and on about trivial stuff. I know immigrants as well as Americans who prefer a straightforward doctor who just does his job.
I'm also pissed they made this test because several of my friends cannot become doctors because they were trained in foreign countries where they don't value all this nonsense chatter. They would be perfectly fine at least serving their own community. These foreign guys all rock the CK tests so they obviously know medicine, but they just had to make this CS test to keep these jobs away from them.

Also, they've shown no correlation between all of those stupid sounds we auscultate for and any degree of sickness and the fact that I could feign it through a top US med school and a national licensing exam shows you how much dumber this test is.

Actually, I think only IMG's should be forced to take this test. I have nothing against IMG's clinical knowledge... after all if they can pass the steps in English then they are qualified as having the knowledge of a physician. The problem I have is in those who don't speak English - which is the area most IMG's fail on the CS. You are not going to be able to gather the relevant clinical data and communicate effectively to the patient their diagnosis and treatment options, as well as complications without these communication skills. I might know all the medicine in the world, but I sure can't expect to go to Japan and practice medicine without being fluent in the language. Also, as noted above I also doubt your clinical acumen if you don't even auscultate or otherwise examine your patients!

 

[Gotti]

Yeah, I'm sorry to go on that rant. I'm just frustrated by all this crap we have to go through to get through med school. Also, my English and ability to study for what the tests are looking for is good enough to get me through, but I'm just frustrated for some friends I know who struggle with these things. I suppose I do some ausculating and other exam stuff, not quite as completely as what this exam wanted, but I do some and this exam did make me review what all the signs mean again although I still haven't seen them used in real clinical situations.

I still feel like the way I and many others interact with patients is perfectly fine even though it doesn't fit what this test defined as "rapport." Actually, all I'm saying is that to get through their entire checklist, it took away from my normal rapport with patients which has been rated high by my attendings. So for this test, I feel you just have to do like 60 percent of the checklist in First Aid and then make up some standard cheat sheet of rapport. This isn't what I would do in real life at all, I'm just saying this perhaps as advice to other test-takers in the future. I mean, I memorized entire clinical scenarios from First Aid and other prep books and did the entire checklist they advertised, but then missed rapport points. What do guys think from your score breakdown?

 

[FreakofMeds]

Hmmm I have a question. I am an IMG and I did and passed my CS 3 years ago. Then we didn't have any performance breakdown for passing. Only failed attempts are offered performance breakdowns.

Did they change that recently? Meaning passers also get performance assessment in different parts of the exam?

 

[superoxide]

Hmmm I have a question. I am an IMG and I did and passed my CS 3 years ago. Then we didn't have any performance breakdown for passing. Only failed attempts are offered performance breakdowns.

Did they change that recently? Meaning passers also get performance assessment in different parts of the exam?

Yes.

http://www.usmle.org/general_information/announcements.html#cs-add-feedback

As part of routine reporting, examinees who fail Step 2 CS receive graphical feedback intended to represent relative strengths and weaknesses on subcomponents of the examination. Starting with Step 2 CS results reported on August 19, 2009, both failing and passing examinees will receive this feedback. Consistent with current reporting policy, the Performance Profiles are intended only for examinees and will not be reported to or verified to any third party.