Scared beyond belief I failed Step 2 CS...again?

[Doctor_meeseeks]

Hey all, newbie poster but been a longtime lurker. I'm Doctor Meeseeks (look at me!). So I just want to vent, but also express my frustration as well. I go to a well known US MD program, US citizen.

Now, right before the rank list order was due this year, I found out I failed step 2 cs (I don't even want to get into discussing the match, but I'll say the CS probably screwed me over). Obviously, I was shocked beyond belief and saw that I failed the CIS portion (did pretty well for ICE though). Now this part I got confused about because I had always been very good on my clinical skills, bedside manner, and patient interactions in my clerkships. Of course, I also find out many more people than usual at my school failed CS than usual this year.

So right afterwards, I go talk to my school. They set me up with standardized patients and clinical performance team. I get to practice a few cases with the SP's and the head of the clinical skills department reviewed my performance. I made sure to act like I did when I took CS the first time and surprisingly, the department head told me I should have passed CS based on my performance with the SP's. The recommendations were very minor, just a couple of minor points on how I communicated with the SP's.

I practice hard with my wife and friends as practice patients up until I left for my second CS test. I took the test in Los Angeles and now I'm scared that I just blew the test again...

What I did (NOT DISCUSSING SPECIFIC CASES):
- Did ask at least 2 open ended questions in the beginning for all patients (Good)
- Did not interrupt patients, made sure to ask if I could write down notes, looked in the eye as often as I could, did let patients know I needed to sit down in each case because of chronic knee pain.
- made sure I asked each patient how they prefer to be addressed.
- Tried to empathize with patients as best I could, saying things like "I'm sorry this is happening to you" or "I completely understand your frustration, I'd feel the same way" in some form. (good?)
- Made sure drapes were applied appropriately if patient didn't already have drapes on
- Summarized as best I could after the history for all patients, as far as I could remember.
- Made sure to know about the patient's life such as occupation, how they feel about their job/does their complaint affect their job, I.E. as much social info as I could get.
- Physical exam: got lung/chest/abdomen for all patients and then went for focused systems, I didn't spend more than 3 minutes on the PE unless warranted. Most of the physical exams started with 6 minutes or close to the 5 minute warning.
- Sanitized hands before physical exam and immediately after the physical exam.
- I tried my best to do the closing statements the way I wanted. I spent at least 1.5 minutes for closing on each patient, but felt a little rushed on time at the end for some of the cases. I ran out of time on a couple of them just as I was asking "do you have any questions".
- On each closing I made sure they knew what I was thinking in terms of diagnoses, what I recommended the next steps were, any counseling needed, asked if they understood what I said, and made sure to ask if they had any questions.

What I felt went wrong:
- One of the cases, I forgot to counsel about smoking in the end (It was the last patient too).
- Another case, I had to ask some difficult questions which may have been awkward, but I did preface it by saying it something I had to ask and that it's "policy" for me to do so and reminded the patient about safety. It was definitely a situation where I had to ask these questions though.
- Forgot to extend the edge of the table for one patient at first, I immediately apologized and fixed it when I realized it.
- Two of the patients, I was confused on a diagnosis since I felt the situation was so vague and I couldn't find anything obvious to think of. So I went simple with the diagnoses. One of these two patients I whiffed on the physical exam completely because I thought I actually did notice an anatomical anomaly. (will not talk more about this, it was really, really weird and was what threw me off completely). All the other patients I felt good about a main diagnosis (did have 3 diagnoses on ddx for all cases).
- Forgot to write the name of the patient in one case, so I looked back quickly at the placard in the room to remind myself.
- Timing was not ideal for some cases, rushed a bit on some of them which made me unable to do the closing section completely how I wanted to.
- Patient notes: Got most of what I wanted to type, but the character limit was a problem, leaving some minor stuff out due to this. This happened my first time too but did fine on ICE so I'm not too worried about this.

Overall on the diagnoses: felt good on 8 of the cases at least, maybe iffy on 1 diagnoses on the ddx for a couple, and two were up in the air but I probably justified them as best I could. Two of the patient cases in my head...I just can't remember them at this point, so I guess things were likely okay if I can't remember anything about them. Overall on the CIS: I am scared about this because I worry I left something out, but I don't know. A lot of my fears have to do with knowing that I failed this part the first time around without any feelings of reassurance that I did things right this time around.

My BIG worry is that I failed step 2 CS a second time. I will be finding out the results on thursday likely. I get scared that with the mistakes I made (per above) that I blew it. Any good wishes/vibes and thoughts would be great. I'm very nervous about all of this

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[Dr.serotonin]

I think you did very well. best of luck

 

[Siqoraaa]

I hope everything goes well. It is horrible that they don't tell you what mistakes you made the first time.
There seems to be widespread agreement that failing CS is something that can happen to anyone, and its not a reflection on your abilities at all.

Good luck!

 

[Redpancreas]

Hey all, newbie poster but been a longtime lurker. I'm Doctor Meeseeks (look at me!). So I just want to vent, but also express my frustration as well. I go to a well known US MD program, US citizen.

Now, right before the rank list order was due this year, I found out I failed step 2 cs (I don't even want to get into discussing the match, but I'll say the CS probably screwed me over). Obviously, I was shocked beyond belief and saw that I failed the CIS portion (did pretty well for ICE though). Now this part I got confused about because I had always been very good on my clinical skills, bedside manner, and patient interactions in my clerkships. Of course, I also find out many more people than usual at my school failed CS than usual this year.

So right afterwards, I go talk to my school. They set me up with standardized patients and clinical performance team. I get to practice a few cases with the SP's and the head of the clinical skills department reviewed my performance. I made sure to act like I did when I took CS the first time and surprisingly, the department head told me I should have passed CS based on my performance with the SP's. The recommendations were very minor, just a couple of minor points on how I communicated with the SP's.

I practice hard with my wife and friends as practice patients up until I left for my second CS test. I took the test in Los Angeles and now I'm scared that I just blew the test again...

What I did (NOT DISCUSSING SPECIFIC CASES):
- Did ask at least 2 open ended questions in the beginning for all patients (Good)
- Did not interrupt patients, made sure to ask if I could write down notes, looked in the eye as often as I could, did let patients know I needed to sit down in each case because of chronic knee pain.
- made sure I asked each patient how they prefer to be addressed.
- Tried to empathize with patients as best I could, saying things like "I'm sorry this is happening to you" or "I completely understand your frustration, I'd feel the same way" in some form. (good?)
- Made sure drapes were applied appropriately if patient didn't already have drapes on
- Summarized as best I could after the history for all patients, as far as I could remember.
- Made sure to know about the patient's life such as occupation, how they feel about their job/does their complaint affect their job, I.E. as much social info as I could get.
- Physical exam: got lung/chest/abdomen for all patients and then went for focused systems, I didn't spend more than 3 minutes on the PE unless warranted. Most of the physical exams started with 6 minutes or close to the 5 minute warning.
- Sanitized hands before physical exam and immediately after the physical exam.
- I tried my best to do the closing statements the way I wanted. I spent at least 1.5 minutes for closing on each patient, but felt a little rushed on time at the end for some of the cases. I ran out of time on a couple of them just as I was asking "do you have any questions".
- On each closing I made sure they knew what I was thinking in terms of diagnoses, what I recommended the next steps were, any counseling needed, asked if they understood what I said, and made sure to ask if they had any questions.

What I felt went wrong:
- One of the cases, I forgot to counsel about smoking in the end (It was the last patient too).
- Another case, I had to ask some difficult questions which may have been awkward, but I did preface it by saying it something I had to ask and that it's "policy" for me to do so and reminded the patient about safety. It was definitely a situation where I had to ask these questions though.
- Forgot to extend the edge of the table for one patient at first, I immediately apologized and fixed it when I realized it.
- Two of the patients, I was confused on a diagnosis since I felt the situation was so vague and I couldn't find anything obvious to think of. So I went simple with the diagnoses. One of these two patients I whiffed on the physical exam completely because I thought I actually did notice an anatomical anomaly. (will not talk more about this, it was really, really weird and was what threw me off completely). All the other patients I felt good about a main diagnosis (did have 3 diagnoses on ddx for all cases).
- Forgot to write the name of the patient in one case, so I looked back quickly at the placard in the room to remind myself.
- Timing was not ideal for some cases, rushed a bit on some of them which made me unable to do the closing section completely how I wanted to.
- Patient notes: Got most of what I wanted to type, but the character limit was a problem, leaving some minor stuff out due to this. This happened my first time too but did fine on ICE so I'm not too worried about this.

Overall on the diagnoses: felt good on 8 of the cases at least, maybe iffy on 1 diagnoses on the ddx for a couple, and two were up in the air but I probably justified them as best I could. Two of the patient cases in my head...I just can't remember them at this point, so I guess things were likely okay if I can't remember anything about them. Overall on the CIS: I am scared about this because I worry I left something out, but I don't know. A lot of my fears have to do with knowing that I failed this part the first time around without any feelings of reassurance that I did things right this time around.

My BIG worry is that I failed step 2 CS a second time. I will be finding out the results on thursday likely. I get scared that with the mistakes I made (per above) that I blew it. Any good wishes/vibes and thoughts would be great. I'm very nervous about all of this

You’re going to find out next Wednesday, not today. Sorry...
Results Reporting Schedule for Step 2 CS - ECFMG News

 

[Doctor_meeseeks]

You’re going to find out next Wednesday, not today. Sorry...

thanks for the update, I realized that myself as well a couple of days ago. Although this gives me a bit of time to not think about this, I know I'd rather have the results now rather than later!

Also, I am definitely on the boat now that CS isn't really a reflection on your skills or abilities and I know quite a few people who I know are solid in their clinical skills and bedside manner that just happen to be given a fail for the test. It's really been a growing concern for my school at least. If only residency programs would understand this and not put so much weight into CS...

 

[Promethean]

You've got this. Your post title had me really concerned for you, but I feel really good about your chances of passing and putting this all behind you from everything you've said.

 

[Doctor_meeseeks]

You've got this. Your post title had me really concerned for you, but I feel really good about your chances of passing and putting this all behind you from everything you've said.

Thanks for the support. I really appreciate it and does make me feel better. It's so easy to feel like you've screwed up after you leave the exam, and then mull over the mistakes you know you made.

 

[Promethean]

Thanks for the support. I really appreciate it and does make me feel better. It's so easy to feel like you've screwed up after you leave the exam, and then mull over the mistakes you know you made.

=)

Just remember that every single person who is ever in your situation feels exactly the same way. The VAST majority of them pass the exam that second time. Especially when they do as you have done, and seriously examine their performance and seek to amend any faults. But no matter how well they prepared, every single one has this same anxiety right now.

You did the thing. It is over. No thing you do or think or fret about now makes any difference. So, you do no harm to yourself at all by putting this as far from your mind as possible. Distract yourself at every opportunity. Give yourself permission to do something fun. Go ahead and behave as if you have slain this dragon. Why delay your elation until you actually see the Pass result? Whatever the outcome, how does it benefit you to feel anything negative right now?

 

[Doctor_meeseeks]

=)

Just remember that every single person who is ever in your situation feels exactly the same way. The VAST majority of them pass the exam that second time. Especially when they do as you have done, and seriously examine their performance and seek to amend any faults. But no matter how well they prepared, every single one has this same anxiety right now.

You did the thing. It is over. No thing you do or think or fret about now makes any difference. So, you do no harm to yourself at all by putting this as far from your mind as possible. Distract yourself at every opportunity. Give yourself permission to do something fun. Go ahead and behave as if you have slain this dragon. Why delay your elation until you actually see the Pass result? Whatever the outcome, how does it benefit you to feel anything negative right now?

What you're saying... I completely get it. It is hard however to truly believe I've slain the dragon this time because I still harbor resentment that I even failed the first time, and I still believe that was completely undeserved. Also, it's the fact that because I know I already failed once, the fear is there that it can happen again.

Also, I didn't know any of this info that the vast majority pass the exam if they have to take it again. I keep on reading about people getting a fail for the second time whenever I research this online, although this is THE INTERNET I'm talking about about.

 

[ketosisevangelist]

I am sorry for your frustration and wish you the best of all things in your future.

 

[Promethean]

What you're saying... I completely get it. It is hard however to truly believe I've slain the dragon this time because I still harbor resentment that I even failed the first time, and I still believe that was completely undeserved. Also, it's the fact that because I know I already failed once, the fear is there that it can happen again.

Also, I didn't know any of this info that the vast majority pass the exam if they have to take it again. I keep on reading about people getting a fail for the second time whenever I research this online, although this is THE INTERNET I'm talking about about.

So, remember the power of selection bias.

All those people who failed once and then passed... they don't rush to the internet to say so. They wipe the sweat off their brow, sigh their big sighs of relief, and disappear into residencies never to look back at that hiccup ever again. It just won't matter anymore once they get their license and move along to the rest of their careers.

The people you hear from are those few who do fail twice... because they are the ones who stick around to make noise. They can't move forward, and they are in serious distress, so they talk about it. They seem to be so very many in number despite being truly just a tiny, tiny fraction of students because a tiny fragment of all the medical students in the country is a large enough group to make there be a lot of scary stories out there about folks who fail twice. Also, last year's stories don't fade away. They stay imprinted on the timeless walls of the internet, so that it seems as if there are more and more each year. So, you are hearing from everyone who *ever* had that happen to them, making it seem like a much larger probability than it is.

 

[Doctor_meeseeks]

So, remember the power of selection bias.

All those people who failed once and then passed... they don't rush to the internet to say so. They wipe the sweat off their brow, sigh their big sighs of relief, and disappear into residencies never to look back at that hiccup ever again. It just won't matter anymore once they get their license and move along to the rest of their careers.

The people you hear from are those few who do fail twice... because they are the ones who stick around to make noise. They can't move forward, and they are in serious distress, so they talk about it. They seem to be so very many in number despite being truly just a tiny, tiny fraction of students because a tiny fragment of all the medical students in the country is a large enough group to make there be a lot of scary stories out there about folks who fail twice. Also, last year's stories don't fade away. They stay imprinted on the timeless walls of the internet, so that it seems as if there are more and more each year. So, you are hearing from everyone who *ever* had that happen to them, making it seem like a much larger probability than it is.

All so very true, thanks for the pep talk. I'll be finding out tomorrow, so I'll be crossing my fingers.

 

[Doctor_meeseeks]

Alright! I PASSED!!

Seems like my ICE took a bit of a dip this time, but nothing in the borderline passing. The CIS was more than good enough this time, although I didn't change anything really in my communication strategy

 

[Promethean]

Alright! I PASSED!!

Seems like my ICE took a bit of a dip this time, but nothing in the borderline passing. The CIS was more than good enough this time, although I didn't change anything really in my communication strategy

Thank you for letting us know how it went.

That is one more dragon slain, one less hurdle that you will ever have to jump again. Onward and upward!