Step II Seriously worried i failed CS

[babycatcher08]

Friends,
I know there are many similar posts out there regarding the same subject, but I am completely freaking out about my recent Step II CS exam. There are a few things that are driving me crazy and I am worried I failed. I always knocked, introduced myself and addressed the patient, gowned the patient, washed hands and apprpriately answered questions. However I know I forgot some KEY physical exam findings on some patients. Examples include that I did not always feel for the thyroid or LAD, I didnt listen for carotids on a suspected stroke patient, and i couldn't get the blood pressure cuff to work on a patient! I feel that i appropriately counseled my patients on what I was going to do, but I don't always think that I counseled them on their diet or smoking cessation. Also, I don't think I ONCE added a ROS part to my note. Although I asked the questions and tried to include them in my HPI, there was no added ROS section to my note.

I really felt comfortable with some of the patients and knew I was on the right track, but these mistakes are haunting me. Does anyone know what you have to exactly do to fail this thing? Any advice for me because the worrying is driving me crazy!

Any input is greatly appreciated. Thanks to all and good luck with the match. (Just another addition to the stress!!)

 

[Rogue_Leader]

I prescribe whiskey.

 

[Belle826]

If it makes you feel any better, I felt exactly the same way when I left mine. I just started replaying in my head the things that I had forgotten, which in retrospect seem ridiculous! I just keep telling myself that the odds are in my favor and that I most likely passed. Does nothing for the anxiety about it though. While whiskey is not my thing, a martini sounds like a good idea🙂

 

[nevercold]

I think you probably didn't fail.

 

[polaris]

Never posted here before, but have been reading for a while. So I just got my score and I was happy, but surprised to see a "PASS." Just a word of enouragement for anyone else waiting for their score, I was also one of those who seriously believed they had not passed. Here are the things I did wrong (that I remember) and still passed:
- never wrote a ROS on my PN
- wrote NKDA, when pt was allergic to ASA
- forgot to counsel a pt on smoking cessation
- kept repeating a few questions that patients had already answered
- was definitely rushed during encounters, because I was worried about time on the PN
- never retook vitals, even with a possible orthostatic
- 2 patients I had no clue what was going on.
- never did a MMSE

So you most likely passed, the worst about this exam is waiting for the results. Try to not think about it, though at times I have to admit I did loose some sleep. Good Luck!

 

[MedGoatTX]

I agree with polaris. I'd been making myself miserable for the past two months thinking of a whole list of things I forgot or did wrong, and I just found out tonight that I passed. Now if you, say, forgot to wash your hands or introduce yourself or whatever on EVERY patient, you might have problems. But if you just forgot one part of the encounter here and didn't do a great physical or forgot the CAGE questions there, odds are you're going to do fine. I think this test penalizes systemic, across-the-board mistakes rather than the individual ones that we keep thinking up and that drive us crazy in the inordinate amount of time it takes to grade this damn thing. And, according to the latest numbers, I think 97% of AMG's should pass this year.

So do what the first responder said, have a whiskey, and try to salvage something out of the time until you find out. Good luck to all.

 

[babycatcher08]

Thanks to you all who have replied. I just keep replaying things in my head that i forgot! My new one is that I dont think I ever checked extra ocular movements but I'm pretty sure I documented CN II-XII intact in my notes! Now, from looking at the patients I could tell they didn't have any lazy eyes, but thats pretty bad!

I know that in the end I will probably be fine, but the waiting game is killing me. Rough part is that I still have to wait a couple of months and that stressful little thing called The Match is thrown in there too. I see lots of bottles of wine in my future...

Thanks again.

 

[Maitreyi]

those posts are reassuring, but I can't help thinking of all the people that didn't pass who didn't seem to make too many mistakes. I made a TON. Everytime I read one of these posts I remember another - so I can't stop worrying. Here's my tally so far:

1)Forgot ROS and allergies on most pts - but ROS was part of HPI
2) on one pt, forgot to do PMH/PSH and meds
3) did not do a murphy's sign on a potential gb patient -(what the hell was I thinking??)
4) put something wildly improbable down as my fist ddx on a pt
5) was not very sure of the dx on a couple . . .

I agree that these encounters are incredibly fake - I usually do very well with patients and did well on my OSCEs - which was harder - so I do think it is very unfair that we (AMGs) have to go through this.

 

[arthrodisiac]

i passed...

1) forgot to wash hands twice
2) ran out of time on 4 stations (didnt complete counseling)
3) didnt tell phone patient to come to office/hospital
4) forgot certain aspects of physical exam on certain patients
5) left two encounters not knowing what the hell was wrong with patient
6) didnt write psychiatric h&p (mood, affect, etc)
7) didnt do orthostatics
i could keep going...

advice
1) smile and be empathetic
2) feeling like a failure is normal, and probably means you passed
3) accept the fact that you WILL do something wrong

 

[NuMD97]

"didnt do orthostatics"

Considering the time constrants, I can't see how anyone could do orthostatics. I think the key with something like that is to show you understand the need, and then put it in the workup.

But how without a watch are people pacing this? The caveat the administrators state, that although clocks are now in the room, it isn't the "official time keeper". In other words if there is a discrepancy, they go with their own clocks. 😱

I like what someone posted on another board: Soon there will be full body cavity checks to prevent cheating. It wouldn't surprise me. Even amplied stethoscopes that some physicians prefer, or for those with hearing impairments are verboten. It's pretty messed up....

 

[arthrodisiac]

didnt do orthostatics

Considering the time constrants, I can't see how anyone could do orthostatics. I think the key with something like that is to show you understand the need, and then put it in the workup.

On that particular patient I would've had time, but didn't want to do it because I hate being an actor, and I knew that it would be normal, although on a real patient I definitely would've done it. On the orientation video, they say...take all vital signs on the door as being correct, but if you feel the need to do orthostatics, you can do it. Why else would they bother putting bp cuffs in the room?

 

[Hard24Get]

those posts are reassuring, but I can't help thinking of all the people that didn't pass who didn't seem to make too many mistakes. I made a TON. Everytime I read one of these posts I remember another - so I can't stop worrying. Here's my tally so far:

1)Forgot ROS and allergies on most pts - but ROS was part of HPI
2) on one pt, forgot to do PMH/PSH and meds
3) did not do a murphy's sign on a potential gb patient -(what the hell was I thinking??)
4) put something wildly improbable down as my fist ddx on a pt
5) was not very sure of the dx on a couple . . .

I agree that these encounters are incredibly fake - I usually do very well with patients and did well on my OSCEs - which was harder - so I do think it is very unfair that we (AMGs) have to go through this.

ARGH, me too! I took it today. It is SO different from being in the regular clinic! Most of the SPs are hostile and you know they are evaluating you. I was nice and washed my hands, etc, but I got nervous and forgot to ask about preg hx in a bleeding female, forgot a key portion of the history (ie Meds x2, Social hx x1) in at least 3 pts, forgot to pull out the leg of the exam bed for a pt once and one pt accused me of palpating her belly too hard! 😱 I can't fail this thing - I'm too broke after interviews and don't have time. I would have rather done two CKs than this - it was NOT representative of my performance in the clinics. 🙁

 

[Arsenic]

ARGH, me too! I took it today. It is SO different from being in the regular clinic! Most of the SPs are hostile and you know they are evaluating you. I was nice and washed my hands, etc, but I got nervous and forgot to ask about preg hx in a bleeding female, forgot a key portion of the history (ie Meds x2, Social hx x1) in at least 3 pts, forgot to pull out the leg of the exam bed for a pt once and one pt accused me of palpating her belly too hard! 😱 I can't fail this thing - I'm too broke after interviews and don't have time. I would have rather done two CKs than this - it was NOT representative of my performance in the clinics. 🙁

i totally know how you feel. the evening after my test i went from calm to straight up freaked out after i started remembering everything i forgot. from buttoning gowns back up to rushing neuro exams and closures to being totally stumped on one case and missing some obvious ddx on others. hell, i was even stressed out over one SP who like rolled his eyes at me when i left the room. 😱 regardless, i got my score today... PASS. please dont freak out, if you look closely on the step 2 board you'll see tons of stories of people forgetting stuff like you did and still passing. as for the pt who said you were palpating too hard, hell maybe she was just "challenging" you to see how you'd react in the same way they ask challenge questions to see how'd you react. good luck Hard24Get, don't stress over this too much.

 

[medblazer21]

Missing a couple of things here and there is not enough to fail. If you want to compare your performance to someone who DID fail, then see my thread in this forum. It sounds to me like your list of mistakes was a lot smaller than mine.

good luck

 

[poopsock]

I would just like to add some encouragement to the above posts (I made a similar post because after taking cs I was almost sure that I failed).

I did the following:
-I literally did not sleep at all the night of the exam because I wasn't feeling well, so I took the exam basically with the flu and zero sleep
-I forgot to get the pmh/sh/fh/allergies/meds on one patient (it was a phone call and I hung up and before I remembered to ask those things...)
-my ddx sucked for about 1/3 of the encounters
-I forgot some key PE things on 3 patients
-I never counseled on etoh or smoking cessation

I did however
-knock
-wash hands
-drape
-give my clinical impressions

I found out today that I passed, but was very, very worried about it.

I feel extremely sorry for those that do not pass, because I could see it being a nightmare with matching and entering intern year, not to mention the monetary price of taking it again. But take heart, you probably did not do as bad as me, and I passed. So have a few drinks and put it out of your mind until your score actually comes back. It is likely that you passed.

 

[Maitreyi]

Thanks for all your posts. But it does still seem kind of arbitrary who passes and who doesn't.
With regard to PE findings, I didn't have many. It is hard to know what they were faking, when they were faking it. For instance, the man with the cough and the pain in his right side - he made a weird sound through his mouth while I was checking breath sounds - and I had no idea what he was trying to do! It certainly wasn't wheezing . . . this is the problem with fake scenarios.

I also didn't take off the gown completely - were we supposed to? I always just uncover the area that I'm examing and then cover it up again right away.

And no, I never checked femoral pulses, did CAGE on anyone who only drank 1-2 drinks a week, or did a gyn hx on female pts who were not having abdominal, gynecological complaints.

I still have a month or so to go for my results. I can forsee remembering a lot more I DIDN'T do . . ..

 

[nevercold]

You know, I spent a month in a family medicine clinic working one-on-one with various physicians there in November, seeing patients in these 15-minute time intervals, and you might recheck a 170/110 blood pressure, but you trust the vitals the nurse gives you if you know she is competent. You don't have time to not trust them.

On my phone patient (pediatrics), I specifically told the mother not to bring the child in and to call back in a couple days. I stand by that, too! If they hold it against me we'll get out the gloves and have a go. 🙂

I also pretty much skipped allergies unless I had extra time or unless we talked about medications in the room. Useful information, but I'd prefer to get other info first if I'm not going to be even considering prescriptions.

I think the worst part of these standardized patients is that some refuse to participate in developing rapport. Some are willing to go outside of the set script of answers, whereas others could very well be reading a teleprompter sitting behind me in the exam room. I very deliberately tried this with one patient and after a couple of questions she realized I was doing more than "Pain? Where" How much? Radiates? Makes it better? Makes it worse?" and suddenly changed her tone to acknowledge my efforts.

 

[babycatcher08]

how long has it been taking for all of you to get your scores back? what kind of time frame of excessive worry am i looking at here?