STEP 2 CS 2017 _ definitely failing

Discussion in 'Step II' started by CS_Freakout, Jul 27, 2017.

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  1. CS_Freakout

    CS_Freakout

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    Jul 21, 2017
    Hey everyone, here's yet another Step 2 CS freakout

    US med student. Did fine in clerkships and Step 1. Took CS July 2017. Pretty sure I bombed the crap out of it - specifically the ICE section. I'm not sure what exactly goes into grading, but here's hoping it's fairly lenient. Like many other anxious people, I've spent too much time crawling through SDN looking for similar experiences with passing results, but I feel like my errors are too glaring.

    Mistakes I made/Concerns I have:
    1) for 4-5 encounters I had 3ddx, for half I had 2/3 ddx, and for two I only had 1ddx (fml). One of them realized after the encounter what I had probably missed in the H&P, and the other was so cut and dry I couldn't think of any other options. I feel like I was supposed to get 3/3 on all encounters, so this is what I'm most stressed about.
    2) used incorrect medical terminology in some patient notes. Anxiety got the best of me and I blanked on proper terms.
    3) probably missed some obvious diagnosis, and felt like some of the encounters had a clear diagnoses and that my alternate diagnoses were very unlikely but still somewhat possible
    4) Some of my work-ups were very short. I didnt pan-order labs (CBC's/BMP's/etc) if they didn't seem relevant or if they wouldn't help patient managment. But I'm not sure if that was a mistake or not. Idk if work ups are graded on completeness or just if they're reasonable enough.
    5) some complaints were so vague that I hope that I was in the ballpark with my ddx

    I feel like my encounters with the patients were overall good/passable, but my concern is that my documentation will be my downfall. Praying that I'll make it along with 95% of the other test takers, but the fear is definitely setting in.

    Supposedly scores come out in a few weeks. Regardless of the outcome, I'll post my results.

    If anyone has any opinions or other experiences comment below. Thanks and good luck to everyone else!!
     
    Last edited: Jul 28, 2017
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  3. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    Sounds very similar to my experience, although sounds like you put fewer unlikely diagnoses than I did. I don't know what got into me, but I felt compelled to try for 3 on each DDx. Some of the 3rd ones were not-so-plausible.

    If you fail, this bodes poorly for me. Never before have I wanted so badly to be in the 95%.

    As I posted in another thread, I also experienced a lot of very vague complaints (hypothetical example: multiple SPs with CC of something like "fatigue") and then not much positive on ROS. My only guess is that they are intentionally trying to keep the DDx possibilities open and not lead you too hard down one path. But really, who can fathom the minds of the CS test writers?

    Keep us posted how it turns out.
     
    CS_Freakout likes this.
  4. CS_Freakout

    CS_Freakout

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    Jul 21, 2017
    On all my school's OSCE's I tried to max out 3/3 ddx but I've heard that on step 2 CS listing extra diagnoses that are not likely ends up losing points. That kind of got in my head, so I tried to not be too reaching with some ddx, but perhaps I should have been? Idk if you end up getting net points for having something in the box vs just leaving it blank. Idk at this point, but it's hard to not dwell on it.

    Below is a link to the Step 2 CS manual. It has 2 examples of progress notes ("deemed acceptable") with mock grading along with just general info.

    http://www.usmle.org/pdfs/step-2-cs/cs-info-manual.pdf
     
  5. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    Yeah, I had actually read the part online about getting a lower score if using unlikely DDx and yet...did it anyway for 4-5 cases (the others I put 2 or had a slightly more reasonable 3rd one). Really can't justify well this poor decision making.

    On my school's practice CS, for the ICE part I got full marks on the history, above average on the physical exam, and average on the workup and "data interpretation" which I assume was the DDx part. On that part, I think I got docked points for not including some DDx as I put two for most of them (however, the complaints were much less vague than actual CS). I think the fact that I had gotten deducted for that on my school CS was part of why I went for three on real CS.

    Also, I don't know if anyone else had this problem, but I ran out of space on my history in the note. It only has 950 characters!! How do you get the full history with PMH, FHx, meds, social Hx, etc in that space? I ended up having to delete some of my specific pertinent negatives on ROS and just write "negative except as stated in HPI" in order to have space for the relevant social and family histories. I hope I will not have too much taken off for this if the SP checks the box that I asked certain ROS questions!!

    It will be a long wait for me until October. I'm feeling very concerned.
     
  6. CS_Freakout

    CS_Freakout

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    Jul 21, 2017
    I had some issues with fitting everything in the HPI on a few cases. I had to changed to bullet format and use some abbreviations to cut down the character count.
     
  7. CS_Freakout

    CS_Freakout

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    Jul 21, 2017
  8. kingofmedicine

    kingofmedicine That is how daddy eat. WOOF. 2+ Year Member

    You can't worry about it. Everyone worries. If you treat them right as a person and as a professional, you did your best. That's what matters and translates into a pass.


    Sent from my iPhone using SDN mobile
     
  9. CS_Freakout

    CS_Freakout

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    Jul 21, 2017
    Yea I know you're probably right. Its just hard to not dwell on it. Especially when you hear from your classmates about how easy and straightforward of a test it was. Just makes me concerned that I really botched it.
     
  10. Anicetus

    Anicetus 2+ Year Member

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    I felt like **** after my test this week.

    I really wish everyone who makes posts about feeling like failing CS come back to say they passed because all we see are legitimate "I failed CS, what now?" Posts.
     
  11. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    Agreed. I will definitely post if I pass to try to give hope to those in our boat. I probably won't if I don't.
     
  12. Anicetus

    Anicetus 2+ Year Member

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    Me too. I'll make that the second bar of soap I'll have to eat if I don't.
     
  13. Anicetus

    Anicetus 2+ Year Member

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    Apr 11, 2013
    Our experiences couldn't have been more identical btw. 100% the exact same issues. I don't want to think about how much time was wasted going back to the HPI to decide what to delete when I remember an important history point I wanted to add.

    Additionally I felt like half of my #2/#3 Dx's had poor justification but the patients just didn't have enough "classic" symptoms for me to ONLY leave Dx #1 by itself.
     
  14. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    Nice to know someone's in the same boat. Good luck, I hope you end up eating those bars of soap!
     
  15. LandoftheJagain

    LandoftheJagain

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    Your mistakes sound very similar to what everyone posts- and thats in a good way!

    FWIW, I feel my mistakes, in terms of ICE, were similar and, if not, more severe. Plus, I feel like I forgot basic s*** like counseling a ton to really dwindle me down to a fail in CIS as well.

    So, based on what you said, and the retrospective rhetoric those on SDN write, I think you'll be more than fine. I really think you'll be ok. You mistakes in my opinion don't nearly grant you a fail. I'll find out my score hopefully this Wednesday and keep you posted as a marker. I bombed my exam worse than you so I'll be a good benchmark!
     
  16. darklabel

    darklabel MS4 5+ Year Member

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    I felt like I failed coming out and made similar mistakes as above and probably even worse ones and passed with nothing touching the grey.
     
    jpwsurf21 likes this.
  17. CS_Freakout

    CS_Freakout

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    Just got my score report - PASSED!!! Granted my ICE was significantly lower than CIS or SEP (nothing in borderline range, but it was touching it).

    I hope everyone else has some good news today.!
     
  18. LandoftheJagain

    LandoftheJagain

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    Congrats OP! As did I! For those reading in the future: you can make lotsa mistakes and still come out alive. Granted, the wait is tortuous.
     
    CS_Freakout likes this.
  19. ca30

    ca30

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    Dec 5, 2016
    This is my first time writing on SDN and its because this was such a big worry for me I made myself sick about it for weeks on end and wanted to pass along some words of encouragement to those in the same boat. I took my exam in June in Philly and felt like absolute garbage when I finished. My school had a practice OSCE that went pretty well, I practiced with family members out of FA for a few weeks which again I thought went well but on the real deal, I felt like all of that prep work was for nothing. Let me say there was not a single patient encounter that went perfectly for me, I either missed history elements, PE elements, counseling elements, documentation elements, or DDx/workup and in many instances combinations of these on EVERY encounter. Literally every day following the test I would remember something else that I had forgotten and it started to consume my thoughts. I couldn't get over the thought that this test that is supposed to be just another hoop to jump through could derail all the hard work I had put into med school so far. Now I am a US student from a US MD school so the SEP was not a concern for me but ICE especially I was dreading as all of my above mistakes seemed to fall into that category.

    Fast forward 6 weeks and I am thrilled to say I passed and with higher performance in all areas!!! In fact, ICE was not even near borderline. It is very common to think that this exam went poorly and I think a lot of that has to do with the fact that so little is known about how the exam is graded and we have so few opportunities to be formally evaluated in this type of setting vs. step 1 where we do countless practice questions and test so we have some sort of range of where we will fall on test day in the back of our mind. I also think many of us think the worst when we take exams especially big ones like boards, and the unique situation with CS is that we only have two options, Pass or Fail. So when things don't go perfectly on test day we default to the worst case scenario which here is failure.

    It is very easy to say try not to worry about it and just put it out of your mind but that is hard and it will be hard for days or maybe even weeks, but I promise it will pass. Eventually, you will get to a point where you stop thinking about this stupid test. Bottom line, as I and many others have noted this exam is not about perfection it's about efficiency, just try to check as many boxes as possible in the limited time and realize you can make A LOT of mistakes and be just fine. Also, take a small bit of comfort in the high pass rates and even though it is easy to believe fully you are in that unfortunate 3-5% of takers, the odds are you absolutely are not. Best of luck to everyone still waiting on results or preparing to take CS in the near future.
     
  20. AshNiffler

    AshNiffler 2+ Year Member

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    The exam felt like a blur and omg what just happened...
     
  21. Milotic

    Milotic 2+ Year Member

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    Thanks for coming back and posting your pass. So many people come on here and state how they are certain they failed and don't come back to post how they ended up doing. A lot of us feel quite crappy after the exam. I so wonder how different the people who DO fail feel vs the ones like you who feel they failed but pass with flying colors.
     
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  22. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    anyone take it on 7/17? will scores be released tomorrow?
     
  23. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    Just got my score back. Pretty sure I made WAY more mistakes than you and I passed comfortably.
     
  24. Milotic

    Milotic 2+ Year Member

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    Guessed on 50% of the cases - did an MMSE when it wasn't necessary. Still passed.
    For those of you in the process of applying, do we need to update programs about the Pass or not?
     
  25. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    You have to resend your USMLE transcript from ERAS I believe.
     
  26. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    could be one of those instances/exams that your result the exact opposite of how you feel. I've read many stories of people who thought they seriously bombed it but ended up doing fine. Haven't heard of many people walking out of CS feeling good about it.
     
  27. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    Get your score back today?
     
  28. AshNiffler

    AshNiffler 2+ Year Member

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    December 13
     
  29. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    best of luck!!
     
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  30. AshNiffler

    AshNiffler 2+ Year Member

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    Thanks, I feel like I won’t get interviews until I do. Congratulations on passing :)
     
  31. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    Thanks! Like I said I made a LOT of mistakes and still was fine, so try to put your mind at ease. What are you applying?
     
  32. AshNiffler

    AshNiffler 2+ Year Member

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    Honestly I’m not freaked out about it, I’m concerned it’s affecting my chances at getting interviews though. I applied for internal medicine.
     
  33. DBV

    DBV

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    I wouldn't think so. I took CS in july and just got my results today. That would mean that people would have to have taken it in third year to have results in eras before today. Also N=1 but I have 12 invites without CS scores
     
  34. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    yeah same I'm applying DR and have had 20+ invites, and just got my CS score today back today
     
  35. AshNiffler

    AshNiffler 2+ Year Member

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    Caribbean non-US IMG needing visa sponsorship...also a program sent me an email saying my application was incomplete without CS.
     
  36. DBV

    DBV

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    well there's your problem
     
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  37. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    As an update for those who read this later, I ended up passing. Asterisks in SEP and CIS and in the middle of the white for ICE. There has to be a lot of leeway in grading, I really made a lot of mistakes!
     
  38. Usmlesteps1

    Usmlesteps1

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    MDApps:
    MDApps:
    I need your help , I am IMG , first of all I was sleeping just view hours the day before exam and my Exam was Afternoon time to 10 pm
    Anyway , since my test I felt brain block , I just can remember 10 cases , I forget 2 , I don't know if I did well or bad in exam but All I remember is that:
    Mistakes:
    1-SP do some head movement in one counter many times ,I didn't ask him why .
    2- I forget MMS exam in patient with head trauma ( I did all other neurological examination)
    3- five cases I felt my first differential D is ok but I wrote other DD that I feel not accurate .
    4- The work up in 3 cases with special exam (like pelvic , rectal ) I wrote it as 3rd diagnostic work up instead of first .
    5- I forget to ask pt who is 17 yo about immunization status .
    6- some cases I didn't ask the SP other associated symptoms .but I clearly know the diagnosis. I was supposed to review that symptoms.
    6- I found 2 SP sitting on chair , I asked while I am standing So difficulty eye contact , also I didn't cover them on the examination.
    7- after I did the closure , I remember some Symptoms in 3 cases then I asked the SP.
    8 -I was totally exhausted in last 3 cases that affect my confident and speech .
    9- I think the SP recognize my fatigue because I was yawning
    10-I felt my language has a lot of frequent stoping for thinking , then I talk.

    The good things:
    1- Knock the door in all encounter.
    2- introduces self and clarify role .
    3- ask the SP if he feel comfortable .
    4- ask the SP how w'd like to be addressed .
    - keep good eye contact .
    - very good empathy
    - try my best in answering the challenging Q.
    5- I did good HPI , ROS , PAM HITS FOSS in all cases( Female I did for all of them LMP RTV CS PAP)
    All heavy drinker ,I asked them CAGE.
    6- I did summarization , transition, paraphrase ,Open Q in all cases.
    6- I wash my hand before all examination
    I did good physical exam for all Cases gentle , Ask consent , exposure , then thanks the SP .
    7- I did closure for all cases , then ask did you understand me , are you agree on my plan, do you have any Question , do you have any concern .
    8- I did counseling in all cases.
    9- I thank the pt then leave the room.
    10- I wrote the notes very well .
    What is the percent that I will pass, please !!
     
  39. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    Dude I hope you didn't communicate with the patient or typed your notes the way you used grammar in your post....
     
  40. Usmlesteps1

    Usmlesteps1

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    MDApps:
    MDApps:
    It is same , I think way
     
  41. AshNiffler

    AshNiffler 2+ Year Member

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    My CS study partner just started learning English 10 months ago, she was also having these issues, I hope she does well.
     
  42. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    You'll pass most likely because I made a ton of mistakes on mine and passed just fine. Good luck!
     
  43. Usmlesteps1

    Usmlesteps1

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    Really !!! I think no one did like me ,, I feel bed , nightmares, sad
     
  44. GrandBuckeyeOH91

    GrandBuckeyeOH91

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    yep that's exactly how i felt...was convinced i had failed it for sure...had nightmares about it, was sad not knowing how this would impact the residency application process. but in the end you'll way more than likely end up passing :)
     
  45. Usmlesteps1

    Usmlesteps1

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    MDApps:
    MDApps:
    Thanks for help and inspiration , hopefully on 13 December I will see the result and pass , OMG 2 months waiting
     

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