Step 2 CS - anyone taken it yet?

[deschutes]

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Spent some of my forced time offline dwelling on this huge cash-consuming endeavour that is the Step 2 Part B...

Anyone taken it yet?

(I know there's a General USMLE forum, but (a) they're talking about Step 1/2 most of the time and (b) I'm STILL on dial-up.)

I just read on the NRMP website that CS results unless taken by December are unlikely to be available in time for the 2005 Match, whatever that means. I had talked to several program coordinators earlier in the year re: their requirements for CS, but they seemed as unclear about it as I was.

Seems like the whole thing is just too new.

Why oh why wasn't I born a year earlier!!! 😡

My laundry is moving faster than my thread-views. Telus really couldn't have picked a better time to crap out.

 

[DrBloodmoney]

All I can sayis...
I thanked my lucky stars when I found out that I was in the last class that wouldn't have to take that. It sounds like a poorly-planned prank.

My sympathies to those who will have to go through it.

 

[b&ierstiefel]

All I can sayis...
I thanked my lucky stars when I found out that I was in the last class that wouldn't have to take that. It sounds like a poorly-planned prank.

My sympathies to those who will have to go through it.

The scoring for the Step 2 CS is only pass/fail. I think the most negative aspect of this exam is that it costs around $1000. I could be using that money for other purposes...

 

[deschutes]

The scoring for the Step 2 CS is only pass/fail. I think the most negative aspect of this exam is that it costs around $1000. I could be using that money for other purposes...

Thing is, when do they need that pass/fail score? By the ROL deadline? (...we've had this conversation before, methinks... or on a variation thereof.)

Do you know that there is a bloody First Aid for the Step 2 CS? Bloody hell.

I think the most negative aspect of this exam is paying an additional $1000 for flight/accom/transport to LA/Philly!

Actually I'm just not going to think about it. It will only depress me.

 

[yaah]

Yeah, that travel part STANKS!!!

I was p.o.'d when I heard about Step II CS, and I didn't even have to take it. At my med school, we did so many of these exercises. At the end of every third year clerkship (as well as DURING the clerkships) we had graded interactions with standardized patients. Then at the end of third year we had a 5-6 hour session with SPs. This is probably true at most med schools, and the fact that they are now basically not trusting US med schools and making every graduate go and do a standardized exam, all I can say is WTF?

If a person finishes med school and cannot do an adequate H&P, then one of three things is probably true:
1) The school deserves to lose its accreditation
2) The student should NOT be in med school and the school should have figured it out at this point,
or most likely 3) The standardized exam and evaluation methods are screwy, do not relate to what it is actually like to be a doctor, and are basically worthless.

Why can't they ask every med school to ensure that every graduate has to meet certain standards in order to graduate? I assume they have these standards for clerkships. Is having this one test going to make everyone a better doctor? Not by a long shot. And placing a burden of thousands of dollars for exam fees, time lost, travel, and hotels on already cash strapped med students isn't right. But hey, they probably give you a free crappy lunch the day of the exam and they probably discount the Philly hotel rooms from $150 a night to $135 a night.

I figured out why they are requiring this test though. Lawyers. The powers that be want to come off as "listening" to patient complaints about lack of time spent with doctors, malpractice, etc. As if testing people on how they interact in simulated situations with fake patients as any real bearing. I saw a survey in which they asked the public: "Do you support future doctors being required to take a test in which they are evaluated on their interactions and physical exam skills with simulated patients?" What do you think the public said, no? Of course they said yes! Who wouldn't say yes to that! And the NBME or whoever uses this survey as evidence that such a test is important, vital, and warranted. What a crock of ****.

I pity you all. I think someone should organize a nation-wide protest where every 4th year student refuses to take this test IF their own school has a similar evaluation method. Then see what happens. I would have participated last year if I had to fly to Philly for this abomination.

 

[Gut Shot]

My med school reams us with standardized patients as well. It's useful until third year, when it becomes blatantly obvious how marginally realistic they are. If every doctor in our hospital was using "correct" interview technique the place would rapidly grind to a standstill.

Med Student: "Tell me more about your nausea..."
Junkie in ER: [Vomits on bed, floor, IV pole, med student, some more on the bed, the wall, and then the highly disgusted CNA trainee]

Our standardized patients are drawn from an adjacent medical school, and several weeks ago one of their coordinators came and talked to us about "communication skills." This person had obviously never interviewed a real patient AT ALL, yet still found ways to be condescending to us and to med students in general about our supposed lack of communication skills.

She even informed us that being in the fake patient business had paid her way through college, that it employs thousands of people nationwide, and that it's not going away. Great! Another revenue-sucking parasite dangling from the medical licensing racket. Perhaps we can start a legal defense fund/class-action lawsuit and sue the bastards for wasting everyone's time and money.

 

[SLUsagar]

Thing is, when do they need that pass/fail score? By the ROL deadline? (...we've had this conversation before, methinks... or on a variation thereof.)

Do you know that there is a bloody First Aid for the Step 2 CS? Bloody hell.

I think the most negative aspect of this exam is paying an additional $1000 for flight/accom/transport to LA/Philly!

Actually I'm just not going to think about it. It will only depress me.

-----------------------------------------------------------------------
deschutes:
sadly enough, there IS INDEED a first aid for the step 2CS - which i'm sure Bhushan or Tao Le et al are just thrilled about, having another successful money-making book....! i heard though that IF INDEED you want to use a book, the ol' OSCE prep book is just fine. but i dunno, i still haven't thought about the exam yet seriously.
I plan on taking BOTH the step 2CS and CK the last week of January (2005), so i seriously hope no is expecting if before ROL are out. My PD told me that everything will be allowed, for at least this year, being the first time CS is implemented....next year, things may change. So we're all good for now...EXCEPT for the $1000.00 we must dish out. And remember, Step 2 CS = Cash Scheme

 

[b&ierstiefel]

We too have graded standardized patient encounters throughout all 4 years of med school. In addition, we have what's called a Comprehensive Clinical Assessment where we go through a bunch of stations which cover live-patient encounters, reading X-rays, reading EKGs, and then answering a couple of stupid questions on EBM. This is the first year that our school has tried to model a portion of the CCA to reflect the new Step 2 CS.

I share your sentiments. If we have to do these fake patient exercises, why the hell do we have to pay $1000+ to take a stupid nationwide test. Cut out the redundancy...cut out the BS.

And plus, I believe we future pathologists should all be exempt from such activities.

Random point - Some random private attending overheard me saying to another student that this is my last month of inpatient medicine for the rest of my life. He yelled at me saying, "if you don't like patients, you shouldn't be a medical student." I told him, "I like patients...bits and pieces of them."

 

[quant]

Random point - Some random private attending overheard me saying to another student that this is my last month of inpatient medicine for the rest of my life. He yelled at me saying, "if you don't like patients, you shouldn't be a medical student." I told him, "I like patients...bits and pieces of them."

Thats a scream!!!!!.............ROFLMAO

Argh i should try to think of such comments...............


Great one andy!!!

Quant

 

[b&ierstiefel]

Thats a scream!!!!!.............ROFLMAO

Argh i should try to think of such comments...............


Great one andy!!!

Quant

Seriously...as my last few weeks (and soon days) of clinical medicine dawns, I become more defiant. I'll even give attendings (other than the one on my team of course) crap if they give me crap. I bring a six-pack of cans of whoopass with me to work everyday.

Interestingly, at the hospital I'm at, I am now known as "the guy who is going into pathology." And some ppl have come up to me and said, "so you're going into pathology right?" I'm like, "uh yeah". They respond, "that's a good lifestyle." All I can say is, "I haven't gone into pathology YET. I don't know for sure how good or bad the lifestyle is. Please STFU about the lifestyle bit." OK I didn't say the last bit 🙂

But seriously, lifestyle is not the major issue at this point. Pathology is a difficult craft to learn (from reading other posts, the learning curve seems quite steep). So I'll be spending some of the free time I have by reading pathology texts instead of answering pages about Mr. X who hasn't shat in months at 2 in the morning.

 

[kem]

I know no one knows me here, I've been a bit of a lurker. I hang out at the ob-gyn forum most often. (Yes, I know I'm crazy) 🙂

I think the worst part about step 2 CS is that they act like people are going to become more compassionate physicians if they take this test. Any arrogant jerk can say the right things "That sounds difficult. Tell me more about your feelings about your abdominal pain" or "What exactly is it about the crushing substernal pain that radiates to your neck that worries you?" for an 8 hour exam. The key is whether you are nice to your patients when woken up at 3 in the morning because the nurse says they need more tylenol.
AAAAAAAAAAAAAAH!!!

I haven't paid for this exam yet because I'm hoping the whole thing falls through and doesn't work out. In other words, I'm still in the denial-anger stage of grief.

🙂 kem

 

[b&ierstiefel]

I think the worst part about step 2 CS is that they act like people are going to become more compassionate physicians if they take this test. Any arrogant jerk can say the right things "That sounds difficult. Tell me more about your feelings about your abdominal pain" or "What exactly is it about the crushing substernal pain that radiates to your neck that worries you?" for an 8 hour exam. The key is whether you are nice to your patients when woken up at 3 in the morning because the nurse says they need more tylenol.
AAAAAAAAAAAAAAH!!!

🙂 kem

Besides the cost, I also think this is one of the worst aspects of step 2 CS. We are paying to take a STAGED exam...fake patients, fake emotion, fake compassion...all FAKE.

I tell ya, if I got paid a nickel for every time I said, "So how does that make you feel?" during these fake exercises, I'd be a millionaire.

 

[cookypuss3]

Random point - Some random private attending overheard me saying to another student that this is my last month of inpatient medicine for the rest of my life. He yelled at me saying, "if you don't like patients, you shouldn't be a medical student." I told him, "I like patients...bits and pieces of them."

Beautiful. Just beautiful. I can't wait to use this. Why are the attendings such nerds about students going into path? They take it as a personal affront that we are not intriuged by or get off on seeing patients. I am really tired of the almost-crappy treatment they dole out. They either laugh, or look at me skeptically, and ask why I hate people. Oh, hell, I'm preaching to the choir. You all know. I just want to stare the attending straight in the eye and go, "Jealous much?" with a cynical and evil arch of the brow.

I sent in my $1000 check for the CS almost 2 weeks ago, an event in itself that is akin to ripping out your own toenails, and it hasn't gone through yet. I don't have the foggiest idea what they're waiting for. Finally I called them up today and said if they didn't deposit it pronto it was going to bounce. Jackasses. The secretary did not sound amused.

 

[Stinger86]

Assuming it's allowed, I'm planning on taking my Step 2 CK during our two week break between junior and senior year and then waiting to take the CS until I am absolutely required to take it for the first time by my school. Like kem said, I'm sorta "waiting" for it to maybe go away.

On a different note, I hear it's really easy to pass this thing, which further validates the opinion that this test is a waste of freaking money. It probably costs like $500 per student to run this thing, and the other $500 is what they lick off the top. Bastards

 

[b&ierstiefel]

It probably costs like $500 per student to run this thing, and the other $500 is what they lick off the top. Bastards

I heard something like this too...like the test costs extra to cover "administrative fees." Yeah...what bullcrap. I'm upset about this.

 

[DrBloodmoney]

Yeah just remember to wash your hands, introduce yourself as a medical student and nod your head a lot. And ask a lot of questions.

 

[deschutes]

Besides the cost, I also think this is one of the worst aspects of step 2 CS. We are paying to take a STAGED exam...fake patients, fake emotion, fake compassion...all FAKE.

I really hope they won't do those culturally-sensitive stagings where you have to take a history through an interpreter because the patient speaks fake Spanish.

In one of those scenarios, a friend of mine said, "Oh, you speak gobbledygook? I speak gobbledygook too! Gobble gobble gobble!"

This coordinator had obviously never interviewed a real patient AT ALL, yet still found ways to be condescending to us and to med students in general about our supposed lack of communication skills.

These are the same people who gush, "Oh look, you used THREE open-ended questions! Hooray!" *clap clap clap*
I looked at her like she had two heads - I couldn't help myself.

I was told at the beginning of clerkship that I lacked confidence.
My fellow clerks apparently didn't have the same problem. But hell, I didn't know a thing and I wasn't going to pretend I did.
"Present the case with a view to convincing us of your diagnosis."
Buddy, I haven't the faintest idea what is going on.
Senior then reams me for checkerboard presentation and proceeds to ask me a ton of questions I never thought to ask the patient.

But still, I am finally beginning to get the hang of this confidence thing!!
I've realized that if you stare at the PGY-1 internist in the eye when you answer their question with "I asked him that and he (the patient) really doesn't remember", they'll usually get off your back. Ha!

 

[deschutes]

I pity you all. I think someone should organize a nation-wide protest where every 4th year student refuses to take this test IF their own school has a similar evaluation method. Then see what happens. I would have participated last year if I had to fly to Philly for this abomination.

I imagine the argument they produce would be that 4th years don't know what's good for them. And there is an increased risk of going unmatched don't you think - what program would want a "trouble-maker"?

Plus the fact that I am an "independent applicant" - the stakes are too high!

I saw a survey in which they asked the public: "Do you support future doctors being required to take a test in which they are evaluated on their interactions and physical exam skills with simulated patients?" What do you think the public said, no? Of course they said yes! Who wouldn't say yes to that! And the NBME or whoever uses this survey as evidence that such a Test is important, vital, and warranted. What a crock of ****.

I read the survey too. They were pushing it through on the flimsiest of reasons.

From the USMLE Step 2 CS page:
"During recent field trials, 20 percent of the fourth-year students who completed a survey said they had been observed interacting with a patient by a faculty member two or fewer times. One in 25 said they had never been observed by a faculty member."

Oh what OUTRAGE! The health of the public is put at risk AGAIN!

Presumably only faculty member staff are real doctors - residents don't count.
And presumably staff doctors have nothing better to do all day than watch hordes of medical students do physical exam manoeuvres.

At my school they have tried to improve the "supervised patient interaction" rates with pain-in-the-ass logbooks.

A skilled clinician is the product of time, patience and experience. No standardized exam can shorten the process.

 

[carrigallen]

Actually this test was originally developed in the 80's for IMG/FMG who were required to take it prior to being licensed.

Then, at the end of the 90's the applications from FMG's took a nosedive, so the USMLC was left with these patient simulation centers and only a few people using them.

Their solution: "Let's make ALL the medical students take the exam". Now it is like a money factory for them.

Moreover, it is a money factory for the book companies - a whole NEW test to sell review prep for.

 

[cjw0918]

A girl at my school just took the test in Atlanta and said it was a breeze. 12 standardized patients with fairly obvious dx. Our school does standardized pts all 4 years and OSCEs and she said it was just like this. Apparently, it's the hassel of traveling and paying for it that sucks so badly. Good luck to all in the application process this year.

 

[b&ierstiefel]

A girl at my school just took the test in Atlanta and said it was a breeze. 12 standardized patients with fairly obvious dx. Our school does standardized pts all 4 years and OSCEs and she said it was just like this. Apparently, it's the hassel of traveling and paying for it that sucks so badly. Good luck to all in the application process this year.

cool cool...i hope my step 2 CS is a piece of cake. it's interesting that my last patient will be a fake patient who is paid to play a role.

 

[Harbster]

I plan on taking it in Chicago this Tuesday. I've prepared using the OSCE...First Aid is not getting anymore of my loan money! I've read and reviewed the OSCE book and felt it was really good! Many of my friends that passed recommended it and I, as well, highly recommend it to anyone taking the CS. Many claim tthe CS is just an english profiency exam. I'll keep you posted on how it goes this coming week.

-Harb

 

[Harbster]

I plan on taking it in Chicago this Tuesday. I've prepared using the OSCE...First Aid is not getting anymore of my loan money! I've read and reviewed the OSCE book and felt it was really good! Many of my friends that passed recommended it and I, as well, highly recommend it to anyone taking the CS. Many claim tthe CS is just an english profiency exam. I'll keep you posted on how it goes this coming week.

-Harb

I recently took the CS last week. Let me tell you, I'm glad it done! Total of 12 patients, seeing the first 2-3 is a little nerve-wrecking since you are just getting the feel for time. Thereafter, you adjust and it becomes a little game. It's mostly pain so polish up your OPQRST. The OSCE book is money!

-Harb

 

[deschutes]

Thanks Harbster! Is it mostly focussed on Dx/Ix or are there treatment/management plans to be considered?

 

[Harbster]

Thanks Harbster! Is it mostly focussed on Dx/Ix or are there treatment/management plans to be considered?

Treat/management not required. Although you must be able to list at least 5 differential diagnoses along work-up tests (ie CBC with diff, EKG, CT, etc).

They are not concentrating on your doctor skills but rather on the basics (ie: Washing hands before examining patient, letting the patient speak without interruption, pulling out the examination bed leg extension for the patient, able to sympathize with the patient, etc).

 

[yaah]

They are not concentrating on your doctor skills but rather on the basics (ie: Washing hands before examining patient, letting the patient speak without interruption, pulling out the examination bed leg extension for the patient, able to sympathize with the patient, etc).

Wow...that test is almost pathetic and sad in its lunacy.

The fact that they charge $$$$, make you travel, and make your residency and graduation dependent on whether you can do stuff like this? Especially when the test is meant to evaluate your skills at relating to patients and being a doctor that patients trust. It's incredibly condescending to make someone who spends so much time, effort, and money in sacrifice to be a physician do something like this for political gain or windowdressing. Because that's all it is. It isn't making anyone a better doctor.

It's like making every lawyer in the country travel 1000 miles and pay $2000 just to test on how well they can sign their name or collate some paperwork.

I'm glad I don't have to take that test. I would feel like it was such a waste that I would not be pleasant to be around. They would get lots of angry letters from me.

 

[b&ierstiefel]

I still believe that future pathologists should be exempt from Step 2 CS. Completely useless for our purposes. What? We're gonna be treating that breast mass with tender love and care and compassion? C'mon let's be serious here!

P.S. It's the beer talking.

 

[Harbster]

Wow...that test is almost pathetic and sad in its lunacy.

The fact that they charge $$$$, make you travel, and make your residency and graduation dependent on whether you can do stuff like this? Especially when the test is meant to evaluate your skills at relating to patients and being a doctor that patients trust. It's incredibly condescending to make someone who spends so much time, effort, and money in sacrifice to be a physician do something like this for political gain or windowdressing. Because that's all it is. It isn't making anyone a better doctor.

It's like making every lawyer in the country travel 1000 miles and pay $2000 just to test on how well they can sign their name or collate some paperwork.

I'm glad I don't have to take that test. I would feel like it was such a waste that I would not be pleasant to be around. They would get lots of angry letters from me.

Yeah, it is very pathetic...What's one to do? Sometimes you just have to shut up, bend over, and take it like a man. 😱 On the brighter side, I do see the light at the end of the tunnel.

 

[b&ierstiefel]

Yeah, it is very pathetic...What's one to do? Sometimes you just have to shut up, bend over, and take it like a man. 😱 On the brighter side, I do see the light at the end of the tunnel.

I've taken it up the *** like a man many times during the clinical months. Having to pay tons of money for this exam takes this to new heights though.