USMLE Step 2 CS December 13th 2017 score release

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Just got mine and passed as well... i will try to post my experience tomorrow since this forum helped me so much
 
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got my scores 20minutes ago, Damn two stars below borderline on ICE, but I still passed. Its a xmas miracle!!
 
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Passed!

I oscillated between extreme nervousness remembering my mistakes in the hours and first week after taking the exam then completely forgetting about it for a couple weeks, only to randomly remember something I messed up on or question whether I did the PE or wrote the correct diagnosis throughout the months

SEP: *
CIS: xxx*
ICE: 3x's in borderline, rest above

In my opinion, the new standards/tougher grading just mean passing got a little tougher, not the difficulty of the exam. In reality, the only thing they can objectively grade harder is the note/workup/diagnosis so work on your ICE portion. I'm a USIMG. I think the main reason for my ICE scores were the differential/workup section. My HPI was solid. Physical exam note could have been a little better; I didn't write what I should have for every single normal abdominal exam (non-tender/non-distended/etc). I didn't write any negatives in the physical section of my diagnosis justification. I rarely wrote shorthand except for HPI/ROS/PMH/PSH/FH/SH/HEENT/wnl. I wrote in paragraph form. I wrote to the limit on almost every patient note. Pretty sure my graders were pissed at the amount of work I gave them compared to others.

CIS Advice:

Not everything the patient does is scripted. Joke around with your patients if appropriate. One of my patients had a husband with a similar job as my father. We joked about the work and what comes with it. I forgot to ask a couple of key questions and guess what, she volunteered that information without me even asking. Another example, a patient had something where he had to act in a lot of pain, he made a quip about how he should have listened to his wife, I commented back that I've yet to meet a husband that listens to his wife enough. He laughed and stopped acting for the rest of the encounter. I forgot to wash my hands before the physical and remembered midway through. As I left the room I apologized again, he said don't worry about it, you'll be fine.

If the patient had a major milestone, say congratulations (anniversary/graduation/promotion in Eagle Scouts). It goes a long way towards developing rapport, making them feel comfortable and it's free points

Leave your politics/religion/personal experiences at the door. Patients can be LGBTQ or drug abusers, don't give them a dirty look or anything worse

ICE Advice:

This was by far my lowest section so I'm not sure what advice to give other than to list some of the mistakes I made and tell you to not do them.

Support your diagnosis with pertinent negatives. This is weird for me for some reason so I never did it in practice and it definitely could have been useful in the exam for grading purposes. I know why I picked a diagnosis, because the patient had a negative *** physical exam and I wrote that in the physical exam section, but I never wrote it in the diagnosis support section. Could have costed me a chunk of points

You can totally screw up an entire case and be fine. Patient had a problem. Even if I was acting, I'd hate to repeat that I have that problem 12 times a day. They were one of my last encounters and the patient was rude and disinterested and I don't think they were told to act that way. I asked if they were on any meds, they said no, I thought it was weird so I asked again, they said no. Finish the HPI/ROS/etc and start to summarize when I say you're not taking any meds. Patient looks at me angrily with a look that reads "da fuq?" and quickly rattles off 5 medications with doses. I didn't get every single dosage and I wasn't going to ask him to repeat it. Due to the nature of the problem, I fumbled around with what to do for a physical exam. I forgot to order the most crucial labs. I only had one diagnosis and another diagnosis not directly related to the chief complaint. I had difficult patients before but it was clear they were acting. This person should not have been a standardized patient. They threw me off my game during the entire encounter and my note suffered. If this happens to you and it only happens once. You'll be fine

Also, practice typing on a windows based platform. I used a mac for all my practicing and when I started typing my note I couldn't copy and paste and thought the computer was acting up or they decided we weren't allowed to use it anymore. Nope, I just kept pressing command+c instead of control+c. I was always the last one out of the room and I'm a fast typer, but I could have done a better job with the note.

For one encounter, I only had one differential. The tests I ordered were justified, but the most obvious test that everyone else probably ordered, I didn't because I read not to in Uworld guidelines but I should have if I followed FA guidelines.

I probably messed up on a few diagnosis or at least the order they should have gone and I should have supported all of them with more justifications. People always say there are no physical exam findings and that's true. Put the negative exam findings instead. So glad this is over. Hope this helps someone. Good luck!
 
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waiting. AMG 9/12 houston. disappeared around 5pm Sunday evening

edit: got score email at 10:38ET saying available at 1100 ET
 
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AMG, Permit did not disappear, no E-mail, no Score up. Took it on 10/6. Looks like I'm waiting another 1-2 weeks :/
 
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PASSED!! Still shaking from all the anxiety that Im pretty sure just left my body but I passed
 
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Never got the email but my score was there when I checked just now! PASS! I am so relieved right now
 
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PASSED!!! I never got a "score email" but report was available 11ET when I checked on the website.
So relieved. I really thought I had failed.

Edit: got the email 30 minutes after my score uploaded
 
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For AMGs scores just got released at 11am Easter Time. I passed!

For those looking at this later, things I felt I did poorly:
  1. Didn't list any vitals in my note unless they were abnormal
  2. Did very little counseling (like stop smoking, stop drinking) even when it was warranted. Just a side note, if you look at the official USMLE scoring criteria, counseling is never listed but lots of people say you still have to do it.
  3. Closure's were very generic. "I think you have this diagnosis and we will run some tests." Never really gave any specific tests just said "some tests"
  4. Never included a specific ROS section such as, "ROS: Negative except for above"
  5. Walked out of one room and didn't even know what was going on. No idea still what that diagnosis was.
  6. Forgot to ask a woman I thought had a PE about travel
  7. Didn't ask a 55yo female with LLQ pain about pre or post menopause. Just thinking about ectopic or something
  8. I felt I never had any physical exam findings and very few history findings. Usually could only list 1-2. On a few occasions I did list 3-5 but that was rare.

Good luck everyone! Who knows, maybe some of us will be interns together and not even know it.
 
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carbonic_anhydrase said:
Second attempt,passed!!!!so relieved!Good luck everybody!
Click to expand...

Congrats on passing! I'm sorry to bring up your fail on your first attempt, but if you want to talk about what you did differently this time that you think helped you pass, I think it would be super helpful! Thanks, and congrats once again!
 
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4th year US MD - Passed! Okay. I was TERRIFIED this exam was going to ruin everything I worked so hard for in medical school. I prepared extensively (read First AID CS and Kaplan Complex cases and even UWorld CS) but I was still terrified because the lack of transparency of this test. And reading posts on here of students who failed even though they did very comprehensive exams and counseling DID NOT HELP MY ANXIETY AFTER THE EXAM.

Since I did found it helpful before my test to read reflections of other students on what they thought went well and the mistakes they made. I hope someone finds this similarly helpful in the future.

My experience:

Mistakes-
- I was not confident in my ddx for 3-4 cases. I definitely missed the primary diagnoses in at least 1-2 cases (from googling afterwards). I felt like there were many vague cases. I have about 10 OSCEs a year since first year, and I think they helped beat into us we needed well supported diagnoses with both pertinent positives and negatives (e.g. afebrile) for everything we put and I did this on test day. TL;DR: I messed up a few of the primary dx or at least the ddx order or whatever, but I think everything I did put made sense (at least to whoever graded my note) due to the supporting evidence. Had at least 5 +/- for each
- I forgot the name of some 'special tests' but I still described it under PE. (Serious word finding difficulties. I figured it was somewhat important to show I knew what tests to physically do even if it knocked my ICE score for terminology)
- I forgot to counsel for an important risk factor in one case it was relevant to the CC.
- Very focused (i.e. short) exams.
- May or may not have been a mistake: but for at least one case I put no work up indicated. Because in real life I would not ordered anything


What I did well (possibly? who knows?)/general CIS stuff
- Intro: how I always did it. Which may have been a bit much but learning anything else would have been messy for test day. "Hi patient name? I am first name I am a 4th year med student. Nice to meet you. Do you mind if I sit down?" then "how can I help you today?" I would not write notes for the first minutes or so.
-Summarized before ROS and then asked if they had any questions or "anything I missed?"
-Used some transition for social history to normalize it and avoid "why are you asking meeeeeee about drug use?????" I counseled right there. Be nonjudgemental. I asked if they were thinking about quitting and if not, said something like we're here for you when you are bla bla bla
-Asked every patient about life stressors. Some about safety in relationships/home.
-Asked again for questions and if it was alright to transition to the physical exam. Tried to explain what I was doing before I did it
-Asked "may I help you retie your gown"
-Sat down for closure. Thanked them for coming in today. Tried my best to use lay person terms to the extreme with both what I thought was going on and with the testing (e.g. blood tests, imaging of X)
-I always asked how "CC is affecting their life?" and would offer a work note, follow up call etc
-Every patient I offered a follow up visit
-Asked if they were okay with the plan and if they had any questions
-Only got 2-3 challenge questions all day which freaked me out
-Re empathy: I used very basic clarification techniques just to let SPs know I was hearing what they were saying (I am not surprisingly applying for Psych). I felt like this helped. Also, it is difficult because they are actors, but I really tried to pretend they were real patients in a FM clinic. This helped me match my affect to supportive statements. Nonverbal communication is huge and can be hard to fake but we can only try with these SPs. I only made small talk with some cases (e.g. ones not in distress) and only after they brought up something I could genuinely comment on.
-For ICE: all of my work up was initial diagnostic testing for what I put for the primary Dx. If I was not sure, but it wasn't expensive, I just threw it on there. I annotated first aid differentials with work ups from uptodate if it was stuff that was not immediately obvious.

For perspective:
ICE: touching borderline on the right
CIS: * to the right
SEP: * to the right
 
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IMG, took step 2 ck (260) and step 2 cs on october 13 th ( CIS on the right, SEP *, ICE 2 * on the left)
I have to be completely honest and say that waiting for my step 2 cs results was way more tough and scary that waiting for the step 2 ck. The lack of transparency and the whole structure of the exam definitely did not agree with me, so I passed way too many hours on forums, panicking and obsessing which is not something i usually do. I ended up finding out things about this exam that i should have known on exam day, so I feel pretty lucky to have passed since it wasn't my greatest perfomance.
I went to the test after a month externship and two weeks of studying / simulating the exam. I read FA and did Uworld Step cs, but I should have practiced writing the notes more. I am a fast typer and writing in english has never been an issue for me, but during the exam I was a lot slower on that cluncky keyboard and I ended up using some layman words. So I know many have said it, but practice practice practice writing the note, especially for the IMGs... An SP may not recognize if you do a maneuver in a clumsy way ( try to look confident though ;), but the doctor who will be reading your notes will definetely notice if you don't use the appropriate terms. Also ( something that i read after the test) the SP don't have a checklist anymore of questions you are supposed to ask, so if you asked something and the answer is relevant be sure to type it- emphasis on the relevant. My ICE was not great, but if there is something i did right I think was summarizing- I heard that people max out the HPI, but i think that is overkill: write what helped you logically achieve the diagnosis, give it a good structure, don't waste time writing extra information that you could be using on supporting diagnosis.
I felt that out of the 12 cases, 10 were very straight forward and two pretty vague... So if it is true that there are two experimental cases, in my exam I felt that it was easy to recognize which ones they were since they were uncharacteristically vague and difficult, but again, this is just my experience. Without giving away too much, some cases were very similar to the FA book. Also i would like to say that I agree wholehartedly with the post above: be as natural,nice and empthetic as possible with the sp, washing the hands/ draping ( some patients might be already draped) etc is important, but the more normal and spontaneous the interaction is, the better- SP's are human, make them smile ( in an appriopriate manner) and they will appreciate it.
Here is a list of my mistakes in each section
CIS section
- I didn't counsel a girl who said she occasionally smokes weed and another pt whose CAGE was negative but i still felt he needed it ( I counselled all the other cases and celebrated the SP who said they quit smoking or drinking)
- was too abrupt in some of the PE, so even though I was walking them through every step, it was a little rushed
Other than that I think i did okay and I came out of the rooms feeling like the SP was satisfied, none of them were being too bellingerant though so the CIS part of my exam was easy ( or at least i felt it was). I don't know if summarizing with the SP's gives you points or not, but I think it is really important and useful in order to check the info you acquired, start putting them together in your head ( repeating the info really helped me focus) and also getting out of the SP possible answers to questions you forgot to ask. (And believe me, no matter how many useful acronyms you use, you still will forget something). I tried to start with an open ended questions but most of my SP's didn't answer me much until i started asking more detailed questions ( try not to bombard them with questions though, always look them in the eye in between especially if you are writing things down)
ICE section
- didn't know i was supposed to copy/past the vital signs ( I know it's dumb, but i thought since they were providing them that I didn't need to report them again), but I used them as supporting findings when appropriate.
- didn't list any negative findings ( also didn't think that they were important)
- unsure about those two vague cases- i think my diagnosis were reasonable enough but I'll never know if they were correct ( when i asked the most pertinent questions related to the diagnosis, the SP answered me in a way that lead me to believe that it was good that i got to that question)
- on two cases I got the first diagnosis right and messed up the differentials ( on the of the two i ran out of time right when i was changing the diagnosis to the correct one),
- put some unlikely differentials in other 2 cases I think ( they were not wrong, but again i didn't know that they took away points for unlikely differentials so in hindsight i would have left them blank since 1st and 2nd diagnosis were solid enough or at least i would have listed some negative findings against them)
- might have missed some information in the HPI or SH
- listed thyromegaly as a positive finding but i'm not sure if it was actually enlarged ( thought the patient was trying to simulate an enlarged thyroid by swallowing very theatrically, but it could have all been in my head.. the whole " pretend" aspect can mess with you)
- my PE were basic, always did HEENT; lungs, heart ( quickly enough), did focused neuro when was appropriate ( from going through the motions with an ophtalmoscope to sensory/ motor when required)- i recommend being as focused as possible and not to worry to much about form, also most of the PEs will be negative. write down only what you did, don't write
As you can see I made many mistakes on my ICE section: even though most my 1st diagnosis and differentials were probably right (except in 2 cases), my notes were pretty minimal so i think i passed only because i showed some good reasoning and i was very thorough with my questions- it helped me reach a diagnosis even in the cases that seemed vague at first. I always tried to not go over 8 minutes, to be able to summarize and to do a decent PE and closure. It is a pretty lenient test and in my case my score in each section reflects justly my perfomance: got the diagnosis right, but should have paid more attention to detail. Just a couple of small improvements like listing a couple of negative findings and not forcing differentials would have made a great difference and made this wait more beareable.
Even with the change in scoring, i feel like the test gives you room to make mistakes ( even some big ones) and it is accessible to IMGs. Waiting for the results is going to be miserable, you have no way of knowing what they really want, so I hope that reading my mistakes will help you like reading similar posts helped me.
 
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AMG no report back today. Took cs on 9/21 in Philly. Anyone else has the same problem?
 
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Ugh. I feel for everyone still waiting.

My neurotic pre-report release googling revealed that a late score does not mean anything in regards to pass/fail. Most people I saw with late scores passed. It seems to be with the grading. I hope this is somewhat helpful.

I hope that the NBME knows most of us really do try to do well on this exam and the considerable anxiety it causes with the wait.
 
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Passed as well!! Was at an interview today and had to check on my phone during off time haha (as well as other applicants doing the same and freaking out all at the same time).

Exam Experience: Definitely interesting. Many cases not very straightforward with diagnoses with not nearly enough data to make a clear cut diagnosis. There is a lot of leeway on this exam. My ICE scores were middling (3-4 stars from borderline); CIS was all the way on the right; SEP also all the way to the right.

I probably missed half (or even more of) the diagnoses (as I said there wasn't much data to go off of). Forgot to document some of the physical exam maneuvers in my patient note. Forgot to do key physical exam maneuvers. Forgot key history questions that would help with the differential on a few cases.
 
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Flyers91 said:
For AMGs scores just got released at 11am Easter Time. I passed!

For those looking at this later, things I felt I did poorly:
  1. Didn't list any vitals in my note unless they were abnormal
  2. Did very little counseling (like stop smoking, stop drinking) even when it was warranted. Just a side note, if you look at the official USMLE scoring criteria, counseling is never listed but lots of people say you still have to do it.
  3. Closure's were very generic. "I think you have this diagnosis and we will run some tests." Never really gave any specific tests just said "some tests"
  4. Never included a specific ROS section such as, "ROS: Negative except for above"
  5. Walked out of one room and didn't even know what was going on. No idea still what that diagnosis was.
  6. Forgot to ask a woman I thought had a PE about travel
  7. Didn't ask a 55yo female with LLQ pain about pre or post menopause. Just thinking about ectopic or something
  8. I felt I never had any physical exam findings and very few history findings. Usually could only list 1-2. On a few occasions I did list 3-5 but that was rare.

Good luck everyone! Who knows, maybe some of us will be interns together and not even know it.
Click to expand...

Congratulations! I think I did the same mistakes plus not summarising in a few cases and in one case I forgot to wash hands!! Expecting my results on 31st January. Did I mess everything up?

Congratulations again!
 
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ih8usmle said:
just registered to post this.

Had major anxiety about this exam result. Im an IMG from the UK, took the test 1st NOV and made some major mistakes, completely blanked out. My permit went almost the same or next day, does anyone know what the means?

God be with us for these two days!
Click to expand...

Mine disappeared the next day too!
 
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Flyers91 said:
For AMGs scores just got released at 11am Easter Time. I passed!

For those looking at this later, things I felt I did poorly:
  1. Didn't list any vitals in my note unless they were abnormal
  2. Did very little counseling (like stop smoking, stop drinking) even when it was warranted. Just a side note, if you look at the official USMLE scoring criteria, counseling is never listed but lots of people say you still have to do it.
  3. Closure's were very generic. "I think you have this diagnosis and we will run some tests." Never really gave any specific tests just said "some tests"
  4. Never included a specific ROS section such as, "ROS: Negative except for above"
  5. Walked out of one room and didn't even know what was going on. No idea still what that diagnosis was.
  6. Forgot to ask a woman I thought had a PE about travel
  7. Didn't ask a 55yo female with LLQ pain about pre or post menopause. Just thinking about ectopic or something
  8. I felt I never had any physical exam findings and very few history findings. Usually could only list 1-2. On a few occasions I did list 3-5 but that was rare.

Good luck everyone! Who knows, maybe some of us will be interns together and not even know it.
Click to expand...
That was pretty much my experience in Houston 2 wks ago. The only thing that was different in my case was that I got out with 1-2 historical findings that point me to 2 solid differentials in probably 7-8 cases. Who knows if that would be enough to pass that exam.
 
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took exam 9/27; permit disappeared Sunday evening. PASSED!
officially done with STEP 2!

Congrats to all who passed and good luck to all those waiting!
 
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blueforest said:
Congrats on passing! I'm sorry to bring up your fail on your first attempt, but if you want to talk about what you did differently this time that you think helped you pass, I think it would be super helpful! Thanks, and congrats once again!
Click to expand...
Sure,my failed component was CIS,my main mistake that I was worried about time that’s why I rushed.I left the room 3-5 minutes before announcement.I didn’t pay much attention to patient’s feeling and their concerns.I was so concentrated on ICE!Big mistake!SP weren’t satisfied I could tell now. I took Ximedus course which helped me a lot.I worked with my empathy and facial expression as well and ximedus is really helpful in CIS component especially
 
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Usmlesteps1 said:
I failllllll 2 section ICE & SEP
What I can Do to improve that
Any advice
Click to expand...

I’m sorry uyou failed. It must be really tough. I’m actually still waiting on my results after taking it in ATL on 10/10. I do have a question though, did your permit ever disappear?
 
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AMG 10/6 taken in Philly, Score did not release last week but permit disappeared today on Sunday. Expect my score to be released this Wednesday.
 
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Mine disappeared today around 4:45pm ET, too! Anxiously waiting for the score release in <3 days.

mcribbits said:
AMG 10/6 taken in Philly, Score did not release last week but permit disappeared today on Sunday. Expect my score to be released this Wednesday.
Click to expand...
 
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