Step II Step 2 CS fail please help!!!!

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ashwilliams123

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10+ Year Member
I can't believe I'm making this thread but I just found out I am one of the 5% or whatever of AMG's who fail Step 2 CS. It still is a shock to me. I've never ever come close to failing anything in medical school, middle of my class, and got mid 230's on step 1 and upper 220's on CK. I'm applying for internal medicine and already have interviews at my top choices and now that pipe dream is shot.

What am I supposed to do? Dates are booked up through mid-late January and my next result wouldn't come back until after match lists are due. I'm so confused and angry and frustrated and so many emotions.

For what its worth, I failed CIS and I have no idea how; That is something I will have to study up on. My interpersonal skills were always a strength on my third year clerkship feedbacks. I always shook hands with the SP's and smiled and counseled most cases (I guess I forgot on a couple of cases) and told them what I thought was going on. I'm so confused and don't know what to do. I feel like my entire third year of medical school was just made useless.
 
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Yes, I failed ICE as well. Apparently with a single x from the borderline box. I also failed the CK exam and had just retaken it a little over 1 week ago. I guess it is not easy making a doctor. I can image the emotional turmoil you all are under now. Especially, since this is supposed to be an exam that everyone passes. I do not have ill will for doctors who participate in scoring with the NBME. The evaluation system apparently has problems and puts unnecessary stress on its participants. I've always had issues with anxiety, insomnia, and depression and this finding d/n help. If any of you have these problems, please do whatsover is in your power and belief system to address them as they determine your ability to approach life. You can pm about what I'm doing if you like. I find it helpful to pretend as if this journey could end today or tomorrow, and it is best to concentrate on the goodness and the goodwill that can be brought to people at each moment.
 
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I just found out that I failed CS today too (CIS). I am in complete shock. I am a Canadian IMG with 240's-250's on Step 1/2. I studied for this exam for 8 weeks just to ensure I aced it and after the exam I walked out feeling it went very well. I shook every patients hand and greeted them with a smile, counseled every patient about smoking, alcohol, diet, safe sexual practices closed properly and answered all the challenging questions. Only in 1 case did I not have time to properly close and ask if they had any more questions. Somehow my CIS score was on the far left side with only a little bit in the borderline. I honestly can't believe this. I already submitted a score recheck because I'm hoping maybe a mistake was made.
 
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openmindcnhealu said:
Yes, I failed ICE as well. Apparently with a single x from the borderline box. I also failed the CK exam and had just retaken it a little over 1 week ago. I guess it is not easy making a doctor. I can image the emotional turmoil you all are under now. Especially, since this is supposed to be an exam that everyone passes. I do not have ill will for doctors who participate in scoring with the NBME. The evaluation system apparently has problems and puts unnecessary stress on its participants. I've always had issues with anxiety, insomnia, and depression and this finding d/n help. If any of you have these problems, please do whatsover is in your power and belief system to address them as they determine your ability to approach life. You can pm about what I'm doing if you like. I find it helpful to pretend as if this journey could end today or tomorrow, and it is best to concentrate on the goodness and the goodwill that can be brought to people at each moment.
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Sorry, but if you don't mind me asking, did you have an X extend past the border zone, or was your score up against the left and you were one box short of having some of your score in the border zone.
 
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I had 4 x's in the borderline performance. The rest to the left. I don't understand this at all. Never had problems communicating with patients, english is my first language and that was the portion I was most confident in leaving the exam.
 
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sorry this has happened to you guys. it's like walking into a nightmare when it really means jack whether we can finish a clinical encounter in 15 min and document under yet another timer. from what i hear from my school, you just have to pass it, so i wouldn't take a failure as the end of your dream of becoming a doctor.

give yourself some time to vent, overcome the awe and shock, and then back up. ask yourself how you prepared for this exam and moving forward for your retake, how you can improve study skills. don't let some meaningless exam bring you down and question your ability to become a strong and competent provider.

Also, FWIW, I went very very heavy on the empathy and compassion (I'm so sorry this happened to you... it's unfortunate that you haven't been able to do the things you normally enjoy doing, etc), regardless of how "serious" the chief complaint is.

good luck, and now that you know what CS is like, you'll for sure pass the second time around!
 
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The only things that I can think of that I didn't consistently do was summarize. I'm really not sure how much I would approach it differently. I was concerned about the patient note after the test thinking that I didn't document enough but communication and interpersonal skills? I'm still in a state of shock.
 
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Is summarizing HPI and PE part of ICE or CIS?
I would assume it's ICE, since I didn't do that consistently and I failed ICE and passed CIS (borderline though)
I am sure I missed PE and Diagnoses on a few cases, but I've heard people missed more and passed with comfortable margin.......I really don't know what I did wrong, and if I sit for this exam again without knowing what went wrong, there is a chance that I might fail again.....
What is NBME trying to accomplish here.... at least let us know what went wrong or give us the grading rubric...
 
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I think summarizing is part of CIS. ICE is patient note and physical exam. I think in order to pass CIS, you need to make them feel comfortable telling you things. You need to make them laugh. I did really well on CIS, and the only thing i can think of that i did besides what ash williams is talking about...is making them feel at ease and joking around with them a bit. I always made sure to chit chat with them, any opportunity i got. Basically, build rapport, don't be so stiff, transition, summarize. talk abt the dx in mind, but let them know that it is not confirmed since you want to be sure with dx texts.
 
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I'm very sorry yall are having to go through this. I cannot even imagine the frustration caused from this stupid exam. One point I wanted to bring up is the tone of voice during your patient encounters. You can ask all the right questions and say all the correct words, but the tone you use has to be believable. You have to look in patients' eyes and make them believe what you are saying or else the encounter becomes just words. Unfortunately, this requires you to practice and use your acting skills. Anyways, I hope this helps some, and really hope you kick ass the second time!
 
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Well, I registered to schedule Step 2 CS again. Anyone know how long it takes to get an app processed? I've never really noticed or cared before but now I feel like I'm on a time crunch to get this exam done again.

EDIT: Nevermind, I found out my app has already been processed, just awaiting verification from my medical school regarding my status as a student. LETS GET THIS SHOW ON THE ROAD!!
 
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All I know is that contrary to what everyone says, this was not a "can you speak English" or a "don't be a douche to patients" test. At least in my experience it absolutely was not. I must be completely 100% missing some unknown factor of interacting with patients that I am not aware of.
 
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CIS is not your English proficiency. It's Communication and Interpersonal Skills. The closure at the end of the encounter and summarzing your H&P probably count as the communication part. Maybe you guys failed the interpersonsal skills part. Maybe several of the SPs got a bad vibe from you and felt you were not empathetic? Being empathetic is not necessarily considered only telling the patient that you are sorry they are going through this disease. A lot of it is probably just the inflection of your voice, facial expression, etc.

But what do I know, I won't get my score back for a while and praying I didn't fail CIS. It's hard to show empathy for fake patients. Fingers crossed!! I have no reason to think I failed, but if I did no big deal I'll just retake it. I don't think many programs require a CS score before ranking you because they know it takes months to get back.
 
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rocketbooster said:
CIS is not your English proficiency. It's Communication and Interpersonal Skills. The closure at the end of the encounter and summarzing your H&P probably count as the communication part. Maybe you guys failed the interpersonsal skills part. Maybe several of the SPs got a bad vibe from you and felt you were not empathetic? Being empathetic is not necessarily considered only telling the patient that you are sorry they are going through this disease. A lot of it is probably just the inflection of your voice, facial expression, etc.

But what do I know, I won't get my score back for a while and praying I didn't fail CIS. It's hard to show empathy for fake patients. Fingers crossed!! I have no reason to think I failed, but if I did no big deal I'll just retake it. I don't think many programs require a CS score before ranking you because they know it takes months to get back.
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A lot of people say that if you speak English and are not a jerk to patients, you will pass this test. That just wasn't my experience with this exam.
 
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Esprit00 said:
People failing the CIS section has to be the dumbest reason for people failing especially if they did well in the other two. It's perhaps the most subjective between ICE and SEP. Unfortunately, it is what it is. Have a look at this document: http://www.usmle.org/pdfs/step-2-cs/Assessment_of_Communication_Skills_Behavior_List.pdf Maybe hitting these points in the next run might help. Either way, my sympathies go out to you guys.
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Hey Esprit,
Do you happen to have the list for ICE also? I couldn't find it on the USMLE website...
 
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Did anyone else take the step 2 cs exam in Philadelphia and fail? I believe it is HIGHLY suspicious that from what I have seen online people are saying to stay away from taking the CS exam at that location because so many people fail!!! Doesn't the USMLE company know about this? I assume they can track the failure rate at each location????
 
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Does it usually only take a few days for the application to go through, so that you can re-register? I always thought it took weeks.
 
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ashwilliams123 said:
Well, I registered to schedule Step 2 CS again. Anyone know how long it takes to get an app processed? I've never really noticed or cared before but now I feel like I'm on a time crunch to get this exam done again.

EDIT: Nevermind, I found out my app has already been processed, just awaiting verification from my medical school regarding my status as a student. LETS GET THIS SHOW ON THE ROAD!!
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Does it usually only take a few days for the application to go through, so that you can re-register? I always thought it took weeks.
 
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Frida13 said:
Did anyone else take the step 2 cs exam in Philadelphia and fail? I believe it is HIGHLY suspicious that from what I have seen online people are saying to stay away from taking the CS exam at that location because so many people fail!!! Doesn't the USMLE company know about this? I assume they can track the failure rate at each location????
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What month did you take the exam?
 
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I believe you need 6x in the grey zone to pass. I saw someone's report and he has 6 in the grey and 5 in the left, and he passed. I failed ICE by 1 asterisk. I am going to submit a score recheck and hope for the best, nothing can hurt me at this point....I already paid $1200 to take this test again, why not pay $65 and buy a chance.
Also, I have heard that when they do a score recheck, they just recalculate your points from the previous grader instead of looking at your notes again and give you a new score. Can someone confirm this?
 
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Step2Report said:
What month did you take the exam?
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End of July in Philadelphia. Oh and yes, I heard same thing about the re-check. Basically they just eat your money. I think this is outrageous! These people are messing with peoples lives....maybe they should actually care about whether people fail....
 
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Ernny said:
I believe you need 6x in the grey zone to pass. I saw someone's report and he has 6 in the grey and 5 in the left, and he passed. I failed ICE by 1 asterisk. I am going to submit a score recheck and hope for the best, nothing can hurt me at this point....I already paid $1200 to take this test again, why not pay $65 and buy a chance.
Also, I have heard that when they do a score recheck, they just recalculate your points from the previous grader instead of looking at your notes again and give you a new score. Can someone confirm this?
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Same score here on ICE ...are they making the exam harder to pass?? How much time did you guys spend preparing? What are you guys doing about the match? Are we allowed not to release our scores and still match?
 
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Philly too...

Have you guys been able to start scheduling? I paid and received their email confirmation.. but nothing else yet..

How likely is it to be able to find a spot? do people drop out like in step1? it seems much much less likely..
 
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thinker said:
Philly too...

Have you guys been able to start scheduling? I paid and received their email confirmation.. but nothing else yet..

How likely is it to be able to find a spot? do people drop out like in step1? it seems much much less likely..
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Yeah, honestly just use check4change and firefox and you can find a spot with no problem. I'm already scheduled to retake in October I'm studying like crazy now for this test.
 
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oh wow.. cool... but how come they havent emailed me the scheduling permit yet? i only got notified of my successful payment etc. I'm not supposed to mail any forms am i ??? maybe because i'm an IMG it takes longer..
 
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thinker said:
Beautiful. Check4change works and I was able to schedule in Nov..

Guys how can I best study for this other than FA? I need videos.
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UW has PE videos and a couple of videos showing how to take a history. But practicing with a partner is the best preparation. When practicing making sure you time your encounter and when writing the PN.

If it was ICE that got you then practice asking the right questions, doing a proper PE and writing a coherent PN with the correct DD and supporting findings. You can't rush the PE, you have to act like you know what you are doing.

If it was CIS that got you then try to get to know the patients on a personal level by talking to them about their interests, say while washing your hands or something. This is what I did with 10/12 patients and I feel that's what saved me. One thing you can ask is "what plans do you have for the weekend?" Then you just nod and think about what you are going to do next until they stop talking. Also ask them what they think maybe going on with them and if they have any questions (twice). You can end the encounter by telling them you will be there for them and they can contact you anytime. Lastly, your tone and facial expressions also matter, you may do everything listed above but if it doesn't convince them then you won't get full credit.

Good luck.
 
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wallsbridges said:
How can I find out specifically what sections of the ICE component I performed most poorly in? I have no idea if it was the interview, PE, or PN. Please help.
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There is no history checklist anymore so ICE is all about PN now. If you asked appropriate questions and gathered all data but forgot to write them down on PN then you fail ICE
 
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slimsol said:
There is no history checklist anymore so ICE is all about PN now. If you asked appropriate questions and gathered all data but forgot to write them down on PN then you fail ICE
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hey, where did you get that from? I read the General Info and Content Description for the CS exam from 2013 and it states that the ICE subcomponent includes checklists completed by the SP plus the PN, which is scored by a physician.
It'd be great if you can post the link where you got this from.
 
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Yea the USMLE website says the ICE component includes a checklist filled out by the SP. In any case is there a way I can request more information about where I performed poorly? Just saying I failed ICE doesn't really help me whatsoever. Unreal.
 
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moyamoya said:
hey, where did you get that from? I read the General Info and Content Description for the CS exam from 2013 and it states that the ICE subcomponent includes checklists completed by the SP plus the PN, which is scored by a physician.
It'd be great if you can post the link where you got this from.
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The checklist is for physical exam, not for history taking. The patients don't grade history taking anymore. This is one of the changes that was made recently along with supporting your differential.
 
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