step 2 cs failed

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drunkendonuts

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Hey guys,

This sucks. I failed the CIS part which is ridiculous... I have several unsolicited letters from patients telling me how great my bedside manner is. Unfortunately, it doesn't seem possible to dispute my score. I need your advice bigtime.

1. I had ERAS auto-release my USMLE transcript, but now it says that to update I need to click "retransmit." Does this mean that as I go to my scheduled interviews they won't see my failure?

2. I will try my best to take it (and pass of course) before rankings are due, but if I can't how will I know which programs require all scores to rank. I am doing neurology. To get my "pass" reported before february, I need to take it before dec. 31 which might be impossible at this point.

3. I narrowly failed (the stars cross the borderline bar). But do you recommend some resource to look at to make sure I don't screw up again?

4. My step 1 score was mediocre. My grades are okay half HPs/H and half P's. Am I going to match???

For those curious: I felt fine about nearly all my encounters. I always conveyed empathy, I washed my hands before every exam, and made good eye contact. I ran out of time with one encounter right as he was asking his "difficult question." On another encounter, I may have accidentally smirked when the sp was obviously trying to be difficult. For everyone else, I shook hands at the end and felt great. My notes (the ICE portion) were above borderline. ughhhh. Btw, I'm an AMG.

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Where did you take the exam? We hear Philly is the place everyone has issues with.

And a failed CS will probably help you get into neuro. Someone who has a neuro personality isn't supposed to be particularly smooth with people (especially under contrived/artificial circumstances). I think you'll match just fine. And when you do move on from this crap, it'll just serve to give you insight into how screwed up the system is sometimes.
 
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Where did you take the exam? We hear Philly is the place everyone has issues with.

And a failed CS will probably help you get into neuro. Someone who has a neuro personality isn't supposed to be particularly smooth with people (especially under contrived/artificial circumstances). I think you'll match just fine. And when you do move on from this crap, it'll just serve to give you insight into how screwed up the system is sometimes.

Yes, in fact, my exam was in Philadelphia!! Is there some way to appeal their decision? The $65 "score recheck" only checks the math, not the subjective evaluation. This thing is really shaking my self-confidence.
 
Yes, in fact, my exam was in Philadelphia!! Is there some way to appeal their decision? The $65 "score recheck" only checks the math, not the subjective evaluation. This thing is really shaking my self-confidence.

I don't think any of us know how "effective" score rechecks are. Probably just a money-making scheme.

That being said, I'll be taking the CS in Philly in May, but maybe I should reconsider.
 
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Hey guys,

This sucks. I failed the CIS part which is ridiculous... I have several unsolicited letters from patients telling me how great my bedside manner is. Unfortunately, it doesn't seem possible to dispute my score. I need your advice bigtime.

1. I had ERAS auto-release my USMLE transcript, but now it says that to update I need to click "retransmit." Does this mean that as I go to my scheduled interviews they won't see my failure?

2. I will try my best to take it (and pass of course) before rankings are due, but if I can't how will I know which programs require all scores to rank. I am doing neurology. To get my "pass" reported before february, I need to take it before dec. 31 which might be impossible at this point.

3. I narrowly failed (the stars cross the borderline bar). But do you recommend some resource to look at to make sure I don't screw up again?

4. My step 1 score was mediocre. My grades are okay half HPs/H and half P's. Am I going to match???

For those curious: I felt fine about nearly all my encounters. I always conveyed empathy, I washed my hands before every exam, and made good eye contact. I ran out of time with one encounter right as he was asking his "difficult question." On another encounter, I may have accidentally smirked when the sp was obviously trying to be difficult. For everyone else, I shook hands at the end and felt great. My notes (the ICE portion) were above borderline. ughhhh. Btw, I'm an AMG.

do you have a non english name? maybe that hurt you..
 
OP, do not click retransmit button whatever you do!!! There is no automatic score release option this year, and the programs will not see your failed attempt unless you choose to retransmit. I think you can match into neurology without Step 2, if the rest of you application is decent and you have applied broadly. I believe programs that require or desire your Step 2 to rank you will let you.

How many stars in the borderline area do you have on your report?
 
OP, do not click retransmit button whatever you do!!! There is no automatic score release option this year, and the programs will not see your failed attempt unless you choose to retransmit. I think you can match into neurology without Step 2, if the rest of you application is decent and you have applied broadly. I believe programs that require or desire your Step 2 to rank you will let you.

How many stars in the borderline area do you have on your report?
thanks for the advice! 5/11 stars in borderline
 
OP,

I'm pretty much in the same boat. AMG, mediocre Step 1, Step 2 CK 230s, applying for Med/Peds programs but I found out last weds that i failed CS with 5/11 stars in the borderline portion of ICE--did well in the other categories.

I feel pretty defeated. That said all the advice I've gotten is to secure a December test date asap--preferable one in the next two weeks. It might seem hard, but if you use firefox and this addon "checkforchange" and spend a day sitting in front of the computer, youll get a date.

Keep your head up and let's both rock this next test.
 
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OP,

I'm pretty much in the same boat. AMG, mediocre Step 1, Step 2 CK 230s, applying for Med/Peds programs but I found out last weds that i failed CS with 5/11 stars in the borderline portion of ICE--did well in the other categories.

I feel pretty defeated. That said all the advice I've gotten is to secure a December test date asap--preferable one in the next two weeks. It might seem hard, but if you use firefox and this addon "checkforchange" and spend a day sitting in front of the computer, youll get a date.

Keep your head up and let's both rock this next test.

do they still make you wait a month to register after you receive your grade? do you mind me asking how much you slipped up on ICE to have failed?
 
I recommend reading Kaplan core case, for their CIS component. leave enough time (2 minutes), at the end of the encounter to explain diagnosis, answer potential questions from the fake patients.
make sure you don't slipped on the ICE component on your re-take. don't slacked off for the physical exam, patient notes, and differential diagnosis.
 
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Welp it's been retaken. I made sure not to run out of time on any encounter so hopefully I remedied any previous deficit. I also tried to make little comments about To build rapport. Thanks for everyone's help and advice!!
 
that was quick.. congrats!!!

Welp it's been retaken. I made sure not to run out of time on any encounter so hopefully I remedied any previous deficit. I also tried to make little comments about To build rapport. Thanks for everyone's help and advice!!

what type of things did you say to build rapport?
 
that was quick.. congrats!!!



what type of things did you say to build rapport?
I started about half the encounters with "I want you to know I take my patients entire wellbeing very seriously. Please feel free to talk about any issues that are troubling you big or small." Then during social hx, I would make some small talk surrounding their job or kids. I also put extra effort into making sure I asked at the end "what questions do you have?" IN ADDITION TO "what concerns do you have?" All this accompanied as many supporting statements as I could throw in. I explained what I thought was going on and what tests would help identify a definitive diagnosis. I also made sure to remind them that they could call me with any more questions if they thought of them later. And just to prove that I'm not some weirdo robot (despite what nbme says), I was told THREE times on three different plane rides over there and back that I have a very relatable personality! And that was at my grumpiest!!! seeing as how I was so close to passing the first time, I can't see how i wouldn't pass this time. But then again, I am still super anxious...
 
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I started about half the encounters with "I want you to know I take my patients entire wellbeing very seriously. Please feel free to talk about any issues that are troubling you big or small." Then during social hx, I would make some small talk surrounding their job or kids. I also put extra effort into making sure I asked at the end "what questions do you have?" IN ADDITION TO "what concerns do you have?" All this accompanied as many supporting statements as I could throw in. I explained what I thought was going on and what tests would help identify a definitive diagnosis. I also made sure to remind them that they could call me with any more questions if they thought of them later. And just to prove that I'm not some weirdo robot (despite what nbme says), I was told THREE times on three different plane rides over there and back that I have a very relatable personality! And that was at my grumpiest!!! seeing as how I was so close to passing the first time, I can't see how i wouldn't pass this time. But then again, I am still super anxious...

Interesting. What did you do before? I'm kinda worried about cis as well since my school didn't teach us that stuff well
 
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Right. I can't remember many glaring things I left out before except: that I ran out of time on one for sure and smirked at obviously terrible acting in another and never made small talk. I also may have used (simple) medical jargon without immediate clarification. Ugh. Mistakes? Yes? But should they cost $2000 + residency jeopardy + untold stress and humiliation??
 
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Right. I can't remember many glaring things I left out before except: that I ran out of time on one for sure and smirked at obviously terrible acting in another and never made small talk. I also may have used (simple) medical jargon without immediate clarification. Ugh. Mistakes? Yes? But should they cost $2000 + residency jeopardy + untold stress and humiliation??

Do ppl really make Smalltalk during this exam. I find that hard to believe.. I have trouble finishing even when I am just asking questions one after another... Sigh..
 
Do ppl really make Smalltalk during this exam. I find that hard to believe.. I have trouble finishing even when I am just asking questions one after another... Sigh..

There was someone who posted on here some time ago saying that he would make small talk particularly when he was washing his hands because that's guaranteed downtime otherwise.
 
I used hand sanitizer right when I walked in the room. It was an acceptable alternative and really quick.
 
Right. I can't remember many glaring things I left out before except: that I ran out of time on one for sure and smirked at obviously terrible acting in another and never made small talk. I also may have used (simple) medical jargon without immediate clarification. Ugh. Mistakes? Yes? But should they cost $2000 + residency jeopardy + untold stress and humiliation??

the answer to your second question--absolutely not. ab-so-lute-ly not
 
Congrats!! Did you change your test venue and did you pass comfortably?? This test has me more worried than all the others. Thanks.

I did pass comfortably! I did not change my test venue just because Philly was the only option (again). When retaking it, I noticed that I rounded on the set of rooms on the opposite side of the hallway (compared to my first attempt). This resulted in different actors but nearly the same cases. Good luck.
 
I have received a lot of personal messages asking me how to pass this stupid exam. So here’s the scoop:


Resources:

- I just studied First Aid for CS. I quickly went through the differential diagnosis section, then acted out several of the sample cases’ q&a. Then, I wrote it up on the official template online. Importantly, I timed myself during both. If you come from a decent medical school, then in all likelihood, you do not need much in the way of studying. It’s really all about the timing and understanding what exactly you’re being graded on.


For the CIS portion, the most important thing is to NOT RUN OUT OF TIME!


- At the beginning of each encounter, I said “This is our first time meeting. So, I want you to know I take my patients’ entire well-being very seriously. Please feel free to talk about any issues that are troubling you big or small.”


- In the middle, besides the usual (hand washing, eye contact, draping, asking to do physical exam, etc.), make small talk. This is very simple. When asking what they do for a living, pick some positive personality trait usually found in that profession and say, "I have a cousin who does that, you must be pretty smart and hard-working, eh?" Then if they have kids, make some comment like, "ooh, that's a fun age. They must keep you pretty busy." Then, of course, always demonstrate empathy. The SPs will be very obvious with their behavior. Always comment on what they're doing. Then just say something empathetic.


- At the end of each encounter, the differential diagnosis must be explained. Then, ask if they agree with your workup. Then, ask for questions. Finally, ask for concerns. Note: asking for concerns is a separate entity.


For the ICE portion,

- The following is a post I found immediately after taking it the 2nd time and kicking myself for not reading it before-hand.

From mpnyc:
----------------------------------------------------------------------------------
FOR HPI: For PAIN the standard LIQQORAAA (location, intensity, quality/quantity, onset, radiation, aggravating/alleviating/associated) For everything else: DOCFP (duration, onset, course, frequency, precipitation factors).*

FOR HX: PAMHUGSExFOSS (previous, allergies, medications, hospitalizations (past medical/surgery/illnessnes/etc), urinary sx, GI sx, sleep, exercise, family hx, obgyn hx, sexual hx, social hx -- for social this includes occupation/tobacco/EtOH (CAGE)/rec drugs/other stressors/living conditions/etc

Now this is a very loose skeleton -- I included extra ROS as needed -- for instance appetite, travel hx, diarrhea/constipation/nausea/vomiting in the GI sx -- obviously CP/SOB/orthopnea/etc for chest/breathing cases -- you'll have to fill in the details.

Also before OBGYN & SEXUAL/SOCIAL hx I always said "Thank you for answering my questions. Now the next set of questions are a bit personal but I wanted to remind you and assure you that everything we talk about is confidential and that these are standard questions that I ask all my patients in order to get a complete history so I can provide the best possible care.

6. For PE: I was very conflicted. On one hand I had everyone telling me to be very focused and do relevant organ system and I had other buddies do more. What I did was I came up with a template from head to toe. I touched a bit on everything from HEENT -- NECK (including thyroid) -- CHEST -- LUNGS -- ABD -- EXTREMITIES. I could do this in about a 1 minute. The reason being was it allowed me time to think about what my focused exam would be without looking like I have no idea what to do. Once I figured out what I wanted to do I would do a more focused exam on the relevant organ system.

Now of course if it is a NEURO or MUSCULOSKELETAL case I would just dive right into that exam because they were lengthy and there is no time to do other stuff. If I had extra time I'd jump back into my 1 minute template.

Now USMLE makes it clear that you will not be graded on irrelevant exams and some people think my method is a waste of time -- but it worked for me. Now from my general template I could come up with a template patient note for a benign/normal exam.

GEN: AAOx3; NAD
HEENT: EOMI; PERRLA; moist mucus membrances; -ve scleral icterus; -ve conjunctival pallor; -ve tonsillar erythema, enlargements, exudates
NECK: supple; -ve LAD
CVS: RRR; normal S1 S2; no M/R/G
LUNGS: CTA B/L; no W/C/R
ABD: + BS in all 4 Qs; tympanic to percussion; soft/NT/ND/-ve HSM/no palpable masses
EXTREMITIES: 2+ pulses throughout; no edema; no cyanosis, clubbing

Now I wouldn't use all of this -- only relevant ones but I wanted to have them in my toolbox to throw out there if I needed them. Of course neuro I used Mini Mental -- Cranial Nerves -- MRS (motor strength, reflexes, sensations) -- as well as RAM; heel to shin; gait; romberg.

Musculoskeletal I used "I PROM MRSP" (inspection, palpation, ROM, MRS, pulses). Always beginning with the unaffected side then moving to the affected side. Starting with distal joints moving towards affected joint as well as proximal joint moving towards affected joint.

7. Now on my sheet before going in the room I wrote down my mnemonics, studied the doorway info, as well as added the words 'SUMMARIZE' and 'COUNSEL' to remind myself of these 2 tasks for every encounter.

8. So here is a sample encounter: Write my mnemonics. Knock on door. Hi Mr/Ms Smith -- I'm Dr. Jones and I'll be taking care of you today. So what brings you in?*

USE MY LIQQORAAA, PAMHUGSExFOSS -- Finish history.

Well thank you Mr/Ms Smith for answering my questions. Do you mind if we begin the physical exam? Please excuse me while I wash my hands.

GO INTO MY TEMPLATE -- Finish PE

Then I usually sat down and said "Ok Mr/Ms Smith. I just wanted to SUMMARIZE everything you told me -- this allows you to get the history organized as well as have the patient correct any parts that you've blanked out on.

Then I said something like this: "So Mr/Ms Smith I wanted to let you know what I'm thinking so far from what you told me as well as from the PE….."
At this point give some kind of differential along with some back up. If you're clueless -- keep it vague and remind them that you'll need to run some tests to really get a handle on what is going on. Keep stressing the fact that without labs/imaging you can't give a definitive diagnosis.

Now at this point I would say something like this: "Besides starting on your lab work there are some things that I'd like to discuss with you -- have you thought about quitting smoking/etc…" COUNSEL!!!!!

So for every patient I had this template during the close.
1. Do you understand my diagnosis?
2. Do you agree with my treatment plan?
3. Do you have any questions for me? ANSWER challenge question
4. Well Mr/Ms Smith, regardless of the final diagnosis I just want to make sure you know that I am here for you and that we will work together as a team to figure out what's going on with you and how we can make you feeling better. It was an absolute pleasure meeting you and I'll call in the nurse to begin the lab work up.

I always left the room with 2 minutes to spare. This allowed me extra time for my patient note.
Now make sure you fill out the whole PATIENT NOTE. The very first encounter that I had since the computer screen doesn't show the whole length of the note, I filled everything out perfectly and sat there with extra 2 minutes and when they said to submit I realized I had forgotten to write down any diagnostic w/u. I guess it was my nerves or whatever but I didn't realize I left it blank until I scrolled the computer down and to submit. So please practice on the usmle website and use their patient note to practice typing and such.
So for one of my notes I had left out the whole diagnostic w/u, but I still scored high marks on ICE because the rest of my notes were good (I'm assuming).

----------------------------------------------------------------------------------

Pretty great, eh? I usually did not do physical exam maneuvers that I didn't think would yield anything. Importantly, just like in real notes, I wrote everything relevant to the primary diagnosis in the HPI. Including any positives AND negatives. So, my review of systems always looked like, "ROS: neg except as above." Also, remember that real doctors will be reading your notes. It's okay to use common abbreviations.


In the workup section

- list the differential diagnosis in descending order of likelihood. In the diagnostic tests, practice CYA medicine and order everything remotely relevant. I don’t grade this stuff, so it’s probably best to use a resource that knows what they’re talking about.


Rescheduling:

- figure out the score release schedule and retake it when you have to. Remember, if you reschedule your exam to a date within 2 weeks of the current date, you can’t re-reschedule without paying double. Use firefox apps to constantly refresh your browser. Check 4 change is pretty good.


Failing sucks. If it happens, keep your chin up. You’ll be a doctor soon enough. Then you can get to work abolishing this shameful excuse for an exam.
 
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