First off, thanks for anyone expressing sympathy for failing the step 2 cs, for the rest of you who have so much time on your hands that you have to accuse medical students of being scheming perpetuators of the worst kind, I hope you knock on plenty of wood, and learn to get a life outside of message boards.
Having failed step2 cs, specifically the CIS component (communication and interpersonal skills), this link has what they are looking for specifically in that component of the step2 cs.
http://www.usmle.org/step2/Step2CS/CommSkills.htm
Of course, the problem lies in the fact that the score sheet looks like an elementary schools grade card, and doesn't delineate any of the specifics for why you failed. Looking at that link though, I'm guessing some of the things that contributed to my getting a poor-borderline on CIS were due to the following:
Rushing through the interviews and trying to obtain too much information too quickly. (thus, not using enough "transitional statements, facilitating remarks", perhaps not giving patients enough time to give their meandering answers) Something tells me that going through the ROS gauntlet just doesn't jive with the conversational flow these interactions are supposed to have. How much ROS is sufficient? That I do not know.
"asking about expectations, feelings, and concerns of the patient support systems and impact of illness, with attempts to explore these areas"
I don't recall doing that for any patients besides the ones that looked really down in the dumps, so I guess you need to ask about patient's support systems when they come in with chest pain or a cough as well. (It can't hurt.)
The rest of the stuff, like washing hands, not gagging the patients to death, empathizing with the patient, summarizing the patient's presentation and the plan, and asking if they had any questions or concerns, I did.
I'm sure there are specific things that if you do, you get a big negative score automatically (i.e. interrupting the patient or telling the patient he might have a myocardial infarction instead of a heart attack)
Moral of the story: This isn't your typical office encounter. Go overboard in everything you do and treat the patient like you're treating a VIP who could get you barred from practicing medicine. Here's what I'm going to do, talk as slowly as possible, smile as much as possible, tell the patient that having "x" must be very difficult to deal with, what sort of support system do you have to deal with "x", with constant attention to their emotions and needs and further concerns, while doing a "focused" H+P all in 15 minutes.
For all the poor souls who failed step 2 cs because of their "poor history taking skills or chart writing", I don't know what to make of that. I'll join the litigation battle if I fail the 2nd time for taking too much time giving patients hugs and not obtaining enough history to write a decent H+P.
Good luck to all.
