Step 2 CS: mistake I made, please honest input

[Jce20]

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Hello all,

Have read this forum for awhile, appreciate what people have to say and the support people give each other.

I'm a US MD student who just finished up step 2 CS. I have a question about how I did things.

I introduced, washed hands, etc. I performed the history and ROS. Typically I felt pretty confident at that point about the main diagnoses. At that point, I summarized and did a closure. I felt this was more important than completing the physical so this is how
I approached it. And by that I mean I said to the patient, "before I perform the physical exam, I would like to talk to you about what I think is going on and what the potential diagnoses are. I proceeded to present the ddx, talk about the plan, then asked if they had any questions. I then performed a physical and many times time ran out while doing that.


A lot of the encounters are a blur so it's hard to determine just ones I didn't end on a closure. But I know for each one I told them a differential and a plan.

Do you think this is a fatal mistake? I am naturally an anxious person and I know I will lose sleep until I get these scores back. I appreciate any and all responses.

Thank you

 

[livinglou]

Hey Jce20. I'm a US MD student as well. I think your approach is very interesting and it's one that I've not heard of before. I don't think that it necessarily was bad because from what I've been led to believe, the diagnosis and conclusion is more important than the PE steps. Maybe it would throw the SPs off a little bit, because that's not the norm (right?). I'm sure you did fine. Having a differential and plan for each is good. If you feel that you connected with the patient, showed compassion and empathy, and essentially "babied" them, then you probably passed.

I've been told from a reliable source that the diagnosis and plan that you give the SPs is not actually graded. They may mark: "Did student give 2 diagnosis and 2 workups?", but not "Student correctly diagnosed X and gave correct workups Y and Z". What is graded is what you write in your PN (ICE). The SP is there to just grade how your communication skills and interactions are with them (the CIS and SEP portion).

I actually have not taken my exam yet. I take mine next Wednesday! I'm a US MD student. So naturally, I have some questions. I have heard that there have been some changes to the exam. These are generalized questions, so as not to violate anything....
What did you use to study? I'm reading FA CS, but probably won't get through all of the cases.
Do you know if there are actual children for peds cases?
Do you know how heavily weighted it is to have a correct primary diagnosis in your PN?
Are you supposed to counsel diet, exercise, smoking cessation, etc. on ALL patients, or just relevant cases?
Was there anything weird that threw you off?
Any last minute advice?

 

[Donald Kimball]

I shared my thoughts on the differential, next steps, and asked for questions/concerns before the physical in my patients. I passed comfortably. You'll be fine.

 

[byaaaaaaah23]

You'll be fine. The order doesn't matter and they won't remember. They literally just have a checklist that they go down when you're done and if you get the check you get the points.

Step 2 CS: where everything is made up and the points don't (really) matter

 

[AshNiffler]

Of your 12 patient encounters, 10 will be scored. Two people will score each encounter: the SP and a physician. The SP will evaluate you at the end of each encounter by filling out three checklists: one for the history, a second for the physical exam, and a third for communication skills. The physician will evaluate the PN you write after each encounter. Your overall score, which will be based on the clinical encounter as a whole and on your overall communication skills, will be determined by the following three components:

1. Integrated Clinical Encounter (ICE) score. The skills you demonstrate in the clinical encounter are reflected in your ICE score. This score will reflect your data-gathering and data interpretation skills. Data gathering. SPs will evaluate your data-gathering skills by documenting your ability to collect data pertinent to the clinical encounter. Specifically, they will note whether you asked the questions listed on their checklists, successfully obtained relevant information, and correctly conducted the physical exam (as indicated by your performance of the procedures on their checklists). If you asked questions or performed procedures that are not on an SP’s checklist, you will not receive credit—but at the same time will not lose credit—for having done so. Data interpretation. To demonstrate your data interpretation skills, you will be asked to document, as part of the PN, your analysis of a patient’s possible diagnoses and your assessment of how such diagnoses are supported or refuted by the evidence obtained from the history and physical exam. Although in actual practice physicians must develop the ability to recognize and rule out a range of disorders, you will be asked to record only the most likely diagnoses along with the positive and negative findings that support each. Physicians who score the PN make a global assessment based on documentation and organization of the history and physical exam; the relevance, justification, and order of the differential diagnosis; and the initial testing modalities proposed. Your final score will represent the average of your individual PN scores over all 10 scored clinical encounters.

2. Communication and Interpersonal Skills (CIS) score. In addition to assessing your data-gathering abilities, SPs will evaluate your communication and interpersonal skills. According to the USMLE, these include fostering a relationship with the patient, gathering and providing information, helping the patient make decisions, and supporting the patient’s emotions. You will be evaluated on your ability to tailor your questions and responses to the specific needs of the case presented and on your capacity to react to the patient’s concerns. Overall, the CIS subcomponent focuses on your ability to conduct a patient-centered interview (discussed at length in Section 2) in which you identify and respond to the broader scope of the patient’s concerns beyond just the diagnosis. The CIS performance is documented by SPs with checklists. You must pass all three components of the Step 2 CS to pass the exam.

Among students who fail the Step 2 CS, U.S. students are most likely to fail because of ICE scores, and IMGs are most likely to fail because of the CIS. Register as early as possible, as some test centers fill up months in advance. 6 3. Spoken English Proficiency (SEP) score. This component scores you on pronunciation, word choice, and the degree of effort the SP must make to understand your spoken English. The SEP score is based on SP evaluations that make use of rating scales.

...according to first aid for CS.