Step 2 CS Mistakes (Major Ones)

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NCMED101

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So I made quite a few major mistakes, mostly for ICE component. Is there any hope for a pass from these?

1. Peds case - missed majority of past history questions not directly related to CC (Got the history for the main complaint and all, but missed past history/social/vaccinations/meds/allergies/etc) Diagnosis was fairly simple so confident in DDx and Workup
2. Missed majority of neuro exam in a case that warranted it. Only did gait.
3. Missed abdominal exam in 2 fatigue cases (both definitely needed it) - Didn't palpate thyroid either 🙁
4. One case in which I had no idea what patient had (didn't ask ROS)
5. Missed simple straight diagnosis in 1 case (got good enough history, but blanked and realized diagnosis right after submitting note). Diagnosis I put were reasonable and supported by HPI.
6. Completely messed up psych case. Patient had a couple of SIGECAPS, but I asked about depressed mood (negative), so stopped inquiring without asking decreased interest. Put it in my differential with appropriate workup though. Could have been (stress?) so either way I messed up
7. Cancer diagnosis - Had cancer in my top 2 differential in 4 cases but for some reason I didn't specify the type of cancer at all...I'm an idiot. I just put malignancy and offered supporting evidence for it
8. Didn't palpate joint in pain case. Didn't do sensory or reflexes either.
9. Didn't ask sexual hx in everyone, just 1 person that I think needed it.
10. Didn't do HEENT or full lung exam (fremitus, palpation, percussion) in 2 respiratory cases at all
11. Missed 2-3 major ROS and HPI related questions for 3-4 cases
12. Work up for CXR didn't specify PA or Lateral
13. Stupid differential as my 3rd in 3 cases

Things I did:
1. Though CIS stuff went overall fine. Maybe 2 patients I didn't really answer their questions well enough. Didn't really show too much empathy for like half of them, but was kind and did all the counceling/closing stuff for most of them.
2. Asked PMH/SHx/Allergies/Meds/Social (alcohol, tobacco, drugs, occupation) for everything else but peds case
3. Summarized HPI, explained DDx, and plan for everyone. Asked if they had questions/concerns
4. Notes were overall structured well except for peds case were I didn't ask majority of HPI.
5. Confident in correct diagnosis in 9/12 cases
6. Workup was always appropriate except for one of the cases I missed diagnosis (missed a major test)

Anyone have any idea if these mistakes will tank me?


EDIT: After a long wait in which I was a neurotic mess and was convinced I failed, I passed with only one star in borderline region for ICE and Higher performance for CIS. Hope this helps other people. Exam is definitely extremely lenient.
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NCMED101 said:
Just based on other people's CS experience and if anyone has similar mistakes?
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Again, how would anyone know if any number of mistakes were 1) made or not made, 2) contributed or not to score & 3) directly resulted in certain outcome or did not change the outcome?

Just relax & forget about it. The test is over. No amount of worrying & speculation about your score or comparison to others will change your score or benefit you at all.
 
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Fair enough, it is difficult to do so though. Was just hoping someone could provide me with some hope to get my mind of this
 
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This type of list you've compiled is something almost everyone does after finishing 2CS. I did this as well and sent messages to people on SDN being like omg my mistakes must have been so bad. And you know what, I passed.

You didn't do as bad as you think you did. Like pd1112 has said, it's over, and you just need to wait it out.
 
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Phloston said:
This type of list you've compiled is something almost everyone does after finishing 2CS. I did this as well and sent messages to people on SDN being like omg my mistakes must have been so bad. And you know what, I passed.

You didn't do as bad as you think you did. Like pd1112 has said, it's over, and you just need to wait it out.
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Thanks, its just frustrating to see the posts about people failing when it seems like they did everything right. People told me it was just a simple come in and speak English test, so thats what I did. Only review I did was look at ~5 cases in FA to understand note layout. Did fine on School OSCEs throughout the year so thought I should be good. For some reasons nerves made me perform a lot worse than I should have
 
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If it makes you feel any better, in 1 or 2 straightforward cases I only put one differential with supporting evidence. For some reason I could not think of anything else and I was fixated on the definite diagnosis. I still passed

I made your mistakes too. I did not do cardio/resp exam in most cases, and I didn't do any thyroid despite the patient having some symptoms. I think you'll be fine. Stop worrying! Can't do anything now anyways


Sent from my iPhone using SDN mobile
 
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I ran out of time writing PN on 2 of the cases. I had to rush through the Dx and didn't have time to fill in supportive findings.

One of the 2 that I ran out of time was my first case. It freaked me out so much that I rushed through my patient encounters for the rest of the exam hoping to squeeze out a few extra minutes for my PN, at the cost of leaving out some physical exams. (I did, however leave enough time for counseling and answering patient questions.)

When examining one patient, I forgot to take out the foot rest and only realized when the patient lie down looking awkward. I quickly apologized and pulled out the foot rest for him but I felt terrible.

The light on the otoscope in one of the examining rooms wouldn't turn on. The examinee before me must have done something. I tried to switch it on (I thought I did everything I was supposed to do) but it wouldn't light up. I must have looked dumb to the SP. In the end, I had to just use the non-lit otoscope cuz I didn't want to spend precious time asking for a proctor to come help.

In one case, I could only think of one diagnosis when talking to the patient. The second I was out the door, I thought of two other differentials and felt like kicking myself cuz one of them was the most likely diagnosis. So, in the end, the #1 differential I have on my PN wasn't the most likely Dx I gave to the patient.

Some of he mistakes I made, I can't tell you without breaking the rules about discussing exam cases, but believe me, I did stupid things. I had nightmares about the exam up to the day the result was supposed to come out. It stressed me out so much that I couldn't even move on and study for the next step.

Long story short, I passed. I hope you do, too. And pls don't waste time dwlling too much on it like I did.
 
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rotml said:
I ran out of time writing PN on 2 of the cases. I had to rush through the Dx and didn't have time to fill in supportive findings.

One of the 2 that I ran out of time was my first case. It freaked me out so much that I rushed through my patient encounters for the rest of the exam hoping to squeeze out a few extra minutes for my PN, at the cost of leaving out some physical exams. (I did, however leave enough time for counseling and answering patient questions.)

When examining one patient, I forgot to take out the foot rest and only realized when the patient lie down looking awkward. I quickly apologized and pulled out the foot rest for him but I felt terrible.

The light on the otoscope in one of the examining rooms wouldn't turn on. The examinee before me must have done something. I tried to switch it on (I thought I did everything I was supposed to do) but it wouldn't light up. I must have looked dumb to the SP. In the end, I had to just use the non-lit otoscope cuz I didn't want to spend precious time asking for a proctor to come help.

In one case, I could only think of one diagnosis when talking to the patient. The second I was out the door, I thought of two other differentials and felt like kicking myself cuz one of them was the most likely diagnosis. So, in the end, the #1 differential I have on my PN wasn't the most likely Dx I gave to the patient.

Some of he mistakes I made, I can't tell you without breaking the rules about discussing exam cases, but believe me, I did stupid things. I had nightmares about the exam up to the day the result was supposed to come out. It stressed me out so much that I couldn't even move on and study for the next step.

Long story short, I passed. I hope you do, too. And pls don't waste time dwlling too much on it like I did.
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I am trying not to, but I just can't help it. I feel like all the other mistakes I've seen on here are so minor compared to mine...I think its fine to tell the patient whatever diagnosis cause it doesn't really matter as they aren't grading you on the accuracy of it. I remember coming up with a better diagnosis on 2 patients as soon as I left the room. It's just that no one else has such vague diagnosis for 4 cases! and whole system incomplete physical exam for 3 cases and finally 2 incomplete HPIs. That's some terrible work I put myself in
 
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I was feeling a bit better, before I started seeing some posts of people who were surprised that they failed ICE portion. It seems like they did everything right, they took a good hx, did a complete physical, good diagnosis with support and still failed. I'm terrified at thinking how I can pass at reading stories like that
 
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Also anyone know how the scoring range is graded for pass fail? Like can you not have any below borderline to pass? Does it have to be that more than half stars have to be above borderline?
 
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I know a guy who passed ICE ,but had a close shave...the chap left out the entire d/d section in one case and left out investigations in 2 other cases..he still passed...and did only cvs/rs ..
 
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cabergoline2 said:
I know a guy who passed ICE ,but had a close shave...the chap left out the entire d/d section in one case and left out investigations in 2 other cases..he still passed...and did only cvs/rs ..
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Wait he only did CVS/RS on all patients without any other systems?
 
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cabergoline2 said:
yah..that what he said...i think that tons of minor mistakes have no bearing in ice...
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But that's like major mistakes...I'm sure he meant he only did heart and lungs, plus a few MSK and abdomen here and there. Nothing like thyroid/neuro/etc. I forgot abdomen on 2 people who i suspected of gi issues...smh.
 
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After several days of thinking about my errors I finally came up with a list that, for now, seems to be all i can remember i screwed up on:

1. Ran out of time to write the tests i'd order for 1 patient
2. Put CT and Xray of head when i meant spine
3. accidentally wrote an incorrect abbreviation for a differential (cant specify due to USMLE rules)
4. forgot to do a few key physical exam maneuvers i.e. heaves, thrills, pmi, when required
5. didnt ask anyone about quality of life being affected/in what way its affected them i.e. didnt ask if affects sleep or work, etc, never said im sorry about their chief complaint, i would just kinda throw in random apologies and sorries when it fit throughout the case or say things like we'll definitely try to help you now, thats the goal, we'll definitely try to get this fixed for u asap, i'll keep u in the loop, ill tell you the results as they come, etc etc etc
6. had 1 awkward moment with a patient that was unexpected during a left lateral decubitus pt said well this is awkward but i apologized right away for it
7. Didn't document things like scars or tattoes but mentioned it to the patient
8. was running out of space multiple times on the HPI so if say a person didnt smoke, drink, etc... i deleted those things from HPI so i can fit something more pertinent, so basically seems like i asked an entire social history but will not get credit for doing so because ran out of space to fit in other things and the things i did ask will not be known now even thought they were done
9. multiple differentials seemed off to me, some i could not think of more than 1 because felt so obvious, other times (possibly 2-4) was completely boggled by what to even put down as first one, and other times something i should have put on the list, i didn't and didnt realize it after, just kinda hoping the ones i kept still can fit the HPI, etc.
10. never put pertinent negatives into the differentials
11. several patients during the encounter (maybe 2) i forgot to ask a key question that would have lead to a certain better test being ordered aka the patient gave clues to something i, in my ever lasting nervousness and anxiety did not pick up on as hey buddy u may wanna ask about this or inquire about that.
12. I never summarized the HPI/physical findings, i just did the closure and told them what I think it can be/why i think its that/what tests id order/why id order them, not sure if doing a closure but not a summary will kill
13. Provided counseling for whoever i thought needed it for things like alcohol... but in case like alcohol i forgot to say the CAGE results... again something i did that won't be in note
14. didn't put in vital signs for every patient... probably had em all for only half and some of them i just put in w/e i thought was actually pertinent
15. Few times wrote "non-medical" terminology
16. scared **** out of patient by saying cancer.... but obviously wiggled around it saying its not for sure we have to run tests, etc etc
17. when i did my abdominal exam... instead of pulling from the bottom... i figured if the patient is already ungowned for the cardiac/resp exam, may as well help them lay down and just pull gown down a little more and do abdomen
18. didnt ask every female about their obgyn history, menopause etc, only if it was needed (or so i thought)
19. lot of my physical exams seemed kinda weakish, i did the typical heart/lungs... +s1/s2 no murmurs rubs gallops regular rate rhythm clear to ausc bilaterally (never wrote no wheezes rales or rhonchi tho whoops)

Im definitely gonna remember other things... but as it stands... it seems like i failed ICE or CIS or both
19.
 
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pk1989 said:
After several days of thinking about my errors I finally came up with a list that, for now, seems to be all i can remember i screwed up on:

1. Ran out of time to write the tests i'd order for 1 patient
2. Put CT and Xray of head when i meant spine
3. accidentally wrote an incorrect abbreviation for a differential (cant specify due to USMLE rules)
4. forgot to do a few key physical exam maneuvers i.e. heaves, thrills, pmi, when required
5. didnt ask anyone about quality of life being affected/in what way its affected them i.e. didnt ask if affects sleep or work, etc, never said im sorry about their chief complaint, i would just kinda throw in random apologies and sorries when it fit throughout the case or say things like we'll definitely try to help you now, thats the goal, we'll definitely try to get this fixed for u asap, i'll keep u in the loop, ill tell you the results as they come, etc etc etc
6. had 1 awkward moment with a patient that was unexpected during a left lateral decubitus pt said well this is awkward but i apologized right away for it
7. Didn't document things like scars or tattoes but mentioned it to the patient
8. was running out of space multiple times on the HPI so if say a person didnt smoke, drink, etc... i deleted those things from HPI so i can fit something more pertinent, so basically seems like i asked an entire social history but will not get credit for doing so because ran out of space to fit in other things and the things i did ask will not be known now even thought they were done
9. multiple differentials seemed off to me, some i could not think of more than 1 because felt so obvious, other times (possibly 2-4) was completely boggled by what to even put down as first one, and other times something i should have put on the list, i didn't and didnt realize it after, just kinda hoping the ones i kept still can fit the HPI, etc.
10. never put pertinent negatives into the differentials
11. several patients during the encounter (maybe 2) i forgot to ask a key question that would have lead to a certain better test being ordered aka the patient gave clues to something i, in my ever lasting nervousness and anxiety did not pick up on as hey buddy u may wanna ask about this or inquire about that.
12. I never summarized the HPI/physical findings, i just did the closure and told them what I think it can be/why i think its that/what tests id order/why id order them, not sure if doing a closure but not a summary will kill
13. Provided counseling for whoever i thought needed it for things like alcohol... but in case like alcohol i forgot to say the CAGE results... again something i did that won't be in note
14. didn't put in vital signs for every patient... probably had em all for only half and some of them i just put in w/e i thought was actually pertinent
15. Few times wrote "non-medical" terminology
16. scared **** out of patient by saying cancer.... but obviously wiggled around it saying its not for sure we have to run tests, etc etc
17. when i did my abdominal exam... instead of pulling from the bottom... i figured if the patient is already ungowned for the cardiac/resp exam, may as well help them lay down and just pull gown down a little more and do abdomen
18. didnt ask every female about their obgyn history, menopause etc, only if it was needed (or so i thought)
19. lot of my physical exams seemed kinda weakish, i did the typical heart/lungs... +s1/s2 no murmurs rubs gallops regular rate rhythm clear to ausc bilaterally (never wrote no wheezes rales or rhonchi tho whoops)

Im definitely gonna remember other things... but as it stands... it seems like i failed ICE or CIS or both
19.
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I would trade mistakes in a heartbeat. All of these seem extremely minor to me. I still don't understand how you guys were maxing out the HPI...I only maxed out like twice. Other times I had plenty of room remaining. Did I not get a thorough hx at all lol?
 
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NCMED101 said:
I would trade mistakes in a heartbeat. All of these seem extremely minor to me. I still don't understand how you guys were maxing out the HPI...I only maxed out like twice. Other times I had plenty of room remaining. Did I not get a thorough hx at all lol?
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I mean i also forgot to ask on a peds case about development birth history etc.... and 2 times i did cn2-12 intact then realized on 1 case i forgot to check cn 11 but still wrote it into note and once i forgot to do cn8 and forgot to do it.... realized after test that i did that... blanked thought i did em all then realized oh dear... so hopefully thats not seen as irregularity since it was just oversight
 
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pk1989 said:
I mean i also forgot to ask on a peds case about development birth history etc.... and 2 times i did cn2-12 intact then realized on 1 case i forgot to check cn 11 but still wrote it into note and once i forgot to do cn8 and forgot to do it.... realized after test that i did that... blanked thought i did em all then realized oh dear... so hopefully thats not seen as irregularity since it was just oversight[/Q

If patient answered your questions CN8 is intact lol
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haha i thought so too but idk just paranoid maybe... cn11 tho whoops but w/e i figured one oversight like that wont be horrible... just that plus the other 20++ mistakes seem to be adding up to a big ol' Fail to me
 
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My overall cs experience which was terrible

1.went okay.though forgot to mention ob/gyn
2.not sure of my 3rd differential
3.horrible.one diagnosis was good 2nd not sure, 3rd one used wrong name for my dx
4.okay
5.okay.missed one dx rest were fine
6.okay
7.horrible.one differential good rest were crappy
8.okay
9.okay
10.okay
11.horrible again.i got so excited about.my first dx tht the next two dx were major crap
12.peds case.forgot birth,immunization,developmental

Things i did
Knocked,Greeted,emphatized,sanitized,counselled,summarized,closed all cases.answer to challenging ques was ok.notes were okay i guess.

I am just worried about the differentials.more worried about the fact that I put some crappy differentials which were not even needed !!.its almost been 5 weeks since I gave it but I still cant stop worrying about it :/..bad times
 
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Shy drager said:
My overall cs experience which was terrible

1.went okay.though forgot to mention ob/gyn
2.not sure of my 3rd differential
3.horrible.one diagnosis was good 2nd not sure, 3rd one used wrong name for my dx
4.okay
5.okay.missed one dx rest were fine
6.okay
7.horrible.one differential good rest were crappy
8.okay
9.okay
10.okay
11.horrible again.i got so excited about.my first dx tht the next two dx were major crap
12.peds case.forgot birth,immunization,developmental

Things i did
Knocked,Greeted,emphatized,sanitized,counselled,summarized,closed all cases.answer to challenging ques was ok.notes were okay i guess.

I am just worried about the differentials.more worried about the fact that I put some crappy differentials which were not even needed !!.its almost been 5 weeks since I gave it but I still cant stop worrying about it :/..bad times
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this sounds very light compared to the things i screwed up on .... wouldnt worry
 
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Hey pk1989, dont worry. Everybody has a diff perspective to their mistakes. To me my mistakes look big and yours seems benign. Plus I was worried about the ICE portion from the very beginning thts why just highlighted those. In the end I hope we all pass. Never knew this would be this nerve-wrecking especially if you have another exam coming up next month !
 
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To everybody worrying, I missed atleast 3 diagnosis COMPLETELY, had 3 I was questionable on, and for sure got 6 right (as either my first or second diagnosis in a case) and I passed the clinical knowledge part with above average. The other stupid part about being nice to the patient and saying please and thank you is a different story.. Standardized patients are dumb.
 
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Mittansky said:
To everybody worrying, I missed atleast 3 diagnosis COMPLETELY, had 3 I was questionable on, and for sure got 6 right (as either my first or second diagnosis in a case) and I passed the clinical knowledge part with above average. The other stupid part about being nice to the patient and saying please and thank you is a different story.. Standardized patients are dumb.
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Did you miss the most likely diagnosis in 3 cases ?
 
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Adding to this.. Just took it yesterday and I'm in the same boat of freaking out about the mistakes I made. Overnight I realized that I wrote VS WNL for one patient, even though her blood pressure was actually 138/something. Also I think for 1-2 patients who told me they drink 1-2 beers/month I wrote "Denies EtOH use". The patient notes section is now what I'm most worried about.. Trying to find comfort in people making similar mistakes on their notes? Anyone?

Am I sunk?
 
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Your mistakes don't seem so major compared to mine IMO. But then again, we all think that we did worse than the others, so I don't know.

Took it on the 15th of July, also waiting for results next week. I'm a US IMG and hopefully my American accent covered up for some of the mistakes I made:

-I had time management issues for 3 patients (Left in the middle of physical for 2, and in the middle of closure for one). In one of the incomplete cases, I could not make a diagnosis without the physical so I had to type in very general differentials.
-2 vague diagnosis cases where I had no idea about the most likely differential
-Did not ask SIGECAPS for an insomnia case (Technically it would be warranted here I believe but I sort of got a diagnosis from the HPI so I forgot and didn't ask)
-Forgot to counsel about smoking and/or alcohol on probably 3 cases where it was warranted. Like I did a closure but the counseling slipped my mind
-I had an awkward moment with palpating PMI in a female with a huge bra (like its support band was extremely thick and went below even the 6th ICS, so I had to have her move it upwards and just plain awkward. Definitely a screw up there, we're not supposed to expose more than needed or palpate there? I don't even know why I attempted to palpate PMI in her case.
-Rest were fine, I finished a min early and got a head start on the note. I always smiled for normal looking patients and kept a concerned expression if they were evidently in pain or anxious/distressed, and was calm and maintained eye contact throughout all of my encounters, and answered challenging questions properly. Washed hands in every encounter and was respectful while performing physicals, and only exposed what was needed (with the exception of that one female).
-What I did with my notes: I always wrote the differentials first (2 dx on most, only 1 dx on an extremely straightforward case, and 3 dx for only a couple cases), then the workup, then general P/E (at least the "pt is in no acute distress, VS WNL" or the distress state/abnormal vital signs as needed). Then I would write the HPI, and copy paste supporting HPI findings as I would go, so that I wouldn't lose points if time ran out, then the systemic exam findings and copy paste as I go. ---For a couple of cases, I had to leave the HPI incomplete (social history left out), and on a couple I couldn't put in the systemic physical exam. For a large majority, I forgot to type in CAGE negative even though I asked it, and in one I completely forgot to type in the alcohol intake even though I asked it. In one of my first ones, the second and third differential had no specific supporting evidence (Like just the same major complaints that I copy pasted in all 3).

Basically, I just don't know if I passed ICE or not and the wait is killing me. Anyone with similar mistakes? Good luck to everyone else who posted on this thread, lets hope we all passed.
 
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lavenderflowers said:
Your mistakes don't seem so major compared to mine IMO. But then again, we all think that we did worse than the others, so I don't know.

Took it on the 15th of July, also waiting for results next week. I'm a US IMG and hopefully my American accent covered up for some of the mistakes I made:

-I had time management issues for 3 patients (Left in the middle of physical for 2, and in the middle of closure for one). In one of the incomplete cases, I could not make a diagnosis without the physical so I had to type in very general differentials.
-2 vague diagnosis cases where I had no idea about the most likely differential
-Did not ask SIGECAPS for an insomnia case (Technically it would be warranted here I believe but I sort of got a diagnosis from the HPI so I forgot and didn't ask)
-Forgot to counsel about smoking and/or alcohol on probably 3 cases where it was warranted. Like I did a closure but the counseling slipped my mind
-I had an awkward moment with palpating PMI in a female with a huge bra (like its support band was extremely thick and went below even the 6th ICS, so I had to have her move it upwards and just plain awkward. Definitely a screw up there, we're not supposed to expose more than needed or palpate there? I don't even know why I attempted to palpate PMI in her case.
-Rest were fine, I finished a min early and got a head start on the note. I always smiled for normal looking patients and kept a concerned expression if they were evidently in pain or anxious/distressed, and was calm and maintained eye contact throughout all of my encounters, and answered challenging questions properly. Washed hands in every encounter and was respectful while performing physicals, and only exposed what was needed (with the exception of that one female).
-What I did with my notes: I always wrote the differentials first (2 dx on most, only 1 dx on an extremely straightforward case, and 3 dx for only a couple cases), then the workup, then general P/E (at least the "pt is in no acute distress, VS WNL" or the distress state/abnormal vital signs as needed). Then I would write the HPI, and copy paste supporting HPI findings as I would go, so that I wouldn't lose points if time ran out, then the systemic exam findings and copy paste as I go. ---For a couple of cases, I had to leave the HPI incomplete (social history left out), and on a couple I couldn't put in the systemic physical exam. For a large majority, I forgot to type in CAGE negative even though I asked it, and in one I completely forgot to type in the alcohol intake even though I asked it. In one of my first ones, the second and third differential had no specific supporting evidence (Like just the same major complaints that I copy pasted in all 3).

Basically, I just don't know if I passed ICE or not and the wait is killing me. Anyone with similar mistakes? Good luck to everyone else who posted on this thread, lets hope we all passed.
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Don't worry about it. It's very hard to fail this exam especially if u are from the USA. Looking at the usmle cs pass rate in ur demographic there is a 95ish chance u will pass ice. No guarantee of how u will do but I felt the same way and still passed.
 
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I took it day before you, panicking very much as well, feel like i failed ICE especially..almost 100% sure I did fail

lavenderflowers said:
Your mistakes don't seem so major compared to mine IMO. But then again, we all think that we did worse than the others, so I don't know.

Took it on the 15th of July, also waiting for results next week. I'm a US IMG and hopefully my American accent covered up for some of the mistakes I made:

-I had time management issues for 3 patients (Left in the middle of physical for 2, and in the middle of closure for one). In one of the incomplete cases, I could not make a diagnosis without the physical so I had to type in very general differentials.
-2 vague diagnosis cases where I had no idea about the most likely differential
-Did not ask SIGECAPS for an insomnia case (Technically it would be warranted here I believe but I sort of got a diagnosis from the HPI so I forgot and didn't ask)
-Forgot to counsel about smoking and/or alcohol on probably 3 cases where it was warranted. Like I did a closure but the counseling slipped my mind
-I had an awkward moment with palpating PMI in a female with a huge bra (like its support band was extremely thick and went below even the 6th ICS, so I had to have her move it upwards and just plain awkward. Definitely a screw up there, we're not supposed to expose more than needed or palpate there? I don't even know why I attempted to palpate PMI in her case.
-Rest were fine, I finished a min early and got a head start on the note. I always smiled for normal looking patients and kept a concerned expression if they were evidently in pain or anxious/distressed, and was calm and maintained eye contact throughout all of my encounters, and answered challenging questions properly. Washed hands in every encounter and was respectful while performing physicals, and only exposed what was needed (with the exception of that one female).
-What I did with my notes: I always wrote the differentials first (2 dx on most, only 1 dx on an extremely straightforward case, and 3 dx for only a couple cases), then the workup, then general P/E (at least the "pt is in no acute distress, VS WNL" or the distress state/abnormal vital signs as needed). Then I would write the HPI, and copy paste supporting HPI findings as I would go, so that I wouldn't lose points if time ran out, then the systemic exam findings and copy paste as I go. ---For a couple of cases, I had to leave the HPI incomplete (social history left out), and on a couple I couldn't put in the systemic physical exam. For a large majority, I forgot to type in CAGE negative even though I asked it, and in one I completely forgot to type in the alcohol intake even though I asked it. In one of my first ones, the second and third differential had no specific supporting evidence (Like just the same major complaints that I copy pasted in all 3).

Basically, I just don't know if I passed ICE or not and the wait is killing me. Anyone with similar mistakes? Good luck to everyone else who posted on this thread, lets hope we all passed.
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Shy drager said:
Did you miss the most likely diagnosis in 3 cases ?
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The 3 cases I completely bombed I had no idea what the actual diagnosis was at all. Like they didn't give me enough info to put together a complete diagnosis and so I just strung together some go to diagnoses for a symptom. The 3 I was questionable on, I know I missed the most likely diagnosis in atleast 1 or 2. That being said, I did pretty much 8 or 9 out of 12 cases write 3 diagnoses and supporting evidence for each. I have a bunch of friends who only wrote 1 or 2 diagnoses for most and my score was higher than theirs, so I'm not sure if having 3 diagnoses helped a with that or not.
 
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Passed!!! I literally could not have screwed up more, guess u really can mess up a lotttttt n still pass good luck all!
 
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lavenderflowers said:
Your mistakes don't seem so major compared to mine IMO. But then again, we all think that we did worse than the others, so I don't know.

Took it on the 15th of July, also waiting for results next week. I'm a US IMG and hopefully my American accent covered up for some of the mistakes I made:

-I had time management issues for 3 patients (Left in the middle of physical for 2, and in the middle of closure for one). In one of the incomplete cases, I could not make a diagnosis without the physical so I had to type in very general differentials.
-2 vague diagnosis cases where I had no idea about the most likely differential
-Did not ask SIGECAPS for an insomnia case (Technically it would be warranted here I believe but I sort of got a diagnosis from the HPI so I forgot and didn't ask)
-Forgot to counsel about smoking and/or alcohol on probably 3 cases where it was warranted. Like I did a closure but the counseling slipped my mind
-I had an awkward moment with palpating PMI in a female with a huge bra (like its support band was extremely thick and went below even the 6th ICS, so I had to have her move it upwards and just plain awkward. Definitely a screw up there, we're not supposed to expose more than needed or palpate there? I don't even know why I attempted to palpate PMI in her case.
-Rest were fine, I finished a min early and got a head start on the note. I always smiled for normal looking patients and kept a concerned expression if they were evidently in pain or anxious/distressed, and was calm and maintained eye contact throughout all of my encounters, and answered challenging questions properly. Washed hands in every encounter and was respectful while performing physicals, and only exposed what was needed (with the exception of that one female).
-What I did with my notes: I always wrote the differentials first (2 dx on most, only 1 dx on an extremely straightforward case, and 3 dx for only a couple cases), then the workup, then general P/E (at least the "pt is in no acute distress, VS WNL" or the distress state/abnormal vital signs as needed). Then I would write the HPI, and copy paste supporting HPI findings as I would go, so that I wouldn't lose points if time ran out, then the systemic exam findings and copy paste as I go. ---For a couple of cases, I had to leave the HPI incomplete (social history left out), and on a couple I couldn't put in the systemic physical exam. For a large majority, I forgot to type in CAGE negative even though I asked it, and in one I completely forgot to type in the alcohol intake even though I asked it. In one of my first ones, the second and third differential had no specific supporting evidence (Like just the same major complaints that I copy pasted in all 3).

Basically, I just don't know if I passed ICE or not and the wait is killing me. Anyone with similar mistakes? Good luck to everyone else who posted on this thread, lets hope we all passed.
Click to expand...

bullethead said:
Don't worry about it. It's very hard to fail this exam especially if u are from the USA. Looking at the usmle cs pass rate in ur demographic there is a 95ish chance u will pass ice. No guarantee of how u will do but I felt the same way and still passed.
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Passed!! Sorry, found out on the 24th but forgot to post it here. So relieved! High performance in ICE (Only one star in borderline), an asterisk in SEP and almost all the CIS stars in borderline. Finally done with this useless test.
 
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hello guys,
(yes, I just joined this forum to meet similar freaked out peers like me). I had my step 2 CS in august and I am literally freaking out after the exam.
I am an international med student, have not taken my step 1 and step 2 CK and here are a couple of things I did wrong.
1-In my first station, I made my female patient very uncomfortable by asking sexual hx(which i thought was pertinent) and when I asked OB/GYN, she questioned my rationale for asking it and I flustered and I auscultated her over the breast which was a huge screwup (although her breast were small) ! and given the fact that it was my first station, I forgot to counsel her on relevant aspects.In all, I forgot counselling on 2-3 cases, but other times i did it on pertinent aspects
2- I mishandled one of the challenging questions hugely.
3-There was a difficulty in comprehending 1 patient in the question which was really important for diagnosis and I think the patient was a bit angry about me repeating my question
5-I forgot to document some of the examinations I had done on the patient, including 1 supporting finding and thyroid exams
6-My top differentials on most cases were strong but the 2nd diff on 2-3 cases were plain brain farts.
7-I never asked any patients if they understood me, I just asked if they have any question for me.One of the patient actually said I was speaking fast.
8-Some of the patients had no challenging questions for me.
9-My patient notes were fine I guess, except for few times when I forgot to document few things.

I am majorly concerned about my empathy part (CIS), I think 2-4 patients might not be happy with me .i TRIED SHOWING EMPATHY EVERYTIME, I did all standard things. I hope I hope I hope I pass.

Anyone who has similar history or is undergoing similar agony please hit me up. Could really use some comforting words.
 
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