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JiniInBottle

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Hi,
So I'm in that phase right now where I've already just recently given the test. but now I'm under the impression that it wasn't as easy I thought it was after coming out of the exam.
1. First case, I didn't get to do a closure.
2. In one patient note, I left out the whole allergies, meds, PMH, psh, fh, sh, ros....I finished everything else perfectly for the case...I thought I was done when I scrolled up and realized that I had left that part to come back and finish.
3. couple of cases, I forgot to pull out the leg rest.
4. I asked eldery pt about help at home/support. however, I didn't ask everyone.
5. There was a pt which I wasn't sure about domestic abuse...but I just didn't really ask about it at the time, I was only thinking this pt is behaving weirdly. However, I wasn't thinking of abuse.
6. I forgot to explore drug abuse issue.
7. I'm most worried about this. A lot of my friends say that you must write a lot of supporting evidence from history when writing under the differential diagnosis. I wrote a couple of things for each differential. And sometimes, even only had one supporting evidence. This is what I saw in First Aid, so I thought it might be okay...however, others are saying you need a lot more evidence???? Should I be worried about this, as I did this for almost all of my patients.
8. In once case, 1 differential was rock solid good. The other differentials on patient note were vague and unclear diagnosis. Like...possible injury from past surgery? I don't know if they count/are good.
9. One or 2 cases, in the hindsight, I think I might have messed up the primary differential.
10. in a couple of cases, i forgot to mention physical exam to be done..like pelvic exam or breast exam....which were pertinent.
11. I was only able to do one or 2 systems for physical exam. The pertinent and a secondary one. Or sometimes only pertinent.
12. I didn't really have any phsyical findings that were positive during physical exam...so I didn't have any supporting evidence for physical except for like vital signs.
13. I thought one of the patient was pretending to be wheezing...but I disregarded because it seemed fake. -_- I think it was a mistake.
14. I didn't finish full neuro exam during one case because I kept repeating the same pinprick questions because it seemed the patient himself was confused. I don't know if he was making it up or it was seriously messed up...fml
15. one of the diagnoses, i misspelled it. so it might not sound like a real diagnosis.

I'm just really worried about my exam. Can you guys elaborate if you had similar problems or concerns or made mistakes...and what happened...did you pass?

I'm just in the limbo right now and there's no definite answers anywhere. I hope we're not expected to write like 8 supporting evidence for each differential. Because for some I only had one or 2. I'm too nervous.
How do they remove 2 cases? are they just your worst case grades?
 
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JiniInBottle

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Also what I did do during the test which was good:
1. ask if they're comfortable
2. ask pertinent questions.
3. introduced myself
4. washed hands
5. closure always included 2 diagnoses (except for oen case where i didn't get to close)
6. always did alcohol and smoking counseling when necessary
7. was polite, calm, comfortable...
 
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lymphocyte

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Coming from a place of 100% compassion, I'm going to tell you the cold hard truth.

Nothing anybody says will help except maybe this: it's a stupid, miserable, long wait for your results. You likely don't remember all the things you did wrong or even the things you did right, and you literally have no power to change anything.

Nobody really knows how this test is graded.
Nobody really knows how things are weighted.
Nobody really even knows how the 2 cases are picked to remove (highest/lowest, lowest/lowest, random, new items, etc.).

I'm really sorry. It sucks. It gets better with time. And then you get your result. If you pass (like the majority of people do), then yay. If you don't, then you'll have to take it again. I wish I could offer more, and I wish you all the best.
 
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Thyroid_Storm

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Hi,
So I'm in that phase right now where I've already just recently given the test. but now I'm under the impression that it wasn't as easy I thought it was after coming out of the exam.
1. First case, I didn't get to do a closure.
2. In one patient note, I left out the whole allergies, meds, PMH, psh, fh, sh, ros....I finished everything else perfectly for the case...I thought I was done when I scrolled up and realized that I had left that part to come back and finish.
3. couple of cases, I forgot to pull out the leg rest.
4. I asked eldery pt about help at home/support. however, I didn't ask everyone.
5. There was a pt which I wasn't sure about domestic abuse...but I just didn't really ask about it at the time, I was only thinking this pt is behaving weirdly. However, I wasn't thinking of abuse.
6. I forgot to explore drug abuse issue.
7. I'm most worried about this. A lot of my friends say that you must write a lot of supporting evidence from history when writing under the differential diagnosis. I wrote a couple of things for each differential. And sometimes, even only had one supporting evidence. This is what I saw in First Aid, so I thought it might be okay...however, others are saying you need a lot more evidence???? Should I be worried about this, as I did this for almost all of my patients.
8. In once case, 1 differential was rock solid good. The other differentials on patient note were vague and unclear diagnosis. Like...possible injury from past surgery? I don't know if they count/are good.
9. One or 2 cases, in the hindsight, I think I might have messed up the primary differential.
10. in a couple of cases, i forgot to mention physical exam to be done..like pelvic exam or breast exam....which were pertinent.
11. I was only able to do one or 2 systems for physical exam. The pertinent and a secondary one. Or sometimes only pertinent.
12. I didn't really have any phsyical findings that were positive during physical exam...so I didn't have any supporting evidence for physical except for like vital signs.
13. I thought one of the patient was pretending to be wheezing...but I disregarded because it seemed fake. -_- I think it was a mistake.
14. I didn't finish full neuro exam during one case because I kept repeating the same pinprick questions because it seemed the patient himself was confused. I don't know if he was making it up or it was seriously messed up...fml
15. one of the diagnoses, i misspelled it. so it might not sound like a real diagnosis.

I'm just really worried about my exam. Can you guys elaborate if you had similar problems or concerns or made mistakes...and what happened...did you pass?

I'm just in the limbo right now and there's no definite answers anywhere. I hope we're not expected to write like 8 supporting evidence for each differential. Because for some I only had one or 2. I'm too nervous.
How do they remove 2 cases? are they just your worst case grades?

I don't have any useful advice, but I just wanted to let you know that I also took it recently and am in the same boat with a lot of similar concerns, particularly with the minimal supporting evidence for each Dx. I wish the expectations and grading process were more transparent...
 

JiniInBottle

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first aid had many cases where they only had one evidence...so i thought it would be acceptable. Plus, there were no findings on the physical exams...
 

JiniInBottle

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It's because my other friends who took Kaplan course said that they're supposed to put negative things in the supporting evidence too. And people put any bs in the supporting evidence that's negative, just to fill up those spots. But I don't think that's fair. I mean any one can copy the negatives and paste it in the lists of supproting evidence for all the differentials. That's so stupid. And not everyone has time for that. I didn't have time for it. Plus, even the pertinent postives I sometimes couldn't make it in time to put in. I feel So nervous now.

Kaplan is ruining it for everyone by teaching these methods that people follow without thinking and using it robotically...without any real use. Like you wouldn't put those things as pertinent negatives in real life.
 

lymphocyte

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It's because my other friends who took Kaplan course said that they're supposed to put negative things in the supporting evidence too. And people put any bs in the supporting evidence that's negative, just to fill up those spots. But I don't think that's fair. I mean any one can copy the negatives and paste it in the lists of supproting evidence for all the differentials. That's so stupid. And not everyone has time for that. I didn't have time for it. Plus, even the pertinent postives I sometimes couldn't make it in time to put in. I feel so ****ty now.

Don't beat yourself up. I had a few stations with just a few (even one) line of supporting evidence and I passed with the stars all the way over in all domains. BS detracts from your points, as per the ECFMG guidebook.

This is what I meant about the long, miserable wait...
 
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JiniInBottle

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Don't beat yourself up. I had a few stations with just a few (even one) line of supporting evidence and I passed with the stars all the way over in all domains. BS detracts from your points, as per the ECFMG guidebook.

This is what I meant about the long, miserable wait...

I know. Coming out of it I was okay. But then, now with the long wait. everyday i'm getting nervous, and I don't even have enough time to study for CK because of my stupid rotations. fml.
But did you ever have only one supporting evidence for the main differential?
And have a vague differential answer for one of the cases. 2/3 of the differentials on one of the cases was vague, and not proper differential.
 

IMG1345

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I know. Coming out of it I was okay. But then, now with the long wait. everyday i'm getting nervous, and I don't even have enough time to study for CK because of my stupid rotations. fml.
But did you ever have only one supporting evidence for the main differential?
And have a vague differential answer for one of the cases. 2/3 of the differentials on one of the cases was vague, and not proper differential.
I also gave my exam recently and am worried about things very similar to yours. The exam is very weird and the limited time puts tremendous pressure on us. Even, I have put 2-3 (sometimes 1) supporting evidence in all cases. I would want to ask you...Did every SP ask you a challenging question?
 
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JiniInBottle

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I also gave my exam recently and am worried about things very similar to yours. The exam is very weird and the limited time puts tremendous pressure on us. Even, I have put 2-3 (sometimes 1) supporting evidence in all cases. I would want to ask you...Did every SP ask you a challenging question?
They did ask challenging questions...i don't remember if all did. But I feel most had some sort of a q....not all
 

qqw

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What do you mean evidence for your differential?

So....something like: 1) Myocardial infarction - substernal chest pain radiating to left arm and jaw ?

I was under the impression that you just list out 4 or 5 diagnoses. So i'm assuming you're ok. My school didnt mention anything about elaborating with evidence for each diagnoses. Unless you do that in the objective portion? ie: Abdomen: Murphy's sign was positive pointing towards diagnosis of cholecystitis.
 
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Thyroid_Storm

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What do you mean evidence for your differential?

So....something like: 1) Myocardial infarction - substernal chest pain radiating to left arm and jaw ?

I was under the impression that you just list out 4 or 5 diagnoses. So i'm assuming you're ok. My school didnt mention anything about elaborating with evidence for each diagnoses. Unless you do that in the objective portion? ie: Abdomen: Murphy's sign was positive pointing towards diagnosis of cholecystitis.

I believe CS used to require 4-5 differential diagnoses without supporting evidence; however, they currently want only 3 differential diagnoses (in order of likelihood) with supporting evidence from the history and/or physical exam. Take a look at how the actual note is structured: http://www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html. What isn't entirely clear is how many pieces of supporting evidence are sufficient to pass.
 

Hockeyfan23

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Took it back in May so also anxiously waiting for results. The pertinent pos and neg aspect of the test is still a mystery to me and still have no idea how this thing is graded. As I saved this part for the end of my note, I usually ran out of time and many times had only one piece of supporting evidence for each diagnosis. I feel this part and a weak physical exam were my downfalls (ie: tapping a few reflexes and doing muscle strength on the upper extremities vs a full neuro when needed; just listening to lungs when full lung exam was needed). Not sure how things will turn out at this point. Just have to patiently and anxiously wait til Wednesday... :nailbiting:
 

Thyroid_Storm

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Took it back in May so also anxiously waiting for results. The pertinent pos and neg aspect of the test is still a mystery to me and still have no idea how this thing is graded. As I saved this part for the end of my note, I usually ran out of time and many times had only one piece of supporting evidence for each diagnosis. I feel this part and a weak physical exam were my downfalls (ie: tapping a few reflexes and doing muscle strength on the upper extremities vs a full neuro when needed; just listening to lungs when full lung exam was needed). Not sure how things will turn out at this point. Just have to patiently and anxiously wait til Wednesday... :nailbiting:

Can you let us know how it goes?
 

Jralf2010

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Keep your head up! We've all gone through this but once you get your results and see 3 passes across the board you'll be happy to be done with the most subjective exam ever haha! You will always remember the mistakes and forget the good things you did. But remember 10 out of the 12 cases will count and theres a minimum passing level for each category. I ran out of time on 2-3 cases and didn't close but I still made it. I got faith that everyone will have good results tomorrow! Good luck!!!
 
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Ina2990

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I just received my score today, and I passed with high performance in all components, as an IMG who took it in Philly, there was no one more anxious than me about getting these results. All I can say is that you can definitely get away with a lot and still pass this exam, I know I did. You don't have to do perfect, just good enough to pass.
 
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JiniInBottle

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I just received my score today, and I passed with high performance in all components, as an IMG who took it in Philly, there was no one more anxious than me about getting these results. All I can say is that you can definitely get away with a lot and still pass this exam, I know I did. You don't have to do perfect, just good enough to pass.


Where do you usually get the results? Do you get notified in your email that you gave to ecfmg?
 

JiniInBottle

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Keep your head up! We've all gone through this but once you get your results and see 3 passes across the board you'll be happy to be done with the most subjective exam ever haha! You will always remember the mistakes and forget the good things you did. But remember 10 out of the 12 cases will count and theres a minimum passing level for each category. I ran out of time on 2-3 cases and didn't close but I still made it. I got faith that everyone will have good results tomorrow! Good luck!!!

Thanks for the encouragement. Can't wait for my results to come out. I took it in Jun so still got a while to wait :(
 
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tmalik616

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Just got my results back yesterday after taking it in April in Philly, and I passed thankfully no where near borderline and a star in SEP, let me tell you how my cases went:
1. Nerves got the best of me and I spent too long on history. I didnt even finish it because the 5 min warning went off so I did 2 brief examinations and started closing before time ran out, so I didnt finish at all. On top of that I could only think of two diagnoses and very minimal evidence for support.
2. Straight forward case, got some confidence back, but still forgot to ask some questions, but luckily every patient tells you something you missed if you ask at the end of your history if they have anything they want to add.
3. Phone case, straightforward.
4. Peds case, took a while to find out what the patient had, and I had a lot of dead air thinking of questions, quite the awkward encounter, but after the initial awkwardness, turned out just fine.
5. Forgot to ask some major questions again which made me nervous again and I was running low on time. Again the patient helped out which helped me reach a diagnosis. I didnt do two full major examinations I should of have.
6. Exact same thing that happened in 5, happened here.
7-12. The cases got easier and easier, much more basic. I had tons of time to spare with the patient. I finished within 7 minutes for each.

Some huge mistakes I made with every patient though: I did not pull the footrest once during my entire exam, not any patients, didn't do any neuro exams even when warranted, and never used the ophthalmoscope.

After reading your experience, it seems like you did just fine, just don't over analyze what you did wrong, but think about how many things you did right! did you greet and introduce yourself to every patient? Did you properly handle their drape? Did you wash your hands? There are a lot of small things that add up, so even if you missed a couple of things for each case, that is a small portion of the whole grading scheme.
 

NCMED101

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Hi,
So I'm in that phase right now where I've already just recently given the test. but now I'm under the impression that it wasn't as easy I thought it was after coming out of the exam.
1. First case, I didn't get to do a closure.
2. In one patient note, I left out the whole allergies, meds, PMH, psh, fh, sh, ros....I finished everything else perfectly for the case...I thought I was done when I scrolled up and realized that I had left that part to come back and finish.
3. couple of cases, I forgot to pull out the leg rest.
4. I asked eldery pt about help at home/support. however, I didn't ask everyone.
5. There was a pt which I wasn't sure about domestic abuse...but I just didn't really ask about it at the time, I was only thinking this pt is behaving weirdly. However, I wasn't thinking of abuse.
6. I forgot to explore drug abuse issue.
7. I'm most worried about this. A lot of my friends say that you must write a lot of supporting evidence from history when writing under the differential diagnosis. I wrote a couple of things for each differential. And sometimes, even only had one supporting evidence. This is what I saw in First Aid, so I thought it might be okay...however, others are saying you need a lot more evidence???? Should I be worried about this, as I did this for almost all of my patients.
8. In once case, 1 differential was rock solid good. The other differentials on patient note were vague and unclear diagnosis. Like...possible injury from past surgery? I don't know if they count/are good.
9. One or 2 cases, in the hindsight, I think I might have messed up the primary differential.
10. in a couple of cases, i forgot to mention physical exam to be done..like pelvic exam or breast exam....which were pertinent.
11. I was only able to do one or 2 systems for physical exam. The pertinent and a secondary one. Or sometimes only pertinent.
12. I didn't really have any phsyical findings that were positive during physical exam...so I didn't have any supporting evidence for physical except for like vital signs.
13. I thought one of the patient was pretending to be wheezing...but I disregarded because it seemed fake. -_- I think it was a mistake.
14. I didn't finish full neuro exam during one case because I kept repeating the same pinprick questions because it seemed the patient himself was confused. I don't know if he was making it up or it was seriously messed up...fml
15. one of the diagnoses, i misspelled it. so it might not sound like a real diagnosis.

I'm just really worried about my exam. Can you guys elaborate if you had similar problems or concerns or made mistakes...and what happened...did you pass?

I'm just in the limbo right now and there's no definite answers anywhere. I hope we're not expected to write like 8 supporting evidence for each differential. Because for some I only had one or 2. I'm too nervous.
How do they remove 2 cases? are they just your worst case grades?

I made similar mistakes, worst is that 1/3 of my differentials in 4 cases were super vague...I put malignancy instead of specifying location...I don't know what was going through my head since the location is pretty obvious based on CC.
 

pk1989

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Took CS today, freaking out, particularly on the history, i forgot to write "HPI:" for ALL 12 patients...and for w.e. god knows reason i kept putting the social history in that same paragraph, the rest was all separate like ROS,pmh, psh, etc....so i asked all the questions but just didnt put social hx as own thing when i shouldve for all 12 of the patients, so the info is there, but since its not broken up, im doomed arent i??
 

NCMED101

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Took CS today, freaking out, particularly on the history, i forgot to write "HPI:" for ALL 12 patients...and for w.e. god knows reason i kept putting the social history in that same paragraph, the rest was all separate like ROS,pmh, psh, etc....so i asked all the questions but just didnt put social hx as own thing when i shouldve for all 12 of the patients, so the info is there, but since its not broken up, im doomed arent i??

Lol...look at my thread. I'll save you some trouble. You are fine
 

pk1989

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Lol...look at my thread. I'll save you some trouble. You are fine

That 950 character limit killed me...at least 1 differential was utter bs...and lets say patient had no smoking alcohol no relevant fam hx etc...i didnt write it into hpi cuz needed space for more useful info
 

NCMED101

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That 950 character limit killed me...at least 1 differential was utter bs...and lets say patient had no smoking alcohol no relevant fam hx etc...i didnt write it into hpi cuz needed space for more useful info

You're still fine, its a focused history, so if you had to remove things that were not relevant then that's perfectly fine. I must have done a terrible job on HPI cause I only ran out of room on 2 cases...
 

pk1989

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You're still fine, its a focused history, so if you had to remove things that were not relevant then that's perfectly fine. I must have done a terrible job on HPI cause I only ran out of room on 2 cases...

Sigh...still feel ****ty...some differentials were bogus...just could not come up with anything legitimate past the 1st obvious one several times...did phys exams but some parts didnt have time for...ran out of time for 1 soap just forgot to put in the tests to order...for cvs/pulm i mean forgot pmi when i shouldve...did some egophony etc on some pts...forgot to put it into note just wrote results of my auscultation... etc etc just feel crappy
 

NCMED101

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Sigh...still feel ****ty...some differentials were bogus...just could not come up with anything legitimate past the 1st obvious one several times...did phys exams but some parts didnt have time for...ran out of time for 1 soap just forgot to put in the tests to order...for cvs/pulm i mean forgot pmi when i shouldve...did some egophony etc on some pts...forgot to put it into note just wrote results of my auscultation... etc etc just feel crappy

I promise you will be fine. My mistakes are way worse, just look at my post
 

JiniInBottle

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I made similar mistakes, worst is that 1/3 of my differentials in 4 cases were super vague...I put malignancy instead of specifying location...I don't know what was going through my head since the location is pretty obvious based on CC.

It's a killer to wait for these results.
 

pk1989

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So for the phys exam...i blanked on the recording, wrote clear to ausc bilaterally for lungs never said no wheezes rales or rhonchi....is something like that a major problem for each patient....on top of all the other mistakes made...makes it seem like i did weak pulm exams ughhh
 

NCMED101

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So for the phys exam...i blanked on the recording, wrote clear to ausc bilaterally for lungs never said no wheezes rales or rhonchi....is something like that a major problem for each patient....on top of all the other mistakes made...makes it seem like i did weak pulm exams ughhh

No
 
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JiniInBottle

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Just checked yesterday: passed :D
no matter how much you fret after taking the test...in the end, it was definitely easier done than I thought. There's hope. For all of you waiting :D
 
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