So I recently re-took my Step 2 CS and I am panicking like crazy this time. The first time I took it, I felt I had some great, straightforward cases and was sure I passed and never worried about it. Turned out I failed the ICE section.
This time I spent all my time studying for the CS like crazy, took a 5-day course, reviewed first aid multiple times, practiced as much as possible and would write at least 5-10 notes a day on FA cases and would practice my PEs while timed with flashcard cases. I even did Bate's Physical Exam book as if they were FA cases. I really put in as much effort as I could and must have gone through FA 3 times.
On the exam (I'll try to be as vague as possible not to expose anything we shouldn't discuss on the specific cases)
1. Completely bombed one station. I almost couldn't get ANY relevant positives or negatives. and I was so concerned on the note about synthesizing the information that I forgot to write PMH, FH, SH, surgical, meds etc. which were all not relevant anyway but still, I asked those and didn't write them in the note! My differentials were a mess too, naturally. So I bombed this case entirely start to finish. The encounter itself was awkward too, young curt patient and I didn't know what to make of it. I stayed professional and empathetic but clinically, it was a disaster. And it's ICE I fear!
2. My phone encounter was the same thing. VERY vague and limited information! Like fever, fussy, no to basically everything I would ask. I still put 3 DDX based on it being a pediatric case and having a vague stab at it with that information. But I was floored with such limited information considering last time my phone encounter had some VERY good pertinent positives which guided me. I wrote Viral Extanem although there was no rash, I meant Viral INFECTION with and wanted to list the specific virus, but the name just wouldn't come to mind under pressure
3. On another case I wrote MRI Arm instead of Xray Shoulder in the workup. I don't know.
4. For my second differential on one case I supported it all entirely as one DDX, then looked up and noticed I wrote a different but related DDX instead and ran out of time before I could change it. I was trying to hard to put in supporting evidence and make it look elegant and express my clinical reasoning, that I bombed the differential entirely. I didn't want to be sneaky and key in the last 3 letters and tried to take the honest approach and just leave it. But I'm just so upset.
5. In one case I forgot to ask smoking, tobacco or drug use. Well, I think I actually remembered to ask them, but forgot to write them. So when I saw I didn't write it, I didn't put it in the note purposefully just in case. I didn't want to fail that station for documenting something I might have forgotten to do, despite the fact I was fairly sure I asked and didn't write anything because it was a no to all 3. Still, I have failed this test once and refused to take any chances. I didn't necessarily feel those answers would have impacted my differentials anyway and were likely all "No" so I chose caution.
6. In at least 3 cases I forgot to document PE maneuvers I know I did, and I'm fairly sure I wrote some of them as evidence to back up my differentials but forgot to put them in the PE section because I was filling some notes bottom to top because I was so scared about the ICE section and left the HPI for last.
7. I was worried about ICE so I neglected an entire closure on one case for extra PE maneuvers. I even dropped the Otoscope and it went crashing into the wall.
8. I don't know why but any patient I did DTRs on had no response even to multiple strikes. I kept panicking. On one case I felt DTR was very much relevant on I actually documented it as diminished brachial DTR b/l - for example - because there was truly no response at all and I was shocked! I did DTR for completeness of the Neuro exam but never expected it to be absent and certainly not b/l even if it was. So I didn't know what to do. When we practiced, my friends would fake the DTR as there unless FA or the case warranted it to be absent. But in my exam I felt like it almost always was! I asked the SP "do you usually respond to this test when your primary care doctor performs it?" to be sure I wasn't hallucinating, but of course there wasn't any relevant information on that.
9. In one diminished DTR case I wish I had documented as absent instead of normal because I think it might have been relevant and should have been diminished. But again I bombed that case start to finish regardless.
I just don't know. If I could take one mistake back I wish I could have had 5 more seconds to type the correct DDX that I mixed up. I feel like I'm going to bomb that station which was otherwise rather good for me because I missed the clear-cut DDX but writing the wrong one by accident and neglecting to change the name until I finished supporting it… I had like 8 supporting points for the DDX I thought it was but couldn't change the name in time
I've been crying so much over this. I worked so hard and it was my second shot but I felt the exam was so much harder this time. Rougher cases and my mistakes on top of it all. I can't believe I bombed the most clear-cut DDX by writing SUBDURAL and supported it knowing it was EPIDURAL.
I just can't fail again. This experience is horrifying to me. I've spent so much time with my own imagination and worn out my friends trying to practice over and over… I want to get to my rotations again and learn from the patients at our hospital. I do feel thinking clinically on the CS was a helpful way to synthesize information quickly and I really do appreciate this experience for fostering that sort of approach. I'm not going to knock the exam or the process… but I just want to get back to medical school and learn what I can on my rotations. I'm praying so hard to put this experience behind me and hopefully pass but it feels so hopeless when I make mistakes like this.
Please, any advice?
This time I spent all my time studying for the CS like crazy, took a 5-day course, reviewed first aid multiple times, practiced as much as possible and would write at least 5-10 notes a day on FA cases and would practice my PEs while timed with flashcard cases. I even did Bate's Physical Exam book as if they were FA cases. I really put in as much effort as I could and must have gone through FA 3 times.
On the exam (I'll try to be as vague as possible not to expose anything we shouldn't discuss on the specific cases)
1. Completely bombed one station. I almost couldn't get ANY relevant positives or negatives. and I was so concerned on the note about synthesizing the information that I forgot to write PMH, FH, SH, surgical, meds etc. which were all not relevant anyway but still, I asked those and didn't write them in the note! My differentials were a mess too, naturally. So I bombed this case entirely start to finish. The encounter itself was awkward too, young curt patient and I didn't know what to make of it. I stayed professional and empathetic but clinically, it was a disaster. And it's ICE I fear!
2. My phone encounter was the same thing. VERY vague and limited information! Like fever, fussy, no to basically everything I would ask. I still put 3 DDX based on it being a pediatric case and having a vague stab at it with that information. But I was floored with such limited information considering last time my phone encounter had some VERY good pertinent positives which guided me. I wrote Viral Extanem although there was no rash, I meant Viral INFECTION with and wanted to list the specific virus, but the name just wouldn't come to mind under pressure
3. On another case I wrote MRI Arm instead of Xray Shoulder in the workup. I don't know.
4. For my second differential on one case I supported it all entirely as one DDX, then looked up and noticed I wrote a different but related DDX instead and ran out of time before I could change it. I was trying to hard to put in supporting evidence and make it look elegant and express my clinical reasoning, that I bombed the differential entirely. I didn't want to be sneaky and key in the last 3 letters and tried to take the honest approach and just leave it. But I'm just so upset.
5. In one case I forgot to ask smoking, tobacco or drug use. Well, I think I actually remembered to ask them, but forgot to write them. So when I saw I didn't write it, I didn't put it in the note purposefully just in case. I didn't want to fail that station for documenting something I might have forgotten to do, despite the fact I was fairly sure I asked and didn't write anything because it was a no to all 3. Still, I have failed this test once and refused to take any chances. I didn't necessarily feel those answers would have impacted my differentials anyway and were likely all "No" so I chose caution.
6. In at least 3 cases I forgot to document PE maneuvers I know I did, and I'm fairly sure I wrote some of them as evidence to back up my differentials but forgot to put them in the PE section because I was filling some notes bottom to top because I was so scared about the ICE section and left the HPI for last.
7. I was worried about ICE so I neglected an entire closure on one case for extra PE maneuvers. I even dropped the Otoscope and it went crashing into the wall.
8. I don't know why but any patient I did DTRs on had no response even to multiple strikes. I kept panicking. On one case I felt DTR was very much relevant on I actually documented it as diminished brachial DTR b/l - for example - because there was truly no response at all and I was shocked! I did DTR for completeness of the Neuro exam but never expected it to be absent and certainly not b/l even if it was. So I didn't know what to do. When we practiced, my friends would fake the DTR as there unless FA or the case warranted it to be absent. But in my exam I felt like it almost always was! I asked the SP "do you usually respond to this test when your primary care doctor performs it?" to be sure I wasn't hallucinating, but of course there wasn't any relevant information on that.
9. In one diminished DTR case I wish I had documented as absent instead of normal because I think it might have been relevant and should have been diminished. But again I bombed that case start to finish regardless.
I just don't know. If I could take one mistake back I wish I could have had 5 more seconds to type the correct DDX that I mixed up. I feel like I'm going to bomb that station which was otherwise rather good for me because I missed the clear-cut DDX but writing the wrong one by accident and neglecting to change the name until I finished supporting it… I had like 8 supporting points for the DDX I thought it was but couldn't change the name in time
I've been crying so much over this. I worked so hard and it was my second shot but I felt the exam was so much harder this time. Rougher cases and my mistakes on top of it all. I can't believe I bombed the most clear-cut DDX by writing SUBDURAL and supported it knowing it was EPIDURAL.
I just can't fail again. This experience is horrifying to me. I've spent so much time with my own imagination and worn out my friends trying to practice over and over… I want to get to my rotations again and learn from the patients at our hospital. I do feel thinking clinically on the CS was a helpful way to synthesize information quickly and I really do appreciate this experience for fostering that sort of approach. I'm not going to knock the exam or the process… but I just want to get back to medical school and learn what I can on my rotations. I'm praying so hard to put this experience behind me and hopefully pass but it feels so hopeless when I make mistakes like this.
Please, any advice?
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I suppose there's nothing reassuring about all this. I don't know how to clear this exam honestly. It feels so hopeless.
