Step 2cs fail, IMG - what can I do?

[Dr. Lost]

Yesterday, I learned that I failed USMLE Step 2cs. I failed the Communication and Interpersonal Skills (CIS) part, but did well in the other two parts. I'm really shocked and depressed. I have no idea what I did wrong. I feel utterly powerless against the system. I couldn't sleep at all last night.

My other scores are OK (Step 1 239, Step 2ck 252, both around 70th percentile). I'm an IMG from a western English-speaking country and I have a few years of clinical experience. Since moving to the US, I've been doing some research and got a masters (at a big-name university). But I have now been out of clinical medicine for 4 years and it's 7 years since I graduated.

I want to get back to clinical medicine by matching into a residency. I feel like my path is already tenuous because I'm an IMG and I've been away for so long. With this big fat fail on my record, I feel like it's hopeless and I should just give up on a clinical career.

What can I do to move past this mistake? What are my chances of matching now?

I was hoping to try for radiology, but I'm also OK with internal medicine. I was also hoping to not need to match in "middle of nowhere" programs. I think that has gone from a hope to a dream...

Is there any point asking for a recheck? Since I have no idea what went wrong, how can I make sure I pass a second attempt?

I see a couple of threads on this forum from people who failed step 2cs, but managed to retake it before anyone noticed. I don't think my timeline will allow that.

Thanks for any advice...

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[ryanr]

My advice would be to look at the First Aid for Step 2 CS book section on communication/CIS and see if you can identify things that you simply did not do or did poorly.

Also, do some self-reflection.
Did you address the patient by name? Were you empathetic? Did you comment or ask on how this was affecting the patient's life?
How was your closure of the encounters? Did you discuss the diagnosis and what the next steps would be? Did you appropriately address their questions and concerns (i.e. challenge question)?
A good closing/summary of the encounter is the most critical part for CIS.

I think the general answer is re-take it and Pass. But make sure you prepare. If you are applying this cycle I would try to get a date before end of December. Otherwise you have more flexibility. My concern for you is that 7 years since graduation is going to be a red flag, and this adds another - probably wouldnt be as big of a deal if you were an AMG regarding CS failure, but as an IMG I think programs will scrutinize this kind of stuff more. Radiology may not be realistic. IM probably doable if you apply broadly. I'm no expert though on any of this.

Sorry this happened to you. Best of luck moving forward.

 

[Dr. Lost]

Thanks ryanr for your reply. Yes, I'm worried that my application already has some red flags and this is just going to sink it outright.

As far as I know, I did everything I'm supposed to. I got the first aid book. I practiced with several people. I went over the usual checklist -- polite introduction, empathize, respond to concerns, ask permission for things, narrate what I'm doing, summarize, conclude.

I'm just going over it again and again and can't find a clear thing that I did wrong. The only thing I can think of is that I asked patients to confirm their name. I was told to do this double check by two senior clinicians I practiced with. Maybe this was misinterpreted as "I forgot your name". I was tired from the travel and could hardly sleep the night before, so maybe I was just too tired.

Perhaps it was just bad luck. Conditioned on failing the first time 65% of IMGs pass (versus 80% the first time). That makes me think the test is highly random. You would think that, conditioned on failing once, the repeat pass rate would be very low. Should I just try my luck again?

 

[ryanr]

Yep, you covered the main things there I think. Also don't forget to use plain language (i.e. not "doctor words") when explaining things.
I think you should give it another go, after studying again even harder than the first time, focusing especially on CIS (yet not neglecting ICE). Leave no rock unturned and leave nothing to chance. I'm confident you can pass this exam.
Regarding the name thing - I think thats fine if thats how you're making your introduction to the room "Mr./Ms. ____?". Even better if you repeat their name later "So Mr./Ms., I know we've talked a lot about..."

 

[quincyfuturemd]

I would also add when practicing with people try and get into chcaracter, not just focusing on proper exam maneuvers. It helps to practice with people who are in medicine as well (ideally people who’ve passed CS). Also don’t forget to counsel on things like smoking.

As far as ending up in “the middle of nowhere” even without failures you are going to get invites from community programs in desirable cities or academic programs from “less desirable” locations just by being an Img. However imo a lot of these places are great for buying houses, raising families, or getting a lot of experience with a wide range of pt populations. So whatever happens go into it with an open mind and honestly red flags and scores don’t change the types of places imgs get IV at but the number of IV.

 

[Riseup2it]

I want to echo the statements made by the folks on this thread and state the importance of preparation. I also failed, but I passed it on my second take. The main difference in my preparation was timing. I spent two months prepping the second time around and I made sure I did not leave any stone unturned. In my case, I had failed the ICE portion, so I made sure I practiced writing notes consistently.

Fast forward to app season, I have gotten IV invites. It is all about how you present yourself. As quincy said above, keep an open mind and realize that no matter where you are obtaining the training, you should look at it in a positive light. Don't lose hope and take the extra time to prep well for this exam.

 

[chickensoupdr]

How do they grade the differential diagnoses? Like, would Inflammatory Bowel Disease count as one diagnosis or should it be split into Crohn's and Ulcerative Colitis? It's still a mystery to me how they grade the notes

 

[quincyfuturemd]

How do they grade the differential diagnoses? Like, would Inflammatory Bowel Disease count as one diagnosis or should it be split into Crohn's and Ulcerative Colitis? It's still a mystery to me how they grade the notes

No one knows exactly how it’s graded but the way I was taught is to be more specific so you can have more than one differential. So UC and crohns can be two separate differentials and then you can suggests tests that will help separate them out.

 

[Mangal]

Hello Dr. Lost
I would suggest to train in a course if you are in doubt what went wrong, that was key for me to ace that exam, specially for the confidence and connection you need to develop with patients. Second thing that worked for me was, honest feedback. If you are practicing with friends make sure they give honest rather than nice feedback.
I would use their names as the first contact and move on.
Smile or be quiet if the situation requires it, but don’t give room to be misunderstood.
I remember in the day of the exam I was the only international, everyone was friendly and I knew I should just focus on my plan and not be pressure by the style they use to cope with the exam.

You can do this and move on.

Mangal

 

[ApplicantZ1]

Hey Dr Lost, I recently found out that I also failed the CIS component. I am completely clueless.
Could you please tell me about how you prepared for the subsequent attempt and how did it go?
Your advice will be highly appreciated. Many thanks.

 

[DoctorWHO007]

Hey Dr Lost, I recently found out that I also failed the CIS component. I am completely clueless.
Could you please tell me about how you prepared for the subsequent attempt and how did it go?
Your advice will be highly appreciated. Many thanks.

Honestly CIS is a pretty easy fix, where as ice is difficult part of the exam. I would say a month before ur exam go do a full 12 case Kaplan CS mock exam. They will rip ur note and all portions of the exam a part, but the 80 page feedback you get is ROCK SOLID and will help u a lot. It'll also strengthen your ICE and will sort of tell u how the exam is graded and how to do ur differentials and all.