Step CS experience, I know.. not again!

[Nabin]

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Here are the things I think I messed up in my exam few days ago

1. Touched the SP's head while beginning to do PE without washing my hands. Apologized immediately and went to sanitize myself. The SP smiled though. Maybe because it was the first case? It got me more anxious and examined the SP really fast and it all looked awkward to both of us!
2. Messed up the main diagnoses in 3 cases.
3. Didn't perform typical PE maneuvres in two cases where it is usually done with closed eyes and also is important to the case.
4. Closed every case but wasn't sure how accurate I was technically in answering the challenging questions. Just went with the flow of my verbal diarrhea.
5. Messed up the phone encounter. I said something stupid to convince the SP to come to the clinic.

Things I did in all the cases:
1. Knocked, greeted taking SP's name, Introduced myself, shook hands,
told my role, asked open-ended question
2. Summarized the HPI. Asked the SP if they needed to correct me or add something.
3. Used transitioning sentences to proceed through different parts of the history.
4. Showed empathy and concern.
5. Asked permission before examining.
6. Sanitized my hands except that one case when I nearly forgot to.
7. Took permission when untying the gown.
8. Told the SP what I was going to do and what I was examining and explained the observations as much as possible.
9. Thanked the patient for letting me examine them.
10. Closed all the cases except one when I had to stop abruptly because the encounter was over while I was halfway answering the challenging question.

What do you guys think?

 

[lymphocyte]

Actual diagnoses, investigations, and specific PE exam maneuvers don't really count for that much according to the academic literature on Step 2 CS (Peitzman 2015). The NBME has moved away from checklist grading to discourage shotgunning ("Hey, lets ask a 20-question ROS"!). Instead, the more important question for ICE is: did your patient encounter and note accurately justify your diagnoses? Safety and especially reasonableness are the keys. It seems like you did fine for SEP and CIS.

Anywho, a priori, you probably passed. The majority of people do.

Peitzman SJ, Cuddy MM. Performance in physical examination on the USMLE Step 2 Clinical Skills examination. Acad Med. 2015;90(2):209-13.

 

[Nabin]

Actual diagnoses, investigations, and specific PE exam maneuvers don't really count for that much according to the academic literature on Step 2 CS (Peitzman 2015). The NBME has moved away from checklist grading to discourage shotgunning ("Hey, lets ask a 20-question ROS"!). Instead, the more important question for ICE is: did your patient encounter and note accurately justify your diagnoses? Safety and especially reasonableness are the keys. It seems like you did fine for SEP and CIS.

Anywho, a priori, you probably passed. The majority of people do.

Peitzman SJ, Cuddy MM. Performance in physical examination on the USMLE Step 2 Clinical Skills examination. Acad Med. 2015;90(2):209-13.

Thank you. That's reassuring. I just want to be done with this exam where I spent a lot more time worrying about than the previous steps.

I remembered a few more mistakes after waking up today:

1. A female SP dropped her gown down completely when I asked her to just lower her gown just a little bit so that I could listen to her heart!

2. In a case, the SP had an adverse reaction to something which I forgot to note down when talking and couldn't remember during the PN. Such a mess. That was important to the encounter.

I don't know how much more flashbacks I am going to get.

 

[lymphocyte]

Thank you. That's reassuring. I just want to be done with this exam where I spent a lot more time worrying about than the previous steps.

I remembered a few more mistakes after waking up today:

1. A female SP dropped her gown down completely when I asked her to just lower her gown just a little bit so that I could listen to her heart!

2. In a case, the SP had an adverse reaction to something which I forgot to note down when talking and couldn't remember during the PN. Such a mess. That was important to the encounter.

I don't know how much more flashbacks I am going to get.

I probably can't reassure you more (and the flashbacks will keep coming) but I just want to say that I completely understand how horrible the wait is. You are not alone. I wish you best of luck.

 

[Nabin]

I probably can't reassure you more (and the flashbacks will keep coming) but I just want to say that I completely understand how horrible the wait is. You are not alone. I wish you best of luck.

Thank you for your words. I feel better. Got to wait it out like everybody else I guess.

 

[cabergoline2]

Actual diagnoses, investigations, and specific PE exam maneuvers don't really count for that much according to the academic literature on Step 2 CS (Peitzman 2015). The NBME has moved away from checklist grading to discourage shotgunning ("Hey, lets ask a 20-question ROS"!). Instead, the more important question for ICE is: did your patient encounter and note accurately justify your diagnoses? Safety and especially reasonableness are the keys. It seems like you did fine for SEP and CIS.

Anywho, a priori, you probably passed. The majority of people do.

Peitzman SJ, Cuddy MM. Performance in physical examination on the USMLE Step 2 Clinical Skills examination. Acad Med. 2015;90(2):209-13.

hi...do you know about any articles that provide any pointers about cis performance ? I feel that most of my errors have been in the CIS section..

 

[Bancrofti]

As a follow up for anyone following this thread. Is shaking hands before sanitizing okay? I didn't prep as much as I should of, so I didn't really think this might have been an issue until just now. I shook everyone's hand as I entered the room and washed or sanitized before doing the physical exam. But I feel like I've heard a few times since then that some people make sure they didn't touch the patient at all until they had cleaned their hands :/

 

[lymphocyte]

As a follow up for anyone following this thread. Is shaking hands before sanitizing okay? I didn't prep as much as I should of, so I didn't really think this might have been an issue until just now. I shook everyone's hand as I entered the room and washed or sanitized before doing the physical exam. But I feel like I've heard a few times since then that some people make sure they didn't touch the patient at all until they had cleaned their hands :/

It's fine. It's really, really fine.

 

[AlmostDoc1230]

Nabin,

This is in response to your message telling me to give you some insight.

To be perfectly honest, it does not really matter that much how you did in the room.

I'm more concerned about how you did on the notes. Without going into too much detail, the note "grade-wise" is worth so much more than your experience in the room. The "Step 2 CS Mnemonics and Tips Made Simple 2.0" kindle book goes into the grading and without divulging too much, it basically says that your note is your key to pass or fail and cites reasons like why the pass rate fell in a specific year when that happened. I urge you to give it a read when you have a chance.

That being said, you should tell me if you finished the note in each room and if it was detailed. You mentioned you did not get the diagnoses right in 3 rooms but did you get the 2nd and 3rd diagnoses? Did the other diagnosis make sense with your supporting details? If you can back up all your diagnoses, then you have no problem.

 

[Nabin]

Nabin,

This is in response to your message telling me to give you some insight.

To be perfectly honest, it does not really matter that much how you did in the room.

I'm more concerned about how you did on the notes. Without going into too much detail, the note "grade-wise" is worth so much more than your experience in the room. The "Step 2 CS Mnemonics and Tips Made Simple 2.0" kindle book goes into the grading and without divulging too much, it basically says that your note is your key to pass or fail and cites reasons like why the pass rate fell in a specific year when that happened. I urge you to give it a read when you have a chance.

That being said, you should tell me if you finished the note in each room and if it was detailed. You mentioned you did not get the diagnoses right in 3 rooms but did you get the 2nd and 3rd diagnoses? Did the other diagnosis make sense with your supporting details? If you can back up all your diagnoses, then you have no problem.

Thank you for your time. Yeah, I actually missed the main diagnosis (I think so, anyways) but my differentials had enough supporting positive and negative findings. I usually had 2, and sometimes 3 differentials and only 1 in one case. I always tried to include important few negative history portions whenever possible because I thought a physician would understand what I was trying to do and why.
I always had 2 minutes remaining whenever I completed my PN because my typing speed is good. I would then use that time to correct spelling mistakes, add important investigation or replace text with technical medical words whenever I could. I wouldn't say my notes were top notch but not below average, hopefully.

 

[Phloston]

Almostdoc1230 plaigarized my material and is the 'author' of the book he's claiming helped him. This thread here: http://forums.studentdoctor.net/threads/how-i-passed-step-2-cs.1196229/#post-17901334

The guy hops from forum to forum making false posts. The above link provides ample evidence.

 

[lymphocyte]

Almostdoc1230 plaigarized my material and is the 'author' of the book he's claiming helped him. This thread here: http://forums.studentdoctor.net/threads/how-i-passed-step-2-cs.1196229/#post-17901334

The guy hops from forum to forum making false posts. The above link provides ample evidence.

I reported him and hope he gets banned.

 

[Phloston]

I reported him and hope he gets banned.

It's just so unfortunate really this person is in medicine. Could you imagine if his school knew about this.

 

[cabergoline2]

yeah...I say that almost doc post in several other forums...though I did not know it was phlostons work he plagiarized from.. BTW those notes have been doing round in the internet for quite sometime..i had them too...did not know that they came from phloston as no author was mentioned..

 

[AlmostDoc1230]

It's just so unfortunate really this person is in medicine. Could you imagine if his school knew about this.

I can't believe You are in medicine. You make false accusations without any evidence. Provide real evidence and I'll apologize. Right now, you're just being a jerk.

 

[Phloston]

The evidence is in the other thread and is unequivocal. I hope senior admin here at SDN can handle this user as soon as possible.