Stressed about CS

Discussion in 'Step II' started by KidAtHeart, Dec 10, 2008.

  1. KidAtHeart

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    So I just took CS a couple days ago. I am an AMG, so the English-speaking part was no problem. I never ran out of time on either the case or the note, but I definitely forgot a thing or two on almost every case. I would leave the room thinking, "Crap, I forgot meds and allergies." I think I may also have missed that an ER patient seemed depressed (he came with an acute injury so I was more focused on that.) I was able to write full notes though, and always had 5/5 ddx and work-up plans. Always draped the patient, asked if I could untie gown, told them exactly what I was going to do in PE before doing it, etc. Didn't get to counseling 1 or 2 patients, and also 1 or 2 of them didn't have a challenging question for me, which worried me a bit. I know 96% of AMGs pass, but still a little nervous about it.

    Anyone have a similar experience and pass?
     
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  2. Termwean

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    I took it October 24th: I was sweating bullets w/ nerves during it...its just so artificial. I think I am good with pts on the floor and in ER. That being said, I have been freaking out thinking I failed it until today when I got the big PASS. I forgot tons of things.....the whole pmh/psh/famhx/sochx on a peds phonecall.....can't pick up phone and redial....forgot to counsel a few...PE was always rushed...barely did neuro exams. But did all the little extra things you are supposed to do......and my notes were very MESSY. No IMGs the day I took it....so it's not like my language skills carried me over the pass threshold.

    if I passed, you can pass....although, I took it in Houston and heard, after the fact, that this is a good location to take it.

    Good luck.....getting scores back is great...nothing really stop me from getting MD now!



     
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  3. pocketknife52

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    I too
     
    #3 pocketknife52, Dec 10, 2008
    Last edited: Dec 25, 2013
  4. goldenpath

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    Thanks to the two previous posters.

    I have been having some anxiety over it as well and hearing all the stuff they screwed up and that they still passed helps.
     
  5. Doxie

    Doxie MS3
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    I had so much anxiety after the exam.....literally cried :( I made a lot of stupid mistakes, completely missed 3 differentials, failed to do anything beyond palpating a hip joint (no ROM, nothing!) on a hip pain chief complaint, handwrote crappy notes where I ran out of space, failed to counsel, ran out of time on 1 case....the list goes on and is long. But it worked out okay and I passed - you are allowed to make a lot of mistakes! Everyone told me it would be okay because I am a good student, but I had so much doubt because you hear of really good people at your school that somehow fail. But the odds are that you passed, don't beat yourself up and make yourself miserable for the next 2 months! It will be okay :)
     
  6. generic

    generic Senile Member
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    I also had lots of anxiety after this thang.

    I think the nature of the test makes it very hard to know how you really did. You could always have come up with a better diff dx; you could always have asked just 1 or 2 more pertinent questions. And who knows if the SP really thought you washed your hands long enough or draped them compassionately or made eye contact during your wrap-up and counseling session?

    But I passed. And breathed a sigh of relief. Gracias a Dios!

    Good luck to those waiting. I took it Oct. 23rd in Houston and got the score today.
     
  7. pocketknife52

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    thats good to hear........man i guess i got lucky cuz i took mine on oct 24th and got my score two weeks ago... i guess i was lucky..
     
  8. generic

    generic Senile Member
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    That did have me pretty worried, cuz I saw that multiple people who took it after I did (and even in H-town also) got their scores back last week or the week before.

    I had visions of the SP's and administrators sitting around tapes of my encounters marking every detail because I was on the borderline. That was the only possible explanation for my delayed score...

    Well, maybe that did happen...but at least I passed! :D
     
  9. elr1983

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    I will join the post step 2 anxiety. I missed so many things on this test........on all the patients I barely did any physical exam, and on a lot of the ones I did do a fairly OK job on, I forgot to document my findings. (ex-forgot to document ROM on wrist pain patient, possible decreased BS on CP patient, thyroid exam on fatigue patient). Also forgot to check lots of stuff....hardly did any neuro exam on HA patient.......no fundus exam, no CN, no eyes.......oh, also forgot to document lymph node exam on weakness patient. Also ran out of time on 2 notes w/ only 2-3 tests ordered. Forgot a few key history items too........weight loss on fatigue patient, post coital bleeding on the irregular periods patient, and I am sure bunches of other stuff. Not sure I always used open ended questions....got into a bad habit of saying, "haven't had any....." due to hearing it constantly from an ER doc I'm working with. Not sure I was empathetic enough, or explained things clearly enough. Seriously, folks, I may be failing this exam...........
     
  10. pocketknife52

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    elr.....

    im not sure what you mean by "barely did physical exam" on many patients.... that could be concerning depending on what you mean...overall your chances are high, regardless of how you feel you did.....
     
  11. elr1983

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    I mean just that I was so rushed. Like I did heart/lungs on everyone, and tried to do other appropriate stuff, but I never had time to do a full neuro exam, like CN's and stuff. And I forgot to document the patient was A and O times 3 after a fall. On CP patients, I didn't do jvd/briuts/check for edema, for example, since I was concerned about the time. Other stuff like that, too......like I didn't do an abdominal exam on a women w/ vaginal bleeding, for example. Mostly just rushed and really, really, minimal. Missed some ddx, too, like forgot to put consussion for a patient who fell and hit their head.
     
    #11 elr1983, Dec 18, 2008
    Last edited: Dec 18, 2008
  12. generic

    generic Senile Member
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    These are my opinions--no one really knows for sure--but I think that everybody takes this test and immediately feels terrible because all the things you missed pop up in your mind.

    Your examples are perfect...forgot to put something "obvious" in your Ddx, forgot to examine something "very important" for that CC, etc.

    I think one key thing is to only have 2-3 of these "big misses" per patient/encounter. Maybe more. But my point is that you shouldn't totally bomb one encounter (forget to do ANY PE on the CP patient--and also yell at him for being slightly obese).

    But everyone will have a list of things they should have done better, and usually a few things per encounter. I certainly felt that way. Probably the 96% of those who passed almost all felt that way.

    So try not to stress too much and try not to think about this exam for, oh, 2 months. Good luck!
     
  13. elr1983

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    Oh, hell, I forgot to counsel him on lifestyle stuff......he was fat, too. I think I totally did botch that encounter.
     
  14. pocketknife52

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    Quote:
    hat
     
    #14 pocketknife52, Dec 19, 2008
    Last edited: Dec 25, 2013
  15. jake2

    jake2 Still in training... still in training...
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    Rember guys, 98% of US grads pass on the first attempt. Aiming for 3rd percentile here. Assuming a correlation, ~70% of those who'd fail step I first time around would pass this test. Of those who fail, 98% pass the second time around.

    The test is a joke and an elaborate way to see if you speak English. Also a good way for the NBME to milk you for a solid amount of cash.
     
  16. anesthesiarocks

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    passing step2 as an amg now with the new score requirements requires a lot more than just speaking english well, draping the patient appropriately, washing your hands, and writing a few simple lab orders and obvious dx's on the differential.

    You better be checking for kernigs signs, murphys signs, brudzinski signs, psoas signs, doing rombergs, dix-hallpike maneuvers, etc(when appropriate for all of course) because thats becoming the new standard.
     
  17. pocketknife52

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    how d
     
    #17 pocketknife52, Dec 26, 2008
    Last edited: Dec 25, 2013
  18. Termwean

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    Hahaaa....you get him pocketknife. Dix-hallpike...my ass....
    I barely did Romberg.....

    maybe look for murphy or rebound if appropriate.....but you better not do it like on a real pt.....you need to barely, softly palpate....they'll fail your ass if you push too hard.
     
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  19. Captopril

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    During my session's orientation, someone asked if they are allowed to do Dix-Hallpike. Everyone was like "dude wtffffff, dont be an idiot"
     
  20. elr1983

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    Well, thanks, now I'm paranoid I pushed too hard!
     
  21. Mistress S

    Mistress S Don't mess with the S
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    Just wanted to add my voice to the chorus of reassurance for those who are freaked about passing CS because they forgot little things. I just found out I passed today, I wasn't too nervous (knowing the stats for US grads on this test) but there was definitely that nagging worry especially because I forgot so many stupid things on test day. I took the test with a friend and we both talked afterwards about all the little things we forgot to do/ask/document in the note. Examples: forgot to ask fatigue patient anything about colonoscopy/stool changes (or look for signs of anemia on exam, or ask for a CBC or colonoscopy in note); barely did neuro exams on anyone; exam of knee in pt. with CC of knee pain consisted of palpating knee and reflexes- no ROM, no anterior/posterior drawer, etc.; in consult case for parent of kid with enuresis, forgot to get ANY PMH or FH- you get the picture.

    I think I am friendly and good with patients in general, and I did remember all the handwashing/draping/introduction stuff that is so emphasized with this test. I got "difficult" questions from most (not all) patients, these were exactly as described in first aid and responding in a reassuring but noncommital manner (e.g., "We'll have to run more tests to rule out cancer, but whatever the test results show we can talk about your options and make sure you get the best care possible") as FA recommends seemed to work fine. My studying consisted of reading the first part of FA on the plane and going through a few (maybe 6?) of the case scenarios the night before.

    Bottom line, I forgot to do all kinds of exam manuevers and ask relevant history questions, or study in any meaningful way, and I still passed. If you are fluent in english and have passed all of your third yr clerkships, and read over the basic structure of the test and remember to do all the little details of introductions and draping, you will pass. It's a total waste of $1000 and 9 hrs of your life that you will never get back, but it shouldn't otherwise be a source of stress. And you do NOT need to do any elaborate exam maneuvers that you would almost never do in the real world. Dix-Hallpike my ass is right.
     
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  22. nockamura

    nockamura Senior Member
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    Yeah, this test is pretty easy assuming you speak English. I barely did a physical exam (of course always do the heart and lungs). My neuro exam was abbreviated to probably 5 CN's and sort of rubbing the limbs to test sensation. Never did any complex PE maneuvers, never even checked reflexes or did a mini mental. Forgot to wash my hands on one guy until I nearly touched him (had already done an opthalmoscopic exam) then I just sort of stopped, ran to the sink and washed up. My "counseling" was limited to, "This could be a number of things. I'd like to run a few tests. After we get the results, I will call you to schedule an appointment to discuss the results and any treatment options". You can say that phrase for any complaint and it'll be right. I said that statement verbatim to all my patients. I wrote notes furiously while they were talking. My eye contact suffered I'm sure. I usually left the room between 2-4 minutes until the end. Notes were easy, I used abbreviations wherever I could. I used some that were not on their approved abbreviations sheet. Got my score today = PASS. Dix-Hallpike my ass.
     
  23. elr1983

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    Step 2 CS score=PASS!!!!!!!!!!

    For anyone concerned about passing--see above for multiple mistakes I made and still passed. I didn't even put all that I remembered on here.

    I will second it, Dix-Hallpike my ass.
     
  24. anesthesiarocks

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    I didn't say you "had" to do things like that to pass. They are part of the scoring system though. If you have a dizziness pt, dix-hallpike is one of the things on their checklist.

    Of course you don't have to get everything on their checklist checked off to pass, so Im not sure what you're point is. If someone makes enough mistakes, whether or not they did a kernigs or a dix-hallpike maneuver may have been that one extra check they needed to put them over the top in that component.
     
  25. nockamura

    nockamura Senior Member
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    Don't say that the "new" standard includes complex PE maneuvers (e.g. Dix-Hallpike). People get unnecessarily stressed about this test as it is. You implied that CS is becoming more rigorous, however there is no evidence for this; the pass rate remains constant at >95%. CS remains a test of an abbreviated history, a half-assed PE and a skeleton note - nothing more.
     
  26. smq123

    smq123 John William Waterhouse
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    I was honestly afraid of doing any remotely complex or exotic PE maneuvers.

    I think there was a story on SDN a while back about a guy who tried to do the Dix-Hallpike on an SP during Step 2 CS. The SP hadn't been "taught" this maneuver, was unprepared and didn't know what to "do"/how to cooperate, and ended up falling off the exam table.

    This may have been a fake story, but I wasn't going to take any risks. Any complex/unusual PE maneuvers got included on my list of 5 further tests/interventions, but I did NOT want to attempt them.
     
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  27. rox

    rox ossified
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    After passing the exam, my advises would be:
    1. Ask about the pertinent positives and negatives. Ask about allergies, meds, family and social history always
    2. Do a brief exam always.
    3. Spend a good deal of time summarizing and explaining to the patients what you think.
    4. Answer all the challengng questions in a diplomatic fashion.
    5. For the PN, try to be brief in the history and exam, yet detailed in the DDx and work-up.
     
  28. KidAtHeart

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    Thanks to everyone for sharing their stories/reassurances. Got my score a couple days ago, and was very relieved to see I passed.

    Everyone posting here is right - you can make a lot of mistakes (or feel like you made a lot anyway) and still do just fine.
     
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  29. Poppy123

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    How many diagnoses were you guys sure of?
     
  30. HumbleDr2B

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    Hey guys, I recently took CS and am a bit worried about 1 case. I said the patients name correctly when I walked in but 1/2 through the HPI somehow I said the patients name again and said it WRONG. The patient replied 'my name is XYZ not ABC', I said 'oh, I am sorry. what did I say?'. She said 'ABC', I said 'I am sory', then said it WRONG AGAIN. Finally correcting myself the 3rd time and saying 'I am very sorry Mrs. XYZ'. I was sooo tired and hungry at this point (last case before break) I forgot ALL of PAM HUGS FOSS (with the exception of sleep which I asked as HPI in this fatigue case). Then I totally did a half hearted neuro exam and probably forgot to examine the thyroid. To top it off my note only had Depression and Hypothyroid in the differentials..totally spaced on the rest like anemia, etc.

    My question is, If I did a good to very good job on the rest of the 11 cases am I ok to pass? I don't want one poor patient experience to bring down my CIS and ICE grades below the lowest threshold.

    For someone living in NY for his whole life I had a hell of a time pronouncing this one name! :xf:

    I feel over 90% confident in 9 of 12 cases (got most all associated symptoms, most of the PE correct, solid note) moderate confident in 2 cases (missed 1 or 2 associated symptoms, 1 part to the PE and/or 1 differential) and really terrible about this ONE case. Will the SP totally think I am a dick and give me the lowest possible score for CIS if I drapped her, asked her if she would like to add anything and was generally really nice to her but had this name fiasco?
     
  31. fidelity

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    Kid, I think you should be fine!
     
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  32. Knicks

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    ^^ Love the sig.
     
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  33. Register3

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    I'm almost positive I forgot to wash my hands/glove on one of the encounters...pretty proud. Is that an automatic fail - for the one encounter or for the whole day??
     
  34. chatterdoc

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    Register3 - it gets nerve-wracking and we all do little mistakes here and there. it's not an automatic fail. i did some stupid things here and there and passed without a problem.

    remember, when u leave the room, the patient will have 15 minutes to answer questions about you while u are writing the patient note. they get asked about your manners and whether or not u asked or did certain things.

    washing hands is only one question out of the lot. ;) and remember...2 of the encounters do not count at all as they are cases they are testing out for the future ;)
     
  35. HumbleDr2B

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    Bump, does anyone have anything to make me feel a little better about this :-(
     
  36. RussianJoo

    RussianJoo Useless Member
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    you'll be fine. i wish i was half as confident as you are about my exams and notes. everything is averaged so even if u did poorly on one encounter but kicked butt on another encounter it will be averaged to doing ok on both encounters.
     
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  37. HumbleDr2B

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    Thanks for replying,

    So hypothetically speaking if the encouters are out of say 10 and you score 3/10 on one and the rest are 7-9/10 you think the average will be fine to give you that roughly 7/10 you need overall?

    I assume since > 90% pass the exam there is SOME room for error even if you get KILLED in ONE or TWO cases?
     
  38. RussianJoo

    RussianJoo Useless Member
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    dude. there's nothing you can do now.. go get drunk and forget about the exam it's done. you don't get your results for 3months. no one knows how they grade or what counts where. so stop worrying and focus on your current clinical rotations or your interviews or something else.
     
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  39. Loanna

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    I understand that this is an experiences-related thread, but I would like to know how someone can change the exam date. From what I understand, all I have to do is enter the ''Browse Available Dates'' section in ECFMG and then what ? The reason I am asking is because even though I receive the notifications about the availability, still I never seem to manage to change my date, because the date I am notified about doesn't seem to be actually available! That happens even when I enter immediately the Ecfmg site for ''scheduling test dates''. Can someone please explain to me what exactly is it that I do wrong here? Do I have to cancel my appointment before entering the ''Browse available test dates'' page?
    Thank you in advance for the clarifications!!
     
  40. chatterdoc

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    i had a case similar to yours. didn't know what the hell to do....

    was lost. i think i only put two possibilities as a diagnosis. it was grueling. i didnt know what to do after a general exam.

    honestly i think that case didnt count...cuz it was too vague. i passed though ....so don't worry....IM SURE ITS FINE :)
     
  41. Law2Doc

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    There will often be a case where you don't have a good ddx, possibly because the SP was waiting for you to go down a line of questioning or hit on something you never did. For the patient with very vague fatigue symptoms, certainly anemia or thyroid issues are things to work up, as is depression, and maybe cancer. Probably wouldn't hurt to get a tox screen and an HIV test too if you can't get a better lead, and you are hurting for tests to list.

    But yeah, you can certainly pass this thing without knowing the diagnosis with 100% certainly of every patient.
     
  42. bikedoc1021

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    bump! just getting this back to page 1...anyone else out there want to share their experiences?
     
  43. lanzarlaluna

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    This seems to be one of the bigger CS threads, so maybe we could change the title and consider this the definitive CS impressions/study advice/questions/tips/therapy thread? (Much like the big ass CK thread in this forum.)
     
  44. 45408

    45408 aw buddy
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    is it bad if I was checking the gag reflex on every patient? one of them threw up all over me :(
     
  45. J1515

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    Did you check sphincter tone as well?
     
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  46. 45408

    45408 aw buddy
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    only the lower esophageal sphincter
     

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