What it takes to fail step 2 cs

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tundri

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I've been freakin out guys.😱 Since I took that test all I can do is flashback the insane amount of things I forgot. I'm an IMG, English my first language.

Has anyone else had this experience?

I know this is everywhere in this forum, but most are a little outdated and I'd like to know about recent experiences.

Thank you.
 
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I think one of the biggest things is your interaction with the patients. I was extremely, overwhelmingly, over-the-top nice to my patients. "It is so nice to meet you today, how are you feeling?" while shaking their hand. "I am so, so sorry to hear about your pain, that must be very frustrating for you." "Your father died? I am so sorry to hear about that". "I will be sure to help you in anyway I can, ma'am. You just let me know if you need anything"

Remember that the patients are judging you when they are grading you on your performance, and a lot of that has to do with how nice you were to them. Always make sure to leave 2 minutes at the end to explain the plan to them (even if you're not 100% sure of the plan, just say somethign, it's better than nothing), and always, always, always ask them if they have any questions for you.
 
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My CS is in about 3 weeks and I was going through forums on how to study. I came across this one and this sounds really helpful, so I'm happy...

2 questions:
1) I was wondering about the mini-cases from FA too, should we read them?

2) During the patient encounter, if you don't get a chance to complete the PE, what would you write in the PN? Are you ONLY supposed to mention the findings of the system you were able to do or are you supposed to write out all the systems (just mention them and write n/a or something)? I am an IMG, and in our med school it was okay to do a focused PE and then write what would be "normal" for the other systems....confuuuseeed🙁

Hope I made sense....thanks in advance
 
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drhappy229 said:
2) During the patient encounter, if you don't get a chance to complete the PE, what would you write in the PN? Are you ONLY supposed to mention the findings of the system you were able to do or are you supposed to write out all the systems (just mention them and write n/a or something)? I am an IMG, and in our med school it was okay to do a focused PE and then write what would be "normal" for the other systems....confuuuseeed🙁
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only document what you did. there is a character limit for various parts of the patient note so listing systems you didn't examine just to write n/a is a waste. definitely don't document anything you didn't actually do ...they take that very seriously. focused PE is the way to go for both the exam and the documentation.
 
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skinMD said:
only document what you did. there is a character limit for various parts of the patient note so listing systems you didn't examine just to write n/a is a waste. definitely don't document anything you didn't actually do ...they take that very seriously. focused PE is the way to go for both the exam and the documentation.
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Thank you 🙂
 
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My physical exam skills are awful. I tested for rebound in a possible appendicitis patient but didn't do Rosvig or psoas. Also had a dementia patient do a clock draw for me. Otherwise I listened to heart and lungs for ~60 seconds on each patient but did nothing else for all 12 patient encounters. Tried to get a good history and be empathetic and wrap up well. Left all encounters a few mins early and focused on writing a good note. Never listed any positive PE findings to supports my differential but occasionally listed a negative PE finding to support.

Result: pass with high performance in all 3 areas. I was stressed about even passing with the new scoring criteria.

Lesson learned: as long as you don't completely implode on exam day, should be pretty easy to pass even with the new scoring criteria. You won't fail because of a missed physical exam maneuver or multiple missed maneuvers. Patients are pretty reasonable. Ask multiple times if they have questions or anything else that might be helpful to you.

Good luck everyone!
 
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IMG with 2-3 days of studying with practice with a partner. Easy pass. This test isn't meant to kill you if you're calm & collected. Try to remember that you do this everyday. Do not panic.
 
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I took my test recently, and one of the biggest things I'm really worried about is my closure. I didn't summarize the pt's HPI, and everything I said was very nonspecific. Even when I tried to discuss my plan, I would tell them that we are going to take some blood tests or imaging studies, but I wouldn't specify which kinds of tests. Lastly, I kept forgetting to counsel my patients. I always made a mental note to counsel them, but I kept forgetting to when the time came. How bad is this? Will this weigh heavily against me? I made so many mistakes on top of this, I'm freaking out.
 
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min27 said:
I took my test recently, and one of the biggest things I'm really worried about is my closure. I didn't summarize the pt's HPI, and everything I said was very nonspecific. Even when I tried to discuss my plan, I would tell them that we are going to take some blood tests or imaging studies, but I wouldn't specify which kinds of tests. Lastly, I kept forgetting to counsel my patients. I always made a mental note to counsel them, but I kept forgetting to when the time came. How bad is this? Will this weigh heavily against me? I made so many mistakes on top of this, I'm freaking out.
Click to expand...

Dude! I did the same thing. Took the test last wednesday and I'm kicking myself for forgetting to counsel the patient on his daily smoking (dude had pneumonia), and now I'm freaking out. I starred and circled that history on my paper but I forgot to talk to him about it after I closed 😡. Does any one have an answer for this/ experience? I think the worst thing about CS is the waiting. It slowly eats you out lol.
 
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maludinesha said:
Dude! I did the same thing. Took the test last wednesday and I'm kicking myself for forgetting to counsel the patient on his daily smoking (dude had pneumonia), and now I'm freaking out. I starred and circled that history on my paper but I forgot to talk to him about it after I closed 😡. Does any one have an answer for this/ experience? I think the worst thing about CS is the waiting. It slowly eats you out lol.
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Count me in on that.. My mistake was kind of stupid, I asked CAGE in all pts that required it but forgot to put it on the patient note, only wrote one haha.

The waiting is awful i really believe they should do something to report score faster.. I have been waiting for 2 months and still have 1 more to go.
 
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min27 said:
I took my test recently, and one of the biggest things I'm really worried about is my closure. I didn't summarize the pt's HPI, and everything I said was very nonspecific. Even when I tried to discuss my plan, I would tell them that we are going to take some blood tests or imaging studies, but I wouldn't specify which kinds of tests. Lastly, I kept forgetting to counsel my patients. I always made a mental note to counsel them, but I kept forgetting to when the time came. How bad is this? Will this weigh heavily against me? I made so many mistakes on top of this, I'm freaking out.
Click to expand...

Hey friend. How did CS go for you? Did you get your score back? I have to unfortunately wait until June to get back my report. I was in the a similar boat with the counseling stuff.
 
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skinMD said:
be VERY careful with this and i recommend the exact opposite! there is a list of approved abbreviations and though not comprehensive (i.e. abbreviations not on there will be accepted) you should err on the side of writing everything out fully because you don't want someone to not understand your note. "BS" is actually a good example of a horrible abbreviation you should avoid. Does it mean breath sounds? bowel sounds? you don't want the reader to be uncertain about any part of your note because they likely won't spend time pondering what you meant. if you are a proficient typist this should not be an issue.
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abdomen: +bs

who would think that means breath sounds ??
 
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Would you fail if you screwed up badly one case???

This has been bugging me ever since I took the exam :/

any comments?
 
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The patient was in acute pain, laying on the bed. So i didn't shake hands because he was uncooperative, but I did address him by his name and I introduced myself. I think I did a good HPI but at the moment of the PE, I didn't washed my hands (I realized that when I was auscultating his lungs) so when I was going to palpate him, I put on gloves. But since then I went blank, because of nervousness. The case deserved a full neuro exam, but I only did pupils reflexes and DTRs (I think). Then I went ahead and did the closure. I think I did arrive at the proper differentials, but when the patient asked the challenging questions, I think one I did answer it properly, but the other one I ended up scaring him.

So, any thoughts?
 
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asuka99 said:
abdomen: +bs

who would think that means breath sounds ??
Click to expand...

I am absolutely horrified that I failed based on several large mistakes I know I made (these aren't your "I only listened to 96 places for breath sounds instead of 124 places" type mistakes... I forgot to document major exams that I performed, quite frequently sadly.

However what I did remember to document, I tried to be as expressive as possible while using only the most standard abbreviating, as an example:

VS: T 100.1F, all others WNL
Gen: Resting comfortably in no acute distress
HEENT: NC/AT; no conjunctival pallor, fundi show no exudates, papilledema, or AV-Nicking, EOM, PERRLAI; TM shows no exudates, erythema, cerumen; Oropharynx shows no erythema, exudates, lesions, or post nasal drip (somtimes I would make an additional comment on tonsilar columns if I felt it was warranted)
Neck: Supple, no lymphadenopathy; no thyroid masses or enlargement; trachea midline
CV: S1-S2 WNL; no m/r/g; RRR
Chest: Lungs are clear to auscultation with vesicular breath sounds in upper and lower lung fields bilaterally (I always listened to 8 spots - and now thinking back, technically could have documented bronchial breath sounds in the anterior positions)
Extremities: No cyanosis, clubbing, or edema; peripheral pulses 2+ symmetric upper and lower extremities (can't remember if I listed the actual pulses I palpated - hoping I did)
Abdomen: Soft; NT/ND; Bowel sounds present and normoactive in all 4 quadrants
Neuro: CN II - XII grossly intact; Sensation intact to dull and sharp sensation bilaterally; DTR 2+and symmetric in biceps, triceps, patellar, and achilles tendons

--So this is basically how I documented my physical exam findings; I think my eagerness to be overly expressive as to what I did EXACTLY may have cost me in the end because I forgot to document a few very important things... we'll see if the detail I went into can save me from missing some tests that I actually performed.
 
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je355804 said:
I am absolutely horrified that I failed based on several large mistakes I know I made (these aren't your "I only listened to 96 places for breath sounds instead of 124 places" type mistakes... I forgot to document major exams that I performed, quite frequently sadly.

However what I did remember to document, I tried to be as expressive as possible while using only the most standard abbreviating, as an example:

VS: T 100.1F, all others WNL
Gen: Resting comfortably in no acute distress
HEENT: NC/AT; no conjunctival pallor, fundi show no exudates, papilledema, or AV-Nicking, EOM, PERRLAI; TM shows no exudates, erythema, cerumen; Oropharynx shows no erythema, exudates, lesions, or post nasal drip (somtimes I would make an additional comment on tonsilar columns if I felt it was warranted)
Neck: Supple, no lymphadenopathy; no thyroid masses or enlargement; trachea midline
CV: S1-S2 WNL; no m/r/g; RRR
Chest: Lungs are clear to auscultation with vesicular breath sounds in upper and lower lung fields bilaterally (I always listened to 8 spots - and now thinking back, technically could have documented bronchial breath sounds in the anterior positions)
Extremities: No cyanosis, clubbing, or edema; peripheral pulses 2+ symmetric upper and lower extremities (can't remember if I listed the actual pulses I palpated - hoping I did)
Abdomen: Soft; NT/ND; Bowel sounds present and normoactive in all 4 quadrants
Neuro: CN II - XII grossly intact; Sensation intact to dull and sharp sensation bilaterally; DTR 2+and symmetric in biceps, triceps, patellar, and achilles tendons

--So this is basically how I documented my physical exam findings; I think my eagerness to be overly expressive as to what I did EXACTLY may have cost me in the end because I forgot to document a few very important things... we'll see if the detail I went into can save me from missing some tests that I actually performed.
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It's a focused physical... why were you doing HEENT on a patient who didn't indicate it? Neuro exam? Extremities? Did you read Step 2 for CS? I thought all this crap wasn't necessary. You've gone into an immense amount of detail. If you did this for every case, that's just a lot of typing. You are way over-reacting if you think you failed due to something you may have missed in documenting PE findings.
 
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evilbooyaa said:
It's a focused physical... why were you doing HEENT on a patient who didn't indicate it? Neuro exam? Extremities? Did you read Step 2 for CS? I thought all this crap wasn't necessary. You've gone into an immense amount of detail. If you did this for every case, that's just a lot of typing. You are way over-reacting if you think you failed due to something you may have missed in documenting PE findings.
Click to expand...

The detail was to illustrate how I would document each particular exam - I didn't put all of this for every case... but when I did put it, this is how I would do it. So for a heart case for instance, in theory I would put:

VS:
Gen:
HEENT: for the fundoscope, and maybe a quick EOMI...
Chest: pulm findings
CV:
Extremities: pulses etc.

but each time I would put these, I would document as in my previous post.

The reason I'm freaking out is because I know at least several cases which I idiotically forgot to put the primary physical exam findings... I can't explain why I did it... just that it happened, and it was like living a nightmare as I was going through the test remembering each time just after I hit submit there was some major test I forgot to put into my PE...

And yes, I went over FA CS ad nauseum... which makes it all that much harder to swallow. I know my performance was poor, and that's just not me being hard on myself.
 
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Took my exam a couple days ago. Literally can't sleep or eat due to stress. was hoping people could help me out with some feedback.

Mistakes I remember:
-Already closed with a patient, but their challenging question required me to quickly perform a sensory test. I did not use gloves the second time.
-Performed all my cardiac exams while they were laying down...didn't untie gown but just slipped my hand under the gown (there was usually enough room). None of my patient's needed a full cardiac exam. Just auscultation.
-Forgot to put a leg rest up on some of my patients.
-Started a physical exam without wearing gloves but quickly realized after about 20 seconds into the exam and put some on.
-usually got 1 or 2 good differential dx in..but the 3rd one was always tough and i generally put some random disease.
-Forgot to check CVA tenderness and include UA/Ux.
-Forgot to ask about how a patient cooks, baths, aka takes care of themselves
-put CN intact when i only checked cn 3,4,6 and 7. i meant to put EOMI.
-one patient refused to open up about what was bothering her, despite asking several times.

What i did right:
-always knocked, greeted said patient's name, had gloves (except what i mentioned above)
-very empathetic and NURsed a whole lot.
-managed to usually get most of OLDCARTS if i could
-always got ROS, past medical, surgical, drug allergies, social, obgyn
-counseled about smoking, safe sex.
-always managed to close and answer any challenging questions.
-always managed cardiac, lungs, abdominal, DTR, pulses, heent.
-always auscultated on skin and patient was drapped.

Not worried as much for CIS or SEP but scared for ICE because i forgot to ask certain questions about their chief complaint and I rushed thru my patient note, sometimes including things that i didn't inform the patient about.

please let me know if my mistakes will cost me to be at borderline or even fail.

also if i need to edit anything due to disclosure issues please let me know
 
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B52 said:
Took my exam a couple days ago. Literally can't sleep or eat due to stress. was hoping people could help me out with some feedback.

Mistakes I remember:
-Already closed with a patient, but their challenging question required me to quickly perform a sensory test. I did not use gloves the second time.
-Performed all my cardiac exams while they were laying down...didn't untie gown but just slipped my hand under the gown (there was usually enough room). None of my patient's needed a full cardiac exam. Just auscultation.
-Forgot to put a leg rest up on some of my patients.
-Started a physical exam without wearing gloves but quickly realized after about 20 seconds into the exam and put some on.
-usually got 1 or 2 good differential dx in..but the 3rd one was always tough and i generally put some random disease.
-Forgot to check CVA tenderness and include UA/Ux.
-Forgot to ask about how a patient cooks, baths, aka takes care of themselves
-put CN intact when i only checked cn 3,4,6 and 7. i meant to put EOMI.
-one patient refused to open up about what was bothering her, despite asking several times.

What i did right:
-always knocked, greeted said patient's name, had gloves (except what i mentioned above)
-very empathetic and NURsed a whole lot.
-managed to usually get most of OLDCARTS if i could
-always got ROS, past medical, surgical, drug allergies, social, obgyn
-counseled about smoking, safe sex.
-always managed to close and answer any challenging questions.
-always managed cardiac, lungs, abdominal, DTR, pulses, heent.
-always auscultated on skin and patient was drapped.

Not worried as much for CIS or SEP but scared for ICE because i forgot to ask certain questions about their chief complaint and I rushed thru my patient note, sometimes including things that i didn't inform the patient about.

please let me know if my mistakes will cost me to be at borderline or even fail.

also if i need to edit anything due to disclosure issues please let me know
Click to expand...

No use worrying about all that now. Just sit back and wait for the results. People have done better than you and failed and others have done worse than you and passed. This exam is a numbers game.
 
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I just want to know if these are considered huge mistakes. I know i can't change anything now.
 
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CDI...do you know how this will affect my chances of a peds residency. I got 215 on step 1 and 223 on ck- both first attempts. cs fail twice...womp womp. Please help. Thank you!!!
 
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coxsackie said:
CDI...do you know how this will affect my chances of a peds residency. I got 215 on step 1 and 223 on ck- both first attempts. cs fail twice...womp womp. Please help. Thank you!!!
Click to expand...

If you mean "Will people look at this as a red flag and possibly not interview me?"

I think you already know that answer. It will certainly make things a lot harder on you having not one but TWO fails on CS which is considered to be a joke by many PDs. Pass the test and have some good explanation for it and make sure to apply very broadly to be safe
 
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coxsackie said:
CDI...do you know how this will affect my chances of a peds residency. I got 215 on step 1 and 223 on ck- both first attempts. cs fail twice...womp womp. Please help. Thank you!!!
Click to expand...

Primary care fields seem to care more about CS than other fields do. I don't know to what extent your attempts will affect your chances though, other than negatively. Once you get into the interview, its on you to do the convincing.

Just be careful on attempt #3 though. States have licensing limits with attempts on USMLE exams. In certain states you can not be licensed if you've failed any exam more than twice, etc.
 
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Hello all-

IMG, 241 step 1, CK in one month.

Just took cs and like so many others I am freaking out. I took it in LA. My first case was miserable. forgot to remember the patients name. almost every question I asked was "no" for her CC, even though I had 3 reasonable DDx and appropriate questions for her CC. I started to close and 2 sentences in the buzzer went off and I had to leave.

After this I never forgot to mention the name. I would go in, say "hello Mr. Mrs X, Im. Dr. Y. so, what brings you in today?" then I would say I want to talk about their CC but first I want to get an idea of their past hx, then talk about the CC, then do a P/E and go from there. Then I would do PMH etc, then CC stuff. Sometimes I knew I wasn't getting at the heart of the CC. In fact, there are 2 cases where I have NO IDEA what the problem was but I just asked a bunch of questions and got many "No"s. This worries me. I also directed the interview and forgot to ask open ended questions, although i definitely did in about 5/12 patients like saying "tell me more" but often felt rushed and simply forgot.

Why I'm worried: I was not as nice as I could have been. I said "im sorry to hear that" from time to time but didn't do it in every encounter. I always asked if they had questions but I could tell about half my patients didn't smile much or were just not terribly pleased it seemed. PLus I saw some in the elevator when I was leaving and they seemed standoffish. Maybe just because they aren't allowed to talk to me but it still freaks me out. Also, my P/E were not extremely consistent or thorough. I always asked permission to examine or untie gowns but inconsistently before every maneuver. Always auscultated on skin.

My closures were ambiguous and sometimes used overly technical terms, although i tried to explain what they meant right after I'd say them. My notes had numerous typos and spelling errors Im sure. I forgot to include VLS on EVERY patient. My DDx was rushed and off on about 7/10 patients and my examination choices were medium in every patient. I'll post my results whenever I find them

If I pass I will be so so so relieved. I do not feel good right now.
 
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Hey I'm in a similar situation. step 1 score 255+, IMG, feeling like i made same mistakes as you. it's an awful feeling. i dont know how i am going to wait it out for 2 months. i've convinced myself that i've failed.
 
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Depends on what you apply to. Radiology could give two ****s how many times you failed cs, as long as your step 1 and ck are in the 250+. Family will def look at cs fails as a huge negative.
 
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I recently took the test. I'm getting worried that I didn't do as well as I thought. After taking the test, I realized I made a lot of mistakes on patient note...with wrong diagnosis and even having only one supporting evidence from the history for many cases. What should I do????
I'm getting really anxious.
 
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JiniInBottle said:
and even having only one supporting evidence from the history for many cases. What should I do????
I'm getting really anxious.
Click to expand...

I'm also wondering about this. I took CS recently and looking back, there were definitely multiple cases in which I could have supported my diagnoses more. I also had 1-2 pieces of supporting evidence for a lot of cases, and I wasn't great about consistently using pertinent negatives. I think I may have underestimated the importance of this. Am I doomed for an ICE failure? Ughhhh, this stupid test...
 
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