I am a US medical student. I passed my school's version of CS, and never had any issues in clinical rotations with Hx&Px's. I took the test at the Chicago site both times. My first attempt was in November 2019. My second attempt was in February 2020 (passed!!!!!!).
My biggest piece of advice is DO NOT TAKE THIS TEST LIGHTLY. Like any test, you need to study for the test. Even though CS is supposed to mimic a clinical situation there are differences. You have 15 minutes to do a complete hx and a focused physical exam, and identify a social issue and address that issue. For the note portion, you have 10 minutes to detail your findings.
I failed the ICE portion of the test the first time.
Retake-> 1 x in borderline for ICE, 3x's in borderline for CIS
The resource I used: First aid: Step 2 CS (for both attempts)
Time for study: First attempt 6 days (no rotation). 2nd attempt (1 month-I was also in a rotation).
Study plan: The first time I studied, I read through the cases and had a colleague act out about half of the standardized pt scenarios. The second time, I read through the book 3 times and had a partner act out all the cases. Also, for the second attempt, I memorized a template for the physical exam. I typed a pt note and then compared them with the book-->make sure you do this!!!!
Tips about the exam:
The cases are pretty standard M3/M4 type of cases. I didn't have any zebras, the First aid book had 90% of the cases I was tested on.
-HX- Use whatever mnemonic to gather a HX. I used old carts. ROS, Meds, Allergies, PMH, PSH, FMH, SH was the order I used. If they told me about any drug use/alcohol use I asked if they wanted to set up a second visit for smoking/alcohol cessation. For the ROS I just went head to toe, I didn't memorize a mnemonic. At the end, I would repeat in a concise manner what they told me, and ask if I missed any things. I would say about 60% of the time the pt would tell me something I missed, in the history.
PX- Know the neuro exam like the back of your hand. Also, know any of the special maneuvers for the abd and the joints. I tried to do a quick lung and heart exam on everyone, but if the CC was about a joint or something I thought unrelated to the heart/lungs, I skipped the heart/lung exams.
Note's
I started bottom up. Differential-->PE-->HX (SH-->FMH-->PSH-->PMH-->ALL-->MEDS-->ROS-->HPI-->CC)-->tests
PRACTICE, PRACTICE, PRACTICE. I'm a slow typer (40-50 words a minute), so getting a typing practice program may be helpful.
Why I think I failed, what I improved upon
My histories the first time were not very good. I know I missed things like duration/description/radiation, stuff like that the first time. That was easy to fix, I also asked the pt's if I missed anything (did during my second attempt) and sometimes they offered info, which helped me a lot. The second time around I addressed any social issues or concerns. I asked a lot of questions quickly, which probably hurt my CIS score. My physicals were not very good both times. I did most of what I needed, but they were rushed generally. For example, I tapped quickly for DTR's, once and then moved on. I forgot to have the pt drink a sip of water for the thyroid, I just had them swallow. I tried to include a heart/lung exam, but sometimes I was running out of time so I only checked one organ system or an affected joint. The second time around I was more vocal about what I was doing. For example, I would say, now I'm listening to your lungs. Then once I was done, I would tell them I heard something or that the lung fields were clear. I tried to leave 3-4 minutes for a wrap-up and counseling. The second time, I told them my top 2 differentials and any tests I was going to order. The first time I think I spoke in too many generalities. Overall, I think the first time, I would get too focused on my top differential. The second time I asked every question under the sun, to ensure I didn't miss and important negatives! On my piece of paper, I made a giant cross. Each sector on the paper was a different area of information (HPI/ROS/Rest of Hx/PE). This helped me later for typing the notes
Notes
The first time around my differentials were weak and poorly supported. For more than half the cases I had 2 diffs with maybe 3-4 pieces of evidence each. The second time I put 3 solid differentials for 9/10 of the cases. I probably had 7-8 supporting pieces of evidence on the first diff, 4-6 for the second diff, and maybe 3 for the last. MAKE SURE YOU INCLUDE NEGATIVES!!!!!!! I forgot to do that the first time, and I believe that was main my downfall. Whoever is grading this test needs to know why your first differential is your strongest because there are negatives ruling out other differentials!!!!! I can't stress this enough! For the PE, I memorized a template, I wouldn't put everything down, but it was something I used as a crutch, so I wouldn't have to think. Make sure you include a "general category" that includes "in no acute distress" or "anxious/pacing/agitated" stuff like that. I copy and pasted vitals as well, or I would put tachycardic, febrile...... The rest of the note was straight forward. ROS I think I put "negative, otherwise stated in the HPI" for every case. I had trouble completing the HPI, I always ran out of time. I would recommend a shorthand template and try to use as many abbreviations as possible. If you are a faster typer than myself, this will likely be less of a problem. I would recommend typing in bullet form, rather than a narrative.
What mistakes I made and still passed
Overall my notes weren't the best, I spent most of the time on the differential and supporting facts, I always ran out of time on the HPI portion.
2-3 of the cases I was only able to type a single sentence in the HPI before I ran out of time.
1 case I was only able to get a Hx, quick neuro exam, ran out of time, thanked the pt, and walked out.
I probably only finished typing 5 of the total 12 cases.
My differentials were better the second attempt. I probably had the correct order for differentials in at least 8 of the cases. I am pretty sure I had the top 2 for all the cases.
For the Hx's I think I got about 90% of the information. Positives and negatives. Sometimes I had to re-ask questions or I would have an awkward silence to process.
PE, my techniques were sloppy and rushed, except when I was doing a specific maneuver(obturator, rovings, Hawkins, drop can test, etc. ). I did at least 60% of what I needed to do. I probably missed 1-2 PE maneuvers per case. I forgot to do a JVD for one case. I never rechecked vitals, I don't think any of my cases needed it though. I forgot to do a mini-mental status exam fully, I ran out of time.
If you failed, I'm sorry. When I found out I failed my heart dropped to the floor. Then after retaking the test (I thought I failed walking out the test), I was anxious every day afterward. Do not take this test lightly, you will get through it and past.
These are my opinions take them or leave them. I'm sure I missed other things, but I hope this helps.
My biggest piece of advice is DO NOT TAKE THIS TEST LIGHTLY. Like any test, you need to study for the test. Even though CS is supposed to mimic a clinical situation there are differences. You have 15 minutes to do a complete hx and a focused physical exam, and identify a social issue and address that issue. For the note portion, you have 10 minutes to detail your findings.
I failed the ICE portion of the test the first time.
Retake-> 1 x in borderline for ICE, 3x's in borderline for CIS
The resource I used: First aid: Step 2 CS (for both attempts)
Time for study: First attempt 6 days (no rotation). 2nd attempt (1 month-I was also in a rotation).
Study plan: The first time I studied, I read through the cases and had a colleague act out about half of the standardized pt scenarios. The second time, I read through the book 3 times and had a partner act out all the cases. Also, for the second attempt, I memorized a template for the physical exam. I typed a pt note and then compared them with the book-->make sure you do this!!!!
Tips about the exam:
The cases are pretty standard M3/M4 type of cases. I didn't have any zebras, the First aid book had 90% of the cases I was tested on.
-HX- Use whatever mnemonic to gather a HX. I used old carts. ROS, Meds, Allergies, PMH, PSH, FMH, SH was the order I used. If they told me about any drug use/alcohol use I asked if they wanted to set up a second visit for smoking/alcohol cessation. For the ROS I just went head to toe, I didn't memorize a mnemonic. At the end, I would repeat in a concise manner what they told me, and ask if I missed any things. I would say about 60% of the time the pt would tell me something I missed, in the history.
PX- Know the neuro exam like the back of your hand. Also, know any of the special maneuvers for the abd and the joints. I tried to do a quick lung and heart exam on everyone, but if the CC was about a joint or something I thought unrelated to the heart/lungs, I skipped the heart/lung exams.
Note's
I started bottom up. Differential-->PE-->HX (SH-->FMH-->PSH-->PMH-->ALL-->MEDS-->ROS-->HPI-->CC)-->tests
PRACTICE, PRACTICE, PRACTICE. I'm a slow typer (40-50 words a minute), so getting a typing practice program may be helpful.
Why I think I failed, what I improved upon
My histories the first time were not very good. I know I missed things like duration/description/radiation, stuff like that the first time. That was easy to fix, I also asked the pt's if I missed anything (did during my second attempt) and sometimes they offered info, which helped me a lot. The second time around I addressed any social issues or concerns. I asked a lot of questions quickly, which probably hurt my CIS score. My physicals were not very good both times. I did most of what I needed, but they were rushed generally. For example, I tapped quickly for DTR's, once and then moved on. I forgot to have the pt drink a sip of water for the thyroid, I just had them swallow. I tried to include a heart/lung exam, but sometimes I was running out of time so I only checked one organ system or an affected joint. The second time around I was more vocal about what I was doing. For example, I would say, now I'm listening to your lungs. Then once I was done, I would tell them I heard something or that the lung fields were clear. I tried to leave 3-4 minutes for a wrap-up and counseling. The second time, I told them my top 2 differentials and any tests I was going to order. The first time I think I spoke in too many generalities. Overall, I think the first time, I would get too focused on my top differential. The second time I asked every question under the sun, to ensure I didn't miss and important negatives! On my piece of paper, I made a giant cross. Each sector on the paper was a different area of information (HPI/ROS/Rest of Hx/PE). This helped me later for typing the notes
Notes
The first time around my differentials were weak and poorly supported. For more than half the cases I had 2 diffs with maybe 3-4 pieces of evidence each. The second time I put 3 solid differentials for 9/10 of the cases. I probably had 7-8 supporting pieces of evidence on the first diff, 4-6 for the second diff, and maybe 3 for the last. MAKE SURE YOU INCLUDE NEGATIVES!!!!!!! I forgot to do that the first time, and I believe that was main my downfall. Whoever is grading this test needs to know why your first differential is your strongest because there are negatives ruling out other differentials!!!!! I can't stress this enough! For the PE, I memorized a template, I wouldn't put everything down, but it was something I used as a crutch, so I wouldn't have to think. Make sure you include a "general category" that includes "in no acute distress" or "anxious/pacing/agitated" stuff like that. I copy and pasted vitals as well, or I would put tachycardic, febrile...... The rest of the note was straight forward. ROS I think I put "negative, otherwise stated in the HPI" for every case. I had trouble completing the HPI, I always ran out of time. I would recommend a shorthand template and try to use as many abbreviations as possible. If you are a faster typer than myself, this will likely be less of a problem. I would recommend typing in bullet form, rather than a narrative.
What mistakes I made and still passed
Overall my notes weren't the best, I spent most of the time on the differential and supporting facts, I always ran out of time on the HPI portion.
2-3 of the cases I was only able to type a single sentence in the HPI before I ran out of time.
1 case I was only able to get a Hx, quick neuro exam, ran out of time, thanked the pt, and walked out.
I probably only finished typing 5 of the total 12 cases.
My differentials were better the second attempt. I probably had the correct order for differentials in at least 8 of the cases. I am pretty sure I had the top 2 for all the cases.
For the Hx's I think I got about 90% of the information. Positives and negatives. Sometimes I had to re-ask questions or I would have an awkward silence to process.
PE, my techniques were sloppy and rushed, except when I was doing a specific maneuver(obturator, rovings, Hawkins, drop can test, etc. ). I did at least 60% of what I needed to do. I probably missed 1-2 PE maneuvers per case. I forgot to do a JVD for one case. I never rechecked vitals, I don't think any of my cases needed it though. I forgot to do a mini-mental status exam fully, I ran out of time.
If you failed, I'm sorry. When I found out I failed my heart dropped to the floor. Then after retaking the test (I thought I failed walking out the test), I was anxious every day afterward. Do not take this test lightly, you will get through it and past.
These are my opinions take them or leave them. I'm sure I missed other things, but I hope this helps.
