USMLE Official 2019 Step 2 CS Mistakes Made & Still Passed (or Failed) Thread

[johnnytest]

TL;DR: Help your fellow classmates by sharing your experience with Step 2 CS. Template below.

Hello Everyone,

I know I speak for others when I say the mental anxiety I felt waiting for my Step 2 CS score was probably unmatched in my 4 years of med school. Only thing that came close was waiting for Step 1 and that was only a 3 week wait whereas this was almost 2 months for me and 3+ months for others. We all know USMLE/NBME does not care about our feelings when it comes to Step 2 CS. They will continue to be vague, force long wait times for scoring reports, remain with 5 centers, make scheduling impossible for 4-5 months out, and continue to charge whatever price they want to make their top leadership richer.

This thread is to help our community during one of the most anxious times of medical school. Especially for those like myself who had taken this exam stupidly late in the summer while going into my match year. I highly recommend for future readers to take this stupid exam as early as possible as your school allows so in the case you do fail you have ample time to re-schedule. Failures happen even to the best medical students and we never know why. There is zero transparency in this process. So, if you passed this exam I implore you to help your fellow classmates out and share your experience. Even if you failed I ask that you contribute as the more data we can acquire the more likely we can try to figure out what they possibly care about. Do I expect to figure something out from this? Probably not as the exam scoring feels arbitrary but this is ultimately to help ease the nerves of many people who are worried they failed. At the end of the day, the test does not and will never define the amazing doctor you will be. I've outlined a template for everyone to use and I'll start us off. Feel free to copy and paste and fill out as appropriate to you. The template is exhaustive for a reason as the more information we can get the better. Hopefully one day our generation will make this test obsolete. Thanks!


Template:

Date, Test Site, Attempt #:

US-MD or US-IMG (Carribs) or Non-US-IMG:

Wait time for score report:

Result on School Mock OSCE/CS and Date Taken: e.g: Bottom quartile, average, above average, two stds above mean, etc.

Test Result: Pass or Fail (if failed please include component(s) failed)

Study Time/Resources:

Test Performance: Feel free to include screenshot of your performance. I recommend using imgur and just inserting link. Or let us know exactly where your stars fell.

Initial Post-Exam Feeling: Everyone might feel like they failed as the days go by as our memory tends to remember only our mistakes but I was split 50/50 right after I left the center because I thought there were some things I did right and I got some diagnosis right.

Mistakes Made: Try to think from an objective point of view. Be honest and as thorough as you can. For those who passed, I feel it's easier to spill the beans and mention all our mistakes. But, if you failed I know our first gut reaction is to say "But, I did everything possible" and maybe you did but often times people are not able to see their mistakes right away or need some time to cope with their emotions first.

Things You Think You Did Right: Whether this be heart and lungs on everyone or thorough patient note or whatever you consistently did and still earned the grade of pass (or fail).

Misc: If this is your 2nd or 3rd attempt, please share what improvements if any you made.

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[johnnytest]

Date, Test Site, Attempt #: Late Aug, Philly, 1st

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 50 days

Result on School Mock OSCE/CS and Date Taken: Feb 2019, one standard deviation below class mean

Test Result: Pass

Study Time/Resources: Realistically 2 days practicing with a friend using First Aid CS cases. Probably 20 cases out of 44 and 8 hrs in total of practicing over 2 days.

Test Performance: ICE (the one I was worried about the most): 5 Xs in the borderline gray area/10 Xs to the right of the borderline area, CIS: halfway to the right, no Xs near the borderline area, SEP: Single star to the right (almost every native English speaker gets this)

Initial Post-Exam Feeling: 50/50 feeling. I felt the day went by so fast and I kept recalling the mistakes I made but also reassuring myself I did some things right.

Mistakes Made:

1. First case sucked for me. Needed to do neuro exam, botched it, needed to do fundoscopy, messed up the right/left rules, forgot to even document in my note that I did the fundoscopy exam. Ran out of time on my note.
2. Second case. Felt straightforward but I forgot the diagnostic test box at the end because I forgot to scroll down
3. Third case. Completely missed asking ob/gyn and vaginal discharge questions as patient in my mind clearly had a UTI but I missed a lot of pertinent questions related to STI and other ****.
4. For I feel half the cases I did some sort of pertinent PE maneuver that was negative and forgot to document in my note.
5. Ran out of time on note for half of cases. And ran out of space on half of notes so had to keep editing it to make it fit.
6. Forgot some pertinent hx such as smoking hx for a case that was lung-related.
7. Closure always felt BS to me
8. I felt my answers to challenge questions were awkward af and I tried my best to be like “oh no dont worry blah blah”
9. For most cases only put 2 diagnosis. I think for only 4 cases I put 3 diagnosis.

Things You Think You Did Right:

1. Heart and Lungs on everyone
2. Clearly used hand sanitizer before each PE and right before leaving room.
3. Provided some sort of closure for every case
4. Counseled probably 4-5 cases and tried to whenever I could.
5. Accurately did depression screening on a patient.
6. I feel I got the #1 diagnosis right on 6-8 patients.
7. For notes, I tired to put as much supporting evidence from history and PE. For some I had like 7-8 supporting details from hx alone.
8. For diagnostic tests, I was careful to not order expensive tests and stuck to blood tests for most. For some I reached something like 7-8 tests for all the diagnosis. Others had probably 3-4 max.
9. Never ran out of time in patient room. Always exited before timer went off. Average 2 mins before timer. Closest was one minute. Earliest was with 5 min to spare.

 

[throwaway2020]

Date, Test Site, Attempt #: First attempt. The exam was in August

US-MD or US-IMG (Carribs) or Non-US-IMG: US MD

Wait time for score report: 2 months

Result on School Mock OSCE/CS and Date Taken: Failed one of my OSCE's third year

Test Result: Pass or Fail (if failed please include component(s) failed): Pass

Test Performance: ICE (3-4 stars left of borderline, 4 stars right of borderline), CIS (Star to the right), SEP( Star to the right)

Initial Post-Exam Feeling: Definitely felt like I underperformed coming out of the exam

Mistakes Made:
1. I only put 2 DDx for most of my cases(8-9) and put 1 DDx for 1 case. For the DDx, I could only think of 3-4 supporting facts max. For a lot of them I could only put 1 supporting fact.
2.I feel like the accuracy of my diagnoses were pretty off for a lot of the cases (4-6 cases).
3. Didn't do a focused physical when it was warranted in about 3-4 of my cases.
4.Forgot to wash my hands in 2 cases.
5. Completely missed a neuro exam with MMSE on a man with obvious dementia
6. Spent too much time writing stuff down on my paper while patient was talking


Things You Think You Did Right:
1.Heart and lungs on everyone
2.I was sure to find something to counsel about on every patient and made sure to address every patient's needs well.
3.The challenge questions were my strong suits. I was able to tease out the challenge question on every patient and I think I answered them sufficiently.
4.Closure was pretty good. I always made sure I was able to spend at least 2 minutes on closure even if it meant skipping part of the physical exam.
5.Social History gathering was pretty good. Was able to find things out that none of the other people I talked to at my testing center was able to get.

 

[Nephronlearner]

Non-US IMG, LA center, late August, 1st
Result: pass
Performance: everything close/at the right border, nothing close to borderline
Initial thoughts: okay... I guess... or not...

Mistakes:
1. one of the patients was being a little slow and difficult with the gown (lowering it in a way that I couldn't examine what I needed to) - got a bit confused, wasted some time on it
2. missed some relatively important diagnostic studies on 2-3 cases
3. did not do all the PE things I should have on each patient
4. forgot to ask some important ROS questions early on and asked them before summary.
5. literally wrote NKA for a patient who told me she had an allergy
6. had no idea what drug a patient was talking about so just wrote something like "OTC cough suppressant" or "analgesic" or whatever it was (don't remember any more)
7. did not ask a patient with epigastric pain about respiratory symptoms and only realised it was related during PE when he was shrugging his shoulders rather than breathing
8. wrote some "clumsy" findings
9. did not do a MMSE when it was required
10. put only 2 differentials on >50% of cases
... and a whole bunch more I am sure

Things I did:
1. closed and summarised all the cases
2. tried to be nice with everyone
3. did heart and lungs on all patients (not sure it was required but whatever)
4. did most of the PE on each case
5. asked patients if they had any questions while washing my hands
6. copy->pasted Hx and PE into my supportive findings in a way that I would put, age, normal VS, anything remotely related to the disease as a supportive finding, often having 10-15 per DDx

 

[anon427]

Date, Test Site, Attempt #: July, Chicago, 1st

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 3 months

Result on School Mock OSCE/CS and Date Taken: Jan 2019, needed to remediate

Test Result: Pass

Test Performance:
- ICE (the one I was worried about the most): 15 stars to the right
- CIS: 7 stars to the right with *
- SEP: Single * to the right

Initial Post-Exam Feeling: literally like ****. I actually vomited afterwards because I felt so terrible and was absolutely convinced I failed. The feeling was worsened by the fact that everyone else in my cohort seemed to be in such a great mood.

Mistakes Made:

• Forgot to perform lung exam in case that called for it. This same case was a really straightforward lung case, but I was just so off (it was my 2nd to last case so I was also pooped) and I was certain it was going to be my downfall.
• There were 4 cases in which I had absolutely no idea what the heck was going on. Like legit, put my best guess and moved on.
• Put unlikely diagnoses and ordered expensive tests that were likely unnecessary. I did fill every entry though.
• In a patient that was concerned about a diagnosis, I interrupted him and said, "oh, you don't need to worry, we have good treatments now." He immediately stopped talking for the rest of the visit. I should have said, "I apologize for interrupting, but did I address your concerns?"
• Someone kept yawning in mine and I didn't address it at all
• Kept doing painful maneuvers in a patient that said "Ow" each time, yet I kept going? At that point I was on autopilot - don't recommend

Things You Think You Did Right:

• Know the eponyms for exam maneuvers (e.g. Lhermitte's, Kernig)
• Finished every note - I always started with the diagnoses and tests. I had 3 diagnoses for each case - not sure if I recommend that, mainly because I was beginning to pick at straws towards the end
• Performed focused exam to allow more time to answer questions
• Always washed hands with sanitizer at the beginning of the case - I didn't wash hands prior to each exam and I guess that was okay because i passed?
• Always ALWAYS provided closure - THIS IS SO IMPORTANT and I think the main reason why I was able to do well on CIS
• I would also ask: "just to make sure I explained everything in a way that made sense, do you mind repeating what I said?" I think this is a tip that not a lot of people know...some actors actually said things that I didn't say during the case but made sense and so I was able to include these tips in my notes.
• Never ran out of time

If I can provide help for anyone through this stressful time, please let me know. I had to wait 3 months for my score, and from day 1, I was absolutely convinced I failed. Best of luck to everyone going through this process!

 

[sharkbyte]

Date, Test Site, Attempt #: Early September, Chicago, Attempt #1

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 1 month 10 days

Result on School Mock OSCE/CS and Date Taken: e.g: Passed my M3 OSCEs, usually pretty solid on history/exam and a bit lower performances in differential

Test Result: Pass

Test Performance: ICE all stars to the right, very close to High Performance; CIS all stars to the right but starting right after borderline performance bar, SEP 1 star far right

Initial Post-Exam Feeling: I initially got pretty worried because for the very last case I ran out of time during the physical exam and had to leave the room without any wrap-up/addressing concerns/counseling and stuff. Otherwise I knew I made a bunch of small mistakes here or there but didn't feel that I made any glaring mistakes worthy of a fail, so my gut was telling me that I passed. But at the same time I had no idea how it would be scored.

Mistakes Made:
1. (probably biggest mistake): Ran out of time on last case during physical exam and basically just had to awkwardly say thank you and leave; no counseling/wrap-up
2. Forgot to do specific physical exam for pt who presented mainly with a complaint regarding that system (lol, I know)
3. Forgot to tell one pt to stop taking a med that's highly implicated with the symptoms he presented with
4. Had 2 for DDx on a lot of cases, so definitely missed some possible diagnoses
5. Missed a handful of developmental/other questions for pediatric case
6. Forgot to check pulses on pt presenting with leg claudication symptoms
7. Mistakenly said colonoscopy instead of EGD when discussing plan with one pt (did put EGD in note though)
8. Probably a bunch of others that I can't really remember right now

Things You Think You Did Right:
1. Heart/Lungs on everyone
2. Washed hands before physical exam on all patients
3. Always made sure to explain what I was going to do before each physical exam, asked them to let me know if they were in pain/discomfort at any time, etc.
4. Made sure to show as much empathy as possible during history taking and wrap-up
5. Thought that my notes were pretty thorough overall, especially history and supporting evidence for diagnoses

Misc: I didn't really study that much honestly. Flipped through the cases in the FA book, probably read through most of them. Didn't do any practice with any other people. I had taken Step 2 CK a couple weeks prior so was pretty burnt out with studying and got lazy. I think my school does a good job of preparing us with OSCEs and I felt pretty comfortable with my history taking/exam skills and communication skills. Still, I would definitely NOT take this test for granted and would recommend reading through all the cases AND getting some practice on a friend/family member/roommate/whomever just so you get experience with counseling, answering questions, etc. Beyond that, it seems like there's definitely a lot of leniency on this test and just do your best while knowing afterwards that you can make quite a few mistakes and still pass comfortably.

 

[Pandy4993]

Date, Test Site, Attempt #: Late August, LA, 1st attempt

US MD

Wait time for score report: 7.5 weeks

Result on School Mock OSCE/CS and Date Taken: May 2019, Passed: borderline pass on communication skills, pass, but probably below average on ICE. I get extremely anxious/stiff in these situations and had to remediate OSCEs at the end of first and second years.

Test Result: Pass!

Study Time/Resources: Read through the mini-cases and the intro of First Aid for CS two nights before the test. Read through the sample cases on the way to the testing center the day before. I had also gone through the mini-cases once before my school OSCE. In hindsight studying more would have made me a lot more comfortable, but I was also relying on CK prep I did earlier in the summer.

Test Performance:
ICE: Two x’s in the borderline box, the rest to the right.
CIS: All x’s just to the right of the borderline box (touching, but not entering the box).
SEP: Star to the right

Initial Post-Exam Feeling: Absolutely terrible. I really felt that it was very likely I had failed. I was used to borderline passing, or just not passing, school OSCEs and this felt so much worse. I just felt I had been extremely disorganized and anxiously all over the place in the rooms and was most worried about failing CIS. Most of the SPs had seemed irritated with me and I wasn’t even sure if I had been making sense when closing the encounters. My physical exams had also been extremely minimal.

Mistakes Made: Hard to remember the specifics, since I was so anxious and unable to focus, but here are some things:

1. Really skimped on the physical exams. Definitely did not do heart and/or lungs on everyone and when I did I never did more than auscultate. On multiple patients I just did an abdominal exam. On one patient I think I just palpated the thyroid, and on another I just looked in her ears/nose/mouth. Didn’t do an abdominal exam on a patient with nausea/vomiting. Only did a couple parts of the neuro exam on a headache patient.

2. I could point to one aspect of the history I missed after each encounter for the first 4-5 encounters. Like forgetting to ask social history questions on one, allergies on another, past surgeries in another etc. I think I did ask everybody about tobacco/alcohol/drugs, though

3. Peds phone case was a mess. I started by calling the “family member” the wrong name, forgot multiple questions about birth history, went back and tried to ask developmental questions after closing the encounter, and overall just seemed to be pissing off the guy I was talking to. He didn’t even say bye at the end, lol.

4. Put the same diagnosis first on the differential for three cases. It seemed reasonable, but I‘m sure there were multiple things in those cases I wasn’t picking up on.

5. On multiple encounters (4-5?) the five minute warning freaked me out, so I cut short my physical, closed the encounter, and then went back to do more of the physical exam before leaving the room. In these cases I asked the patient again if he/she had any more questions before leaving, but I’m sure it came across as disorganized

6. In general, I did not have good rapport with the SPs, although I usually don’t have trouble with this in real life. I had heard I should try to elicit a “challenge question,” but only one person had any questions at all for me. Most of the SPs seemed somewhat cold/annoyed and I don’t think I was doing what I needed to do to get them to open up a little more.

7. Just being too anxious in general made it hard for me to focus. I had to ask SPs to repeat themselves multiple times. When summarizing, they had to correct me a few times. I think I was stumbling over my words and rambling during the closings. Also, I tried to write as much as possible, so I wouldn’t blank when walking out, so there were definitely some awkward silences.

8. I put three diagnoses for each case, even if some seemed questionable. Also was rarely confident in my number one. A lot of my supporting evidence was copied/pasted for multiple diagnoses.

Things You Think You Did Right:

1. I think I had a fairly thorough note for each encounter, except for the fact that I had very few physical exam findings to report. I had some trouble running out of space on a few, but had time to go back and edit on all of them.

2. In general I tried to be friendly, upbeat, and very accommodating.

3. Had some sort of closing for each encounter.

4. Counseled when relevant on all cases.

Misc: I’m glad to be done with this ridiculous test. It really took me 8 or so encounters to feel okay. I’m still not sure what they’re really looking for with the workup. I think I was more aggressive than I would be in real life, but much less than First Aid. If I could go back, I would practice timing with a real partner at least a couple times. Also I’d echo the OP: take this early! Many of my classmates took it in May, which I think was a smart choice.

 

[Siberia]

Date, Test Site, Attempt #: July 15th, Philly, Attempt #1.

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: ~3 months

Result on School Mock OSCE/CS and Date Taken: >2std

Test Result: Pass or Fail (if failed please include component(s) failed): Pass

Study Time/Resources: 10 days (3 days dedicated at home) - Only used First Aid for Step 2 CS. Practiced alone for 7 of those 10 days after rotations. Spent the last 3 days practicing on mom and dad back home.

Test Performance: ICS smack dab between Borderline and Higher Performance. Higher performance for both CIS and English proficiency (single star).

Initial Post-Exam Feeling: Felt shocked. Had 4 very similar cases within the same system (that was relatively lower yield) and 3 stations that I straight up walked into the room and went "wtf" when I saw the patient. Time felt tighter than when I practiced, knew that I flat out forgot some things, but knew that I had gone in with a plan and did a very solid history for almost every patient even if the only answer the patients gave me was "no" and felt like some patients didn't really want to be there or see me. Felt really shaky on the diagnoses in general.

Mistakes Made:
1. First patient, just barged straight into the room after reading the little card. Had no plan in mind. Jumbled history, lots of stuttering, not to mention I had no idea what to do for that particular system. Luckily, the patient seemed to pity me and gave me additional information when I asked, "So I want to make sure that I've covered everything that you wanted to bring up. Is there anything that comes to mind that I might have missed or you want to talk about?" Just did everything I could think of physical examination wise.
2. Third patient, was more prepared, but SAME EXACT system as patient 1 and same exact prompt. Was caught super off guard seeing the same thing. This would happen again 2 more times during my examination with the same exact system. While doing a physical examination, patients drape fell off and I started yelling I'm sorry. Proceeded to accidentally stab the patient while doing a neuro exam.
3. Walked out of a room feeling fantastic with minutes to spare. Figured out while I was writing my note that I had forgotten my social history, family history and allergies.
4. Forgot to recheck abnormal vitals - wrote it down by ran out of time and got kicked out of the room by a proctor.
5. Completely mixed up two very different types of psychiatric illnesses. Proceeded to panic while doing the note.
6. Was handed lab results. Proceeded to say "I'm going to repeat them anyways - things change"
7. Didn't remember the difference between different types of hearing loss.
8. Totally did a physical examination on someone in street clothes (where you're not supposed to do a physical)
9. Wrote the same ddx twice and timed out before I got change it.
10. Didn't counsel well, I found time really tight. I think I only did it for like a third of my patients.
11. Remembered to ask patients to repeat what we talked about for my last 3 patients. Completely forgot the first 9.
12. Ran out of room while typing up my notes...

Things You Think You Did Right:
1. Very thorough history - always tied it off by asking the patient if I had overlooked anything or if there was anything further they wanted to discuss. 2/12 patients said yes and gave me information that I didn't think to ask or forgot.
2. Completely nailed Wells Criteria, think I ordered the right test.
3. Completed a full mini mental status exam
4. Completed depression screening questions
5. Did my best to comfort the patient. Halfway through the exam, I was like maybe I'm not making them feel loved enough and just tried to stay engaged and overly thoughtful. Seems like it paid off.
6. Washed hands on all patients.
7. Always asked patients to tell me if things were painful and explained everything I was doing as I was doing them.
8. Always took questions and answered them as professionally as possible.


Misc: I've worried about this exam more than Step 1 and Step 2 CK. I think that even though this is pass fail, it feels extraordinarily crushing because of the long turnaround time. I think that this is a relatively normal feeling and a lot of people end up going through the same thing. Keep your heads up - if there's anything that I can do to help, feel free to shoot me a msg or a question!

Random Note: To anyone curious about the disappearing step 2 cs prompt online -never disappeared for me until late this afternoon after I got my score. So it's not indicative or whether or not you'll get the score.

 

[HowAreYaNow]

Sure I'll play!

Date, Test Site, Attempt #: 9/6/19, Philly, Attempt #1

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 40 days

Result on School Mock OSCE/CS and Date Taken: PASS; took in April 2019; squeaked by on my school's version of ICE but otherwise did fine

Test Result: Pass or Fail (if failed please include component(s) failed): PASS

Study Time/Resources: FA, studied for amount a month no more than an hour per day, ran it twice

Test Performance: Stars all the way to the right on SEP and CIS, X's all above borderline on ICE

Initial Post-Exam Feeling: Felt relief when I finished but almost immediately started thinking of mistakes I made, by the time scores came out I had pretty much convinced myself I failed.

Mistakes Made: Didn't put vitals on any note (except mentioned as a pertinent positive like once), completely forgot to counsel one patient on smoking cessation, felt like some patients were difficult to build rapport with, I either didn't get at or didn't have a "challenge question" on most of my patients, my PE's were REALLY bad, had like one or two cases with a very vague CC that made it difficult to elicit a good hx, my ddx were meh and I feel like my workups were either too much or too little, honestly was also afraid I started introducing myself too quickly (aka just as the door was closing behind me as opposed to waiting for to close completely).

Things You Think You Did Right: Introduced myself and stated my role the same way each time, I thought my histories were overall pretty good, used the "empathy phrases (sorry to hear that, I understand why you feel that way, etc.), used hand sanitizer every single time (lol), was able to at least do heart and lungs on everyone, even though I struggled to get at challenge questions was able to ask some variation of "what's concerning you/anything else I should know/etc." for most if not all patients, was able to close each encounter with at least a basic plan.

Misc: FA is probably fine by itself. I definitely worried more for this test than for Step 1 and CK, probably because of the subjectivity in scoring as well as having less to occupy my time (easy or no rotations, for example). I think I'm living proof than even people like me who suck at assessment/plan can do just fine on this test.

 

[throwaway1000000]

Def do as much physical exam you can. Whatever you can think of. Easy points to get. Def study. Know the common differentials for common chief complaints. Rule them in or out with your questions. Practice note-writing. Write a ton of notes on their online software to try to be under 10 minutes. Counsel patients. Tell them clearly their ddx and treatment plan.
Don't go in without studying. Study for 2 weeks or more depending on your comfort level.

 

[nebuchadnezzarII]

Date, Test Site, Attempt #: Philly, First-Attempt

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: Long ass time

Result on School Mock OSCE/CS: 1 SD above mean; taken 3 months prior

Test Result: Pass

Study Time/Resources: 1-2 weeks during light rotation just reading cases from the CS book and some online sources. Practiced writing the Notes.

Test Performance: ICE (medium-low); CIS (medium-high); nothing on or behind the gray area

Initial Post-Exam Feeling: Felt like I did not pass after the exam.

Mistakes Made: Endless.

Advice: Do not take this exam lightly. People will say that they didn't study for it or that "it was so easy." People are dinguses. There's no guarantee you will have a easy time, so prepare well. Even the BEST students can fail this and sometimes do. Practice writing up the Notes and have a methodology to how you approach the patient.

 

[OrangeTub]

Date, Test Site, Attempt #: July

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 14 weeks

Result on School Mock OSCE/CS and Date Taken: e.g: Passed

Test Result: Pass or Fail (if failed please include component(s) failed): Passed

Study Time/Resources: FA

Test Performance: 4 x borderline on ICE, rest above. CIS/SEP highest performance (single star on right end)

Initial Post-Exam Feeling: Felt fine immediately after, progressively became more paranoid as the weeks progressed.

Mistakes Made: 2 DDX for probably 8/12 cases but with good 6-8 supporting facts for each. Felt confident on the ones I put down. Probably didn't do enough physical exam maneuvers. Forgot to counsel on half the patients but seemed to not have impacted CIS score.

This is not meant to brag but as a AOA student at a top 15 school with 26x/27x, I was shocked with my ICE performance in the end. DON'T UNDERESTIMATE THE EXAM. I have a suspicion that especially with the changes towards computerized grading, that having 3 DDX instead of 2 DDX may be a significant contributor to your ICE grade, as I've noticed that people who put down 3 for all cases seemed to perform better even if with less supporting facts for each. I erred on the side of minimal workup and minimal DDX since in my mind I tend to rule out certain diagnoses quickly like you would do in real life or on clinics. Didn't seem to work well in my favor.

Also agree with poster above about people being full of ****. Don't trust classmates and people online that say this exam is a joke. Please trust me when I say just study for this exam so you don't have the 14 weeks of anxiety that I went through this cycle. People like to spout nonsense mantra like "2 months for step 1, 2 weeks for step 2, #2 pencil for step 3" just because they heard it somewhere and think they're cool for repeating it. I'm sure lots of those people are doing more than they say as well. You better believe as hell I'm not going into step 3 with no preparation.

Things You Think You Did Right: Joked around, made SPs laugh. Finished every case with time spare. Closed every note with time to spare.

 

[shtumpa]

Date, Test Site, Attempt #: August 19, Philly, Attempt #1

US-MD

Wait time for score report: many days

Result on School Mock OSCE/CS and Date Taken: PASS; didn't do well on communication, ran out of time a lot. Did fine on exam.

Test Result: Pass or Fail (if failed please include component(s) failed): FAIL, ICE

Study Time/Resources: FA, couple of weeks, ~ couple hours per day.

Test Performance: Stars all the way to the right on SEP and CIS, No X's above borderline on ICE.

Initial Post-Exam Feeling: After borderline failing school exam due to communication issues, felt like it went ok. Physical exams were so totally half-ass because I was nervous about time for closing. Just from remembering the notes I thought half were very good, a quarter questionable, and a quarter lousy. But I didn't think I obviously failed ICE, as some cases went really well. Forgot many workup sections but didn't think that is necessarily a fail. But patient exam checklists probably cost me (or did they do away with those? Don't remember. I think so).


Mistakes Made:

Forgot about workup section on like half my cases (I'm hoping this was a significant part of my fail but I highly doubt this alone is anywhere close to a failure).

Physical exams were some of the most putrid muckery ever seen. But checked almost everyone's thyroid. Yay!

Total brain fart in one case with a classic three differential we learn in like the first month of med school. Just total brain freeze. She was looking at me like I was an idiot. She's right. I could only think of the least likely diagnosis (put them all on note though with the diagnosis I offered her 3rd).

Had to be reminded to wash hands for the first patient.

Ran out of time on note for some patients.

Used lay terminology cause I couldn't remember medical term (don't remember exactly what it was, something stupid).

Mixed up two terms that meant exactly the opposite of what I meant (don't remember exactly what it was, something stupid).

Wanted to fill up supporting evidence so threw some ingenious dubious crappage against the wall (don't do this).


BUT I had some really good ICE encounters one after the other, so did not think I totally failed. Maybe some I did well on were "experimental."



Things You Think You Did Right:

I found physical exam finding that wasn't obvious! I was extremely proud of myself. To be fair, maybe it was actually somewhat obvious. OK really obvious. I mean he said (CENSORED). You know what I'm talking about.

Articulated well.

Handsome tie.

They obviously liked me, or at least thought I communicated well. Made sure to summarize and counsel everyone.


In summary, my failure was most likely due to those mysterious sadistic experimentals again, just like step 1 and CK. Not my fault. No need to study much, will pass next time. After my CK retake.


Seriously, just did not study enough. For ICE, differentials for most complaints you should be on autopilot for ROS, physical exam, and note. I relied on thinking through cases but there isn't enough time. Easily rectified. Need to check on my loan status.

 

[ciestar]

Date, Test Site, Attempt #: 7/18/19, Philly, first attempt

US-MD or US-IMG (Carribs) or Non-US-IMG:
USMD

Wait time for score report: three months almost to the day

Result on School Mock OSCE/CS and Date Taken: e.g: Bottom quartile, average, above average, two stds above mean, etc.
<10th percentile. I absolutely bombed it

Test Result: Pass or Fail (if failed please include component(s) failed)
Pass

Study Time/Resources: a litte here and there with FA. I got through all the cases. I was on an ambulatory rotation at the time and got some practice with it daily, which helped.

The rest.. i dont remember. I know my first case I had zero clue what the diagnosis was, so a terrible way to begin.

 

[ScreamingInternally]

Date, Test Site, Attempt #: May 29th I think, Philly, Attempt #1

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 3 mos.

Result on School Mock OSCE/CS and Date Taken: dropped it like its hot. Had to meet with a prof and asked me to remediate

Test Result: Pass or Fail (if failed please include component(s) failed): PASS

Study Time/Resources: FA, took a weeks off after CK, probs studies for 2 days and did some mock cases with my gf

Test Performance: really high on the interpersonal skills part, little above avg on clinical understanding

Initial Post-Exam Feeling: felt pretty good about it (better than step 1 and CK, got sick after 1 and drunk after CK so... yeah). Definitely knew I made some mistakes but was confident I passed for most of the waiting period.

Mistakes Made: Completely forgot entire sections of the history on my pediatric case, forgot to add a bunch of info to another A+P, was strained on time for 3 or so cases. My physical exams were garbo. Must've missed something on one case (older lady p/w poor hearing per family, no sxs of hearing loss on exam, no issues at home w/ abuse, no mood issues, no signs of neurocognitive defects on exam). Literally had no idea wtf that one was about to this day.

Things You Think You Did Right: everything. Nah but for real, empathy statements are my forte, im good at handling the challenge q's, good at explaining diagnoses thoroughly. Decent history taking. Everything else is meh

 

[chocoholicsoxfan]

Why is everybody saying heart and lungs on everyone for things they did right? I didn't do this and I got almost all the way to the right on ICE

 

[throwaway1000000]

Why is everybody saying heart and lungs on everyone for things they did right? I didn't do this and I got almost all the way to the right on ICE

I don't think you need to on everyone.
But it is easier to spend the 20-30 seconds doing it than wasting the mental energy to think about whether they need it or not unless it extremely obvious and completely unrelated.
It is good to be on auto-pilot mode as much as possible and you don't lose points anywhere for doing it.

 

[johnnytest]

Why is everybody saying heart and lungs on everyone for things they did right? I didn't do this and I got almost all the way to the right on ICE

That's a good point. I did it because I knew ICE section would be my weakest so I figured I rather do it in case I do get some points from it. I didn't pass ICE with flying colors so who knows maybe my ICE score might have been lower if I didn't get some of those points on heart and lungs or it might not make any difference.

 

[johnnytest]

Date, Test Site, Attempt #: August 19, Philly, Attempt #1

US-MD

Wait time for score report: many days

Result on School Mock OSCE/CS and Date Taken: PASS; didn't do well on communication, ran out of time a lot. Did fine on exam.

Test Result: Pass or Fail (if failed please include component(s) failed): FAIL, ICE

Study Time/Resources: FA, couple of weeks, ~ couple hours per day.

Test Performance: Stars all the way to the right on SEP and CIS, No X's above borderline on ICE.

Initial Post-Exam Feeling: After borderline failing school exam due to communication issues, felt like it went ok. Physical exams were so totally half-ass because I was nervous about time for closing. Just from remembering the notes I thought half were very good, a quarter questionable, and a quarter lousy. But I didn't think I obviously failed ICE, as some cases went really well. Forgot many workup sections but didn't think that is necessarily a fail. But patient exam checklists probably cost me (or did they do away with those? Don't remember. I think so).


Mistakes Made:

Forgot about workup section on like half my cases (I'm hoping this was a significant part of my fail but I highly doubt this alone is anywhere close to a failure).

Physical exams were some of the most putrid muckery ever seen. But checked almost everyone's thyroid. Yay!

Total brain fart in one case with a classic three differential we learn in like the first month of med school. Just total brain freeze. She was looking at me like I was an idiot. She's right. I could only think of the least likely diagnosis (put them all on note though with the diagnosis I offered her 3rd).

Had to be reminded to wash hands for the first patient.

Ran out of time on note for some patients.

Used lay terminology cause I couldn't remember medical term (don't remember exactly what it was, something stupid).

Mixed up two terms that meant exactly the opposite of what I meant (don't remember exactly what it was, something stupid).

Wanted to fill up supporting evidence so threw some ingenious dubious crappage against the wall (don't do this).


BUT I had some really good ICE encounters one after the other, so did not think I totally failed. Maybe some I did well on were "experimental."



Things You Think You Did Right:

I found physical exam finding that wasn't obvious! I was extremely proud of myself. To be fair, maybe it was actually somewhat obvious. OK really obvious. I mean he said (CENSORED). You know what I'm talking about.

Articulated well.

Handsome tie.

They obviously liked me, or at least thought I communicated well. Made sure to summarize and counsel everyone.


In summary, my failure was most likely due to those mysterious sadistic experimentals again, just like step 1 and CK. Not my fault. No need to study much, will pass next time. After my CK retake.


Seriously, just did not study enough. For ICE, differentials for most complaints you should be on autopilot for ROS, physical exam, and note. I relied on thinking through cases but there isn't enough time. Easily rectified. Need to check on my loan status.

Thank you for sharing your experience. Sorry you have to go through this again but I'm sure you will pass it next time.

 

[chocoholicsoxfan]

Date, Test Site, Attempt #: 9/3/19, Chicago, 1

US-MD or US-IMG (Carribs) or Non-US-IMG: USMD

Wait time for score report: 2nd Wednesday of reporting period

Result on School Mock OSCE/CS and Date Taken: e.g: passed in May. Completely winged it. I think I was about average

Test Result: Pass

Study Time/Resources: I took it on a Tuesday. On Sunday, I went through 20 FA cases with my mom and SO. On Monday, I skimmed the mini cases.

Test Performance:

Initial Post-Exam Feeling: I didn't really think about it too much for a few days after. A week later I started to worry about some big mistakes. It was only the week before score release that I was really worried about failing

Mistakes Made: Forgot a few relevant PE maneuvers on 3-4 pts, didn't always ask pts to expand on potentially relevant ROS complaints, forgot to screen for depression in a pt that warranted it, think I counseled maybe 3 pts?, may possibly have made up a PE finding (though I'm still not sure), didn't shake hands with anyone because I wasn't sure about hand washing, finished every room like 5 mins early, sometimes thought about tests later which I didn't mention in my close and just added to my note, also I'm a fast talker

What I did Right: felt good about histories, felt pretty confident in my diagnoses, closed with everyone, PEs were thorough (especially neuro ones), didn't do unnecessary workup or add diagnoses if not needed, offered tissues to crying pts, made sure all questions were answered and got challenge Qs from pretty much everyone, had good supporting pertinent positives and negatives

Misc: used gloves, did NOT do heart and lungs on everyone

 

[maddy]

Is there anyone who used abbreviations a lot in the notes and still managed to pass?

 

[Dominus]

As someone still waiting for my score, you guys have no idea how much better this all makes me feel. Feel good about CIS but for ICE I have been super scarred. Glad to see there is some leeway for forgetting to record exam findings or putting the occasional dumb thing on my differential.

Edit :For future internet people, I passed with no stars in the borderline whatsoever.

Prep: 1.5 weeks of studying first aid, talked through differentials with friend.

Post-Sept Impression: walked out glad I was done, had a panic attack that night when reflecting on test, thought I failed for a week, calmed down but then got anxious again when my permit dissapeared.

Mistakes made:
1. Did not record physical exam maneuvers that I did on 4 to 5 patients
2. Skipped half a neuro exam on a possible tbi
3. Did not do dtr exam on neuropathy pt.
4. Forgot to record RRR on 8 patients for CV exam
5. Did not counsel 2-3 patients, including an adolescent using drugs and alcohol
6. Had no idea what was happening for 1 pt., bad ddx entries for 2-3 others, went ham on ordering tests for a few cases
7. Again, really skimped on some of my physicals
8. Put negative findings that ruled out a differential on my ddx list for like 6 patients, did not realize we only needed to put things that ruled a ddx in

Things I did right:
1. Thorough hx
2. Counseled almost everyone
3. Wrapped up at the end for every patients
4. Felt good about notes, aside from the mistakes above, had 3 ddx for almost everyone, felt good about my hpi, good workups for what I thought might be going on
5. Finished all notes and encounters on time
6. Good empathy, eye contact, positive patient responses, got challenge questions for almost everyone

 

[slowlydrowning11]

Promised myself I would post this if I passed so here it is.

Took the exam in Philly; I'm an US-MD. I've been worried sick for the last 2 months
Score: ICE: 3 Xs in boderline/12 in higher performance
CIS: 9 stars in higher performance
SEP: 1 star in higher performance

Mistakes made:
1) Poor ddx on 3 cases; I really thought ICE would be my downfall
2) Did not counsel a single patient (no one needed counseling as far as I was concerned) but thought I didn't counsel as much as I should have
3) Thought my PEs were really poor on at least 2 cases
4) Character limit ran out on several HPIs so had to edit a lot
5) Really poor supporting evidence for all my ddx (2-3 tops).

Things I did well:
1) Introduced myself well
2) Showed as much empathy as I could muster
3) copied and pasted vitals for each note
4) Put reasonable diagnostic workups for each pt

I know you've all heard this many times but the grading is lenient. I REALLY thought I was going to fail but I didn't. I wish you all the best of luck

 

[mcat_taker]

Hi everyone, I really appreciate you guys posting mistakes made and passed or failed. I am worried sick about this exam and getting my results and have had so much anxiety about it (Way more than step 1 or CK). My biggest issue with it is that they give you no feedback on your results. All I wish from the NBME is to make the grading more transparent for us.

I walked out of step 1 and CK feeling like I passed because after doing uworld and NBMEs you feel comfortable that you'll at least pass the exam even if you have no idea how well you did. You trust your practice exams and the fact that you've done thousands of questions. I passed both and never had much anxiety afterwards.

There's no official practice CS exam and no one seems to know exactly how it's graded. For example none of us know if there are auto fails for stations or which part of the note counts more towards your grade, or if you need to rule out diagnoses with pertinent negatives or just put pertinent positives, etc

I feel the entire test day felt like a blur where I felt pressed for time on everything. I never checked anyone's reflexes. I definitely forgot to pull out the bed extender for abdominal exams . I feel very shaken up about the entire process.

 

[canada667]

did my exam in November 2019 and received results in Dec 2019 so I did not have a long hard wait
Img from the US
first attempt
Passed star in ice and sep
study material: sps at clinics, first aid fifth edition pdf, csevideo 90 days on and off
we did not have any prep courses at my school just clinics I did in Chicago Cook county.

post exam, I was okay, felt pretty good. I did help knowing result were around a month or less away. I think If I had to wait a really long time I would have been more stressed out. During the exam I felt confident after the 2 case. although Im gluten free so I was hungry most of the day and was nervous that would impact my interactions with sps. Just coming out of clinics and watching csevideo it was pretty similar to the exam so being hungry took the back burner.

Note if you have diet restrictions do not forget to bring your own food!

mistakes
forget to do gait and romberg in neuro case
did not do snellen chart in dm type of case
did not do both active and passive rom b/l in msk case

did right
washed hands, made questions for sp while doing so, I feel like that was a good move kept things rolling
was nice and calm
answered the sp questions
listen carefully
knock greeted
no need to drape it was already there
offered water in a case (cant reveal the cases) but will say very similar to cse video and fa and kaplan cc

pn
don't remember all the details but did do 2 dd with pe findings and hx findings
I think that was the biggest challenge was under nerves makings sure dd is targeted to case cc

 

[mcat_taker]

I realized I never did fundoscopy on anyone that presented with elevated BP on their vitals sheet. The CC was always something unrelated to their blood pressure but they either had elevated BP on the sheet or a PMHx of HTN and I never did fundoscopy. Can anyone chime in as to how necessary this was for the PE? I also never repeated taking a BP in the room because I felt it would take too much time.

 

[Dominus]

I

I realized I never did fundoscopy on anyone that presented with elevated BP on their vitals sheet. The CC was always something unrelated to their blood pressure but they either had elevated BP on the sheet or a PMHx of HTN and I never did fundoscopy. Can anyone chime in as to how necessary this was for the PE? I also never repeated taking a BP in the room because I felt it would take too much time.

I cannot say that you will for sure be fine but I did not do fundoscop on a single soul. Passed with no borderline stars.

 

[mcat_taker]

Mid December, Atlanta, Attempt #2:

US-IMG

Wait time for score report: 6.5 weeks

Result on School Mock OSCE/CS: passed my school's mock CS before failing my first attempt at the real CS last year on ICE

Test Result: Pass 2nd attempt

Study Time/Resources: Studied for 2-3 hours per day for about a month. Just used FA 6th edition. Practiced every case with someone and wrote out every note

Test Performance: Passed ICE with 1 X to the left of borderline, 6 X in borderline and 8 Xs to the right of borderline. CIS: all Xs just to the right of borderline with nothing in the grey area. SEP single star to the right

Initial Post-Exam Feeling: Walked out feeling terrible. This was my second attempt and I had prepped longer for this attempt but I still walked out feeling just as terrible as the first time I took the exam

Mistakes Made: I don't know how you guys can remember all this stuff cause literally the entire day is such a blur but some examples of my mistakes were:

-first case forgot to do an MMSE on someone who warranted it, did not fit textbook criteria on SIGECAPS, so I was really stumped on the diagnosis and ran out of time before being able to close and have a plan for the patient, forgot to discuss their alcohol use, had to walk out of room without finishing
-Forgot how to properly examine a thyroid. I literally just touched it and made SPs air swallow (did not use water)
-Did not examine for JVD, did not do DTRs on anyone, did not use tuning forks for neuro exam, did not use pin prick tool for sensation
-Did not do fundoscopy on people with elevated BP on the vitals sheet or with HTN related pathology
-Started top down for this attempt instead of doing differentials first so my HPIs were thorough on the note but then I was rushing filling out supporting evidence for differentials and my work ups were done with whatever remaining seconds I had left as I did them last. As a result I definitely forgot to add in some stuff I wanted to order like FOBT, rectal exams if needed, A1C etc. My investigations were very minimal.
-had 1 case that i only put 1 ddx and no investigations (but i felt this was warranted ) But i forgot to write "no investigations necessary" just left it blank.
-did not put history/exam findings to rule out diagnoses only put to rule in
-forgot to pull out leg rest when doing abdominal exams so legs were hanging off table

Things You Think You Did Right:
-heart and lungs on everyone (didn't realize this is a waste of time and not necessary)
-asked them if they had questions and summarized encounter
-showed empathy with their pain and what they were dealing with
-carefully took off gown and tied it back up, only exposed what was necessary
- used sanitizer before physical exams
- did SLR and femoral nerve stretch test on a patient who warranted it, did a proper MSK spine exam
-wrote out vitals if they were elevated otherwise put wnl
-wrote out positive and negative ROS
-thorough history, remembered suicide risk if necessary, LMP if needed, etc
-checked for neck LAD when needed, looked into ears when necessary

I was never as stressed as I was waiting for the results on this test. For 2 months I could not do anything but think about the mistakes I had made. When I took step 1 and CK I walked out convinced I had at least passed due to having passed NBMEs UW SA etc, but this exam has no official practice exam, the scoring is subjective, and none of us know how exactly it is scored. My advice is to prepare for this exam like it is any other USMLE exam. Take it seriously. Do not let the pass fail nature fool you. I took this exam the first time with 10 days of prep, thought I would be fine because I have never been awkward with patients and my clerkship performance and patient encounters were always good. But being able to think fast in the heat of the moment in this exam requires a lot of repetition and practice. Now I have an attempt on this exam and it will hurt me for residency chances. You know yourself. If you are weak at exams and not the strongest student to begin with take this exam seriously like I should have the first time. I sat this exam the first time with 10 days of prep when I had given myself months for step 1 and CK. Why did I do this ??

Practice practice practice. Go over the mini cases in first aid not just the long cases. The mini cases are great for building your differential list and give great examples of things to order. You don't need to have perfect differentials as long as you have some that you can justify. The more practice you do the faster you can finish the encounters with a focused history and spend longer on the note. I always felt I was very pressed for time on the note cause I never finished encounters with extra time. I also would recommend going over exam technique. I feel most students don't pay attention to this but why get stressed out over your exams. Learn to do them properly. Review some videos on them like spine, neuro, HEENT, etc. Practice exams with someone that knows good technique.

I think it is important to only order work up to rule in or out your differentials. Tell the patient a diagnosis you suspect and your prelim work up in the room. I know as medical students it is reflexive to just punt this by saying you needed to discuss the plan with your attending but you can't do this in CS. If you suspect cancer you just need to tell them in the room etc. I know it is hard to do this. Reflexively you just want to be vague and say you need to order some tests lol. CS is really about being able to fill the role of a doctor. When in doubt do what you would do in clinic if you were the doctor taking care of that patient. Act confident. Have a plan for every patient even if you have no idea what is going on. Do not use too many abbreviations. I know time is an issue but write stuff out if you can. I think my first attempt was also due to too many abbreviations used.

 

[Dr Finesse]

Date, Test Site, Attempt #: 20 Dec., 2019 // Philly // First

US-MD or US-IMG (Carribs) or Non-US-IMG: US MD

Wait time for score report: 40 days (received today)

Result on School Mock OSCE/CS and Date Taken: I took the school OSCE in June 2018, then took a research year, and came back and applied for residency/took CK and CS quite late. Passed the mock exam, but narrowly passed the ICE component. Blew the CIS component out of the water. We had ungraded OSCEs our first/second year, and my feedback on each of those was also that I needed to improve the ICE component.

Test Result: Pass (thankfully, given how late I took it)

Study Time/Resources: First Aid CS (this is truly all you need). Literally about two days looking at cases. Truthfully, it should've been much more since I was coming off a research year. I distinctly remember being on my friend's guest bed in Philly the night before, at 1am, trying to cram this stuff into my head. You can best believe I'm gonna recommend against this. Also I didn't practice anything on anyone

Test Performance: ICE: 2 stars in borderline, 13 to right // CIS: 11 to right // SEP: max, as you would expect for native English speaking test taker.

Initial Post-Exam Feeling: Absolutely terrible. I felt so bad. I "knew" I had failed - it wasn't a matter of how worried I was, I was thoroughly convinced. I remember thinking, "How was I lazy enough to let this ruin my last semester of medical school? All I had to do was put in a couple more days of work." I was kicking myself hard. This got worse the following week, but slowly better as I spoke to more people and read threads, etc. like this one and saw that people made far worse mistakes than I and still passed. At that point (about a week ago), I became fairly confident I'd passed, though still nervous.

Mistakes Made: Here we go. There are some specific patients I remember so I'll be detailed on those (without giving case info), but otherwise will go with the flow.

• First patient: Missed the correct diagnosis, which in retrospect is a very common diagnosis in the field I'm going in. Embarrassing. This patient warranted a neuro exam and I ran out of time so I literally didn't do ANY part of the neuro exam. In fact my exam in this room was fairly cursory, as was my note, which I ran out of time on. I remember being only halfway through PE and not listing any diagnostic tests. I had listed one (wrong...) diagnosis. Without a doubt, a completely botched room.
• On one patient only, I listened over the gown with my stethoscope in 2/4 heart areas. When reading about likelihood of failing, I read many posts where people said this counts catastrophically against you. One guy said in an sdn post, "I'm sorry but this will count heavily against you, potentially failing you," which sufficiently terrified me. While it is poor form and you should avoid it, they clearly overstated how bad it is, and in retrospect, how in the hell would any of them know? I caution you against taking statements like this seriously. In any case, still try to avoid this. Fortunately I did this on only one patient.
• In most rooms, I actually did not pick up many physical exam findings. This was frightening to me because when I had to list supporting evidence, often times I literally would have just one supporting piece for ALL 3 of the diagnoses I listed. For example (and this was NOT a case, so this is totally made up), if a patient had back pain and I thought it was an epidural abscess, when I did an exam, the only thing I felt I elicited was the tenderness (as opposed to erythema, neuro findings, etc.), my diagnosis would be "epidural abscess" and supporting findings would be literally "back tenderness". The fact that 7-8 of my cases looked like this was ultimately the reason I left feeling like I failed.
• For diagnostic tests, I often put the "bigger" ones, like imaging, procedures (such as lumbar puncture). I rarely put common blood tests (except like pregnancy test, blood glucose, etc.). I don't think I put CBC or electrolytes for any.
• I did not counsel about 5/12 rooms, either because I couldn't find anything to counsel on (about 2) or because I ran out of time (about 3). Speaking of which...
  • Ran out of time in 4+ cases. Every single time I came out of the room, everyone else was already on their note.
• Didn't finish at least 3 notes.
• In a patient with a psychiatric issue, while trying to "close" the encounter, I accidentally gave her two wrong diagnoses. It must've been funny to watch. I said, "I think what you're going through can be attributed to xxx disorder" then said "Actually I'm sorry I meant to say yyy disorder" and finally said, "I'm sorry it's been a tough morning. This is zzz". This came from not knowing the diagnoses cold and therefore becoming frazzled under pressure.
• I didn't read the directions on the prompts to the room. I just read the first part that had their name, why they came in, and their vitals (sometimes I glossed over this so fast that I never remembered in the room, and I never rechecked vitals, including for a patient who was unstable and likely needed that). I often ignored the bottom half where the actually instructions are because I assumed they'd be the same every time.
• In one room there was a patient who seemed irritated from the moment I came in. A couple times throughout the interview, I politely asked, "I get the sense something is bothering you right now. Did I offend you?" You might say this is a good thing (and it is - remember these ppl are just acting), but her irritation and lack of physical exam findings somehow, someway, led me to write a psychiatric diagnosis that was probably so out there that the person who read it may have spit out their coffee.
• Missed several diagnoses and lab tests that became apparent afterwards.
• In one patient's diagnosis list, I used poor medical terminology. Minor, but definitely lost something from it.
• I got challenge questions in maybe...4/12 rooms. This worried me, as I interpreted this as being because I either was moving too slow, or not saying/asking the right things. Typically challenge questions in First Aid are triggered when you say something (ex: patient may express fear over an EKG when you mention it for their chest pain) and I assume test day is the same. Since I wasn't getting them, I was sure I was screwing up.

Things You Think You Did Right:

• Hand sanitizer in every room. In most rooms (8+), I sanitized twice - once before shaking patient's hand, once before PE, that way it was crystal clear I was doing it. Do NOT wash your hands. It takes too long, you get water on the floor (don't want to slip do you?), you have to dry them, etc. Just use the hand sanitizer and don't get it in the SP's eye. This should be easier than introducing yourself.
• In my exam, all the patients who needed to be examined were already draped so NBME stole my thunder.
• Every single patient, introduced myself, said my role, asked if they were comfortable/needed anything.
• Remembered to do a thyroid exam for a room where we often forget thyroid disease being on the differential.
• Always asked patient if I could touch them before starting the exam, and then talked them through what I was looking for and what I was seeing. Part of this was to cover myself. In most rooms I didn't see physical exam findings, so I wanted to state that, while recording, in hopes that evaluators would have leniency. May or may not have worked.
• Crushed a couple of advanced maneuvers that I surely would've not done had I not crammed FA the nights before.
• Paid attention to vitals in a case where they were absolutely critical to getting the correct diagnosis. This was my last room and I felt like I aced it. In fact, it was the only room out of 12 that I felt even slightly good about.
• Cordial and polite with everyone, and I tone/expression matched all of them. I've always been great with CIS so I wasn't concerned about this sort of thing.
• I came in each room and started with the same spiel: *knock knock*, "Mr/Mrs. xxx? Hi, my name is yyy and I am the doctor on the team taking care of you. Are you comfortable? I'd like to ask you a few questions about what brought you in today and do a focused exam on you - is that alright?" Then, without fail, go into, "What brings you in? Tell me more about the zzzz pain/ache, etc." This consistency probably nabbed more points than we all think.
• Only put history/exam findings I for sure elicited, as opposed to what I thought of later.
• Did CC, HPI, PMH/PSH, Meds, Allergies, SHx, SexHx, FHx on every single patient regardless of how big/small the issue was, how relevant, etc. If patient mentioned alcohol, I CAGE'd them very quickly every time (even if they said occasionally - this takes like 15 seconds) and documented it.
  • For SHx, always asked occupation, smoking, alcohol, injection drug use, marijuana/cocaine
  • For SexHx always asked, REGARDLESS OF AGE: currently active? men/women/both? what type of protection? ever had STI? when was last screening? // If patient was sexually active, I asked if they wanted STI testing today. If patient didn't use barrier protection, I used this is my chance to counsel in case I didn't get to later. Speaking of which, when something comes up that you CAN counsel on, always do it immediately. This way you get those points and don't have to worry about forgetting later (which...you likely will forget).

Misc: This was my first and thankfully only attempt, but let me use this opportunity to say this. If you are a native English speaker, either take the exam before September of the year you're applying to residency, or give yourself a FULL WEEK of focused studying, especially if you took a research year. If English is not your first language, you will need to practice with people to make sure you have the SEP section covered. You should probably have two weeks of dedicated studying, particularly if you have shaky English.

Prepare according to where you are in your training. If you took a research year, add at least a few days on to your studying. If you are non-native English speaking, practice delivering information seamlessly, and practice having people ask you questions. If you just finished third year, you may need less study time but still study at least 3 days.

When you finish the exam, ignore the naysayers. Avoid people who try and scare you for making a certain mistake. They don't know crap. NONE of us know how this mess is scored beyond just the three sections needing a pass, and that's not gonna change. No one on this forum or on the internet can predict how you did, or how whatever mistake you think you made will affect your score. Remember - I was convinced I failed because of things I had heard, and then passed quite comfortably. Still, do yourself a favor and avoid having 40+ days of ridiculous stress. No test can ever define you, but theres no reason why you can get through 3 years of med school and not get through this exam, as long as you prepare based on where you're at. Prepare comfortably. Ignore doomsayers. And most importantly, live your life.

 

[honorax123]

Date, Test Site, Attempt #: Nov 13, Los Angeles, First attempt

US-MD or US-IMG (Carribs) or Non-US-IMG: US-IMG

Wait time for score report: 77 days

Result on School Mock OSCE/CS and Date Taken: e.g: Bottom quartile, average, above average, two stds above mean, etc. // No mock test

Test Result: Pass

Study Time/Resources: 40 days// First Aid CS. Didn't go through "Mini cases" which I regret, only went through the actual cases between 2 and 3 times depending on how much I actually remembered from each case. Studied with my mom as a patient mostly and with my girlfriend who took step 2 CS a year before me.

Test Performance: ICE: 4 stars on lower, 6 stars on borderline, 5 stars on higher performance
CIS: 5 stars on borderline, 6 stars on higher performance
SEP: 1 star on higher performance (max) Not a native speaker, but have no accent and lived in the US for various years growing up.

Initial Post-Exam Feeling: Felt like my whole experience was a 7/10, but the waiting time is SO LONG that every week made me more anxious and could remember mostly the things I didn't do as good as I initially remembered.

Mistakes Made: (Hope this helps)
* Ran out of time in 4 cases. I was counseling the "patient" and as soon as I heard the "Encounter is now over" I just said, "I really hope everything was clear, it was great seeing you, good bye" and the door was opened by a proctor and told me to leave immediately. On 2 cases I wasn't even able to counsel the patients, had just finished the physical (for which I only did a relevant - to the case -physical exam) when my time was over. The last case I ran out of time was just terrible, I hadn't even finished the physical exam, the "patient" wasn't really telling me anything, he kept on trying to make me nervous on purpose (and achieved it) he realized I didn't knew anything about basketball and kept on asking me basketball questions, we didn't connect at all, and when I ran out of time he started laughing at me. Till this day I remember him laughing while I was leaving the room and that had me messed up for the rest of my cases.
* Had absolutely no idea what a (realized later) Neuro patient had, made up some diagnoses, questioned her more on the endocrine and CV systems, but had a really really really good physician - patient relationship in that case, spoke about her kids, family, pets, while I was trying to figure out what was actually wrong with her. Realized about 30 days after the exam, this was actually a fairly simple Neuro case that was no where close to what I typed as my differentials...
* I asked about the possibility of being pregnant to a teen patient that told me she wasn't sexually active.... twice. Still had pregnancy as one of my differentials...
* Didn't do a fundoscopy on a patient I realized later actually needed it...
* Left a patient with both of his legs hanging on the exam table (Didn't use the extension). Patient asked if it was normal for him to be laying on his back with his legs "in the air"> This was the same patient I ran out of time terribly.
* Ran out of characters while typing notes either 2-3 times. Had to start cutting spaces, commas, to reduce characters and ended up running out of time both times.
* Should have practiced more my encounter timing. During my practice I was running out of time every now and then, but by the exam date I thought I had that under control.



Things You Think You Did Right:
* Really focused on the patient chart at the beginning of every encounter. In one of them the vital signs were a major clue...
* Washed my hands before every physical exam. Soap (minuscule amount) and rinsed as quickly as possible and used paper to dry.
* Focused a lot in the patient, asked him/her questions outside of the case without getting too personal. Many of them told me they appreciated me taking my time to ask that and that it meant a lot to them (seemed like they were supposed to say that)
* I really felt it went 10/10 in 5 cases. Great interview using the Mnemonics , had a really great physician - patient relationship, found what I was looking for in the physical, counseled and even joked around with some of them, great patient note
* I got a really upset (because of me "being late") female patient, and I mean REALLY UPSET, to calm down and ended up even thanking me at the end of the encounter by simply asking a little extra about her dogs
* Noticed a patient was purposely speaking with a kind of "Russian like" accent and assessing if I had any trouble understanding her. Never asked to repeat anything, everything seemed clear to me. Another patient with a "Southern American" accent, was purposely speaking that way and really fast. As with the previous patient I described, I didn't ask him to repeat anything or made anything seem like I was having trouble understanding him (And I really wasn't but seemed to me that was to evaluate the English proficiency)

 

[medicalCPA]

I hope this helps someone. I know I read through this thread religiously while I was waiting for my CS result.

Date:
22 November 2019

Test Site:
Philadelphia

Attempt #:
1

US-MD or US-IMG (Carribs) or Non-US-IMG:
US-MD

Wait time for score report:
68 days

Result on School Mock OSCE/CS and Date Taken:
Passed, but barely. Took the mock CS in January 2019, so I was also afraid that I had forgotten what enabled me to pass it when the time came to take the real thing.

Test Result:
Pass

Study Time/Resources:
(a) First Aid for CS haphazardly. In our clinical skills course, my school has a list of "the 12 most common chief complaints," so I did those ones in FA first, then began going through cases randomly. I tried to align them with the list of chief complaints published by the NBME, but I ran out of time before doing them all.
(b) Some AMBOSS cases, but I did not practice writing the notes.
(c) Practiced with a friend two nights before.
(d) Because I was worried that I would not type quickly enough on the exam to finish my notes, I also did typingclub.com exercises over like 6 weeks (~10-15 minutes/day) to increase my typing speed, especially for numbers and symbols because I was worried I would not be able to type quickly enough during the exam.

Test Performance:
ICE: 3 X's to the left of borderline, 6 X's in the borderline window, and 6 X's to the right of borderline
CIS: 3 X's in the borderline window, 8 X's to the right of borderline
SEP: 5 X's near the "higher performance" portion. Surprising. However, I grew up outside of the US and I still have an accent.

Initial Post-Exam Feeling:
I legit did not definitely feel one way or the other. Initially, I thought there was a good chance I might not pass the exam, and that feeling grew much worse during the waiting period.

Mistakes Made:
-Case 1: Patient was angry with me for some reason that I could not fathom. I also ran out of time both during the encounter and while writing the note, so I did not include either the possible diagnoses or the recommended diagnostic tests in the patient note. For the remaining notes, I wrote the differentials first before going back to fill in the H&P in order to prevent this from happening again.
-Cases 2-12: Don't remember the specifics any more. I know I ran out of time during 2 other encounters, did not close for most of them, did many half-assed physical exams and missed several more (did not do a Weber and Rinne test on a patient who definitely needed one), and the workup section on my notes was really sparse. There were several PE maneuvers that I did but did not document (I know I did a Murphy's test that didn't show up in my note), and I definitely did not do heart/lung/abdominal exams on all my patients. I also don't remember how many differentials I put on my cases. I think I tried to put two on all of them. If I put 3 on any one, it was the exception. I don't remember counseling a single patient, either.

Things You Think You Did Right:
-I used hand sanitizer for every encounter (first thing I did once I walked in)
-I tried to use empathy statements where I could ("I'm glad you came in, we'll figure this out together")
-Even though I am not sure I mentioned the diagnosis to the patients, I summarized every case to the patient and asked if I had missed anything, except the first one, and got most of them to ask me their challenge questions.
-Told patients that I would be looking down to write the notes so I wouldn't be dinged for not maintaining eye contact.
-Did PAMHITSFOSS on most patients, MVPLAP on nearly all the women.
-Remembered to include the vital signs for every patient note.

 

[Increaseyourstep]

I promised myself I would write one of these after my hellish wait since November. To anyone reading, this test is incredibly lenient. I cannot even fathom how many things I missed, but will list below. Do not do what I did and search all forums and posts possible about failing, it will make you lose hair, sleep, and potentially years of life.

Date, Test Site, Attempt #: Nov 2019, 1st, Chi.

US-MD or US-IMG (Carribs) or Non-US-IMG: US MD

Wait time for score report: 50+d

Result on School Mock OSCE/CS and Date Taken: I took the school OSCE July 2019. Performed very well.

Test Result: Pass

Study Time/Resources: I had a few clinically orientated rotations and had done extremely well throughout medical school both clinically and within our OSCEs. I created an outline of what I would say in the room and what exam steps I'd do. Didn't touch FA or any other resource. Honestly did not think anything of this exam prior to driving up the day of.

Test Performance: Higher performance in all categories. Truly shocked on this considering I had relegated myself to failure

Initial Post-Exam Feeling: I thought I wasted every moment of work I had thrown into medical school. Full disclosure, I have done very well, 25x step 1, 27x ck, top 5% of class, aoa, etc. I am used to knowing the number of questions I miss per exam including the prior steps; this one blitzed me. I truly thought I failed. I had driven up the night before on 2 hours of sleep and felt in a daze on all encounters. I drove back and just counted how many things I missed/should have seen/etc. I felt like I Le-Roy Jenkin'ed it... I regretted not getting a hotel and spending the night before there.

Mistakes Made: Nothing specific in this post per NBME rules

• Ordered a few ridiculously invasive tests due to spending time in the ED on rotation...
• Exams were the most piece-meal hackery of all time... It has probably been since 1st year when I last reviewed how to properly examine a patient vs. what is actual practice. I did not practice on anyone or anything in regards to physical exams.
• With the above exam, I had few exam findings and the ones I did I was never sure if it was real or I was making it up...
• Never ordered more than 2 dx tests per pt
• Did not counsel on some rooms
• Had legit no idea on some rooms. Told SP my dx and w/u to get a face of dejection... Had to run with it
• Felt 100% on less than 1/4 of the rooms, somewhere 50-75% on most.
• Missed several dx's and lab tests...
• Used several abbreviations not on the list (former scribe typing fast)
• Was not the best at using medical terminology for some words...
• Missed several exam steps related to my ddx
• Used otoscope for all pupillary exams...

Things You Think You Did Right:

• Gloved every single room just prior to the exam. Did not wash hands prior to this
• Shook hands. Acted incredibly emphatic. Made alot of small talk based on SPs vocation or hobbies. Exuded confidence with my hack physical exams, ddx, and w/u.
• Always asked permission before pex and explained each step/ ensured comfort.
• Wrote a verbose, well written note. Type at 100wpm so could fill everything. Physical exam incredibly detailed on the appearance, vitals, etc... to make up for lack of exam findings.
• VS each time, everytime. Interpreted even if AFVSS. If not, listed and delineated it in both the pex box and ddx.
• Faked confidence extremely well
• I treated each encounter like another day in clinic. I had no format in each room, just acted exactly as I would if seeing a new consult or new pt in clinic with the exception of over-embellishing the social niceties. No pamhitsfoss, etc. I just let the encounter flow naturally. YMMV.
• Crisp conservative shirt and tie, clean white coat, pressed pants, shiny shoes. Looked the part, helped faking confidence easier.
• Always summed things up at end, frequently asked if there was anything I could clarify or if the SP had questions along the way and at the end.

MISC: If you're reading this and waiting for the score report-- just breathe, 95% chance you passed. I wish I'd have had back the last two months of my life as worrying about a contingency plan made if difficult to enjoy Thanksgiving and Christmas with the family. None of the worry was worth it. I scored incredibly well on this exam with ample error; far more than I can remember.

 

[FMDoge2020]

Finally finished with this awful exam!! This thread was so helpful in calming the nerves while I was waiting on my score. Hope this helps the future CS takers!

Date, Test Site, Attempt #: 11/19, Atlanta, First Attempt

US-MD or US-IMG (Carribs) or Non-US-IMG: US-MD

Wait time for score report: 10weeks

Result on School Mock OSCE/CS and Date Taken: Probably <5th percentile? (Literally passed by 0.2%)/Took it 2months before CS

Test Result: Pass

Study Time/Resources: 3months on and off, intense prep(2-3hr/d) 2 weeks before exam while on FM rotation/First Aid Step2 CS, Anki deck, and used sister and brother-in-law as SP.

Test Performance:
ICE-2 on left, 6 in borderline, 7 on right
CIS-All on right, 7 spaces away from borderline
SEP-1 on right with *

Initial Post-Exam Feeling: I thought about just running away while typing my 7th encounter. Absolutely horrible and definitely thought I failed. Everyone who took it with me all felt it was very easy...which made the sense of doom even worse. Didn't sleep at all the night before and slept 2hours before the exam. Ate only two bags of chips over 36hours before the exam because I was dry heaving from the anxiety. Continue to heave on my way back to the hotel. Cried at the airport/plane on the way back home. It was very bad.

Mistakes Made:
Encounter part-
-Sloppy physical exam: forgot to do ENT that probably needed it, used the wrong tuning fork, didn't complete the whole MSK exam that needed it, overexposed patient's chest in 2 cases, crappy neuro exam.
-Proceed to finish the exam of the other side anyways on a patient that was very repulsive to that exam. (gave me horrifying flashbacks)
-Accidentally interrupted a patient TWO TIMES because I thought he finished his sentences. His death stare was as scary as Pennywise.
-Tried to speak louder so patient can hear me better but accidentally yelled and proceed to yell for 3 more sentences before realizing it.(two hours of sleep+hunger is not a good combo for success)
-Absolutely bombed an obvious challenge question. It was so obvious that it still hurts thinking back
-Lost my English speaking ability for like 7 sentences in one encounter ( Not a native speaker, and I tend to lose a lot of grammar and sentence structure when I'm tired; such as now)
-Had multiple awkward silences while trying to come up with things to ask.
-Didn't think for a few seconds before answering some of the challenge questions that I otherwise would have gotten them right.
-Forgot to ask multiple important pertinent (+) and (-) on at least 4 encounters
-Didn't give definite diagnoses in half of the encounters
-Forgot to read the vitals/doorway info carefully

Typing part-
-Sloppy exam and forgetting pertinent= lots of crappy notes that were probably as bad as my first patient note at the beginning of 3rd year. I would say at least 4 notes were really sloppy, 5 were alright, and 3 I had absolutely no idea what I was typing
-Forgot how to properly document MSK exam and neuro exam
-My handwriting is so bad that I can't read it sometimes. Couldn't document 2 of the FHx because of that. lmao
-Misspelled a medication on 3 of the encounters, thankfully I don't think the meds were pertinent to my encounters
-Differentials were very bad. Pretty sure 3 of them were completely incorrect (or at least the top 1 diff is definitely wrong), Most of them have 2 diff only.
-Didn't have ROS in all of the note
-Didn't document vitals in most of the notes ( I think only in one of them because I believed it was pertinent to the diagnosis)
-Supporting evidence were very very bad
-Overall, I think I got maybe 6/12 of the correct diff on 1st diff, 3/12 of the correct diff on 2nd diff. The rest of the 3 I have no clue what they are


Things You Think You Did Right:
-Heart and lung on all patients. Necessary? Probably not. But those two systems are high-yield to me.
-Document heart and lung like they did in First Aid
-Always knocked, confirm their names, washed hands via tiny squeeze of sanitizer, introduced myself in a polite way
-Squeezed out the "challenge questions"/other pertinents in all of them by obnoxiously/constantly asking them "anything I missed?/anything you want to add?/any other concern before we do exam?/any other pain or discomfort?/any other questions or concerns?/Are you okay with the plan? (they can be very hard questions or just simple yes/no + reason question mentioned in First Aid)
-Had all the fundamental parts of HPI and PMH (I used OLDCARTS and SHIMAXI)
-Didn't ask obgyn hx if not needed
-Took good social history (occupation, lifestyle, drug, and sex) --> counsel like I did to my patients in clinic when appropriate
-Closed in all of them and had patients agreeing to my plan
-Finished early in 10/12 of the encounters by 1-2minutes (couldn't think of anything so instead of awkward silence, I closed and walked out)
-Had workup pertinent to my differential diagnosis in all of the notes

Anyway guys, as you can see, this test is fairly lenient in some ways. But the fact that it takes 2+months to come out plus having vague grading criteria is just horrible. I was depressed the whole interview season b/c of this test. If you are a 3rd year reading this, please schedule the test super early(around Oct~Dec of 3rd year) so you can take it around July-September. That way it gives you some peace of mind knowing that if anything goes wrong you can still retake and have the score by match. Remember, 95% of you all will pass! Odds are in your favor. Good luck to you all and wish you all the best.

 

[IDK1493]

If I didn't list out my pertinent negatives and just wrote ROS negative unless stated above, will this lead to a fail in ice? Did anyone do this and pass?

 

[Dominus]

If I didn't list out my pertinent negatives and just wrote ROS negative unless stated above, will this lead to a fail in ice? Did anyone do this and pass?

I did that and passed. You can even look in my post history and see me freaking out about it earlier this year.

 

[IDK1493]

I did that and passed. You can even look in my post history and see me freaking out about it earlier this year.

I saw! I saw the part where you said you did list them in the HPI, albeit inconsistently...I didn't even do that lol

 

[step2csworriesme]

I didn't write normal s1/s2 on any of my exams, just wrote RRR no M/R/G (plus no JVD, carotid bruits, pedal edema, and 2+ radial and DP pulses- if it was a cardiac case). With no normal s1/s2 will I be in trouble?

 

[Kerosene Hat]

I didn't write normal s1/s2 on any of my exams, just wrote RRR no M/R/G (plus no JVD, carotid bruits, pedal edema, and 2+ radial and DP pulses- if it was a cardiac case). With no normal s1/s2 will I be in trouble?

I took the COMLEX-PE, but did the same as you and passed.

 

[step2csworriesme]

Hopefully they're graded similarly. I hope not documenting s1/s2 wont tank me. Especially considering you probably don't have to do a cardiovascular exam on every case

 

[FMDoge2020]

Hopefully they're graded similarly. I hope not documenting s1/s2 wont tank me. Especially considering you probably don't have to do a cardiovascular exam on every case

My guess is if it is not relevant to the encounter, typing them out won't hurt you.

Sent from my SM-G965U using SDN mobile

 

[Dominus]

Date, Test Site, Attempt #: 07. 02.2020, Atlanta, 1st attempt.

US-MD or US-IMG (Carribs) or Non-US-IMG: Non-US IMG

Wait time for score report: Still waiting for it.

Result on School Mock OSCE/CS and Date Taken: Don't have OSCE's at my school. But have always been in the 10%.

Test Result: No result yet. I will update once it is out.

Study Time/Resources: 1.5 months, live study partner and FA.

Test Performance: Not out yet.

Initial Post-Exam Feeling: Had no idea how the test went for me. Started recalling mistakes I did in all that rush and things I did not do. Now trying to convince myself I have a chance to pass.

Mistakes Made:
1. Okay case. Started pretty well. Could not finish the last portion of PE in my PN.
2. Went well but was very vague, the SP resisted in not answering my questions properly.
3. Completely botched the ddx, wrote something quite unlikely as my 1st ddx. Probably forgot to include special tests I did in my PE.
4.Got a challenging question whether the SP's symptoms were related xxx ? I did question that system and did not find significant hx to cause the symptoms. Still thinking whether the SP was trying to hint something at me. Tho, when I started talking about my impression and what the SP could have, he was in tears. Does that mean it could be the correct ddx? LOL
5. Another case where I missed out on the most possible ddx, it was there, very straight forward but I was probably dissociating by the time I came up with my ddx. Also forgot to council the PT here. My ddx were still possible and I supported them with 4-5 points each but mehhh.
6. Ran out of time while counseling and doing closure in one case.
7. Forgot to ask some pertinent questions to the presenting complaint. I still think I got the primary differential correct but still, did not have a lot of things to support it. The SP said he lied to the nurses and had a different complaint than the one listed on the doorway. I was like Gurrrll really??
8. Feel like the rest of somewhat okay, probably missed to include things I asked the SP in my PN. Oh and forgot to document some parts of the lung exam I did in my PN.
9. 3-4 hx supporting points for most of my differentials, not sure if it is enough. Any comments? At times, this went up to 5-6 for the primary ddx.

Things You Think You Did Right:
1. Formal but nice attire
2. Explained my entire physical to the SP
3. Counseled as much as I could
4. Had 3 ddx in 9 cases, 2 in 3.
5. Sanitized hands in all cases.
6. Did not use WNL for any physical exam note. I always wrote down what I did not see or hear or whatever.
7. Always took proper PMH and SH and OB/GYN if necessary.
8. The tests I ordered were overall alright.
9. Never left a PN portion blank.


MISC: I know the anxiety will not change my test result and I will still be happy if I passed and be sad if I failed, however, I am really worried about ICE and whether those two missed diagnoses could cost me the exam. Any input is appreciated and I definitely am going to update this post once I have my result.

I wildly missed the mark on at least one case and missed obvious ddxs on 2-3 other cases. It's tough to not worry about it for sure.

 

[izchief360]

Date, Test Site, Attempt #: 1/2020, Houston, 1st attempt

US-MD or US-IMG (Carribs) or Non-US-IMG: USMD

Wait time for score report: 42 days

Result on School Mock OSCE/CS and Date Taken: Didn't have one

Test Result: Pass

Study Time/Resources: First Aid Step 2 CS - went through each of the cases timed with a friend (15 min encounter, 10 minute note) over the course of 5 days. Compared notes after each case and made a few flashcards that I never really reviewed (although I do think there was value in making the cards).

Test Performance:

Initial Post-Exam Feeling: Felt fine. Felt like my prep was sufficient and the cases in the book were very appropriate compared to the real test. Some SPs were flat-affect af, others weren't afraid to crack a smile and show their pearly whites. Was happy to leave the test center. Spent the late January afternoon strolling through Houston neighborhoods with a friend and his dog.

Mistakes Made: Forgot to ask about suicidal ideation as I was going through SIGECAPS for a patient. May have used the reflex hammer with a Thor-like vigor on an unlucky patella - patient responded accordingly. Forgot to put the pt's temperature (fever) as a supporting physical exam finding for one DDx.

Things You Think You Did Right: Heart+Lungs on all, + pertinent physical exams on top of that. Washed hands in all rooms, and announced it. Asked a thorough OBGYN Hx when indicated. Did not miss PMH, PSH, Meds, Allergies, FH, SH on any patient. I was very satisfied with my notes. I'd say 80% of them had 3 well-supported differentials, the other 20% had 2.

Misc: The absolute best thing you can do is have a reproducible template that you can jot onto the paper before entering the room. I usually spent 60 seconds doing this, and the encounters went pretty smoothly because I did. Was not pressed for time in any room or on any note.
This video was absolute gold for demonstrating how I can consistently copy/paste to pull info from the HPI into the supporting findings for each DDx. This saved me a bunch of time on all the notes.

 

[Creed_Bratton]

Test Site: Houston, US-MD, 1st attempt
Wait time for score report: 2 months
Result on School Mock OSCE/CS and Date Taken: passed, way back in summer, about average performance

Test Result: Pass

Study Time/Resources: skimmed FA + about 1 week of practicing with a buddy

Test Performance: all stars to the right, ICE about 1 inch to the right of borderline, CIS 1.5-2 inches to the right

Initial Post-Exam Feeling: Felt absolutely awful. As soon as I left the center I started remembering mistakes I made - and they were numerous. Was very open to the idea that I failed it.

Mistakes Made: A million.
Forgot to do several basic and relevant physical exam maneuvers in several rooms.
Wildly missed the mark on one or two diagnoses (very obvious in hindsight).
Forgot to order several very obvious tests. Forgot to ask a few relevant history questions.
Didn't do sexual history on many patients. Forgot to ask a patient about safety at home, although it was warranted.
Felt like one SP was very cold or mad at me for some reason - tried to counsel him about smoking, but he was having none of it.
Had a couple of rooms when I had no idea about the order of my differentials - highly likely I was off with it at least a few times.
Didn't counsel everyone.
Had a very limited physical exam on some patients - in hindsight, probably due to premature closure (decided on the diagnosis within the first few minutes of the encounter and did not keep thing broad enough afterwards). Finished first in my group with one patient.
Definitely used some abbreviations in the note, although mostly tried to spell everything out.
Wrote "left side" instead of "right side" on one patient note.
In one room told a patient one diagnosis, then left the room and changed my mind entirely - wrote a completely different diagnosis on my note.
Told another SP we won't need an xray, then proceeded to order it in my note.
Remembered to ask some questions I forgot earlier and ended up asking them at the end of the encounter or during the physical exam.
Had very little supportive physical exam findings on my patient notes, most of my supporting reasons came from the history.

Things You Think You Did Right: Washed hands and cleaned the stethoscope every time. Heart and lungs on everyone. Counseled several patients. Had 3 differentials and a few reasonable tests every time. Always asked PMH, FH, meds, allergies, SH (smoking, drinking, drugs; forgot about sex), ROS. Had vital signs and mostly ok ROS each time (lots of pertinent positives and negatives, then finished with "Negative except as above". Put most of the other info I elicited in my note. I think I had decent closure for most patients, always had time for questions and got challenge questions in more than half of the rooms.

Misc: Practice, practice, practice either with FA cases or with AMBOSS. Practice typing the notes quickly (I am a slower typer, so that was definitely a concern). Also, I know it's easier said than done but try to not freak out afterwards. I hope seeing the million mistakes I made will help other folks have more faith in themselves.

 

[perrycardium]

Date, Test Site, Attempt #: Last week of February, 2020. Philly. 1st attempt.


US-MD or US-IMG (Carribs) or Non-US-IMG: USIMG

Wait time for score report: 2 months

Result on School Mock OSCE/CS and Date Taken: Mostly average on school OSCEs but then never really prepared for those.

Test Result: Pass

Study Time/Resources: 2 weeks. Skimmed thru FA CS and AMBOSS. Did 10-12 cases with med school buddies.

Test Performance: asterisk to right for SEP. 8-10 stars all the way to right for CIS. 13-14 stars all the way to right for ICE.

Initial Post-Exam Feeling: Walked out knowing I nailed at least 9/12 cases. 1 case I had no idea what happened. 2 other cases were a 50/50. Exam went by very quickly. The staff is aware that students are anxious and they were all nice and helpful.

Mistakes Made: Forgot to glove up before PE for one case, apologized mid way and fixed my mistake; patient laughed and said it was no problem. Did a thyroid exam in a case that did not warrant it. Forgot 1 cranial nerve repeatedly in 2 cases then went out and put “CN II-XII grossly intact” in both notes.

Things You Think You Did Right: Did my PE maneuvers correctly except CN as mentioned above. Forgot about previous case and went into next room with an open mind. Counseled, summarized, asked basic Hx for every patient. Asked a lot of specific ROS for each complaint. Never ran out of time on notes or encounters. Had 2 differentials on 10 cases. 3 differentials on 2 cases. Work up ordered was very basic; I always considered doing cheaper cost modality than a more expensive one.

Misc: This is just a test and there are rules and thresholds for definite pass and fail. There are certain things that are forbidden and then there is a long list of things you can mess up and still clear the exam. The test is indeed very forgiving as long as you don’t repeat mistakes on multiple cases. They expect you to have a basic idea of asking specific ROS for each problem, then be nice to your patients and follow up with a structured note that has all of the collected information. FA CS mini cases can help with fine tuning your ROS for each chief complaint.

Score release day: FSMB trick works for IMGs and USIMGs even if you haven’t taken CK yet. It’s 1am EST on day of release. Didn’t work for my brother who is an AMG. He ended up getting his score report around 11am.