This isn't a drill: I really think I BOMBED CS

[LandoftheJ]

Hey folks,

I challenged CS last week and I really can't get off my mind how poor my performance was. I've been treading the forums here for some hope but it really feels that everyone with "bad" mistakes seem minuscule in comparison to mine. FWIW, let me know if I break any USMLE code of conduct areas and I'll delete my post/parts of my post. What I will do is once I get my score back in many weeks I'll post how I end up- it'll help future readers.

I can't specifically think of anything, but:
1) All in all my ddx SUCKED. Like BRUTAL. This is whats worrying me the most. As in, I hardly even thought I got one. I see on the forums people saying "oh yeah, mine were decent" but I felt a lot of my cases were things I had no idea about and it was a shot in the dark. Maybe thats just for me.
2) The order of my tests didn't really follow a pattern. If, at the end, I thought of a new one, I put it at the bottom even if its less invasive.
2) Lots of cases where I came out going "*uck, I really blew that" and figured out sort of what was going after
3)My notes weren't fluent. They followed a format with new headings, but the HPI was choppy.
3) None of my patients seemed entirely pleased after
4) Forgot to counsel on a few
5) Possibly, by accident, made up PE findings (not as in the test I did, but rather what I saw) on a few patients
6) Forgot the SHx or drug allergies once in a while
7) Apparently theres a way to write down medications? I just wrote down NKDA after "Meds"
8) Forgot until halfway through to wash my hands on one encounter
9) Probably forgot a few key points in the history (definitely did).
10) included negatives or ROS things in the HPI
11) PE maneuvers were sort of awkward, not as smooth as I would of liked.

The things I did good:
Nice, I guess
Hit basic points in the PN.

I really think I messed this up. I used FA to study with a partner, had mnemonics for ROS, practiced on the PN, but I feel the whole thing went to ****.

I'd appreciate any insight from people that have passed or failed and how doomed I may be- and don't worry about holding back!

J

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[harharharp]

I felt exactly the same way, did pretty much all of those things, and passed without anything close to borderline. You're probably gonna be fine.

 

[yrmd]

Hey folks,

I challenged CS last week and I really can't get off my mind how poor my performance was. I've been treading the forums here for some hope but it really feels that everyone with "bad" mistakes seem minuscule in comparison to mine. FWIW, let me know if I break any USMLE code of conduct areas and I'll delete my post/parts of my post. What I will do is once I get my score back in many weeks I'll post how I end up- it'll help future readers.

I can't specifically think of anything, but:
1) All in all my ddx SUCKED. Like BRUTAL. This is whats worrying me the most. As in, I hardly even thought I got one. I see on the forums people saying "oh yeah, mine were decent" but I felt a lot of my cases were things I had no idea about and it was a shot in the dark. Maybe thats just for me.
2) The order of my tests didn't really follow a pattern. If, at the end, I thought of a new one, I put it at the bottom even if its less invasive.
2) Lots of cases where I came out going "*uck, I really blew that" and figured out sort of what was going after
3)My notes weren't fluent. They followed a format with new headings, but the HPI was choppy.
3) None of my patients seemed entirely pleased after
4) Forgot to counsel on a few
5) Possibly, by accident, made up PE findings (not as in the test I did, but rather what I saw) on a few patients
6) Forgot the SHx or drug allergies once in a while
7) Apparently theres a way to write down medications? I just wrote down NKDA after "Meds"
8) Forgot until halfway through to wash my hands on one encounter
9) Probably forgot a few key points in the history (definitely did).
10) included negatives or ROS things in the HPI
11) PE maneuvers were sort of awkward, not as smooth as I would of liked.

The things I did good:
Nice, I guess
Hit basic points in the PN.

I really think I messed this up. I used FA to study with a partner, had mnemonics for ROS, practiced on the PN, but I feel the whole thing went to ****.

I'd appreciate any insight from people that have passed or failed and how doomed I may be- and don't worry about holding back!

J

Did many mistakes, really thought I failed, suffered for two months. Everyone on sdn told me I should pass and I did! This exam is not meant to be an obstacle to your career, it's to make sure you can function as a physician in the future, unless there's a huge red flag or something that, in their opinion, would stop you from having a regular physician patient interaction , not writing as decent note up(not perfect), you should pass. I was borderline in CIS because I forgot leg rest, using the drape as I should have and probably asking too many irrelevant questions, I learned from my mistakes and now I notice that I'm better at patient interaction honestly, but things like that won't fail you in the exam, I truly think most people fail because of patient note and typing speed, that's at least what happened to the people I've spoken to.

 

[yrmd]

Hey folks,

I challenged CS last week and I really can't get off my mind how poor my performance was. I've been treading the forums here for some hope but it really feels that everyone with "bad" mistakes seem minuscule in comparison to mine. FWIW, let me know if I break any USMLE code of conduct areas and I'll delete my post/parts of my post. What I will do is once I get my score back in many weeks I'll post how I end up- it'll help future readers.

I can't specifically think of anything, but:
1) All in all my ddx SUCKED. Like BRUTAL. This is whats worrying me the most. As in, I hardly even thought I got one. I see on the forums people saying "oh yeah, mine were decent" but I felt a lot of my cases were things I had no idea about and it was a shot in the dark. Maybe thats just for me.
2) The order of my tests didn't really follow a pattern. If, at the end, I thought of a new one, I put it at the bottom even if its less invasive.
2) Lots of cases where I came out going "*uck, I really blew that" and figured out sort of what was going after
3)My notes weren't fluent. They followed a format with new headings, but the HPI was choppy.
3) None of my patients seemed entirely pleased after
4) Forgot to counsel on a few
5) Possibly, by accident, made up PE findings (not as in the test I did, but rather what I saw) on a few patients
6) Forgot the SHx or drug allergies once in a while
7) Apparently theres a way to write down medications? I just wrote down NKDA after "Meds"
8) Forgot until halfway through to wash my hands on one encounter
9) Probably forgot a few key points in the history (definitely did).
10) included negatives or ROS things in the HPI
11) PE maneuvers were sort of awkward, not as smooth as I would of liked.

The things I did good:
Nice, I guess
Hit basic points in the PN.

I really think I messed this up. I used FA to study with a partner, had mnemonics for ROS, practiced on the PN, but I feel the whole thing went to ****.

I'd appreciate any insight from people that have passed or failed and how doomed I may be- and don't worry about holding back!

J

Did you finish the notes on time? Did you leave anything blank? Can you provide an example of how you would write a PN? I know you're scared and freaking out but most likely your diagnosis were right or close. When do you get your score?

 

[LandoftheJ]

Did you finish the notes on time? Did you leave anything blank? Can you provide an example of how you would write a PN? I know you're scared and freaking out but most likely your diagnosis were right or close. When do you get your score?

Thanks for the advice- it really means a lot!!! As for the notes, I left nothing blank on them (other than maybe only putting 2ddx and nothing for PE findings on the dx). And my notes would be similar to what FA had, maybe not as long, such as:

56 yo M c/o of a bump. Started two days ago, acute onset, severity, alleviating, aggravating, character (the basic stuff). Maybe a few more things related, maybe a few negatives if I could, then Ros (negative except for above), pmh/psh, meds, fh, sh.

See that's the thing, is I feel my ddx really were that bad. In retrospect, I think I missed a few easy ones :/

 

[yrmd]

I think you're good on the note part, don't worry so much about the diagnosis I felt like I messed up a few as well and some I felt like I was compeletely off but I think honestly if you supported your diagnosis with proper evidence and you related the symptoms the patient had to the diagnosis you chose, you should be fine. Honestly no one knows really how this test is graded for sure, but in my opinion and according to my experience I would say you will get a pass.

 

[LandoftheJ]

I think you're good on the note part, don't worry so much about the diagnosis I felt like I messed up a few as well and some I felt like I was compeletely off but I think honestly if you supported your diagnosis with proper evidence and you related the symptoms the patient had to the diagnosis you chose, you should be fine. Honestly no one knows really how this test is graded for sure, but in my opinion and according to my experience I would say you will get a pass.

Think its adequate? I sure hope so! I think I supported them with basic enough things, no relative negatives (had them in the HPI sometimes). Then what would constitute a fail in your opinion? I hear people doing the same thing as me above and failing ICE...

Once again, I really appreciate your help in easing the nerves!

 

[OhSnaps!]

I felt the same way, yet I passed. The waiting game is the worst, good luck. Try to think of something else.


Sent from my iPhone using SDN mobile

 

[yrmd]

Think its adequate? I sure hope so! I think I supported them with basic enough things, no relative negatives (had them in the HPI sometimes). Then what would constitute a fail in your opinion? I hear people doing the same thing as me above and failing ICE...

Once again, I really appreciate your help in easing the nerves!

Honestly, it's true what everyone says. No one really knows what could lead to a fail. But in my opinion, I think you would have to have no clue about what's going on or how to write a soap note to fail. If you read first aid you should be ok I think. Focus on your rotations and other exams, it gets better as the weeks go by

 

[harharharp]

Think its adequate? I sure hope so! I think I supported them with basic enough things, no relative negatives (had them in the HPI sometimes). Then what would constitute a fail in your opinion? I hear people doing the same thing as me above and failing ICE...

I included no pertinent negatives as support in the ddx section and did fine on ICE.

 

[LandoftheJ]

Thanks everyone for the thoughtful replies. Its nice to hear that everyone makes mistakes yet seems to pass. As everyone has mentioned, I'm just going to remember that I did was FA said (for the most part) and that mistakes are inevitable- combine those two it should be ok.

I promise to keep everyone posted on my outcome!

 

[violence]

Same exact boat. Just took it few weeks ago, only got chance to do PE for one system per person, Notes were horrendous, was skipping all over the place. Was forgetting how to write PE findings, some only had 1 DDx, barely any pertinent negs, straight up forgot what pneumonia was (yeah, that level). Pleeeeeeease let me pass this

 

[Jayhawkdoc91]

1. Hey all, just wanted to see what you guys thought of the mistakes I made during the exam.
   
   In one encounter, pt told said he had an allergy to something but in my haste on the note, wrote that he had none...
   
   In another patient I wrote that lungs were clear bilaterally in haste and bc of carelessness but when I was listening to lungs, the exam was hindered by a particular sign/symptom. Otherwise I documented the exam accurately. How much would they ding me for this?
2. Performed the physical exam from the left side in many of the patients, but did do the appropriate maneuvers..how much would this affect me?
   So frustrating to think about all the little mistakes...

 

[doyouhaveaflag]

Oh man, I feel very similar to you OP and made a lot of the same mistakes. I think I really bunged up the DDx on a few, and the others I definitely put in unlikely things for the 3rd (should have just stuck to two!). There's definitely one where I have no idea what was actually wrong with her. I'm hoping that it was an experimental/non-graded one. I think I did very well on the CIS and SEP, but I'm really worried about failing the ICE. I'm pretty sure I forgot to write surgical Hx on all but one of the notes as well.

I struggled with how vague some of the complaints seemed and then the ROS negative for things you would usually associate with particular diagnoses (and I asked a very extensive ROS on ones where nothing was jumping out as the obvious answer). I guess they're trying not to lead you too strongly down one path, but some supporting evidence of one dx over another would have been useful!

I also struggled with the PE. I often couldn't tell when they were trying to fake something! As a (hypothetical) example: was that a decreased lung sound, or was my stethoscope placement just not-so-spectacular? It's possible I wrote down completely wrong findings because I mistook a faked sign.

I won't find out my score until Oct, when it may be too late to retake before match lists get made. Really concerned about it.

Please do keep us posted what your results are! If you pass, it will give me hope!

 

[LandoftheJagain]

As a quick update: I PASSED! NOTHING CLOSE TO BORDERLINE.

I'll give a more detailed reply to those still waiting/ future people scrolling these forums like I did. It was a huge sense of relief for me and I'd like to pay it forward.

 

[Juneilow]

I just wanted to piggyback and put my story in as well. After I got out I felt all right about my performance, thinking that I must at least have done enough to pass, but the long wait gives you a lot of time to think about your mistakes and I was so worried before the results came in this morning.

Here are some of my mistakes:
1. didn't wash my hands in case 1, didn't even notice until I had left the room
2. forgot to scroll down enough to write anything in the diagnostic study section
3. did not do ANY neuro exam for loss of consciousness
4. realized over lunch break I hadn't been shaking anyone's hand so only shook for the last half
5. missed one primary diagnosis entirely (like I didn't even list it) because I didn't realize until I looked it up at home that something in his history could cause his symptoms
6. missed another primary/differential because I confused the symptoms my head and thought I could rule it out
7. listed the most pressing (possibly life-threatening) diagnosis last because I missed the subtle hints SP was giving that I should
have explored more at the time
8. did same as #7 but it wasn't a life-threatening ddx
9. did not SIGECAPS at all in a patient in which it was warranted
10. physical exams were pretty generic
11. forgot the name for an orthopedic test and had to just describe it in my note
12. no doubt missed a lot of easy diagnostic options in my notes (didn't really write CBC, CMP, etc.)
13. got tongue-tied a few times when trying to answer the challenge question
14. NEVER summarized
15. didn't adequately back up most of my differentials, especially with reasons why I ranked one over the other

Things I did do that I think saved my life:
1. took a pretty thorough history for each patient, running through a mnemonic to remember what to ask
2. made sure to always start with an open-ended question (I have a tendency to want to jump the gun)
3. before I entered each room, took time to write down at least 3 differentials to help direct my questioning
4. after they explained their complaint, made sure to pause and expressed empathy in a way that (I hope) was not rushed/perfunctory
5. practiced a script for my entrance and for how to ask about social/sexual history so I could deliver them smoothly
6. gave them time for the challenge question and made sure to ask multiple times if there was anything else they had a concern about
7. was able to close each encounter by the time limit, including explaining what tests I wanted to do
8. did CVS and respiratory exam on every patient
9. offered water for a patient to swallow, turned off the lights for someone with sensitivity
-- actually I couldn't find the light switch for about 20 seconds (seemed like a lifetime in my head), so I recommend learning where the light switch is

In the end I passed with * on SEP, high performance on CIS, and (as I had expected) borderline on ICE, dipping a bit into low performance.

I think what I would advise for anyone is to practice thoroughly to build up your confidence, because a lot of my mistakes had to do with my stress/panic and it only became clear after the fact. Going through with a clear head means you can more quickly call up things that you missed, and take a step back to say "where do they want me to go with this?"

Good luck to everyone taking the test – it was a harrowing few months waiting for the results and I'm so happy it all worked out in the end.

 

[EazyE1907]

For those who passed. how did you transition into asking about sexual history. did you do the whole this will be confidential shpeel?

 

[darklabel]

For those who passed. how did you transition into asking about sexual history. did you do the whole this will be confidential shpeel?

I just jumped into it. I only asked one pt because it could've been an ectopic.

 

[EazyE1907]

I just jumped into it. I only asked one pt because it could've been an ectopic.

and u passed cs??

 

[NSV]

I grouped sexual hx with social hx unless it was OBGYN related. Something like this "Now I am going to be asking you some questions about your social hx, the questions range from alcohol use to sexual activity, I just want to reiterate that everything you say remains confidential". Ended up with 1 star all the way to the right for CIS.

If you have any other q's let me know!

 

[darklabel]

and u passed cs??

Yessir, found out this week too and nothing borderline.

 

[augeremt]

For sexual history, I didn't even bother with any transition statements and included it in OB history for women and social history for men. I used the same non-judgmental tone for sexual history as ROS to make it seem like just another question I had to ask. If a patient looked at me funny, like they were wondering why I was asking about their sex hx when they had a cold, I said that I ask everyone those questions, including 80 year-old-women. Also, when I could tell the patient was getting tired of all my questions, I would say, "I know this is a lot, but I'm almost done" or "a few more questions to make sure I'm getting the full picture" or something similar.

I scored middle of the road on CIS. No borderline or high performance stars.

 

[doyouhaveaflag]

Oh man, I feel very similar to you OP and made a lot of the same mistakes. I think I really bunged up the DDx on a few, and the others I definitely put in unlikely things for the 3rd (should have just stuck to two!). There's definitely one where I have no idea what was actually wrong with her. I'm hoping that it was an experimental/non-graded one. I think I did very well on the CIS and SEP, but I'm really worried about failing the ICE. I'm pretty sure I forgot to write surgical Hx on all but one of the notes as well.

I struggled with how vague some of the complaints seemed and then the ROS negative for things you would usually associate with particular diagnoses (and I asked a very extensive ROS on ones where nothing was jumping out as the obvious answer). I guess they're trying not to lead you too strongly down one path, but some supporting evidence of one dx over another would have been useful!

I also struggled with the PE. I often couldn't tell when they were trying to fake something! As a (hypothetical) example: was that a decreased lung sound, or was my stethoscope placement just not-so-spectacular? It's possible I wrote down completely wrong findings because I mistook a faked sign.

I won't find out my score until Oct, when it may be too late to retake before match lists get made. Really concerned about it.

Please do keep us posted what your results are! If you pass, it will give me hope!

I wanted to update for those looking for hope on these forums. I passed! Asterisks in SEP and CIS and in the middle of the white for ICE.

Clearly how you feel after this exam does not predict actual performance.