Worried about CS -- took it already

[theunderdog]

Took Step II CS few days ago. I know over 97% of AMGs pass, but I can't stop worrying. As the days go by, I keep realizing how many mistakes I made.

First, for 4 patients, I did a CV exam in the room. But when I got out, I completely forgot to document it on the progress note for these 4. Good thing all these patients were non-cardiac related. On an additional patient, I left the entire physical exam section blank by accident.

Second, because I hit the character limit several times, I couldn't squeeze in some vital information. I've always been an excellent progress note writer, but the character limit is ridiculous. I included every single possible detail on the physical exam... extraneous stuff doesn't count against you... but does it?

Third, I missed some key differentials for several patients. HIV being one of them. And because I missed the differential, I couldn't order those related tests on the workup.

Should I be worried? Did anyone else who made such catastrophic mistakes like stupid me end up passing? It's going to be a painful 2 months of waiting.

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[lanzarlaluna]

I completely understand how you feel. I'm particularly worried about the ICE component. I really feel like I bombed this thing. Yes, many people feel this way and still pass, but I'm still going to feel sick to my stomach until mid-December.

 

[tarlovcyst]

96% of American MDs pass, while 87% of all others pass... all 1st attempt.

24 people take it each day at a center, given that there's only one session a day. That means out of 4 days worth of students taking CS, only 4 American students fail. On a different 4 days worth of students taking CS, 13 of all others fail. That's actually reassuring.

Everybody makes mistakes on this test. Stupid or not, I'm glad the test is pass / fail.

It sounds like you didn't make the collossal mistakes. If you forget to wash your hands on even one patient, you fail the entire CS. I never learned to "properly" drape the patient in medical school, but it's emphasized greatly on CS. If you even fail to drape a patient, the consequences are great.

Anyway, don't worry about the test. You'll probably get your result back before 2010 begins. If you pass, it'll be a nice way to kick off the year.

 

[thesauce]

Do you really fail the entire CS if you forget to wash your hands once?

I used gloves instead, and I'm pretty sure I did it for everyone, but I'm not 100% positive. Man, that's a steep penalty!

 

[tarlovcyst]

Do you really fail the entire CS if you forget to wash your hands once?

I used gloves instead, and I'm pretty sure I did it for everyone, but I'm not 100% positive. Man, that's a steep penalty!

You could either wash your hands or wear gloves. Either is fine.

It depends on how lucky you are. Only 10 of 12 are scored. I had 2 chest pain cases and 2 fatigue cases. I'm assuming only one of each will be scored.

Washing hands is a major component of one of the three components used in passing CS... unfortunately.

 

[harmnot]

I just recently took cs and am feeling the worst I have ever felt in my life. I have a feeling that I may have failed but I won't know for certain until late December. My question is should I fail, is 2010 match over for me? Not that I can even find an early date to re-take cs but I would have to wait until the results come in first before reapplying right? I have 15 interviews set up and I just don't want to bother even going to them at all...what for if I may end failing...

 

[anestylet]

you can't help but worry about it. i passed and heres all the mistakes i made
1.right before walking into room 8 i realized i had been forgetting to do the summary for the patient
2. did brief CV, resp, GI (2 min max for all)exams on almost everyone. no eye, ear, mouth although it was probably indicated on someone haha
3. felt like i was totally missing something from the way the patient was acting in 2 encounters.
4. rushed to do the exam on a couple people, sweaty large hands didnt fit well into the gloves and as i was pulling them on the cheap vinyl snapped and it took me a sec to decide but in the end i said forget it and just examined with a 1/2 covered hand haha.

as long as you said "im sorry for your loss or that must be difficult for you" when it seemed moderately appropriate and can take a competent hx (we're not talking about winning the IM clerkship model H&P here) then you'll be fine.
4.

 

[harmnot]

I did not do a complete H&P on some patients. Some of the patients looked at me like I needed to ask more questions. Other than that...as if that isn't enough to fail me...I did decent on everything else...I think. Am I doomed?

 

[Scorcher31]

Anestylet I just wanted to thank you. I had just taken the comlex pe which is similar to the usmle cs and was also very anxious about how i did. I made some mistakes on every patient. Some were larger than others, but nothing dangerous or improper by any stretch of the imagination. Your comments are really going to help me chill out a bit till Jan. when I should get my grade. It's nice to hear that there were other people who made multiple mistakes on most patients, some more than minor mistakes and still passed.

 

[harmnot]

Okay, just remembered another one: how bad is the damage when the SP gives you that look of you need to ask more question

 

[ieatmop]

...If you forget to wash your hands on even one patient, you fail the entire CS...

Long time lurker, first time poster

I just took CS and am freaking out as much as anyone else. I just wanted to correct this bit of misinformation. I have spoken to numerous people who have passed, both residents and fellow M4s, and many of them have said that they forgot to wash their hands on a few of the patients and they still passed.

 

[DrTennis]

Okay, just remembered another one: how bad is the damage when the SP tells you "You need to ask more questions"

They actually told you this? I didn't think they're allowed to give you hints/cues like that. Did you go ahead and ask more questions like the SP told you?

 

[harmnot]

They actually told you this? I didn't think they're allowed to give you hints/cues like that. Did you go ahead and ask more questions like the SP told you?

I have heard of SP giving looks to students like they should be asking more questions or if things don't appear right.

 

[Blesbok]

How bad is it to test pinprick/toothpick without warning that it is going to hurt? I told the pt I was going to test if she had normal feeling in her foot. I poked her lightly and she said ouch. I asked if it hurt and apologized after saying that I just needed to make sure she had normal feeling in her feet.

 

[thirdangel]

My CS was a disaster.

1. I didn't finish on time for most of the cases and for 2 or 3 of them a proctor came in to get me just as I was trying to close.
2. The bed was stuck and I did everything that I had practiced on the table before the exam started and it still wouldn't budge. As I decided to move on, the head of the table suddenly dropped. If the SP didn't really have a headache then, she sure did after I was done!
3. I ran out of time to document a neuro exam in the patient note on a patient with a neuro complaint.
4. I also ran out of time to completely document my differential and diagnostic tests on 1 case.

Needless to say, it was a nightmare waiting for the results, but I passed.

Good luck to you!

 

[45408]

2. The bed was stuck and I did everything that I had practiced on the table before the exam started and it still wouldn't budge. As I decided to move on, the head of the table suddenly dropped. If the SP didn't really have a headache then, she sure did after I was done!

that's awesome

 

[thirdangel]

that's awesome

Sure, NOW it is a little bit funny, but I am still completely horrified by that incident!

 

[drmom33]

My CS was a disaster.

1. I didn't finish on time for most of the cases and for 2 or 3 of them a proctor came in to get me just as I was trying to close.
2. The bed was stuck and I did everything that I had practiced on the table before the exam started and it still wouldn't budge. As I decided to move on, the head of the table suddenly dropped. If the SP didn't really have a headache then, she sure did after I was done!
3. I ran out of time to document a neuro exam in the patient note on a patient with a neuro complaint.
4. I also ran out of time to completely document my differential and diagnostic tests on 1 case.

Needless to say, it was a nightmare waiting for the results, but I passed.

Good luck to you!

Thank you for sharing, this gives me some hope, I seemed to have made the same mistakes (minus the table incident) and more, and am just so anxious waiting for my scores, it's killing me!

 

[Knight_MD]

How catastrophic is forgetting to withdraw the "leg rest" out of the bed for one patient, even though the patient ASKED FOR IT. I didn't understand her and just covered her legs even more....

Also, how FATAL is forgetting to mention an important drug allergy in the PN, which could affect treatment?

Coz, yeah... among many other things, those two were the biggest.

 

[Saladin MD]

How catastrophic is forgetting to withdraw the "leg rest" out of the bed for one patient, even though the patient ASKED FOR IT. I didn't understand her and just covered her legs even more....

I just took the CS and forgot to pull out the leg rest on about 4-5 patients lol. I only did it when they asked. But honestly, I can't imagine that would be "fatal."

Also, how FATAL is forgetting to mention an important drug allergy in the PN, which could affect treatment?

Doubt it's fatal...but again haven't gotten my result yet. I just don't think anything is fatal because you can fail a couple stations and still pass overall.

 

[theunderdog]

I also ordered a million things on the diagnostic workup section of the progress note. I definitely order more than 5 tests, since I grouped them together... like bloodwork, imaging, etc. I ordered everything possible to rule out my 5 differentials.

Anyone else do the same?

 

[theunderdog]

Took Step II CS few days ago. I know over 97% of AMGs pass, but I can't stop worrying. As the days go by, I keep realizing how many mistakes I made.

First, for 4 patients, I did a CV exam in the room. But when I got out, I completely forgot to document it on the progress note for these 4. Good thing all these patients were non-cardiac related. On an additional patient, I left the entire physical exam section blank by accident.

Second, because I hit the character limit several times, I couldn't squeeze in some vital information. I've always been an excellent progress note writer, but the character limit is ridiculous. I included every single possible detail on the physical exam... extraneous stuff doesn't count against you... but does it?

Third, I missed some key differentials for several patients. HIV being one of them. And because I missed the differential, I couldn't order those related tests on the workup.

Should I be worried? Did anyone else who made such catastrophic mistakes like stupid me end up passing? It's going to be a painful 2 months of waiting.

I was the OP for this thread. Worried out of my mind for 8 weeks with a bunch of Houston folks.

Just if anyone was curious, I passed. So yes, you can make very big mistakes and pass. I wasnt even close to failing, according to my performance report.

 

[Hector55]

thanks bro we appreciate it. I'm just spooked that i failed it again since it is taking so long tocom back. Last time it took them till the last day to tell me i failed.

 

[InternationlDoc]

Long time lurker, first time poster

I just took CS and am freaking out as much as anyone else. I just wanted to correct this bit of misinformation. I have spoken to numerous people who have passed, both residents and fellow M4s, and many of them have said that they forgot to wash their hands on a few of the patients and they still passed.

Amen. I was freaking out till I read this - WTF?! forgot to wash hands once and failed?! who says that? that would be super unfair.