Yet another CS freak out thread

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dellmed

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Took CS recently and walked out feeling pretty decent, but that means nothing. Here's what I have going for me:

1. Native English speaker
2. Took very thorough HPI/PMH etc
3. Knocked, introduced myself, shook hands, always washed my hands, asked for additional questions
4. Draped properly, explained what I was doing
5. Happy with patient note--very good DDX and supporting things (80% from history since most physical exam findings negative)
6. Happy with workup ordered
7. Pretty sure I got all DX, missed maybe one so 11/12 at worse


Now the bad stuff:

1. Time. In nearly every case, I tried to be as empathetic and nice as possible, so I didn't start my physical exam until the 5 minute warning was called. This lead to a cursory physical, although I feel a lot of cases didn't warrant much of a physical at all.
2. Ran out of time for summorization due to extensive counselling in one case.
3. Had a few awkward encounters, a psych case that I could have handled better
4. Documented cursory things that I didn't explicitly say I was looking for--am I going to fail because I said no clubbing or cyanosis of fingers if I didn't touch them? I dunno if that's necessary--I mean I DID see the fingers during the encounter--not like they had gloves on.


I'm sure I'll think of more, but man I do not wish this exam on my worst enemy. So stressful knowing how subjective and secretive the grading scheme is. Ugh.
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From what you posted, it sounds like you're fine.

So long as you finished your case or nearly finished your cases with substantial patient counseling and answering questions, the interview should be alright. You are correct that you get deducted points for a sloppy physical but it's generally not make or break.

Awkward encounters, depending on what you did or didn't do, often happens in the CS. As you stated, the CS can be subjective so even though you thought it was awkward, the grader might not.

Documenting things you didn't do is a big no-no and that can actually fail you. However you don't always have to explicitly say that you are looking for so and so every time you do a physical. If this is all you did wrong with a few other similar cases, then you are just nit picking.
 
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HarryPlopper said:
From what you posted, it sounds like you're fine.

So long as you finished your case or nearly finished your cases with substantial patient counseling and answering questions, the interview should be alright. You are correct that you get deducted points for a sloppy physical but it's generally not make or break.

Awkward encounters, depending on what you did or didn't do, often happens in the CS. As you stated, the CS can be subjective so even though you thought it was awkward, the grader might not.

Documenting things you didn't do is a big no-no and that can actually fail you. However you don't always have to explicitly say that you are looking for so and so every time you do a physical. If this is all you did wrong with a few other similar cases, then you are just nit picking.
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The problem I think is that there just isn't enough transparency on what is actually graded. I just don't get how this exam is supposed to be more representative than the two years of clinicals and the evaluations you get during them. Something could happen on one of these fake patients or one of the patients could just not like you and BOOM your career is over.

Hopefully I did enough to pass. Seeing a "pass" on this exam is going to be more relieving than match day.
 
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dellmed said:
The problem I think is that there just isn't enough transparency on what is actually graded. I just don't get how this exam is supposed to be more representative than the two years of clinicals and the evaluations you get during them. Something could happen on one of these fake patients or one of the patients could just not like you and BOOM your career is over.

Hopefully I did enough to pass. Seeing a "pass" on this exam is going to be more relieving than match day.
Click to expand...

Most of the information on what to expect and how to succeed is found in FA and blogs online. The CS isn't representative of what you know in clinicals and everyone knows that really smart people can fail this test.

From what I've observed, people who normally fail aren't the ones freaking out about the test when they leave but those who are complacent (n=7). They blow off the test because they think it's an automatic pass and a joke and they don't bother putting more than 2 days to study.

This is an opinion but if you fail the test, it doesn't necessarily make you look stupid but it might make you look lazy. All you needed to do was follow instructions on how to pass, practice cases, and to keep your composure.

I hope you pass as well and good luck.
 
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HarryPlopper said:
Most of the information on what to expect and how to succeed is found in FA and blogs online. The CS isn't representative of what you know in clinicals and everyone knows that really smart people can fail this test.

From what I've observed, people who normally fail aren't the ones freaking out about the test when they leave but those who are complacent (n=7). They blow off the test because they think it's an automatic pass and a joke and they don't bother putting more than 2 days to study.
Click to expand...


That makes me feel a bit better because I definitely did not blow off this exam. I studied and practiced.
 
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To give you some hope, I felt terrible when I left the Step 2 CS exam. I felt that my physical exams were very brief, since I only ever had a few minutes to complete them. And I felt that I couldn't type fast enough during the time period after the SP visit, I always ran out of time (apparently, I am not a fast typer). I even had an experience with a very moody SP...not good. I walked out of the exam feeling like I may have failed, and that I could be the one medical student from my school to fail in years..

And 8 weeks later, I found out that I had passed!!! I also found that many of my classmates felt nervous leaving the exam, and wondering if they failed, and they all passed as well.

I think you will be fine! Good luck! The waiting for the results is the worst part.
 
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The more I think about this exam, the worse I feel about my physical exam portion. In 10/12 cases, I didn't start until the 5 minute warning was sounded. Man this whole thing just sucks. Hard to concentrate on clinicals at the moment.
 
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Phloston said:
I really don't know what you're freaking out about. Sounds like you got a 22/25 on an MCQ and are worried whether you still got an A in the class.
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Haha reading a post by you reminds me of my step 1 prep. (great micro powerpoints btw)

Anyways, if I end up failing, I'm not sure what I could have changed. It feels like some secret test that you have to roll the dice on. Unfortunately, for IMGs it counts vs AMGs who can easily take and have their results back after the match.
 
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i did most of those except forgetting to drape. well, failed cis. i really don't know what it takes to pass but hopefully, you did.
 
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chichi18 said:
i did most of those except forgetting to drape. well, failed cis. i really don't know what it takes to pass but hopefully, you did.
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Good lord, i dont know what to think anymore. There were no drapes in my exam that i saw....jeez i hope not. Ugh. I am miserable.
 
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Any advice on pediatric cases? The questions are a bit different from the typical "abdominal pain" chief complaint. Any input?
 
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There's no way to know, although they have put up a "more detailed" information bulletin about what they expect in each section of the exam. Try to put it out of your mind until the result comes out. Like you said, it's us IMGs that have to worry if we fail.

skk3 said:
Any advice on pediatric cases? The questions are a bit different from the typical "abdominal pain" chief complaint. Any input?
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Thread hijack much? Start a new one, I'll put down some points.
 
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thehundredthone said:
There's no way to know, although they have put up a "more detailed" information bulletin about what they expect in each section of the exam. Try to put it out of your mind until the result comes out. Like you said, it's us IMGs that have to worry if we fail.


Thread hijack much? Start a new one, I'll put down some points.
Click to expand...


New thread
 
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at my exam the drapes were folded but were on the patient's lap so when I examed the patient's abdomen I pulled out the leg rest and draped the patient from the leg up to minimize exposure.
 
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HelpPleaseMD said:
at my exam the drapes were folded but were on the patient's lap so when I examed the patient's abdomen I pulled out the leg rest and draped the patient from the leg up to minimize exposure.
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Wait....if someone is wearing pants you need to drape their legs with pants on??
 
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i thought i was the only one with
HelpPleaseMD said:
at my exam the drapes were folded but were on the patient's lap so when I examed the patient's abdomen I pulled out the leg rest and draped the patient from the leg up to minimize exposure.
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I thought i was the only one with the problem. A few of my patients had drapes. So, How do i get points for offering them the drapes if they already have one on? I don't think they train their SP as well as they want us to believe.
 
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well count me in on spazzing out about about the CS. i took it early february and apparently scores wont be back til late april/may. it would be a terrible reason not to start residency if i failed :( shouldve taken this bad boy earlier, didnt realize it took so long to report the score back. i read some posts about people getting scores back within a month.

i dont even remember if draped all my patients. i was able to get a history, do a PE and discuss the plan with all the patients. one patient helped me a little bit by asking a particular question at the end that i missed (i actually smirked at him when he said he had explosive diarrhea during the HPI... i think i mentally checked out at this point). it seemed like all my DDx didnt have any relevant physical findings so i didnt put down much in that section.
 
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yikes! I took the exam today in Houston and it was tough... well.. not really...it was timing that was the issue. History was great, but the physical exam was so haphazard and quick it was embarrassing. I literally did a PE in 1-2 minutes (HEENT, CV, Resp, Abd) because my history took all of the 10 minutes. For the CV and Resp, all I did was auscultate. I wanted to leave sufficient time to counsel the patient, which fortunately I did. As for the patient note, it was so freaking difficult to justify my diagnosis in the PE section because there were no real findings!!! (other than pain). I had a lung case -- I will use pneumothorax, which was NOT my real case but very similar -- which was a slam dunk pneumo given history. However, during the PE, of course it was CTAB because the SP did not have a collapsed lung.... So trying to justify my dx on my patient note on the physical exam section was awkward. I had to find a clever workaround to try to word it in a way so the person reading it knows I'm not an idiot...

I honestly think I read too much of FA. The diagnoses of the cases in FA were one of many things and a little more vague. For example, one of the FA causes had "fatigue" as the CC which could have been hypothyroidism or depression. Both had positive hx findings. In the real exam, it was a slam dunk 1 diagnosis and trying to squeeze out and justify 2* and 3* diagnoses was difficult. Ugh, I sincerely hope I passed because I don't want to do this again... I heard most AMGs fail because of CIS, but if I do fail, it'll likely be due to ICE (PE and note)...

/end verbal rant.
 
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Keep me in your prayers. i take it tomorrow. Really tired of studying and not quite sure if I would ever be more prepared.
 
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Took the exams and Now, i feel terrible that I took it. Did not complete 3 or 4cases, did not call one pt by the right name and did not really feel like i connected to one of the pt. Hopefully, i pass. I just wish i had given it one more week but I had been studying for about 1month evenings.
 
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dellmed said:
Took CS recently and walked out feeling pretty decent, but that means nothing. Here's what I have going for me:

1. Native English speaker
2. Took very thorough HPI/PMH etc
3. Knocked, introduced myself, shook hands, always washed my hands, asked for additional questions
4. Draped properly, explained what I was doing
5. Happy with patient note--very good DDX and supporting things (80% from history since most physical exam findings negative)
6. Happy with workup ordered
7. Pretty sure I got all DX, missed maybe one so 11/12 at worse


Now the bad stuff:

1. Time. In nearly every case, I tried to be as empathetic and nice as possible, so I didn't start my physical exam until the 5 minute warning was called. This lead to a cursory physical, although I feel a lot of cases didn't warrant much of a physical at all.
2. Ran out of time for summorization due to extensive counselling in one case.
3. Had a few awkward encounters, a psych case that I could have handled better
4. Documented cursory things that I didn't explicitly say I was looking for--am I going to fail because I said no clubbing or cyanosis of fingers if I didn't touch them? I dunno if that's necessary--I mean I DID see the fingers during the encounter--not like they had gloves on.


I'm sure I'll think of more, but man I do not wish this exam on my worst enemy. So stressful knowing how subjective and secretive the grading scheme is. Ugh.
Click to expand...
dellmed said:
Took CS recently and walked out feeling pretty decent, but that means nothing. Here's what I have going for me:

1. Native English speaker
2. Took very thorough HPI/PMH etc
3. Knocked, introduced myself, shook hands, always washed my hands, asked for additional questions
4. Draped properly, explained what I was doing
5. Happy with patient note--very good DDX and supporting things (80% from history since most physical exam findings negative)
6. Happy with workup ordered
7. Pretty sure I got all DX, missed maybe one so 11/12 at worse


Now the bad stuff:

1. Time. In nearly every case, I tried to be as empathetic and nice as possible, so I didn't start my physical exam until the 5 minute warning was called. This lead to a cursory physical, although I feel a lot of cases didn't warrant much of a physical at all.
2. Ran out of time for summorization due to extensive counselling in one case.
3. Had a few awkward encounters, a psych case that I could have handled better
4. Documented cursory things that I didn't explicitly say I was looking for--am I going to fail because I said no clubbing or cyanosis of fingers if I didn't touch them? I dunno if that's necessary--I mean I DID see the fingers during the encounter--not like they had gloves on.


I'm sure I'll think of more, but man I do not wish this exam on my worst enemy. So stressful knowing how subjective and secretive the grading scheme is. Ugh.
Click to expand...
I am in same situation as ur. But my concern is most of casses I was just able to write 2 d\d and support them. Rest was same like u mentioned but im v worried.took exam in feb.
 
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Does any one has idea as I heard out of 12 only 10 are graded.so which 2 are not graded random r only ur worst 2.
 
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drakhuram said:
Does any one has idea as I heard out of 12 only 10 are graded.so which 2 are not graded random r only ur worst 2.
Click to expand...

Some cases are experimental. In other words, they are being tested out before being included as "real" cases. 2 cases don't randomly get dropped. People that administer the exam already know which two cases will not be included but as an examinee you don't. So you should think of every case as a "real" case.
 
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amine2086 said:
Some cases are experimental. In other words, they are being tested out before being included as "real" cases. 2 cases don't randomly get dropped. People that administer the exam already know which two cases will not be included but as an examinee you don't. So you should think of every case as a "real" case.
Click to expand...
 
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But what if u did v well on those 2 cases they will still b dropped? And what about just 2d/d with supportive findings in most of cases?
 
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Guys: Huge relief. I passed. I was so sure i would fail. I praise God almighty. Good luck on all of you still waiting.
 
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Omg passed. Holy moly it feels so good. Excellent English. High pass cis. Medium in ice
 
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dellmed said:
Took CS recently and walked out feeling pretty decent, but that means nothing. Here's what I have going for me:

1. Native English speaker
2. Took very thorough HPI/PMH etc
3. Knocked, introduced myself, shook hands, always washed my hands, asked for additional questions
4. Draped properly, explained what I was doing
5. Happy with patient note--very good DDX and supporting things (80% from history since most physical exam findings negative)
6. Happy with workup ordered
7. Pretty sure I got all DX, missed maybe one so 11/12 at worse


Now the bad stuff:

1. Time. In nearly every case, I tried to be as empathetic and nice as possible, so I didn't start my physical exam until the 5 minute warning was called. This lead to a cursory physical, although I feel a lot of cases didn't warrant much of a physical at all.
2. Ran out of time for summorization due to extensive counselling in one case.
3. Had a few awkward encounters, a psych case that I could have handled better
4. Documented cursory things that I didn't explicitly say I was looking for--am I going to fail because I said no clubbing or cyanosis of fingers if I didn't touch them? I dunno if that's necessary--I mean I DID see the fingers during the encounter--not like they had gloves on.


I'm sure I'll think of more, but man I do not wish this exam on my worst enemy. So stressful knowing how subjective and secretive the grading scheme is. Ugh.
Click to expand...

passed

good luck to all those still waiting
 
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