Yet another post-CS freakout...

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sylvi

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So I felt ok about CS day of, but keep remembering more and more mistakes in hindsight. My top residency choice so far requires a first time pass, and I'm on the LAST day of score reporting that should occur at the latest early January. (So if it somehow got bumped into the next group, could be as late as Feb 20). Here's what I'm worried about so far:

(1) Did VERY few physical exams. Didn't do heart and lungs on everyone (though I started to late in the exam). Pretty sure I should've done a full neuro exam and MMSE on one patient and literally only did PERL & EOM. Did an absolute crap job on the maneuvers for an MSK exam.

(2) Pretty sure I literally forgot to introduce myself by name at several stations. (Just said something like "I'm the medical student on your team.") Not sure how many times this happened.

(3) Didn't write HPIs in the format shown on the NBME site (where some sections are in list form - I just did one continuous paragraph that wasn't necessarily always organized in a consistent way). I do at least think they were thorough.

(4) History and especially PE rationales for differentials were very weak and I don't think written in formal enough terminology.

(5) Forgot to council re: quitting for a smoker.

I do think I did a pretty good job of history taking, summarizing, showing empathy, knocking, asking patients how they wanted to be addressed, cuing most (though not all) physical exams, etc. I think I'm mostly worried about my straight up lack of physical exams.

Help me be less crazy in the interim! Please :)
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It sounds like you did things to show empathy and other basics like knock on the door. When you do such things, the SPs are much more on your side when grading for subjective things. Also, almost everyone forgets some things since time is so limited so you're no different from the majority of students.
 
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Sylvi, when did you take your Step 2 CS? I took mine Nov 15th and I am also having serious concerns. Similarly as you I forgot some things here and there. I forgot to counsel at least one case about smoking cessation. One of my notes lacks PMH/PSH, FH, SH, Meds, Allergies. In regard to physical exams I tried to be as much focused as I could but time limitation simply makes it impossible I could do everything perfect. So almost in every single encounter there will be something I could do better. Just can hope for passing grade .......
 
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felitix said:
Sylvi, when did you take your Step 2 CS? I took mine Nov 15th and I am also having serious concerns. Similarly as you I forgot some things here and there. I forgot to counsel at least one case about smoking cessation. One of my notes lacks PMH/PSH, FH, SH, Meds, Allergies. In regard to physical exams I tried to be as much focused as I could but time limitation simply makes it impossible I could do everything perfect. So almost in every single encounter there will be something I could do better. Just can hope for passing grade .......
Click to expand...

Nov 3rd - I mean you (and I) probably did a lot more things right than wrong. It's just nervewracking regardless because of how nebulous the grading criteria are. But hey, you're not fretting alone! :p
 
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Having HPI in list format isn't a big deal afaik. I took a kaplan prep course and they said HPI can be sentences if you want, or just spaced with commas. But for PMH they advised following a list format. OP I'm sure you did well! As long as you were empathetic and remember to wash your hands, drape your patient, etc. it shouldn't be a big deal. When I took the kaplan mock test I passed the CIS component (tho just barely), even tho I forgot to counsel every single patient.
 
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sylvi said:
So I felt ok about CS day of, but keep remembering more and more mistakes in hindsight. My top residency choice so far requires a first time pass, and I'm on the LAST day of score reporting that should occur at the latest early January. (So if it somehow got bumped into the next group, could be as late as Feb 20). Here's what I'm worried about so far:

(1) Did VERY few physical exams. Didn't do heart and lungs on everyone (though I started to late in the exam). Pretty sure I should've done a full neuro exam and MMSE on one patient and literally only did PERL & EOM. Did an absolute crap job on the maneuvers for an MSK exam.

(2) Pretty sure I literally forgot to introduce myself by name at several stations. (Just said something like "I'm the medical student on your team.") Not sure how many times this happened.

(3) Didn't write HPIs in the format shown on the NBME site (where some sections are in list form - I just did one continuous paragraph that wasn't necessarily always organized in a consistent way). I do at least think they were thorough.

(4) History and especially PE rationales for differentials were very weak and I don't think written in formal enough terminology.

(5) Forgot to council re: quitting for a smoker.

I do think I did a pretty good job of history taking, summarizing, showing empathy, knocking, asking patients how they wanted to be addressed, cuing most (though not all) physical exams, etc. I think I'm mostly worried about my straight up lack of physical exams.

Help me be less crazy in the interim! Please :)
Click to expand...
sylvi said:
So I felt ok about CS day of, but keep remembering more and more mistakes in hindsight. My top residency choice so far requires a first time pass, and I'm on the LAST day of score reporting that should occur at the latest early January. (So if it somehow got bumped into the next group, could be as late as Feb 20). Here's what I'm worried about so far:

(1) Did VERY few physical exams. Didn't do heart and lungs on everyone (though I started to late in the exam). Pretty sure I should've done a full neuro exam and MMSE on one patient and literally only did PERL & EOM. Did an absolute crap job on the maneuvers for an MSK exam.

(2) Pretty sure I literally forgot to introduce myself by name at several stations. (Just said something like "I'm the medical student on your team.") Not sure how many times this happened.

(3) Didn't write HPIs in the format shown on the NBME site (where some sections are in list form - I just did one continuous paragraph that wasn't necessarily always organized in a consistent way). I do at least think they were thorough.

(4) History and especially PE rationales for differentials were very weak and I don't think written in formal enough terminology.

(5) Forgot to council re: quitting for a smoker.

I do think I did a pretty good job of history taking, summarizing, showing empathy, knocking, asking patients how they wanted to be addressed, cuing most (though not all) physical exams, etc. I think I'm mostly worried about my straight up lack of physical exams.

Help me be less crazy in the interim! Please :)
Click to expand...
Hey! Did you end up passing? I'm in a similar boat where my PEs were VERY limited even if indicated I woouldn't do certain manuevers based on time constraints and me worrying if I'd have time to counsel the patient.
 
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Similar experience. I unfortunately listed a couple differentials on a few cases that were either just flat out wrong or poorly supported. For some reason I wanted to fill every box that day and it was probably a bad idea. Any others with similar but passing experience? I think I got the main in all but 1 wherey differentials were all crap...
 
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step2csscrewup said:
Similar experience. I unfortunately listed a couple differentials on a few cases that were either just flat out wrong or poorly supported. For some reason I wanted to fill every box that day and it was probably a bad idea. Any others with similar but passing experience? I think I got the main in all but 1 wherey differentials were all crap...
Click to expand...

I passed today, had one star in the borderline area for ICE. For 2 cases, I only had one diagnosis. For another, I didn’t list the most common/obvious diagnosis in the ddx. I made up a diagnosis (it was also the top diagnosis) on another case. One case I had a terrible second diagnosis with one line of evidence. One case I ran out of time and left off some important evidence. For each case, my top diagnosis only had 4-5 pieces of evidence max, with the other ddx having 2-3.

I will say I felt really good with at least 6 cases.
 
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