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USMLE Step 2 CS Forum USMLE Step 2 CS Discussion Forum: Let's talk about anything related to USMLE Step 2 CS exam


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  #1  
Old 11-04-2014
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Default Passing CS after failing first attempt

Greetings fellow Step 2 CS takers,

I want to just write a little bit on how I managed to pass the step 2 CS after failing it the first time. I've used USMLE-forums as a resource over the past few years and I would like a chance to give back.

Background:
I'm an American IMG.
I had a >240 on my Step 1
English is my 1st language
I failed my first attempt due to low CIS

1st Attempt:
Inadequate preparation time: I studied for my CS for about 2 weeks (but only 1 week intensely). I was very busy with projects and electives, and I let myself fall for the myth that the CS was just an English proficiency test. It wasn't even like I was goofing off, it was just poor overall prioritization. Watch out for that and don't shortchange the CS.
My inadequate prep caused several problems...
My interview wasn't as smooth as it could have been and I lost some time in each encounter, which hurt my CIS indirectly. If you want to be safe memorize a flowchart for each clinical problem and practice it until it's second nature--Abdo pain, dyspareunia, infant seizure etc.
I also cut corners practicing. I was cramming so I would often just jump into the hx/physical (i.e., the hard part) without going through all of the introduction formalities (how may I address you? Are you comfortable? Are the lights too bright? Can I write while we talk? etc). In the actual exam I didn't have a canned introduction which meant I started each encounter a little off balance.

Communication and Interpersonal Skills
I passed the ICE very comfortably but I failed the CIS by a wide margin. It wasn't even close. That really messed with my head. I kept asking myself how I could have bombed the communication/interpersonal skill aspect of the test when I thought I did fine? Was I arrogant or insensitive to the SPs? I certainly didn't think so, connecting with patients had always been one of my strong points. Unfortunately, the CS score report didn't offer any specific feedback regarding where I got dinged so I had to review the 12 encounters from memory.

Based on my fuzzy recollection there were a few things that stood out.
1) my time management wasn't great and I often had to short change the summary/plan at the end. Sometimes the bell would ring mid-sentence.
2) I was inconsistent in asking to do things for the patient (i.e. blanket, dim lights, offer water,)
3) I didn't always directly address the death of a loved one if it felt inappropriate or awkward: Ex: (65 year old patient) "Family Illnesses? Well my father died 20 years ago of a heart attack. Heh, my mother's doing well at 90 though"--- "Wow, 90 that's great!" vs "oh, I'm very sorry to hear about your father".
4) In the heat of the moment I forgot on several occasions to extend the foot rest portion of the bed before examining.


After soul searching and reading more about the test I came to several conclusions (some of which may seem blatantly obvious). These realizations helped me pass the 2nd time and I hope may help others.
1) Ultimately, the CS tests how well you can do the CS, not necessarily how well you can conduct a real clinical encounter.
2) Passing the CIS part means hitting all the items of the checklist, not necessarily demonstrating tact, let alone real CIS.
3) There is no way for them to give you credit for non-verbal cues, empathetic tone, word choice, pauses, clinical judgment etc. If you don't blatantly demonstrate empathy then you don't get checked off.
4) Don't neglect your summary

I think #4 is where I failed. In my training it wasn't as emphasized (which isn't a valid excuse) and I think i subconsciously deprioritized it during the encounters.

These were my mistakes. For you though, figure out what you did wrong, work on it and don't make the same mistake twice.


So after Failing...
Take a deep breath. Go to youtube. Search "You had best yourself". This gem from Full Metal Jacket's Sergeant Hartman will be your mantra for the next several months.

Day 1: You cannot reapply for a testing permit until 24 hours after your score is released. Use that surge of disappointment to your advantage and plan out your next move. Download Check4Change and practice using it. I'll explain C4C later. Make sure you have First AID CS (Which you should already have). I chose to buy a 30 day subscription to CSE videos. Honestly there's a lot of opinions on how useful these videos are. My feeling is yes, they are low production value, yes, the are imperfect but they do demonstrate what a passing performance looks like and that can be very helpful. I made it through about 1/2 of the cases during the 30 days. I also bought a 1 day Kaplan practice CS test. These fill up too so don't wait too long. You'll have to weigh the cost, which is around 1k before travel/lodging but I think it's worth it. I have severe doubts about their 5 day course but the practice test was useful. I took it about 1 week before my real test and it gave me confidence, practice and helped me clear up a few systematic errors in my game.

Day 2: Register for your USMLE token. This can take 1-3 weeks to arrive. Sorry, there's no way to expedite this process. It sucks, especially if you took your 1st attempt late in the game. Just hope that your stuff gets processed quickly.

Week 2-3: You'll get your email confirmation. Don't get excited yet. Spots fill up quickly, and unlike the Step 1/Step2 CK there aren't a million centers to choose from. There are only 5, remember? Most likely (especially if it's approaching Sept) you'll see that all the spots in every center are booked for months. This is life telling you it doesn't care about your plans. The solution is the aforementioned C4C program. Basically it's a program that refreshes a screen looking for any changes (i.e., open slots). Once again, figure out how to use this program. Have a tab open for every city and every potential month. For the next X days work next to your computer, eat next to your computer, sleep next to your computer etc. About 5-6 times a day you'll hear the annoying "Ch-Ch-Changes" ringtone that alerts you to the fact that somebody on this planet has dropped his/her CS reservation and there is a slot open. You have ~5 seconds to decide/confirm this reservation before someone else grabs it. Bellum omnium contra omnes.

Day X--Test Day. I remember being really nervous but much better prepared. My first encounter was mediocre and I ended mid sentence again but for every other encounter I controlled my pacing. I left thinking I failed it again for sure. Thankfully I didn't.


Best of Luck
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The above post was thanked by:
ainiluey (11-04-2014), cnimd (01-15-2015), dfuguet (09-21-2016), Drsouheyla (04-20-2015), kalimo87 (02-15-2015), MedicalExaminer (12-08-2014), menatallah Elgohary (11-05-2014), mihirkakara (02-15-2015), missymeihua (02-13-2015), New123 (09-21-2016), seniortaker (11-04-2014), Vfibulator (01-20-2015), yulin6369 (04-11-2015)




  #2  
Old 12-07-2014
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Hey thanks for ur post
Two questions
Did u take ur exam both times at the same center?
And I am using csevideo the 2015 videos that go with fa 5th edition iam assuming u used a later date like the older ones. I already watched em for a month n gonna go for another month but just looking for feedback. I can't afford kaplan n I'm not crazy for the us reviews. Most if the live courses are in ny I don't want to travel for a study program. I liked them the csevideos a lot it follows fa to the line I see so many people fail the first time n I don't wanna do that n everywhere I read fa is the bible for cse exam so I'm reaching out n congrats on ur pass
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  #3  
Old 12-07-2014
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No, I actually took my 2nd test in a much "harder" center. Knowing that before my test certainly didn't help my nerves but I was way beyond being picky about which center had the highest pass rates. I'm not convinced that test center shopping is all that useful even for the first attempt.

Good point about the CSE videos being old. That was one of the problems and complaints about them. I think it was 2012 when they changed part of the scoring system for the test and the videos were from before that. I don't know anything about the 2015 version but for me, the old videos were still helpful. What I wanted was just to see a passing performance and model my style after that.

First Aid is a bible. Like I said just memorize a cluster of questions for each chief complaint. If you memorize FA you'll get the Hx down. Just don't neglect the CIS like I did. Always summarize. Happy to answer any more q's if you have them.
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  #4  
Old 12-07-2014
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Hi

I am retaking my exam and I wanted to know more about the process of applying 2nd time. You mentioned something about USMLE token?

If my eligible period doesn't end until next year, can I just not reapply and wait 2-3 weeks for the Scheduling Permit?

Did you mean scheduling permit when you said "token?". Sorry if I misunderstood.
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  #5  
Old 12-08-2014
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Yes, I meant the scheduling permit. You'll have to essentially buy a new test if you are retaking it. Processing for the permit can take 2-3 weeks. I'm not sure what you mean by eligible period. If I'm not mistaken the scheduling permit is good for 1 year (unlike the CK which is a 3m block I think).
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  #6  
Old 12-09-2014
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Star C4C how to download and use

hi can someone explain how to use C4C application.
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  #7  
Old 12-18-2014
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Opaqu thanks for ur response did u spend time outside the room before u went in?
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  #8  
Old 12-18-2014
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I took about 30 seconds. I was usually one of the last ones to enter the room. I was nervous about blanking out so i used that time to generate a mental list of ddx and associated questions based on the CC prompt. I ran out of time on my first patient encounter but finished with about 20 sec to spare on most of the rest.
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  #9  
Old 12-28-2014
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Hi opaque. Thanks for your response. I'm confused I hear that at least a minute in front of the door is good when I practice at home I spend abt a min to get it all down then I follow the csevideo in detail cause if fa is the bible and cse videos is exactly in detail to fa. Fifth edition then I should be ok right.
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  #10  
Old 12-28-2014
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there is nothing wrong with taking a full minute if you budget your time. I know that's what they recommend but I don't think most people take that long. as I mentioned, one of my problems was running out of time so I didn't want to take any longer than i absolutely had to. I mean time allocation is just an issue of personal style and preference, just make sure whatever you're doing doesn't make you run over the time limit when you practice.
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  #11  
Old 01-04-2015
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Hi opaque. It's really nice of you to help me out. I've been watching the csevideo sand timing myself I think a minute is really good for it makes me push myself to write as much as I can as fast as I can. I don't know if I asked you but were tree any crazy cases that I need to be concerned abt. I'm doing all fa n csevideo cases which are the same do I need to think outside of that. Any ideas
Thanks
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  #12  
Old 01-17-2015
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To kitty Or opaque
First I want to ask for second time takers should I go to a different center?
Kitty will you need sp for fa csevideo program. I would like to discuss each case from the video action view and the fa book view Pm your interest ed
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  #13  
Old 01-24-2015
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Anybody home?
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  #14  
Old 02-03-2015
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Mommy1 what do you need and where are at in your prep. I can prep with you but I have already put in a few weeks so if your studying is advanced send me a pm
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  #15  
Old 02-08-2015
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Kitty I am gona pm you I have viewed more material. What have you done so far when is your exam
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  #16  
Old 02-11-2015
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MommmY hi. I have gone over all of csevideo 1 time so far on my second time I'm watching the videos alongside the new first aid my exam is end of February where are you at do u need help
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  #17  
Old 04-05-2015
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thanks you kitty and opaque I did my exam and followed your advice and it was a big help the advice the videos and the first aid wish me as I am waiting on my result but I think I did well the exam is just like csevideo and all my cases were the same so you guys are right in your advice thank you
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  #18  
Old 04-10-2015
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[hey mommy congrats ont taking your exam gl

QUOTE=mommy1;714450]thanks you kitty and opaque I did my exam and followed your advice and it was a big help the advice the videos and the first aid wish me as I am waiting on my result but I think I did well the exam is just like csevideo and all my cases were the same so you guys are right in your advice thank you[/QUOTE]
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  #19  
Old 04-15-2015
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thank you mitochondria and gl to you also
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  #20  
Old 09-21-2016
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Used Check4change and got a date just a few hours later! A miracle! Keep the faith friends you will get through these difficult times!
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  #21  
Old 09-30-2016
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Opaque window. Congratulations on passing your cs. I used CSEVIDEO 2015 and I did excellent on my cs. Kitty and mitochondria keep up study and you will do fine.

I don't know what c4 change is so I don't know how to use it. Sorry

Any advice on ck opaque ?
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