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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 04-29-2015
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Default My CS Mistakes

I took the step 2 cs exam in los angeles a few months ago and I found out today that I passed. The past few months I was freaking out thinking about all the mistakes that I had made, and I would constantly read these threads for therapeutic effect to ease my nerves. I always said I would post my experience here if I passed so others could see that you do not have to be perfect, or anything close to it, because I missed stuff in every case and still passed with above average performance in all three categories. So here goes...

1. Didn't ask about last menstrual period hx even though it was necessary. Forgot social history. Wrote the hpi last and was working on adding a few things when the time ran out.

2. Telephone encounter, didn't counsel patient on most obvious reason for his complaint; forgot to put important social hx data in note even though I asked it.

3. Forgot to shake hands with patient upon entering due to nerves; forgot to do and document rigidity and guarding for abd exam when it was definitely necessary; forgot to put ob hx when it may have been important

4. fine

5. fine

6. Forgot to ask about sick contacts or weight loss in a case that required it. Did full lung exam but forgot to write tactile vocal fremitus and percussion findings in note even though I did it. Put my hand on his bare back and he winced because my hand was cold. I apologized with empathy and warmed my hands together.

7. Weird case, guy wouldn't answer any of my questions about alcohol/cage questions even though it was pertinent. So eventually i just moved on. He was getting defensive and I didn't know how to respond so I just sucked up to him and eventually just moved on and got all the rest of my history and pe.

8. Encounter went well but I missed the most obvious diagnosis and it was so simple, but just didn't think about it til I was driving home at night, and said wow how could I miss that.

9. Only could think of one ddx, and so I just randomly put a second one that made no sense.

10. Put biopsy for an investigation even though it was way out there.

11. Fine

12. Fine

So these were my mistakes. What I always made sure to do was to make sure I did the diagnoses and investigations first, followed by hpi and pe last. I made sure I did PE last because I am overly detailed with my notes sometimes and sometimes I would be just finishing HPI with PE still remaining to write, and there was only like 1 minute left. So since I had memorized a template for the PE, I would hurriedly write that. However I knew DDx, investigations, and hpi were areas I had to give more thought so I juts put those first.

Also I made sure to have empathy always. This is the new direction of the test, that you really have to show real empathy and not fake empathy. I watched some usmle videos and the lady would just say "im sorry to hear that" quickly like it was a checklist type thing that the sp would give her credit for empathy. They do not give empathy points just for asking if they are okay. They want to see real empathy. Like a real patient. Most people I heard failed, were very stoic with flat affect.

Anyways this is my experience. As you can see, you don't have to be anywhere near perfect, but the things I got out that are completely essential to do, and if you do, you will pass are.

1. Show Real Empathy
2. Finish every encounter and get through all the closure and counsel. If you are getting short on time and have to cut something short, cut short the PE. Do NOT miss out on closure and counsel.
3. Make sure you finish the note each time! I advise doing the PE last and having what youre going to write for PE on autopilot because if you notice your getting short on time, you can easily throw together a focused PE onto the note in 90 seconds or so.
4. Move on from each case. Sometimes I felt like I totally bombed a case and started freaking out and let it affect me going into the next room. This then screwed up my mind set and performance in the next room. For me it took to the first break for me to sit down and control my thoughts and tell myself I had to get it together. After that, I felt more comfortable.
5. You don't have to be perfect. So practice your timing and just relax.
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  #2  
Old 04-30-2015
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Kids

Quote:
Originally Posted by ViaR View Post
I took the step 2 cs exam in los angeles a few months ago and I found out today that I passed. The past few months I was freaking out thinking about all the mistakes that I had made, and I would constantly read these threads for therapeutic effect to ease my nerves. I always said I would post my experience here if I passed so others could see that you do not have to be perfect, or anything close to it,

Thanks much for posting your experience - really has calmed my thoughts - after exam euphoria - I have started realized my mistakes. But like you I never missed closure/counseling - always explained clearly next steps we together gonna do & asked SP understanding and agreement to proceed with my plan of action. Can you please tell me what was your strategy in closure ?
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  #3  
Old 05-02-2015
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Hey

My advice to you now is to relax and try not to think about the exam

Chances are you passed, as most people who realize their mistakes in detail only remember them because they prepared so well.

Oddly enough, most of those who fail a component think they did great and don't know what they could have done to improve that component.

It's not about how many mistakes you made or making too many "fatal" mistakes (i made some mistakes i thought were fatal, including a completely wrong counseling on one of the cases in the last 15-20 seconds of the encounter!)

I was also late on my closure in 3 other cases. I finished my closure and didn't have time to even check if these patients had any questions for me.

I was so scared of these mistakes because they seemed to be enough to fail. But it's not about doing enough to fail. It's about doing enough to pass. And what I did do compensated for these things.
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  #4  
Old 05-02-2015
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Also when you put them all together it might seem like you made a lot of mistakes. But if you think about it, some of your mistakes affect your ICE score and some of your mistakes affect your CIS score. This is okay because you don't need a good overall score, you just need to not fail any component (even if all your components are borderline). If all your mistakes affected the same component, then I would be more worried you might fail that component.
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  #5  
Old 05-02-2015
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Hello everyone,

I took my Step 2 CS recently. Now, I can't give any explicit information regarding any of the cases as obviously this would violate USMLE's confidentiality agreement. But I just wanted to get some feedback from people. I had a Peds case and I did everything ok on the SEP and CIS component. I felt like my ICE component was fine along with the patient note. My patient note was fully complete from top to bottom except I only put 1 diagnosis and it was an accurate diagnosis along with history finding. I would say it would be among the top diagnoses and I put some good diagnostic studies but I missed some diagnostic studies but I put a good amount. Do you think that I would fail this case. This is freaking me out. Anyone, please help please please please !!!!!!!!! Has anyone run into this type of situation where they put only one diagnosis and the associated findings but filled the rest of the patient note fine. Kindly let me know. Thanks so much
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