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  #1  
Old 05-14-2013
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Default My CS Errors

This is my post from another forum. I figured I've read a ton of experiences from this forum, so I'd like to share mine... This mostly lists what I did wrong.

What I did correct was:

Knocking, hand washing, asking lots of open ended questions, -- I always asked this right after getting Site, Onset, Character --- "Could you please tell me your concerns?" I felt like asking the patients their fears was important... I believe it's a major disconnect in medicine that people have hidden fears and are either holding them back, or don't get the chance to bring them up. I also asked for any questions. I told them everything we say is confidential. I told them the reason I was asking any tough questions... like sex/EtOH/ MMSE -- I told them it was a standard question and just helps me to put together a complete picture. I'm sure I did a lot of other things correctly... but you know, those are more difficult to remember than big errors.

DDx... I think I did alright, not amazing, not horrible. Some of my ordering was definitely wrong. My supporting reasoning was mostly crap I would say... That portion is really tough.

The tests I ordered were mostly right, but I know I forgot a lot of tests which would definitely be required.

The ICE portion is what is concerning me however -- here are my errors.

It all started at the beginning of the day. I practiced typing patient notes for about 2 weeks to prepare for this test, using a bullet format given on their Interactive Patient Note. Well it turns out this is a sham... on the real test, if you use bullets the remainder of the line is counted as a character for each remaining character on that line. While having to type in prose isn't the biggest issue in the world, when you've been practicing a certain way for a few weeks and have to entirely change your strategy on test day... needless to say, it's an issue that can definitely hurt you.

After that it's all downhill:

1. I ran our of time while telling the patient their diagnosis on 2 cases. I ran out of time while trying to tell the patient some closing remarks on another 3-4. Luckily for the most part I counseled during the HPI, so I was running out of time while trying to say some lame statement like "yall come back now ya heard?" Not literally, but if you've taken the test you know what I mean.

2. I was not able to complete very good physical exams on nearly anyone. Pain case, got ROM, sensation and gait, but was unable to get straight leg, or motor strength... heart case and I forgot to take femoral pulses, no JVD (getting the patient to lay back with the "5 MINUTES HURRY THE HELL UP" sound of doom playing in the back ground is a daunting task.) And a myriad of other tests which I forgot to/ didn't have time to perform.

3. Documentation, documentation, documentation. I performed SOOOOOO many tests that I didn't document in my note either due to fear, pressure, stress, anxiety or whatever adjective for pissing my pants exists. This is where I am deriving my most fear. On a case where it was absolutely critical, I did not document heart of lung tests that I performed because I was sooooo proud of myself that I remembered to perform a fundoscopic exam I was focusing on remembering to document that, then totally forgot to put CV/Lung findings... major major error. I think there were several other instances where I didn't document the critical test related to the exam.

4. A guy smoked 1PPD x 40 years... did I think this was important enough to document? Well yes, but guess what... I ran out of space because I couldn't write in bullet form and time ran out so I couldn't go back and figure out what to delete quickly enough to fit it in.

5. Pertinent negatives? Who needs 'em? Apparently not me, because I didn't list any in the DDx portion.

Well that pretty much sums up what I can remember. I have lost a lot of sanity over these idiotic mistakes I made. It's saddens me to think my career which I've dedicated hundreds of thousands of dollars and countless thousands of hours of hard work, may now be over...

As for documentation this is how I did it... Please note I didn't write all of these tests for every patient, but I did write them in this format for whichever tests I did perform. I just wanted to be as descriptive as possible, and since they don't specify well which abbreviations are acceptable I mostly tried not to risk it on too many different ones. This may have wasted some time, but better safe than sorry I suppose...

Now with that said, I forgot to document a lot of tests I actually performed... so I'm really scared about that part.

VS: T 100.1F, all others WNL
Gen: Resting comfortably in no acute distress
HEENT: NC/AT; no conjunctival pallor, fundi show no exudates, papilledema, or AV-Nicking, EOM, PERRLAI; TM shows no exudates, erythema, cerumen; Oropharynx shows no erythema, exudates, lesions, or post nasal drip (somtimes I would make an additional comment on tonsilar columns if I felt it was warranted)
Neck: Supple, no lymphadenopathy; no thyroid masses or enlargement; trachea midline
CV: S1-S2 WNL; no m/r/g; RRR
Chest: Lungs are clear to auscultation with vesicular breath sounds in upper and lower lung fields bilaterally (I always listened to 8 spots - and now thinking back, technically could have documented bronchial breath sounds in the anterior positions)
Extremities: No cyanosis, clubbing, or edema; peripheral pulses 2+ symmetric upper and lower extremities (can't remember if I listed the actual pulses I palpated - hoping I did)
Abdomen: Soft; NT/ND; Bowel sounds present and normoactive in all 4 quadrants
Neuro: CN II - XII grossly intact; Sensation intact to dull and sharp sensation bilaterally; DTR 2+and symmetric in biceps, triceps, patellar, and achilles tendons


Ok well there it is... anyone who has passed/failed, tell me how you think I may have done.
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  #2  
Old 05-14-2013
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From what you posted im pretty sure you will pass, there is a thread section here in which you can check mistakes made by fellow forum members and the outcome (with both old and new format).

Eventho ICE is hard i dont think you will have a problem with it.

By the looks of it you seem like an AMG, which is better for you... Im basing this assumption on statistics only.
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  #3  
Old 05-14-2013
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Quote:
Originally Posted by XpaezX View Post
From what you posted im pretty sure you will pass, there is a thread section here in which you can check mistakes made by fellow forum members and the outcome (with both old and new format).

Eventho ICE is hard i dont think you will have a problem with it.

By the looks of it you seem like an AMG, which is better for you... Im basing this assumption on statistics only.
Well, in fact I am an American however I am a FMG. With that said, I don't consider myself to be any better/worse than your average AMG. I ended up as FMG because I wasn't a science major in undergrad.

My step scores are above the average joe AMG... while I know step scores don't correlate to passing CS, I think there is something to say about work ethic or whatever with regards to preparation.

Point being, interaction with the patients and knowledge of what is expected in a standard patient encounter certainly wasn't the issue.


Thank you for your words though... I know I messed up on ICE, the bottom line is how well I did on my HPI I suppose. Until then I'll just continue sweating bullets lol!

The problem is it is affecting my mental health (not in a clinical way, more in a "can't focus on the task at hand kind-of-way lol.) I would take out another semesters worth of loans just to have my score back right now
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  #4  
Old 05-14-2013
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Quote:
Originally Posted by je355804 View Post
Well, in fact I am an American however I am a FMG. With that said, I don't consider myself to be any better/worse than your average AMG. I ended up as FMG because I wasn't a science major in undergrad.

My step scores are above the average joe AMG... while I know step scores don't correlate to passing CS, I think there is something to say about work ethic or whatever with regards to preparation.

Point being, interaction with the patients and knowledge of what is expected in a standard patient encounter certainly wasn't the issue.


Thank you for your words though... I know I messed up on ICE, the bottom line is how well I did on my HPI I suppose. Until then I'll just continue sweating bullets lol!

The problem is it is affecting my mental health (not in a clinical way, more in a "can't focus on the task at hand kind-of-way lol.) I would take out another semesters worth of loans just to have my score back right now
I didnt mean to offend you by saying you were an AMG, I noticed that because you said thousands of dollars.. that is all.

I didnt implied AMGs are better, I was just stating a fact regarding passing outcomes between AMGs and IMGs.. Again I dont think you will fail because you seem like a smart guy and people that fail this test either do it because they act like robots or their english completely sucks (IMG only)

I do know about the mental pain the waiting causes... I waited for 3 months to get my score back.. so i know the feeling
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Old 05-14-2013
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Quote:
Originally Posted by XpaezX View Post
I didnt mean to offend you by saying you were an AMG, I noticed that because you said thousands of dollars.. that is all.

I didnt implied AMGs are better, I was just stating a fact regarding passing outcomes between AMGs and IMGs.. Again I dont think you will fail because you seem like a smart guy and people that fail this test either do it because they act like robots or their english completely sucks (IMG only)

I do know about the mental pain the waiting causes... I waited for 3 months to get my score back.. so i know the feeling
Haha sorry, didn't mean to sound offended... I wasn't at all. Bottom line is the average american FMG isn't exactly the most amazing student. I however like to think I'm a bit above that... not bragging, just speaking to some truths about Caribbean students.

This is why I'm so sad about my performance, because I know this could ruin my career... I also know I prepared, and just performed horribly.

I have to say it is encouraging to hear someone who's been there give some encouragement! It's much appreciated!
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  #6  
Old 05-15-2013
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Thanks for sharing your experience. Dont worry much,have faith in God....Good luck for the result
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  #7  
Old 05-16-2013
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Quote:
Originally Posted by je355804 View Post
This is my post from another forum. I figured I've read a ton of experiences from this forum, so I'd like to share mine... This mostly lists what I did wrong.

What I did correct was:

Knocking, hand washing, asking lots of open ended questions, -- I always asked this right after getting Site, Onset, Character --- "Could you please tell me your concerns?" I felt like asking the patients their fears was important... I believe it's a major disconnect in medicine that people have hidden fears and are either holding them back, or don't get the chance to bring them up. I also asked for any questions. I told them everything we say is confidential. I told them the reason I was asking any tough questions... like sex/EtOH/ MMSE -- I told them it was a standard question and just helps me to put together a complete picture. I'm sure I did a lot of other things correctly... but you know, those are more difficult to remember than big errors.

DDx... I think I did alright, not amazing, not horrible. Some of my ordering was definitely wrong. My supporting reasoning was mostly crap I would say... That portion is really tough.

The tests I ordered were mostly right, but I know I forgot a lot of tests which would definitely be required.

The ICE portion is what is concerning me however -- here are my errors.

It all started at the beginning of the day. I practiced typing patient notes for about 2 weeks to prepare for this test, using a bullet format given on their Interactive Patient Note. Well it turns out this is a sham... on the real test, if you use bullets the remainder of the line is counted as a character for each remaining character on that line. While having to type in prose isn't the biggest issue in the world, when you've been practicing a certain way for a few weeks and have to entirely change your strategy on test day... needless to say, it's an issue that can definitely hurt you.

After that it's all downhill:

1. I ran our of time while telling the patient their diagnosis on 2 cases. I ran out of time while trying to tell the patient some closing remarks on another 3-4. Luckily for the most part I counseled during the HPI, so I was running out of time while trying to say some lame statement like "yall come back now ya heard?" Not literally, but if you've taken the test you know what I mean.

2. I was not able to complete very good physical exams on nearly anyone. Pain case, got ROM, sensation and gait, but was unable to get straight leg, or motor strength... heart case and I forgot to take femoral pulses, no JVD (getting the patient to lay back with the "5 MINUTES HURRY THE HELL UP" sound of doom playing in the back ground is a daunting task.) And a myriad of other tests which I forgot to/ didn't have time to perform.

3. Documentation, documentation, documentation. I performed SOOOOOO many tests that I didn't document in my note either due to fear, pressure, stress, anxiety or whatever adjective for pissing my pants exists. This is where I am deriving my most fear. On a case where it was absolutely critical, I did not document heart of lung tests that I performed because I was sooooo proud of myself that I remembered to perform a fundoscopic exam I was focusing on remembering to document that, then totally forgot to put CV/Lung findings... major major error. I think there were several other instances where I didn't document the critical test related to the exam.

4. A guy smoked 1PPD x 40 years... did I think this was important enough to document? Well yes, but guess what... I ran out of space because I couldn't write in bullet form and time ran out so I couldn't go back and figure out what to delete quickly enough to fit it in.

5. Pertinent negatives? Who needs 'em? Apparently not me, because I didn't list any in the DDx portion.

Well that pretty much sums up what I can remember. I have lost a lot of sanity over these idiotic mistakes I made. It's saddens me to think my career which I've dedicated hundreds of thousands of dollars and countless thousands of hours of hard work, may now be over...

As for documentation this is how I did it... Please note I didn't write all of these tests for every patient, but I did write them in this format for whichever tests I did perform. I just wanted to be as descriptive as possible, and since they don't specify well which abbreviations are acceptable I mostly tried not to risk it on too many different ones. This may have wasted some time, but better safe than sorry I suppose...

Now with that said, I forgot to document a lot of tests I actually performed... so I'm really scared about that part.

VS: T 100.1F, all others WNL
Gen: Resting comfortably in no acute distress
HEENT: NC/AT; no conjunctival pallor, fundi show no exudates, papilledema, or AV-Nicking, EOM, PERRLAI; TM shows no exudates, erythema, cerumen; Oropharynx shows no erythema, exudates, lesions, or post nasal drip (somtimes I would make an additional comment on tonsilar columns if I felt it was warranted)
Neck: Supple, no lymphadenopathy; no thyroid masses or enlargement; trachea midline
CV: S1-S2 WNL; no m/r/g; RRR
Chest: Lungs are clear to auscultation with vesicular breath sounds in upper and lower lung fields bilaterally (I always listened to 8 spots - and now thinking back, technically could have documented bronchial breath sounds in the anterior positions)
Extremities: No cyanosis, clubbing, or edema; peripheral pulses 2+ symmetric upper and lower extremities (can't remember if I listed the actual pulses I palpated - hoping I did)
Abdomen: Soft; NT/ND; Bowel sounds present and normoactive in all 4 quadrants
Neuro: CN II - XII grossly intact; Sensation intact to dull and sharp sensation bilaterally; DTR 2+and symmetric in biceps, triceps, patellar, and achilles tendons


Ok well there it is... anyone who has passed/failed, tell me how you think I may have done.
Great experience sharing. Thank you!

Did you put down PEs for all of the systems in each SP encounter even if some examinations are less relevant to your ddx? For example, you also perform HEENT and extremities PE in a patient with abdominal pain suspected with appendicitis?
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  #8  
Old 05-16-2013
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No I only did physical exams if I felt they were relevant... I just typed a few systems there to illustrate how I typed the PN.
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  #9  
Old 05-18-2013
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Thanks for sharing your experience, your mistakes are nothing when compared to some of my friends' but still they passed. So don't worry, I'm sure you will pass this CS....

Quote:
Originally Posted by je355804 View Post
This is my post from another forum. I figured I've read a ton of experiences from this forum, so I'd like to share mine... This mostly lists what I did wrong.

What I did correct was:

Knocking, hand washing, asking lots of open ended questions, -- I always asked this right after getting Site, Onset, Character --- "Could you please tell me your concerns?" I felt like asking the patients their fears was important... I believe it's a major disconnect in medicine that people have hidden fears and are either holding them back, or don't get the chance to bring them up. I also asked for any questions. I told them everything we say is confidential. I told them the reason I was asking any tough questions... like sex/EtOH/ MMSE -- I told them it was a standard question and just helps me to put together a complete picture. I'm sure I did a lot of other things correctly... but you know, those are more difficult to remember than big errors.

DDx... I think I did alright, not amazing, not horrible. Some of my ordering was definitely wrong. My supporting reasoning was mostly crap I would say... That portion is really tough.

The tests I ordered were mostly right, but I know I forgot a lot of tests which would definitely be required.

The ICE portion is what is concerning me however -- here are my errors.

It all started at the beginning of the day. I practiced typing patient notes for about 2 weeks to prepare for this test, using a bullet format given on their Interactive Patient Note. Well it turns out this is a sham... on the real test, if you use bullets the remainder of the line is counted as a character for each remaining character on that line. While having to type in prose isn't the biggest issue in the world, when you've been practicing a certain way for a few weeks and have to entirely change your strategy on test day... needless to say, it's an issue that can definitely hurt you.

After that it's all downhill:

1. I ran our of time while telling the patient their diagnosis on 2 cases. I ran out of time while trying to tell the patient some closing remarks on another 3-4. Luckily for the most part I counseled during the HPI, so I was running out of time while trying to say some lame statement like "yall come back now ya heard?" Not literally, but if you've taken the test you know what I mean.

2. I was not able to complete very good physical exams on nearly anyone. Pain case, got ROM, sensation and gait, but was unable to get straight leg, or motor strength... heart case and I forgot to take femoral pulses, no JVD (getting the patient to lay back with the "5 MINUTES HURRY THE HELL UP" sound of doom playing in the back ground is a daunting task.) And a myriad of other tests which I forgot to/ didn't have time to perform.

3. Documentation, documentation, documentation. I performed SOOOOOO many tests that I didn't document in my note either due to fear, pressure, stress, anxiety or whatever adjective for pissing my pants exists. This is where I am deriving my most fear. On a case where it was absolutely critical, I did not document heart of lung tests that I performed because I was sooooo proud of myself that I remembered to perform a fundoscopic exam I was focusing on remembering to document that, then totally forgot to put CV/Lung findings... major major error. I think there were several other instances where I didn't document the critical test related to the exam.

4. A guy smoked 1PPD x 40 years... did I think this was important enough to document? Well yes, but guess what... I ran out of space because I couldn't write in bullet form and time ran out so I couldn't go back and figure out what to delete quickly enough to fit it in.

5. Pertinent negatives? Who needs 'em? Apparently not me, because I didn't list any in the DDx portion.

Well that pretty much sums up what I can remember. I have lost a lot of sanity over these idiotic mistakes I made. It's saddens me to think my career which I've dedicated hundreds of thousands of dollars and countless thousands of hours of hard work, may now be over...

As for documentation this is how I did it... Please note I didn't write all of these tests for every patient, but I did write them in this format for whichever tests I did perform. I just wanted to be as descriptive as possible, and since they don't specify well which abbreviations are acceptable I mostly tried not to risk it on too many different ones. This may have wasted some time, but better safe than sorry I suppose...

Now with that said, I forgot to document a lot of tests I actually performed... so I'm really scared about that part.

VS: T 100.1F, all others WNL
Gen: Resting comfortably in no acute distress
HEENT: NC/AT; no conjunctival pallor, fundi show no exudates, papilledema, or AV-Nicking, EOM, PERRLAI; TM shows no exudates, erythema, cerumen; Oropharynx shows no erythema, exudates, lesions, or post nasal drip (somtimes I would make an additional comment on tonsilar columns if I felt it was warranted)
Neck: Supple, no lymphadenopathy; no thyroid masses or enlargement; trachea midline
CV: S1-S2 WNL; no m/r/g; RRR
Chest: Lungs are clear to auscultation with vesicular breath sounds in upper and lower lung fields bilaterally (I always listened to 8 spots - and now thinking back, technically could have documented bronchial breath sounds in the anterior positions)
Extremities: No cyanosis, clubbing, or edema; peripheral pulses 2+ symmetric upper and lower extremities (can't remember if I listed the actual pulses I palpated - hoping I did)
Abdomen: Soft; NT/ND; Bowel sounds present and normoactive in all 4 quadrants
Neuro: CN II - XII grossly intact; Sensation intact to dull and sharp sensation bilaterally; DTR 2+and symmetric in biceps, triceps, patellar, and achilles tendons


Ok well there it is... anyone who has passed/failed, tell me how you think I may have done.
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