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Old 06-19-2013
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Question Failing ICE component of the CS

Any specifics on what would cause someone to fail the ICE portion of this test.
Mostly those that failed seems to have failed that part.
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Apart from the usual suspects like incomplete/incomprehensible PNs & wrong/incomplete system exam, the only thing I can think of is that they didn't do the PE right.
For example. in order to get points for chest auscultation you should listen for the full cycle (inspiration+expiration) at each point. Many people do it in a hurry and think that they did it right but they didn't get any points for chest exam.
Also, for heart/abd auscultation you must listen for 3 seconds at each point to get points.
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I agree with Novobiocin.

To see in which component IMGs usually fail check this poll
For IMGs who failed the exam, in what component did you fail?

To read the definition of each component check this
Step 2 CS Components Definitions

-
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Old 06-19-2013
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oh ok i see what you are saying. I keep seeing that people think they failed ICE because they didn't close or couldn't answer challenging questions? i thought that was part of the CIS grade?
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Quote:
Originally Posted by skyline24 View Post
Any specifics on what would cause someone to fail the ICE portion of this test.
Mostly those that failed seems to have failed that part.
Soon you will become a nocturnal human being with all these thinking


REASON WHY PEOPLE FAIL ICE;

not having a good PN that a physician, or resident who reads it would understand.

Not justifying your DD,

Lying on your PN

incomplete PN

Faking your Physical Exam

and last but not least, not asking any question related to your DD.

You should ask minimum 6 questions related to the issue,

Example:

Chest pain [Did you have palpitation, do you have tightness in your chest, shortness of breath, fever, nausea, what makes it better, what makes it worst, does it radiates anywhere] but most importantly where is your pain.

Or

Vaginal Discharge-- {what colour is your discharge, do you have an itch, history of STD if yes did partner get treated, Consistency, Volume, any wearing pad, any blood in it, do you have an rash, urinary changes, abdominal pain, WOmen health all of it]
any some more in both as above.

also not asking enough questions regarding to the issue/CC


and everything NOVOBIOCEN said
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shima did u take this exam already?? you seem to be a pro at all these questions.
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Quote:
Originally Posted by shima View Post
You should ask minimum 6 questions related to the issue,
Correct me if I am wrong shima but there is no longer a history checklist.
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Quote:
Originally Posted by skyline24 View Post
shima did u take this exam already?? you seem to be a pro at all these questions.

My husband took it , he had so many , so many mistakes, he cried 1 time, he jsut wanted to pass, and he passed with high perforamnce

his mistakes piled more than yours.


I would tell you if you failed or not.
No sugar coating, trust me


Look in every case the ICE has 45 points.
the other section like CIS has 20-25 points depending on the case,
the SEP has 5 section.

you need to pass all section by 65%. as per any other exams in USMLE.

Now

Reason why you would fail that are in my list , are not what you have mentioned, maybe if you come up with something more, I can help you.

Also I have noticed everyone tends to make the same mistakes as everyone else.
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Quote:
Originally Posted by Novobiocin View Post
Correct me if I am wrong shima but there is no longer a history checklist.

you are correct, but I am saying if you do not at least ask 6 questions, how can you justify your DD.

I say 6 because for every case there is like 6 Associated sysmtoms, or associated question to ask in order to either justify something or rule out something out.
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Shima i sent u a PM
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Quote:
Originally Posted by skyline24 View Post
Shima i sent u a PM
I send one back
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I passed 1 week ago , i can tell you stuff that i made which i think was correct.

For physical exam - do a proper one, dont try to make it quick otherwise u wont get credit for it.

they mentioned some examples above.

For PN - for differential diagnosis - try to be as accurate as possible when explaining your DD - dont put - Peptic ulcer disease - be more specific - write for example - Gastric peptic ulcer , or Duodenal ulcer.

never abbreviate in differentials.

Use appropriate abbreviations in History section and try to be as descriptive as possible. I suggest you focus on your speed of writing. I ran out of space during the exam

Do NOT forget your workup tests.

DO NOT forget to write your physical and history findings for each differential.

for PE section - u can copy paste the vital signs and write something about the General appearance. Always describe the General appearance in every case.
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Old 06-20-2013
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Quote:
Originally Posted by shima View Post
you need to pass all section by 65%. as per any other exams in USMLE.
Where did you saw that percentage? The guys in ximedus use 75%, e.g, they grade each component with a maximum score of 4 and for you to pass their simulated exam you need to get 3 out of 4 (75%) in each subcomponent..
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Quote:
Originally Posted by shima View Post
Look in every case the ICE has 45 points.
the other section like CIS has 20-25 points depending on the case,
the SEP has 5 section.
you need to pass all section by 65%. as per any other exams in USMLE.
How do you know these numbers?
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Quote:
Originally Posted by Sadde View Post

never abbreviate in differentials.
Some abbreviations are perfectly acceptable in DD e.g. RA, SLE etc (Source Kaplan CS course).
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Quote:
Originally Posted by shima View Post
Look in every case the ICE has 45 points.
the other section like CIS has 20-25 points depending on the case,
the SEP has 5 section.

you need to pass all section by 65%. as per any other exams in USMLE.
After recent changes, now CIS has 40 points (fixed) and ICE has about 30 (the points varies between the two major components of ICE i.e. PE & PN depending on the case). SEP has 5 points as before. (Source Kaplan CS Course).
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Quote:
Originally Posted by Novobiocin View Post
After recent changes, now CIS has 40 points (fixed) and ICE has about 30 (the points varies between the two major components of ICE i.e. PE & PN depending on the case). SEP has 5 points as before. (Source Kaplan CS Course).

but is pass rate 60% or 65%
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Quote:
Originally Posted by shima View Post
but is pass rate 60% or 65%
Above 65% for ICE
Above 75% for CIS
Above 90% for SEP
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Quote:
Originally Posted by Novobiocin View Post
Above 65% for ICE
Above 75% for CIS
Above 90% for SEP
This seems about right.
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Quote:
Originally Posted by Novobiocin View Post
Above 65% for ICE
Above 75% for CIS
Above 90% for SEP
I understand,

so why is

XX{XXX } in SEP a pass. this is 60%. or is over the {XXXXX} 90%.

Because I seen XX{XXX } pass but XXX{XX } fail in SEP
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i think it's ok to abbreviate some things in the ddx...

like COPD, TB..etc. i wouldn't abbreviate PE bc that could be either pulmonary edema or pulmonary embolism.
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what does the { } mean? borderline area?
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Quote:
Originally Posted by skyline24 View Post
what does the { } mean? borderline area?

yes borderline,
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Quote:
Originally Posted by shima View Post
I understand,

so why is

XX{XXX } in SEP a pass. this is 60%. or is over the {XXXXX} 90%.

Because I seen XX{XXX } pass but XXX{XX } fail in SEP
I have no idea how to interpret this......
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i agree with novobiocin.
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Quote:
Originally Posted by Novobiocin View Post
I have no idea how to interpret this......
Assuming it is true that you need 90% in SEP (which I dont know if it is), borderline would be somewhere around 90/starting at 90%.
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Assuming it is true that you need 90% in SEP (which I dont know if it is), borderline would be somewhere around 90/starting at 90%.

I have personally Seen XXX{XX } Fail, and XX{XXX } pass.
but no idea, maybe that means 90%
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Quote:
Originally Posted by shima View Post
I have personally Seen XXX{XX } Fail, and XX{XXX } pass.
but no idea, maybe that means 90%

I don't know, the only score report I have seen is my own
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Old 06-22-2013
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I'm sorry to hear about this! I am absolutely fed up with this system. They provide more feedback for your step 1 exam than the CS, which doesn't seem fair. Wish we could go back to the days where the CS motto was "speak english and you pass." That couldn't be farther from the truth from what I've seen.
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Old 06-22-2013
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Please help me Shima, or anyone else for that matter. I think I failed my Step 2 CS. Here are my errors:

1) I completely bombed 2 of the cases. There were 2 lightheaded cases, but I didn’t have time to do even a Neuro or HEENT exam on them. I only did cardio, pulm, and extremities, and then did my closure for them. Ironically, both of these cases were the same chief complaint, so I suspect/hope that one of them is experimental and wont count.
2) I draped some of the patients incorrectly for abdominal exams. For example I pulled the gown down completely, exposing the chest.
3) I didn’t summarize the H&P for ANYONE. I did a strong closure, and explained my workup, but never did a summary.
4) For pre-diabetic patient, I didn’t counsel him on food, I didn’t check his sensory on exam, and I didn’t do a fundoscopic exam. I also didn’t order an albumin test on the workup. I did cover his primary disorder though.
5) For cervical disk herniation, I wrote down the diagnosis as impinged nerve. I don’t know if they accept non medical terminology.
6) I forgot sexual history for a couple of patients.
7) I forgot to ask one of the female patients about her menstrual cycles. I don’t think it was related to the diagnosis, but still.

I think the rest of the exam went well. I did the standard things correctly, wash hands, use patients name, respectfully spoke, discussed smoking/drug/sex issues. I did a closure for everyone, and never ran out of time. I believe I got 10/12 diagnoses right, and guessed on those 2 lightheadedness cases. I'm American so English isn't an issue. My main concern is the two cases that I bombed, and the draping issues for the abdominal exam. Am I guaranteed to fail?? Please help!!
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