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Old 10-09-2013
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Steps History: 1+CK+CS
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Smile For those who failed

First off, take a deep breath and calm yourself down. If anyone tells you that this isn't the end of the world and you want to punch them in the face, i know exactly how you feel. Unless they've experienced what you are experiencing right now, they WILL NOT the heart sinking feeling you get when you read the word FAIL on your score report. It's a blow to your application, no doubt. But here's some advice from somebody who was exactly where you are on June 12th at 9:05am (will never forget).

Step 1. Intropect. See your score report over and over again and see which section you failed in. If it's SEP, then you'll need to really improve your english by either watching more american movies, talking to more americans, listening to american music! Not sure what else you can do, because SEP is the ONLY section whose standards haven't been raised by USMLE over the past years.

If it was ICE, then you'll need to work on better time management and asking more relevant questions/performing relevant PEs. I messed up on the CIS part but was equally scared of failing ICE the second time around, so here's what i did. When the encounter begins...TAKE A DEEP BREATH and tell yourself that you can get through this. Then quickly jot down 2-3 differentials on your blue sheet and THEN enter the room. Remember all the mnemonics? It's possible you'll blank out right before the encounter begins, so PRACTICE as many times as you can - simple chief complaints like headache, chest pain, diarrhea, confusion/forgetfullness, abdominal should come up with 3 things in less than 15 seconds. Regardless, use 30-40 secs to calm yourself down, gather your thoughts and then go in. The SPs are pretty good at denying all the negatives with a quick NO so focus on getting the exact sequence of events in the HPI. ROS is almost always "negative other than HPI"

Patient Note - PRACTICE PRACTICE AND PRACTICE. Try to write the HPI and diagnosis first along with both pertinent positives and pertinent negatives. Yes, they ALL count. If you suspect appendicitis but there was no rebound tenderness, mention it still. The doctors grading you need to see your thought process and how you'll go about your differentials list. So leave the physical part to the end and finish the other parts first.

If CIS was your problem, then you have some work to do as well. I am an IMG whose done all rotations in the US so i very well understand how the system works. Still, i failed CIS the first time round. Here's what i did back then -
1) Sat on the stool. While it may not seem like a big deal, it resulted in repetitive loss of eye contact as i was noting everything down like a robot while the patient was talking. My focus was to get the facts right and to the point rather than building a rapport. I was still nice to the SPs but i guess they want you to be alot more dramatic during the CS.

2) Took notes like a mad man, haphazardly. Try to jot down whatever is relevant and try to retain the information instead. Things like SOCRATES atleast, try to remember that since you'll have to repeat it to the patient during the summary. Big things like Family hx, past surgeries, abortions/miscarriages etc....sure you can note them down. And when you do, ask for permission "Is it ok if i take a few notes while we talk?"

3) Didn't close on all the cases. Ran out of time doing the relevant PE. I hear that if you miss 3 closures, there is a high chance you'll fail. So the key is to TIME YOURSELF and forget the PE if times running out. Close the case, discuss atleast 1-2 diagnosis and tell them what test you'll be doing. Ask if they have any questions and you'll fetch more points than if you do percuss the belly!

4) Knocked and barged into the room. WAIT 3 SECONDS or for them to say COME IN.

5) Introduced myself without being right infront of them. Big mistake! If they aren't comfortable, they may not give you a point.

6) Summarized while washing my hands. Rookie mistake. That meant i was discussing relevant information with them awkwardly turned sideways! I think i got docked points for this as well

7) Introduced myself as a medical student and my name is hard to pronounce, so i feel like the SPs didn't remember my name by the end of it!

Ok, this post will last forever if i don't get to the point. For my second time round, i did the following - Knocked before entering, stood infront of them, smiled and cracked a joke here and there. Sat only if the patient himself/herself was in a fetal position (indicating abdominal pain), otherwise maintained eye contact and blindly wrote on my blue sheet. WORE GLOVES AND used those 5 secs to ask something like "Hows your summer coming along?" BROWNIE POINTS again. I can't tell you how theatrical you need to be because thats how we are in the hospitals and that's what SPs expect from you. Just that when we're nervous, we forget these tiny details and are always scared of running out of time.

1st time - Took it in Philly. Many IMGs around. Failed
2nd time - Took it in Chicago. Only 2 IMGs, all others AMGs with short coats. Passed

So if you feel like this is the end and you have lost all chances for a US residency, then trust me, I KNOW THAT FEELING. Never lose hope, feel free to PM me if you have any questions at all. I'll try my best to help you in whatever way i can. Wish each and everyone of you the very best for this and all other USMLE exams!
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The above post was thanked by:
50539 (12-18-2013), Bres (10-09-2013), CisternaChyli (08-14-2014), Leishmania (10-09-2013), Mitosis (10-09-2013), natalia321 (10-10-2013), water (10-10-2013)

Old 10-10-2013
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Steps History: 1+CK+CS
Posts: 514
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Thanked 138 Times in 123 Posts
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Congratulations on passing!!
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