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  #1  
Old 11-07-2013
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Angry Worried that I failed Step 2 CS...My Mistakes...

Took CS recently in Philadelphia and I am worried that I will fail:

Here are my mistakes:
1) Forgot to mention to do a rectal/pelvic to the patient and write it down in the note
2) Forgot to write vitals and general appearance in the note for all cases (but I did write high temperature and normal blood pressure for 2 cases under supporting physical exam evidence for the ddx)
3) Forgot to order bilirubin level for suspected gallbladder cases for 2 cases
4) I did a ROS with the patient, but never had a separate title in my HPI (I did include it in the HPI for the most part though)
5) Did a thyroid exam for 1 patient, but forgot to write it down in the note
6) For 2 MSK patients, forgot some special maneuvers
7) Missed OB/GYN history, sexual history, alcohol, drugs, and tobacco use in a few patients (probably missed a few other questions, but not sure if it was pertinent or whether I would have time for asking it)
8) I felt a flustered or like I was moving a little quick in a few cases
9) For ROS, I sometime grouped symptoms together, instead of asking them one by one
10) Only wrote 2-3 ddx for each case, but my school told us thats all you needed
11) I feel that parts of my PE were lacking or not complete...like for heart and lungs I would just write: CTA b/l, no wheezes heard and RRR, S1 and S2 heard. No murmurs heard. Forgot to write down ronchi and rales for lungs, and gallops, heaves, lifts, and thrills for heart).
12) Probably missed a few diagnostic tests that I should have ordered.

What I did:
1) I always introduced my self
2) washed my hands
3) asked if they had an questions and had a closure for each patient
4) answered the challenging questions to the best of my ability
5) explained what I thought was going on and a ddx and what tests we would order
6) shook their hands
7) was courteous empathetic for the most part (Always pulled out the leg rest, asked if they needed water if they coughed, asked how they were doing if they looked concerned or worried, etc.)
8) explained what I was doing for the physical exam for the most part
9) counseled for the most part
10) I maxed out the HPI box for almost all encounters, so I tried to include as much possible in that section
11) Tried to write as much as possible for pertinent negatives and pertinent positives for each ddx

I'm really worried that I missed some key parts of the patient encounter and patient note, do you guys think I will pass?
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  #2  
Old 11-09-2013
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bump......
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  #3  
Old 11-10-2013
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I think you did well enough to pass
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  #4  
Old 11-11-2013
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just realized...i don't think i ever summarized and misdiagnosed a few patients probably too......what'd u guys think in addition to all those other mistakes?

this wait is gonna be brutal
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  #5  
Old 11-12-2013
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Default i hope you will pass

ive seen students that have made more mistakes and passed so don't worry about your performance I am sure you will be ok, I will pray for u
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  #6  
Old 11-12-2013
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thanks...just realized...i don't think i ever summarized......what'd u guys think in addition to all those other mistakes?

this wait is gonna be brutal
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  #7  
Old 11-13-2013
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Closure is perhaps the most important part of CIS and if you managed to do that in all cases, you should be alright. That said, looking at the list of the things you missed, i don't see a cause for concern. Gluck!
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  #8  
Old 11-19-2013
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bump...another mistake lol: for one case, i wrote ovarian cyst, but didn't have time to write any supporting history or PE findings, it was my 3rd ddx...what'd u guys think? Will this cause me to fail in addition to my above mistakes?
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  #9  
Old 11-22-2013
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bump...any more comments on my performance based on my above mistakes? Will I still pass?
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  #10  
Old 11-25-2013
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Default My Cs mistakes! freaking out

hey guys..i just took my cs exam and i keep thinking about the mistakes i made over and over again. Feeling soo depressed. I studied alot for this exam but completely blanked out during my encounters as my nerves kicked in real bad. Here are the mistakes Ive made. I am sure i made many more but this is what i was able to recall! pleaase give me an honest anwer!!

1) forgot to ask occupation and didn't get proper diagnosis

2) forgot to ask LMP and it was pertinent

3) alcoholic forgot to council on alcohol intake and messed up diagnosis

4) fine

5) fine

6) fine

7)completely blanked out on history questions didn't even ask heat/cold intolerance although it was pertinent. Didnt do a proper PE.

8)forgot to ask about illicit drugs and smoking

9) fine

10) messed up challenging ques

11) fine

12) fine


Ahh freaking out...any input will be helpful
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  #11  
Old 12-12-2013
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Passed!!!!! Thank God!!!!!
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  #12  
Old 12-12-2013
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OMG IM SOO HAPPY FOR YOU!!

congratulations!!!!

I made similar mistakes as yours....your post really gave me hope...i really hope i pass.

my biggest feal was i missed questions like GYN history, sexual history, alcohol, drugs, and tobacco use in a few patients

how many pts did you forget these questions on? and also since u forgot to ask them...did u not write them on your PN aswell??
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  #13  
Old 12-13-2013
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Quote:
Originally Posted by medstar View Post
OMG IM SOO HAPPY FOR YOU!!

congratulations!!!!

I made similar mistakes as yours....your post really gave me hope...i really hope i pass.

my biggest feal was i missed questions like GYN history, sexual history, alcohol, drugs, and tobacco use in a few patients

how many pts did you forget these questions on? and also since u forgot to ask them...did u not write them on your PN aswell??
i probably forgot parts of the history on all of the patients. For example, I asked past menstrual period, but forgot to ask other parts of the GYN history. I don't think it matters if you didn't ask a full history, as long as you asked the majority of pertinent history questions.

For the patient note, I didn't include anything I didn't ask.
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  #14  
Old 04-04-2015
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Default scared!

Hey guys, I just took my cs a few weeks ago and really scared about how it went. Especially the ICE part, if someone could shed some light:

1) can't remember it
2) should've put the the 2nd ddx as first and vice versa but they were both good. 3rd ddx was way off, had one supporting point, don't know why I even put it
3) first 2 ddx pretty wrong. 3rd ddx was way off (had supporting points but only 1-2)
4) went well
5) went well
6) went ok
7) encounter went ok, ddx were also ok (i didn't have more than 2 supporting points for each ddx)
8) really wasn't sure what patient had, weak ddx and 1-2 points supporting them
9) went well, but forgot 1-2 important questions about chief complaint
10) went well, but forgot 1-2 important questions about chief complaint as well
11) went well
12) went well


Aside from that I would usually finish with 1-2 minutes to spare after closure, counseling and the basics (washing hands, proper draping, knocking, physical exam etc). I'm mostly worried about the ICE but then again who knows about the other sections, I just feel I messed up a bunch of diagnosis that I should've gotten.

Thanks for any advice
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  #15  
Old 04-29-2015
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Quote:
Originally Posted by Step2csscared View Post
Hey guys, I just took my cs a few weeks ago and really scared about how it went. Especially the ICE part, if someone could shed some light:

1) can't remember it
2) should've put the the 2nd ddx as first and vice versa but they were both good. 3rd ddx was way off, had one supporting point, don't know why I even put it
3) first 2 ddx pretty wrong. 3rd ddx was way off (had supporting points but only 1-2)
4) went well
5) went well
6) went ok
7) encounter went ok, ddx were also ok (i didn't have more than 2 supporting points for each ddx)
8) really wasn't sure what patient had, weak ddx and 1-2 points supporting them
9) went well, but forgot 1-2 important questions about chief complaint
10) went well, but forgot 1-2 important questions about chief complaint as well
11) went well
12) went well


Aside from that I would usually finish with 1-2 minutes to spare after closure, counseling and the basics (washing hands, proper draping, knocking, physical exam etc). I'm mostly worried about the ICE but then again who knows about the other sections, I just feel I messed up a bunch of diagnosis that I should've gotten.

Thanks for any advice

I think you should be fine. I just got my results back right now, and I made wayyyy more mistakes than you have listed, and I passed with no stars even close to borderline. As long as you finished your notes on time, showed empathy to the patient, you will be fine. Good Luck!
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  #16  
Old 04-29-2015
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Even People who make no mistakes Fail this exam. This is an unpredictable exam. So, stop fussing over your past and concentrate on your future exams. I hope and pray that all of you will pass this exam !
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  #17  
Old 04-29-2015
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I hope you're right, i feel i did some dumb mistakes like:
-missed ddx on 3-4 cases (may have put it as 2nd or 3rd)
-for some ddx I put some wrong supporting points
-I always put 3 ddx but I feel that may have been a bad idea, some of them were really a stretch (with 1 supporting point)

Did you feel like that at all?
Thanks
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  #18  
Old 04-29-2015
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Quote:
Originally Posted by ViaR View Post
I think you should be fine. I just got my results back right now, and I made wayyyy more mistakes than you have listed, and I passed with no stars even close to borderline. As long as you finished your notes on time, showed empathy to the patient, you will be fine. Good Luck!
I hope you're right, i feel i did some dumb mistakes like:
-missed ddx on 3-4 cases (may have put it as 2nd or 3rd)
-for some ddx I put some wrong supporting points
-I always put 3 ddx but I feel that may have been a bad idea, some of them were really a stretch (with 1 supporting point)

Did you feel like that at all?
Thanks
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  #19  
Old 05-21-2015
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I recently took CS in Chicago. At the end of the testing center, I was approached by one of the proctors and told that one of my patient encounter notes didnt save on the computer and I was told I had to do a 13th patient interview and note. They wouldnt give me any more information but said I would risk failing if I didnt do an extra case. I have heard this happening to someone else (note did not save and had to do a 13th encounter) and he ultimately received an incomplete despite doing the extra case. I really hope the NBME doesnt screw me on this. Because besides that incident I felt like I did fine. I have CK in 10 days, but all I can think about is having to do CS over again.

Any one have any thoughts or similar situations they would like to share? Thanks
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  #20  
Old 08-07-2015
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despite your mistakes i hope you have enough to pass and get by
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  #21  
Old 08-11-2015
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I hope you do pass
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  #22  
Old 11-24-2015
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Default any feedback

Quote:
Originally Posted by haroldford915 View Post
I hope you do pass
hi.. did u pass.. can you advice me on this

hello friends, i have posted similar concern before, but i need advice from someone who have passed. I have been reading peoples experiences but dont know weather these mistakes which i did in exm lead me to fail...
so 1. in one case i forgot to perform CVA tenderness which was essential to rule out DD, i am so angry on myself how ican i forget. but pt was kind of weird that freaked me out and forgot this test to do
2. i did perform tinel s and phalen s test but i totally forgot to mention i PN because that test came negative.
3. i did not add d dimer or doppler ultrasound in workup of a pt but i added CT pulmonary angio. which is more imp to confirm diagnosis,is it fatal not mentioning above thing?
4. i messed up DDs coz was not able to come up with most likely DD, there were so many possibility like more than 3 and have to put only 3 but my PE, PN, workup and encounter was good
5. is it require to perform neuro in case of depressed pt if we only do MMSE? coz i did nt perform neuro in that case
6. in one case forgot to counsel on weed but rest was fine
7. forgot to check for tremors in pt where i was suspecting hyperthyroid prob but rest i did everything
8. i was not able to add immunisation history in a case coz ran out of space and word limit
9. is it a mistake telling pt tht he might have cancer but will rule it out by workup ?

rest of the thing i did not left my PN blank, did everythng from knoking door, introduce, permission, transition sentence, making pt comfortable, drapping, putting gloves, closure, counselling, relevent question n focused exam, i mean i always did focused exm first if i hv tim then only heart and lung otherwise not... :toosad

i dnt knw wt my result gonna be.. plzzz help .. give some experienced opinion on it... m really freaking out...
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  #23  
Old 11-24-2015
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hi did u pass? need your advice on my mistakes

so 1. in one case i forgot to perform CVA tenderness which was essential to rule out DD, i am so angry on myself how ican i forget. but pt was kind of weird that freaked me out and forgot this test to do
2. i did perform tinel s and phalen s test but i totally forgot to mention i PN because that test came negative.
3. i did not add d dimer or doppler ultrasound in workup of a pt but i added CT pulmonary angio. which is more imp to confirm diagnosis,is it fatal not mentioning above thing?
4. i messed up DDs coz was not able to come up with most likely DD, there were so many possibility like more than 3 and have to put only 3 but my PE, PN, workup and encounter was good
5. is it require to perform neuro in case of depressed pt if we only do MMSE? coz i did nt perform neuro in that case
6. in one case forgot to counsel on weed but rest was fine
7. forgot to check for tremors in pt where i was suspecting hyperthyroid prob but rest i did everything
8. i was not able to add immunisation history in a case coz ran out of space and word limit
9. is it a mistake telling pt tht he might have cancer but will rule it out by workup ?

rest of the thing i did not left my PN blank, did everythng from knoking door, introduce, permission, transition sentence, making pt comfortable, drapping, putting gloves, closure, counselling, relevent question n focused exam, i mean i always did focused exm first if i hv tim then only heart and lung otherwise not... :toosad

i dnt knw wt my result gonna be.. plzzz help .. give some experienced opinion on it... m really freaking out...
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  #24  
Old 11-26-2015
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Despite all of your mistakes I hope you pass your exam
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