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.
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.
