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Old 04-25-2014
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Default USMLE CS failed then pass experience and advice

All glory and thanks to GOD and GOD alone to whom I know that I have passed this exam in my second attempt. My first promise after passing was to pay back some of what I owe to GODís mercy and try to alleviate some of the worries that this exam is causing to some of you who are waiting for the result and for the ones who didnít make it and failed since I exactly know how the feelings are and I really donít wish it for anyone to go through like I did. I couldnít study or concentrate on anything else up until I got my passing result. I will try to put my whole experience before you without any discussions about the cases. I am also going to attach both of my score reports for comparison that might add an additional help to see where I was standing and what I did differently in both attempts and how it affected me positively or negatively.
I took the exam first on June 7th, 2013 and second on March 17th, 2014 both in Chicago. I did practice with live partner all along in my first attempt and only online using skype for the second attempt and only had live partner for 4 days before exam.
In my first attempt as you can see from my report, I failed in the ICE part of the exam, which I already knew before getting the results due to bad patient note write up. In my first attempt I did everything that they asked us not to do in the latest nbme update about how the patient note should be. I had non-medical terms for some diseases, I provided some to almost no support for what the differential diagnosis would be in a lot of diagnosis and didnít prioritize differentials according to the most likelihood. On top of all of this I had a very bad keyboard typing with numerous spelling and grammar mistakes ( I guess I didnít have to say this since you can notice it here yourselves, lol), since English is my second language, and caused a misunderstanding to what I was trying to say in my notes. What I did differently is exactly the opposite of what I have done in the first attempt and the result as you can see in my report, which is a huge improvement and pass. Although I passed comfortably in ICE, I still made a lot of mistakes:
-not asking some relevant questions in most of the cases, but I think it didnít affect me since it was only important to role out other diseases and not affecting the ability to be able to diagnose the presenting complaint. However, I am sure i was marked down for it.
-forgot to do many relevant physical exams, like eye, abdominal or inguinal lymph nodes check, when all where relevant to the case in almost 5-7 cases and forgot to do the whole neuro exam in 2 casesand whole abdominal exam in one case and it was important( for example in one case the only thing I did was neck and reflexes exam and thatís it)
-wrote somethingís that I didnít do in 2 cases, things I forgot to do and remembered while writing the note.
-had supporting evidence in the history of the differential diagnoses without writing it down in the hpi section in 2 cases, since I wrote dd first when I wrote my note, then work up then hpi then physical exam to be last.
- didnít write some things I asked about in my patient note in almost 3 cases and it was relevant to the diagnosis that I come up with.
-Only wrote positives in my differential diagnosis supporting history and physical, no pertinent negative at all. But I had a lot of pertinent negatives in my HPI section.
-while writing one note I realized when the time was over and I scrolled down to hit submit that I didn't write any work up even though i had time to do it, I screamed and everybody was looking at me. They realized that I made big mistake. i just didn't do it and don't know how it happened.
The almost failure in CIS, and what I think the reasons are due to the following:
-not discussing the differentials and work up with the patient and no counseling at all in 2 cases since I was so anxious and confused in my first 2 cases, just walked out of the room, can you believe this! Did it correctly in my first attempt for all cases.
-even though I felt I was Rushing the physical exam in almost 3-4 cases I still had so many physical signs. it was worse in my first attempt with over the speed limit in almost all cases where I had no physical signs, I guess it was my fault since I didnít give the patient time to show me the sign.
- knocked on the door and rushed into the room. Was more relaxed in my first attempt and waited for moments before going in.
-I cant remember exactly but I think I didnít call 2 patients by name ( I just forgot) and made a mistake in one of the patients name as I walked into the room and he told me that this is not his name and have to look into the info paper in the room to read his name, and most of the cases I walked into the room calling the patients name by reading it from my note and not memorizing it before entering the room. No problem in that in my first attempt, where I memorized the patient name and said it correctly before entering the room.
-Didnít explore any of the patients implied concerns as its being tested and I only realized why almost all of them doing what they did. Well I should have known that I am in a test and being tested on it. This aspect wasnít even tested in my first attempt, thats why I over looked it. itís a new thing. I still answered their verbal concerns.
-Told one of the patients that he might have cancer(a big no no) then apologized and explained that we just have to role it out. Didnít have that in my first attempt.
-didnít summarize in 2 cases but when I did summarize almost all of them gave me extra info. I Almost didnít summarize at all in my first attempt, may be once or twice.
-left the room with at least 2 minutes to spare except for 1 cases where I finished on time.
I was able to do the same in SEP with English being my second language.
Final Advice:
For you not to only pass but also do great and be comfortable in making sure that you have passed do the following and this what I would do If I have to take it again:
First, understand what they are testing and this is done by practicing FA and analyzing what the NBME have recently posted on their website on how the CIS and ICEare tested and what are they looking for to pass. Doing this, which I didnít do, will make you understand and be confident about how to study and what to ask and how to write your patient notes correctly while practicing and will grant you a confident and comfortable first time pass that I couldnít do myself because it was posted after I failed, even with that I failed to analyze it correctly for the CIS section. Study and analyze the mini cases in FA, its extremely important and will help you make the diagnosis in the room in no time and role out defferentials and only do focused exam.
Second, Practice, practice and practice with live partner if you can by using FA book which is a must but not enough for CIS as they are testing new things and have developed new materials which you can find in nbme website. Only do focused physical exam, thatís what I did. For example, you donít have to do heart and lung in joint pain case or abdominal exam in a neuro case. Look on line for how the supporting history and physical exam finding look like in the patient note.
This is my experience to the best of my allowed capabilities. I wish all of you the best of luck and all the success in your lives and if this post have made you feel better and/or directed you to be better I think I have got my reward from GOD since he is the connection between us. All the best.
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USMLE CS failed then pass experience and advice-cs-1.pdf   USMLE CS failed then pass experience and advice-cs-2.pdf  
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The above post was thanked by:
amen (04-26-2014), coronary (11-18-2015), Heparin123 (04-25-2014), JLY7 (04-26-2014), MOG247 (04-25-2014), Oncology_freak (04-29-2014), spaduri (04-25-2014), Torm2 (05-02-2014)

Old 04-25-2014
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Well done for passing!
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Old 04-25-2014
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congratulations on passing ,do you think 1 month prep is enough for IMG ?
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Old 04-25-2014
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Thank you for giving your experience. Did you write PN during taking history? or just memorized what patient told you. Does writing some notes during PE is time-wasting?
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Old 04-26-2014
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Thanks MOG247.

usmle1: Thanks and if one month is enough is a broad question and I don't think anyone can answer this question for you since everybody is different and I think you should be able to assess yourself and see where you stand to be able to answer this question correctly and only then decide to take the exam or not. I hope this helped.

peymand83: You are welcome, I am glad to help. I took notes while taking history and for sure its going to cost you some time and points for eye contact, but still doable if you done it correctly and only wrote without talking and if you where talking don't write. I was able to do that with at least 2 minutes to spare in each case except one where I finished on time. I hope this helped.
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