Ivan Wudexi USMLE Step 2 CS Experience



I promised myself that I will write my experience if I passed CS. So here it is! this is for people who are anxious about their performance after the exam. I remembered leaving the CS exam room feeling like I was not performing my best. My performance was borderline on both ICE and SEP, (ICE was worst), passed with high performance (*) on my CIS component.
Things that I recognized was not well done on my examination:
1. In one psychiatry cases, I was so thrown off and I forget to ask the PMH to the patient. I could not put any PMH on my patient note as a result. I did not believe I satisfied the patient, but I was nice to the patient. (i remember feeling that I failed the patient encounter after I leave the room).
2. I added 3rd diagnosis that is a little bit far off from the presenting complaint in one case.
3. I asked the patient to repeat their answer in at least 2-3 encounters.
4. I had two cases where I put the most likely diagnosis in the 2nd ddx column (just realized after the exam).
5. I forgot to put some important physical findings into the supporting evidence column.
6. In almost all cases, I felt that the patient was not very satisfied with my performance (they do not smile to me much I feel)
7. forget to ask about weight changes for most patient encounter. there is one patient that I should have asked about weight changes as it is related to her disease but I did not.
8. Missed to do one important physical examination for a patient. but also I skipped on many physical examinations due to time constraint. I just did a very focused physical exam. like when a patient has abdominal pain, I only did abdominal exam.
9. I remembered in one case where I explained to fast about the diagnosis and plan to the patient because I believed I was running out of time.
10. One patient actually almost asleep while I was asking her question. (i don’t know if it was me, or the patient was just sleepy!)
11. only had one laboratory exam in one patient note due to time constraint.
This is just what I remembered, I might have missed other things too!!

What I did well:
1. Always introduce myself, explained what I am going to do, asked an open-ended question, informed the patient about the confidentiality of the information he/she gave. summarized patient history before proceeding to the physical exam.
2. washed hands, did a focused examination, showed empathy to patients.
3. offered appropriate counseling, diagnosis, and plan and respond to challenging questions in most cases.
4. finished all encounter on time.
5. I put at least 3 supporting history findings for each ddx.

So as you can see I have a lot of things I have not done well and few things that I have done well.
I thought I was doing fine with my patient note and did badly on the patient encounter. but it turns out that I was doing excellent with CIS component and worst in my ICE component.

I am not sure whether I have borderline score on my ICE because I was not performing enough physical examinations or my patient note was not good enough. I consider myself doing decent on my patient notes as when I practiced with friends, I did not usually get a lot of feedback regarding it. It may be because either I had not gathered good data from the patient or I must not had been able to write down important pertinent findings in the patient notes.

I hope this experience can help somebody. I am not perfect and I still passed! Good luck!




October 12, 2019
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