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  1. #1
    antoniohg is offline Junior Member 510 points
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    what went wrong??

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    Hi guys! I posted this threath in the CS forum a couple of days ago but I haven't got any answer so far.... can anybody please help me???
    ....
    Hi everyone! I would like some comments about my CS exam.
    First of all, I took my CS on September and recently got my failed score. I constantly checked on the web page and found an available date before December 31. So for all of you guys that need date soon, keep trying because you never know when you will find one. I found mine at 5 in the morning.

    Now, even though I passed my spoken English and the integrated clinical encounter. I failed the ICS subcomponent.
    Questioning skills were slightly beyond borderline (in a positive way). Information skills and professional manner/ rapport where borderline. I donít understand why the overall outcome was below borderline. Any way I remember correctly that I was very respectful, always introduced myself, used correctly the patient name, drape them (not to all because some of them I though didnít need it), made eye contact, wash my hands. I think I did follow ALL of the respectful items recommended. I did reviewed my differentials and workup plan with them . I think I did a pretty extensive closure and counseling (at least in most of them).
    The only thing I didnít do much was to step by step tell the patient what I was doing; like if Iím looking for fluid overflow while touching their ankles or, Iím checking for peripheral pulses to point some.

    Please help me because my second chance is near. Do you really need to drape all of them even though you are not going to perform a physical exam? And not telling step by step all of the components of the physical exam were the reasons of my failure? Maybe I missed something in the history that could help me in the counseling but Iím pretty much sure that I did ask about alcohol and cage, smoking and sexual habits to all.

    Thank you very much!!!!
    Last edited by antoniohg; 12-16-2009 at 02:06 PM.

  2. #2
    antoniohg is offline Junior Member 510 points
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    one more thing, any recommendation against taking notes while interviewing the SP?

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    azulpanther is offline Moderator 696 points
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    I believe the 1st aid for the CS book is very awesome. If you do everything they recommend, you should pass without a problem.

    If it was me I would be very vocal with the patients. Explain everything you do. Even if its really silly.

    Make sure you know your differentials and diagnostic exams cold.
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    jaywalk81 is offline Useless Guru 521 points
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    Do you really need to drape all of them even though you are not going to perform a physical exam?
    i dont recall in any that you dont need to do a PE, with the exception of if not actual pt was not in the room (telephone parents in regarding their sick child)
    even the gyn pt needed a PE, of course you dont do the gyn part but you still do a abd exam to r/o abd pathology, but you had to tell the pt you will be back with a chaperone for the gyn exam and why

  5. #5
    antoniohg is offline Junior Member 510 points
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    I had a patient with a suicide attempt. My objectives were to take a history and to NOT perform a physical exam....she was sitting on a chair so I didn't drape her.

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    stateofequilibrium is offline Super Moderator 6105 points
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    Quote Originally Posted by antoniohg View Post
    I had a patient with a suicide attempt. My objectives were to take a history and to NOT perform a physical exam....she was sitting on a chair so I didn't drape her.
    Maybe something changed when I took the CS. But did it tell you on the board before you went in to the room NOT to do a PE?
    Posterior Fornix.

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    LqdPls is offline Senior Member
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    Quote Originally Posted by antoniohg View Post
    I had a patient with a suicide attempt. My objectives were to take a history and to NOT perform a physical exam....she was sitting on a chair so I didn't drape her.
    In relation to this particular patient you made the assumption that this was a purely psychiatric case. Therefore, not only were you penalized for not doing a PE, but your history was likely also incomplete. Nonetheless you passed the ICE portion of the exam so it appears that your history taking, PE, and note were just fine. The section you failed is actually quite subjective. Therefore, how you speak, what you say, and how you relay information may have been perceived quite differently by different SPs. Maybe you were tense, nervous, spoke way too fast, used complicated medical terms that the patient did not understand.

    BTW, in your post you state that you draped some patients and counseled most of them. Most and some is not all, therefore maybe it was your inconsistency that got you into trouble.
    Last edited by LqdPls; 12-17-2009 at 09:36 AM.

  8. #8
    antoniohg is offline Junior Member 510 points
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    I appreciate your comments! In that patient my doorway information did specified: do not perform a physical exam.
    I usually speak fast so that's the first thing I will work on. And of course I will explain everything during the physical exam.
    I think it is better to speak more than I should instead of not speaking as much.
    My exam is next week by the way...

  9. #9
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    SPODAT is offline Senior Member 520 points
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    **If you have not read First Aid, read it, the tips and tricks are essential.

    I passed on my first attempt, but didn't feel completely sure, because I thought I had been inconsistent. My sense, from hearing results of others on here who ended up passing, is that probably 80% consistency is way more than enough. They don't expect you to be a physician or a robot.
    First Aid for CS emphasized that it is extremely important to do several things that SP's are instructed to award points for such as
    Knocking on the door (points)
    greeting by name, handshake, eye contact (points)
    Draping (points)
    Eye contact, nodding, interactive questioning in hx (points)
    Summary of History (points)
    Talking Exam (brief words, not constant monologue, per FA) (points)
    modest movement, untying, re-tying of gown (points)
    Summarizing the exam and differentials (points)
    Explaining the plan of action, testing (points)
    Statements of compassion and empathy (I see you're hurting, we're going to address that...)
    Explaining stat treatment and follow up (points)
    Counseling and closure (anything else I can do for you?) (points)

    I'd 2nd that slowing down, saying less, but very clearly is important. SP's can get irritated and picky if they feel you aren't respecting them, speaking without eye contact, being too agressive or paternalistic.

    Regarding writing, I think it shows the patient you are taking them seriously, as in a real patient encounter. I think it's critical, it also helped me to be more focused on write up.

    You are highly likely to do fine this time. Probably helpful to know the routine and site, to lessen anxiety and slow down the speech.

  10. #10
    I need advice is offline Member 510 points
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    For what it's worth, I thought the kaplan mneumonics they have in their cs book were pretty good and made sure you addressed all the main points of the CC. I don't have my results back yet, so can't fully endorse it, though on testday I thought they were helpful bc sometimes you can get/lost or have trouble focusing in such an artificial situation.

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