Down for the Count
Well, interviews are done! I had the great pleasure of meeting one Dr. Nick Genes whilst in New York. My first-ever in-real-life blogger meeting. He is even cooler in person!
Expect posting to be light for the next month or so: I’ve got both parts of Step 2 (“The Boards”) to take, which I’m already loathing.
There appears to be no published information about how we’re truly graded for Step 2 CS (“Clinical Skills”) besides if we went through the motions of “listening” with our stethoscope and speaking English. The patient note we have to write tells us to list “up to 5 possible diagnoses” and “up to 5 tests or procedures for workup.”
A mysterious physician apparently grades us, but on what basis we’re not told. For including a broad differential, or a narrow one? Can I, and should I include the great imitators, like HIV, TB, or syphilis on my differential? How about malingering? Should I go all out for the million dollar workup for patients? Classic ankle sprain. Ankle MR and X-Ray, please. But maybe we should tap it and send the aspirate for analysis. Or maybe he has disseminated gonococcus? Might as well get a CBC and test for GC/CT, too. Throw in an HIV there too, just for completeness’s sake. Is it honestly more important for me to know how to order a bunch of worthless, expensive tests than have a clue how to treat someone with an ankle sprain? (Treatment is not part of the “Clinical Skills” exam.)
Not that any of this matters, though. I speak English, am a pretty compassionate guy, pretty socially adept when talking to patients*, and know where to put my stethoscope. So I probably won’t be one of the 10 people that don’t pass this year — yes, that’s right, I have a 0.05% (those decimals are correct, 0.0005) chance of not passing the exam.
* I find it totally fascinating that I actually have a pretty darn good rapport with strangers-turned-patients, but put me in a social situation at a bar, club, party, or other social gathering and I freeze up socially pretty consistently. Little know Graham fact.
Just got my CS “score” back today (nope, not one of the 0.05%ers).
First: what is the use of a test that has a pass rate of 98% for primary English speakers????
(correct answer: someone in the USMLE-Prometric upper echelons [really, do you doubt that they're in the same bed?] knee jerked when Americans squawked about “poor bedside manner” and decided that a moronic $1000 test that doesn’t test anything was the right answer?)
Second: what is the use of a test that states “pass” as the outcome???? What about feedback? Was I accurate on my assessments? Histories? Exam skills? Lab/imaging requests?
Third: What are the docs/patients actually looking at?
Fourth: What is the use of taking a history from a robot? When asked, “Are you having stomach pain?” the response is “No-I-am-not-having-stomach-pain” that truly creeped me out.
And CK is no where near as difficult as Step1 – by now, you’ve already seen most of it and it’s no longer rote memorization – you can reason through most of the questions. I upped my score from Step1 by 30 points with only a week of studying (used Kaplan consistently during third yr and a week of USMLEworld) – and our school takes the CK the summer between third and fourth years.
Break a leg on your boards, Graham. Hopefully not a compound fracture, though. :)
A socially-awkward blogger? You don’t say…
I’ll buy you a few glasses of liquid anti-anxiolytics if you’re up here. The anxiolytic effects are dose-dependent and doses should be titrated until you get up and shake that thang.
That IS an interesting Little known Graham fact! I never would have guessed. At one level, it’s comforting to know that it’s another club of which I’m not the sole member. Next time you’re in Chi, we’ll go be socially awkward and frozen together at Sidetrack. ;)
Go kick some serious medical butt on those boards. Good Karma being sent your way.
Buena suerte, machito.
I’ve had two exams today myself. Fun fun.
If you’re a native US-English speaker and went to an accredited US med school you’ll do just fine on CS. It is a BS exam. Take a couple hours, read “First Aid for CS” (I’m not a big fan of the First Aid series, but this one is good), and try to enjoy the provided lunch. Remember, you’re paying $1000 for that sandwich.
It’s much more than 10 people who don’t pass. 4% of test takers fail, so that’s more like 680 out of the class of 2008.
[...] come up with a differential diagnosis for the problem in question (this is good), but there’s no description of how broad a net to cast. The “workup” portion of the exam is incredible. It’s apparently more important [...]