Med School Hell – Step 2 CS: Blow Me

This post is raw and holds nothing back. If you’re uncomfortable with vulgar language, please turn back.

April 28, 2007
By: Cherokee


The damn monkey is off my back. I f’ing passed.

Step 2 CS, for those of you who don’t know, is a newly instituted (2004) part of Step 2, the second of three Step exams one must pass in order to become licensed to practice medicine. Personally, I think the damn thing should be its own Step. Have four Step exams to prove how insane the licensing process is, instead of pretending it’s part of Step 2. Before long, the geniuses at the NBME will split off the communications portion of CS and have a “Step 2: Empathy & Social Work” exam.

What does the test entail? It’s a $1000, daylong exam, which is structured as follows: 12 patient encounters, each 15 minutes each. During each encounter, you are supposed to do a history & physical, and after each encounter you get 10 minutes to write out your findings, workup, and diagnosis on a patient note. Ten encounters are graded, and two encounters are non-graded test encounters. (One-sixth of the exam, therefore, is horseshit to begin with.) The grading is pass or fail, and more on that in a bit. There are only five testing sites around the nation: Atlanta, Chicago, Houston, LA, and Philly. The test is insanely hard to schedule unless you do it many months in advance.

It actually took me two tries in order to do it. Yes, I failed the first time I took Step 2 CS. Because of that, some of you might think I’m kind of an idiot. Here’s what I have to say to you:

1. You’re correct: I’m kind of an idiot.
2. Clinical medicine blows and I don’t really care about patients*, and especially not H&Ps and patient notes.
3. I’m going into Path: I’m not gonna be an intern next year or a clinician when I graduate residency, so I don’t give a shit about all this.
4. Actually, forget all that. Blow me, just like Step 2 CS can do.

In all seriousness, this test is crap. I hope that someone sues the NBME over it and wins. Other than it being completely unnecessary, because medical school and residency prepare you to be a practicing clinician, there’s no way to know WHY you passed or (more importantly) WHY you failed. If you pass, which is about 80-90% of US students, all they do is put “pass” on your score report. If you fail, they give little bars in each of the three areas that really give you no good information. The three areas:

A. English Proficiency
B. Communication: You probably can fail because you don’t drape people properly, which obviously reflects your lack of proficiency in medicine. This section is graded by the standardized patient.
C. Data Gathering: A reasonably fair area to test, consisting of the patient encounter and the patient note. The patient encounter is graded by the standardized patient, who ostensibly has no knowledge of disease pathology or presentation (and any sort of degree?) other than the script and checklist he/she is given. The patient note is graded by clinicians.

Supposedly there is a percentage of medical students who are not competent enough to be clinicians, and this test allegedly weeds them out. I’m not a great clinician, I never have been, and I never really aspire to be. But I passed. So the test is about knowing how to pass the test. In fact, someone on the internet somewhere mentioned that someone without ANY medical training could grab First Aid for Step 2 CS, study for a month, and go pass the exam. I agree with that statement.

For those of you that have the exam coming up, do a few things: learn Step 2 CS for First Aid backwards and forwards. Use USMLE World or the Kaplan book as well. Most importantly, practice with a partner or spouse! Have an algorithm for taking a history and physical and do it every time. Know the steps you have to do (state your name, drape, etc.) and the questions you need to ask for each symptomatology complex outlined in First Aid. That is, chest pain = location, quality, intensity, time course, diaphoresis, position, medicines tried, dyspnea, palpitations, etc. That makes it SO much easier to rattle off questions instead of trying to remember exactly what you need to ask. Use First Aid or Kaplan’s mnemonic for history taking. Create lots of mnemonics.

Don’t underestimate the test. Know that it is possible to fail, as I did to begin with, but you can also make a ton of mistakes (as I did the second time) and still pass. 80-90% of US students pass the first time. When I took the test the second time, I changed a few things: I knew the mnemonics better for each symptomatology complex, I did better physical exams, I typed my notes instead of writing them, and I did a better closure. Closure is important! Read First Aid for more about that stuff.

I pity those of you who have yet to pass this evil test. May God have mercy on your souls. As for Step 2 CS: suck it long, and suck it hard.

*I actually care about people, I just don’t like dealing with sick patients. Part of me blogging for Hoover’s badass blog is to help convince some of you NOT to go into medicine. Or, at least, let you know what to expect. That’s pretty damn humanistic!

Are you convinced to leave medicine? If so, you may feel like you are alone. You may feel clueless about what to do next. However, quitting medicine could turn out better than you have ever thought possible. And here is why you should get out …

This article is part of Hoover’s Med School Hell series. Med School Hell reveals the crazy truth about the crappiness of the US medical education and healthcare system … while making you laugh so hard, you’ll crap in your pants.

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