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 USMLE Expectations during CS  

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Hi Guys,

Well, after failing CS in first attempt and seeing my Match 2008 go away I started wondering a lot of questions. I am a trained Ob/Gyn and as an intern I had weekly ER 24h-wards.

My biggest concern with this test was CIS, where I did pretty good, but to my surprise I FAILED IN ICE.

So the question arises logically... WHAT DID I NOT DO THAT USMLE EXPECTED ME TO DO?

In reviewing in my mind that day, I think the big mistake was that, maybe, I reacted as a doctor, and took care of the patients just like I would do in a real setting. For example, a clear case of intracraneal bleeding, with the full symptomatology favoring a SAH, after turning the lights off, I collected basic PMH, checked for papilledema and orientation, and then ended up the encounter telling her that we would do a CT scan STAT to start treatment ASAP.

Now, WHAT IS USMLE EXPECTING of such a neuro case? Was I supposed to do a FULL NEURO PE? like a medical student?

I have a few more examples (in which you could easily arrive to 2 o 3 DD in the first 5 minutes), in which I think my mistake was to believe they were testing my clinical skills in the wrong way... maybe they just wanted me to show that I know all the PE's, and know all the mnemos to collect data... NO SO MUCH THAT I KNOW HOW TO PROCEED in a case like of SAH.

So, what are we suppose to do?


Is it that?

I can't simply imagine telling a patient with a SAH, "I need to perform a neuro PE Mrs., would you please sit up for me?", "can you close your eyes?", etc, etc...

Guys, what do you think? what is your feeling regarding this?

Thank you all.


Guys, no one has any single idea to share about this?

I apologize if I stated an obvious or silly concern... but I believe that sometimes, the way things are might not appear obvious until we crash against reality.

I am trying to double check with someone willing to share their thoughts that I am actually on the right lane... now.



check this post, pretty strange for me, but who knows


Dear Werther , its not the end of the world , and theres no harm done in delaying ur match application , just take it easy , this is a small bump on the road of ur career ...

The CS test ( as i have understood ) is designed for STUDENTS who didnt finish med school yet , and as a student , they dont expect u to act professionally ,but they expect u to know all the essential stuff ( as trivial it may sound for a doctor that have been practicing for a long time ) ...

just forget abt u being a doctor ,and read the first aid just like i am doing , FA is a student-to-student guide ,and u can flip through it easily in 2 weeks ... u dont need to concentrate much on DD's and WU's since u are already familiar with them ...

just imagine urself in a utopian hospital where everyone have enough time to ask the patient abt his first laugh ( lol ) ... ask all the questions ,(act) as if u are doing a PE the would cover every tiny detail of the ( SYSTEM RELATED TO CC ) ,show empathy and spoil the SP with kind gestures .
Type ur PN on the computer ( cuz it would look more neat ) ,write everything (general) as in PAMHUGS FOSS LIQORAAA ... and i think this would make us pass ..

i didnt take my exam yet ... hands on heart ... but hey man , one should worry abt no problem : if it has a solution : theres no need to worry , if it doesnt : theres no use of worrying !!!!!!

Best of Luck in ur second (and final i hope ) attempt



Thank you so much for your input... I really think that you have the point... and I feel so stupid that I didn't think it that way. This only goes to show that, specially for those already trained, it is very important to practice with someone who knows what all this is about. I practiced with my girlfriend who had no idea about medicine... and I remember doing FA and she telling me "But you didn't ask about the first laugh!" and me saying (annoyed with the book), "But come on! that is so not something you would ask a 54 yo guy with chest pain, diaphoresis, and lightheadedness!", BIG MISTAKE.


Me007, I saw that post... BE VERY CAREFUL with that experience... I don't really feel that it's even near the real thing.

It appears to me that data gathering and PE is of paramount importance... mora then the DD and worksups.


Hey buddy ,glad i can be of some help.

Next time , dont waste ur time practicing with anyone ... i know that there are 8517282 pairs of eyebrows that are raised now : but its logical ,and i will tell you why :

In FA ( the best book ever conceived for this exam ) they said clearly : Questions are basically the same in all encounters ... so what u need to do , is to PRACTICE asking questions rapidly and effeciently , practicing with someone wont do u a lot ... it would only gives u some advantage in PE ( which is debatable since we are supposed to ACT not to really examine)

Bottom line : Know your first aid , gather some rare cases tht might confuse u , and prepare ( beforehand) the questions related to each system , and PN's general skeleton

my email is [email protected]

feel free to contact me if u want to discuss any particular case

kind regards



My dear fellow men and women!


As everybody says, this community helped me so much, walked with me all the way... now I have to say THANK YOU ALL, for the support and for just being there be it actively or just in my mind every time I read your inputs in the multitude of threads.

I got my PASS today in the CS in Houston, which I failed in first intent. Today was the most stressful day, and thankfully now is one of the most important days in my professional life.

Thank you, God bless you. wink

PS: ...FYI: the OASIS trick didn't work for me for CS, and I almost die! shaking head


Happy for you!


Congrats werther


Thank you guys!

Someone asked me what did i do different this time... well... doing everything i wrote at the beginning of the thread. It doesn't matter how acutely ill the patient is, every thing is TRIGGER... and you do everything by the book. You are not in an actual clinic or ER.

It's essentially a semiology test. Period.

Thanks guys again!


Werther, congrats mate.. nodnod
I am more afraid of CS than I have ever been of anything at anytime..your experience will prove helpful to me. Thanks for sharing. smiling face


I know how you feel Deja-vu, it was unbelievable to me to think I failed the first time after passing the worst exams, Step 1 and CK!

But you need to keep in mind what I said and you will be good.

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