Step 2 CS Preparation: 3 Reasons Why Your Step 2 CS Notes Are Failing

In today’s lesson, we’re going to take a look at the 3 biggest reasons why your Step 2 CS Patient Notes are failing. Mastering your Step 2 CS Patient notes are an essential part of thorough and adequate Step 2 CS preparation. Let us know if you liked the video by sharing it with your friends.

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If you feel like reading the lesson instead, the entire transcript can be found below.

Hello everybody and welcome back…

Today were going to dive in and discuss the 3 biggest reasons why your Step 2 CS patient notes are FAILING…

By the time we’re through this video, you’re going to understand what the 3 biggest causes of poor step 2 cs patient notes are, you’ll understand why this is and how to fix it so that you can put out high quality, passing step 2 cs patient notes…

My name is Dr. Paul and I’m the director of programs here at the USMLE Success Academy. Over many, many years of helping students prepare for and pass their Step 2 CS exams, we’ve seen it all..

In recent years, there is a trend of students failing the ICE component of their exams. And while this is caused by many things, one of the biggest red flags were seeing are very poor patient notes.

But were going to fix that for you right now.

So lets dive in a take a look at the top 3 reasons why your patient notes are failing…..

Top 3 Reasons Why Students Are Failing Their Patient Notes

Reason #1: You’re giving the reader a poor initial impression… But what does that mean?

Well, consider this… you go to a restaurant and you sit down and order your food, and you’re waiting in anticipation of a great meal, and it gets to the table and its messy, sloppy, and the presentation is awful.

Yes, the food might taste good, or it might taste outstanding, but the initial impression packs a huge punch and carries a lot of weight.

So, if you create your patient note and the HPI isn’t well laid out, your past medical history, social history, sexual history, etc. are not well laid out and framed for easy reading, you’re starting off with your back against the wall right away..

Heres the thing guys, you need to present a note that is pleasing to the eye, easy to navigate, and easy to grade. If the person reading your note is turned off right away because it looks sloppy and unprofessional, do you think they’re going to spend an additional ten minutes trying to figure out what’s going on? I doubt it.. so that’s your first very big mistake, putting together a sloppy note.

But how do we fix this? Well, its actually really easy…

Be sure to create a crisp, clean, professional note. It’s not hard, just make sure your note comes off as clean and easy to read and you’ll avoid this problem.

Reason #2: Lack of adequate information in the HPI…

Ok, so this one is a real pet peeve of mine and the reason why is because there are mnemonics out there designed to ensure that you ask and document all of the relevant and necessary information for the HPI…

There’s no excuse not to have a thorough and detailed HPI that answers all of the main questions that the reader needs to see….

And just so that you don’t say “Well, i don’t know these mnemonics”, heres the one we give to our actual Step 2 CS program students… Write this down if you don’t know it so that you don’t make this mistake.

So the mnemonic we use is LIQOR PDFCSAAA. You only use LIQR, which is location intensity, quality, and radiation, if you’re dealing with pain.

Otherwise, if its a non-pain case, such as lets say hypothyroidism, you’ll always use OPDFCSAA…

Let me say that again… you’ll always use OPDFCSAAA.

So if you are doing an encounter, you need to always include those components into your HPI, and they stand for onset, progression, duration, frequency, chronic/intermittent, setting, alleviating factors, aggravating factors, and associated signs or symptoms. You absolutely, positively need to include that information into your HPI…

If you don’t, then you’re just being neglectful and you won’t get full points, and might in fact miss enough information that it leads to a note failure. Please, don’t make this easy to avoid mistake.

Reason #3: Poor differential diagnoses, poor ordering, and poor support….

Now, thats actually 3 separate things but I’ve included them into one topic because they’re all so important…

So what does this mean? Well, its quite simple… It means that your differential diagnoses need to be spot on, there is no room for error or highly unlikely differentials…

These days you have so much competition that you need to be perfect…. but how do you do this?

It’s easy: You study… you study a lot. You cannot take the CS exam lightly anymore, so it’s imperative that you’re putting in the time and effort to make sure your diagnostic skills are on point.

Now, if you’ve got 2-3 good differentials that are possible based on the findings in the encounter, you need 2-3 good, strong pieces of support for each… As a rule, we tell our Live Step 2 CS students that if you can’t find 2-3 strong pieces of support for a differential diagnosis, then it probably isn’t as good as you though it was….

And finally, ordering your differentials are highly important. This means that if you’ve got 3 differentials, you need to order them in a way that has your most likely differential first, your second most likely differential second, and your third differential third…

You absolutely do not want to just throw them down in any order without really considering which is more like than the next… If you do that, you are likely going to lose points.

So, there you have it… 3 of the big reasons why students are failing their step 2 cs patient notes….

Let’s do a quick recap:

Reason #1: You’re making a poor initial impression… Make sure your notes are nicely formatted and pleasing to the eye… If you write a note, look at it critically and ask yourself if it looks good at first glance. If it doesn’t, keep working and practicing until you get comfortable writing a solid note.

Reason #2: Lack of adequate information for your HPI… Remember what i said, you have mnemonics to ensure that you never miss an important HPI question. If you’re missing information for your HPI, you’re either not using the mnemonic or you’re being sloppy when converting your encounter note into a patient note… Either way, you need to improve this part of your note.

And Reason #3: Your differentials are weak, lack support, and are not in the right order from most to least likely. This is fixed by studying your clinical knowledge information hard enough that no encounter leaves you scratching your head wondering whats going on.