CS fail

November 2, 2011

A question sent to me:
Will good US clinical experience and US letters overcome a CS fail? Do applications get screened for exam fails?

No and no.
CS fail is almost non existent in AMGs.
About 15% of IMGs fail the CS. An blog viewer sent me the likely reason for his CS fail was lack of prep time. He has a terrific score on step 1 and should have done well on the CS. He was working and only had a limited time to study and only a limited time off to travel to the US to take the exam. I think that those who fail the CS underestimate the difficulty of emulating the American exam style. Many people who do quite well on the steps fail the CS.

Remember the CS does not evaluate your clinical skills. It evaluates if your clinical skill style matches that of soon to be American grads. American grads don’t have trouble being understood and don’t write notes like an IMG. Most of the trouble with the CS is that it tests style. If you have not practiced in the correct style of the exam you will not do well no matter how accomplished you are in your own school or hospital. I know a lot of IMGs who fail the CS because of lack of preparation, not lack of knowledge. How else is it that an IMGs steps can be above 240 and fail the CS? It is not a knowledge issue it is a style issue. You must learn the American style of speaking to patients, and documenting your findings. Interestingly men do worse on the CS than women, see my other CS post for details.

The ERAS program allows for filtering of a lot of things. The ERAS program can filter for applications from a particular school, for a particular score on all exams or for US experience (but not specific experience like research, observerships or clerkship rotations as a student).

What the ERAS program can’t filter for is exam fails. So if you have scores above the filter cut offs for that particular program and have failed a step or a CS one can only exclude your application by looking at the examinations tab. The question is which candidate does a program take, the one with terrific step scores and a failed CS or the one with terrific scores and no failed CS?

Good candidates look very similar. A failed attempt at CS is hard to overcome. Can you overcome a fail? Sure and I know people who have but you are at a distinct disadvantage in the matching game.

For those of you who will take the CS, do not underestimate it.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

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