DH Failed Step 2 CS and I'm freaking out!

[EKG]

This is my first time posting here, so hope I'm doing it right.

My husband is an IMG, in his 4th year. Very smart but not a hard enough worker. Has a hard time studying diligently, and the self doubt and low self esteem make him delay and push off confrontation with the exam. So ends up taking months and months and months to get the USMLEs done (years in teh case of Step 1)
He is going for Peds and I believe he'll be great. He's fun with kids, empathetic with parents, and knows his stuff. He thrives in his rotations, but is just an awful test taker.

• He took Step 1 and didn't do great.
• He took Step 2 CK yesterday (after pushing it off again and again) and we're waiting for the results. Based on diagnostics, not likely to be much above passing.
• Today we found out he failed CS. There are no available test dates for months...

I'm beside myself. He is supposed to be applying to the 2014 Match. But how is he going to match with this red flag on his record? And if he doesn't, it means taking another year off...It means more uncertainty, more our lives being up in the air and everything on pause.

I'm trying so hard to be supportive, but I feel like my encouragement is running out...
When he's in study mode, he gets a free pass. He's never around, conversation revolves around him, everyone is expected to move mountains for him. You can do that if you're gonna knock the exam out in a few weeks, but if you're going to take your sweet time, you have to learn to integrate better. I'm mad at him for not being more prepared, mad at the exam for not passing someone clearly qualified, and afraid for how this is going to affect our lives.

He gets so discouraged and depressed, and I'm expected to pick him up. But he needs to want this badly enough to work harder and carry himself through. It's too much for me and I don't feel like I can go on motivating him for the both of us.

I'm afraid I can't handle my need to keep it together as well as his need for constant support/motivation/and management.
I don't know if I have what it takes to be a medical spouse...

Help!

[SoonerTexan]

I'm so sorry and don't have a lot of specific advice, but you came to the right place!

[Curegirl]

I'm totally clueless when it comes to all the tests but wanted to offer you a welcome and hugs

[v-girl]

I'm sorry. I have no advice, but you've come to the right place.

[WolfpackWife]

I wish I had advice for you, too, but we haven't made it to Step 1 yet so I'm pretty clueless. I do offer you sympathies though, I can totally understand that you'd feel frustrated at being the support system and faithful "sidekick" to him and he seems to not be putting his best foot forward all the time. The training and career in medicine is enough of a sacrifice without having to worry that you're giving up and doing so much and your medical student/resident spouse isn't pulling their weight in the schooling they so badly wanted.

[diggitydot]

I'm mad at him for not being more prepared, mad at the exam for not passing someone clearly qualified...

First and foremost, welcome to the group. Keep posting when shit goes sideways. It helps. A lot.



Second, don't be angry at the test for "not passing someone clearly qualified..." It's not personal. The CS portion of the tests can be subjective, and I've known some crazy smart people who have failed it, but they all failed for a reason, even if it's a weak ass reason.

You can't make him want to do study. By the time he's at this point in his academic career, he should damn well know how, when, where, why, and with whom to get the job done. It's not something for you to fix. That's all on him. If he doesn't want it bad enough to change his behaviors, that's his problem to fix. You have zero control over it.

Being an IMG/FMG can be a rough road. Add in inadequate study skills, and little desire to work hard? That sucks donkey balls. Truthfully, residency will chew him up and spit him out if he doesn't change those two behaviors. Even an easier-than-usual residency in a non-competitive specialty.

Dude has a major paradigm shift coming. You can't force him to "get it" before he's ready. And maybe it takes something big like failing the CS for that paradigm to shift on him.

Just know that failing the CS isn't the end of the world. He can rally and overcome the issue. Hopefully, it's the swift kick in the ass he needs to adjust his behavior.

Hang in there. The "not knowing the consequences or what will happen next" is the toughest part of the entire med spouse gig.

[EKG]

Thank you, and thanks to everyone for all the encouragement.

He actually works very hard on the wards, and I'm not worried that he won't have the stamina to work long days in the hospital as a resident.

It's just these damned standardized tests!!! They are killing him, and taking me down with him!!

[SoonerTexan]

So DH's school has these things called OSCEs (don't ask me what it stands for) that are basically practice tests to prepare them for the Step 2 CS. He actually "failed" (there's no real grade or lasting impact) the first one because he essentially figured out the issue too quickly and didn't take what they considered to be a full history. The feedback helped him--his next OSCE was super easy. I gather they are looking for certain things and not knowing the "drill" could be costly, even if you are really doing fine on the whole. Is there anywhere he can get feedback? Any training courses? Did he use any of the book aids? I know there is a First Aid for Step 2 CS.

I could be wrong, but I don't think all residency programs require Step 2 scores during the initial interview process. When is the next time he can take the test? If it is before March (or better, before Dec), maybe he can take the time to do some sort of prep, pass the second time, and still be able to match this cycle. I don't know if that is truly possible, but it is worth looking into. See if you can get him to focus on finding a solution ASAP, because he is going to need to act fast.

That being said, is there a Peds advisor he can talk to? It's probably worth seeing how likely he is to match this year based on his stats. If there is no adviser, there is other data out there that will help him know. If his chances are really low, it might be worth saving the money you would be spending on the interview process and have him buckle down hard for a year and retake the Step 1 and maybe the Step 2 CK if that score is on the really low side. I'm sorry--I know no one wants to hear that. I hope he has high enough scores that matching this year is a real possibility.

[MrsK]

There are remediation courses for Step 2. They are pricy and intense but worth it. He may have to fo out of town for a few days to take the class. Do it. As for the match, he might end up off cycle which sucks but it's not the end of the world. Also, don't waste your time being angry at the test. There is no point in being mad at the iceberg for tearing a hole in the Titanic. When the ship is sinking you either learn to swim or drown. No time to be pissed off.

Sent from my SCH-I545 using Tapatalk 4 Beta

[oceanchild]

Is English his native language? I know poor English can really trip people up on Step 2 CS.

Welcome aboard, and sorry it came at a time of crisis.

[SoonerTexan]

So someone who know more needs to confirm this (Cinderella?) but I asked DH about it tonight and he said he thinks you can't pick and choose which USMLE tests you send, you can just send the entire transcript. If this is true, that might be a big problem. You need a Step 1 score for sure, but if a failed Step 2 is going to show up, that really might kill any chance he has of matching as an IMG. I'm so sorry. You guys really might consider delaying a year and having him apply for the first time with stellar scores. In the long run it will get him into a better program and probably a better life for you both. Again, you need to confirm the USMLE thing though. He wasn't sure.

[corn poffi]

Nope, that's all good info! Also, I don't think that anybody can start residency until they pass CS. So, if he did well on CK, and ended up matching (honestly, not likely at this point), he would not be able to start the program until after he passes CS. Which, in some programs, is considered a fireable offense. This is harsh, but is not in anybody's best interest for him to go for the match until he passes.

One more year of uncertainty is better than some if the other possibilities. Blaming the exam is futile and will probably make you both more upset. Hugs.

[ladymoreta]

You're in the right place. I have no more advice, but I'd like to welcome you to iMSN. Please keep us updated. We are here for you!

[medpedspouse]

OSCE = Objective Structured Clinical Exam

When one of our students failed, I set up a one man OSCE to watch and see where the issue was. In this case, dude was super smart and would figure out the differentials but "did not do the math" per say. So, he would get dinged from the SP for missing steps and get dinged on the note for missing info.

[Cinderella]

I'm sorry to tell you guys this but as an IMG spouse I think that it's too late for you guys to apply for the 2014 match. Also ST is correct that a failed Step will show up no matter what and this could filter you guys out for interviews. Your best hope is to wait for the next match and prepare better for the next time.

This is because you have to be ECFMG certified to match. That means you have to have Step 1, Step 2 CK and Step 2 CS. The deadline for taking an exam to get the test results in time for the application date of September 15 was July 27th. Otherwise any exams taken after that date in late July and August will be released September 25th which is 10 days after the applications are due this year. This is an annual delay.

You could apply and note that your Step 2 CK score is pending but this puts your application in a holding pattern. You could also risk applying late but that means you will miss interview spots that fill up fast when the application process starts. However, with a failed Step you won't be ECFMG certified and thus not eligible for the match unless the Step is retaken and passed before the ROL deadline. I believe you can only take a Step once every 30 days if you failed. At this point finding a slot is going to be limited because you're competing with all the AMGs that can apply for the match and take Step 2 CS during the interview period. The results for Step 2 CS take twice as long to be released than the rest of the Steps which is likely to put you guys past any available interviews at that point. You have to take Step 2 CS before December 31 so that you can have your score back before the rank order list deadline in Feb in order to be ECFMG certified or you'll have to withdrawal from the match. If you have the money to apply for the match and want to go for it while waiting on Step 2 CK and have a slot before Dec 31st to retake Step 2 CS give it a shot. You never know unless you try and you don't want to regret not giving it your all.

Luckily sometimes a failed Step 2 CS is overlooked when it's passed on the second try. Out of all the Steps it has the highest ratio of failure for IMGs and unfortunately is the most expensive. I was really worried about dh failing that Step too but he proved me wrong and passed with high performance on the first try. If your husband retakes Step 2 CS but he fails it again I'd cut your losses right there and move on. A low Step 1 score with two times failed on the same Step, or two failures on two different Steps like both parts of Step 2 is like the plague and nobody will want to touch the IMG. We've had program directors advise to not take a Step until you're absolutely ready because of this.

Also the official practice exams that you pay a $40 - $60 fee for are recommended. They're the NBME and the one on USMLE world. They are the official simulated practice exams like the Steps and give the most accurate range of what score you may get on the Step before to go take it. My husband took 3 official practice exams before he went for his Steps to see his progress. He took two of the general $40 ones and one of the specialty $60 ones. The higher specialty fee practice exam tells you your areas of weakness and strength so you know what you need to work on and what you don't. He'd take a general one for a base line, then a specialty one to focus on his weak areas and then another general exam to see his progress and go from there. When he got into the range he wanted he went for the actual Steps and did well each time on the first try. There is also the "First Aid" books for all the Steps that are recommended and there are Kaplan lectures out there that are also helpful. Plus my husband went through the USMLE world question bank twice before taking the exam and read the first aid book twice. A lot of people say just focus on the USMLE world question bank more than the books, but my husband recommends the books because of the condensed material. At the very least have him sign up on USMLE forums for IMGs and seek out study partners. My husband did that for Step 2 CS with a group of 4 people who all met on Skype for their practice lessons together.

If your husband retakes Step 2 CS and passes, but fails Step 2 and has a low Step 1 score I'd advise to cut your losses and move on. If he passed Step 2 CS on the second try but has low Step 1 and Step 2 CK scores you can still give it a shot but don't hold much hope. Out of 8,000 IMGs that apply annually 4,000 or less match each year. He may squeeze into the percentage that is above the cut off line. If not at least you can say you tried and gave it your all and you can attempt to apply to the next match. Some people don't match the first time but they keep applying and have matched on the second, third or fourth round. However, I have yet to see an IMG match that failed Step 1 or Step 2 CK even though they retook it. They may be out there but I haven't seen it happen in the last five years.

So sorry for what you're going through. I feel your anguish and can sympathize. A lot of what you describe is what I've experienced myself and I could have written your post. In fact sometimes I've written the exact same thing on here. I know how difficult it is to be patient and supportive of your spouse during this process. I think we can all relate to that on some level because the medical lifestyle takes a lot. It doesn't just end here in the test taking time either. The training goes on and there are more tests and more things to deal with. I've read posts from attending wives 17 years out that will tell you the medical lifestyle never ends. Birthday's are missed, holidays are missed, anniversaries, ect. You get the idea. Knowing what I know now I wouldn't recommend this path. I'd suggest something that more meets the individual's aptitude like for my husband I would suggest engineering because I think he's brilliant at math and mechanics. There are other fields to go into that are related, or other interests to pursue that they may excel at and have better success.