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Old 12-06-2014
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Default how important is patient note? did I fail?

I walked into this exam with no preparation under the guidance of my friends to just "take it." Rescheduled at the last second for an earlier date but I obviously now regret it. Forgot to wash my hands with three patients. On the patient note I included all possible diagnoses (even those unlikely). i also included physical findings that actually proved my diagnosis wrong. <-- did this because I thought the DDx was supposed to be all inclusive including those that might be unlikely given the history and physiacl exam. I may have done this for half the cases until I realized my error. I also almost never had a physical exam result that helped to prove a diagnosis. Ran out of time with my first patient. Did cursory physical exams (always cardio, pulm, and abd) for each patient never really having the time to do specific exams for most patients. Didn't counsel correctly on 3-4. Thoughts? It's extremely hard to tell how I did relatively but it's honestly sent me into a severe state of anxiety. Particularly because I'm in the process of interviews and I just took it (which leaves me with possibly one retake in January or Februrary (although I heard you have to take one WHOLE month after you receive the bad news?) So on the whole how important is the patient note?

I also never draped a patient given that all of them were already draped when I came in?
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Old 12-09-2014
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Originally Posted by cloud805 View Post
I walked into this exam with no preparation under the guidance of my friends to just "take it." Rescheduled at the last second for an earlier date but I obviously now regret it. Forgot to wash my hands with three patients. On the patient note I included all possible diagnoses (even those unlikely). i also included physical findings that actually proved my diagnosis wrong. <-- did this because I thought the DDx was supposed to be all inclusive including those that might be unlikely given the history and physiacl exam. I may have done this for half the cases until I realized my error. I also almost never had a physical exam result that helped to prove a diagnosis. Ran out of time with my first patient. Did cursory physical exams (always cardio, pulm, and abd) for each patient never really having the time to do specific exams for most patients. Didn't counsel correctly on 3-4. Thoughts? It's extremely hard to tell how I did relatively but it's honestly sent me into a severe state of anxiety. Particularly because I'm in the process of interviews and I just took it (which leaves me with possibly one retake in January or Februrary (although I heard you have to take one WHOLE month after you receive the bad news?) So on the whole how important is the patient note?

I also never draped a patient given that all of them were already draped when I came in?
thing you shouldn't be worried about
1) yes all the physicals you did whether to rule out or not should be
documented so far as u did it physicals are there to support and also to rule out.
2) draping: all sp's are draped so no biggie
3) ran out of time in one px: no biggie cant make you fail in general
4) did ardio an d pulmo for all sp's : is a good tactic ( if we dont leave out the focused system) s if anythign it should boost up your ICE
5) well it all depend on what you said during the counselling then we can judge but as long as u addressed the situation and you were not judgemental or rude, then it shouldn't matter much

things you should be worried about
1) forgetting to wash your hands : you could loose some CIS points from this
but for only 3 sp's its not catastrophic
2)almost never had a physical exam result that helped to prove a diagnosis: <<hard to believe. did u do proper physicals? it could hurt your ICE ... at least there had to be some forms of tenderness or weakness or dec ROM , or abnormal vital signs at the most, or rashes or discoloration or swelling did u closely observe the sp's ? you almost always cant come up with your number one diagnosis with out some form of support from physicals.
3) never had time to do specifics: could hurt you ICE better to even start with the focused physicals b4 diverging
4)including all possible diagnosis including those unlikely: well this is a 50/50 as long as u had at least one or two "appropriate diagnosis" u should be fine but if you were just sticking random differentials without good support from your history then u might be in more trouble than you expect.

overall its a subjective exam and you never know.. keeping fingers crossed for you and hope you scale through at least. and for others reading this post. please dont listen to your friends make sure you practise properly and you are doing the right things, maybe to be absolutely certain join a review course and practise with real SP's.
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faith255 (12-09-2014)
  #3  
Old 12-09-2014
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Originally Posted by obinocle View Post
thing you shouldn't be worried about
1) yes all the physicals you did whether to rule out or not should be
documented so far as u did it physicals are there to support and also to rule out.
2) draping: all sp's are draped so no biggie
3) ran out of time in one px: no biggie cant make you fail in general
4) did ardio an d pulmo for all sp's : is a good tactic ( if we dont leave out the focused system) s if anythign it should boost up your ICE
5) well it all depend on what you said during the counselling then we can judge but as long as u addressed the situation and you were not judgemental or rude, then it shouldn't matter much

things you should be worried about
1) forgetting to wash your hands : you could loose some CIS points from this
but for only 3 sp's its not catastrophic
2)almost never had a physical exam result that helped to prove a diagnosis: <<hard to believe. did u do proper physicals? it could hurt your ICE ... at least there had to be some forms of tenderness or weakness or dec ROM , or abnormal vital signs at the most, or rashes or discoloration or swelling did u closely observe the sp's ? you almost always cant come up with your number one diagnosis with out some form of support from physicals.
3) never had time to do specifics: could hurt you ICE better to even start with the focused physicals b4 diverging
4)including all possible diagnosis including those unlikely: well this is a 50/50 as long as u had at least one or two "appropriate diagnosis" u should be fine but if you were just sticking random differentials without good support from your history then u might be in more trouble than you expect.

overall its a subjective exam and you never know.. keeping fingers crossed for you and hope you scale through at least. and for others reading this post. please dont listen to your friends make sure you practise properly and you are doing the right things, maybe to be absolutely certain join a review course and practise with real SP's.
Thanks for the feedback. I definitely wish I had read the official usmle website more, otherwise I would have been way more on point with regards to my ddx. Honestly I think the reason that I never had few physical sx to back up my ddx was because I felt rushed and because a lot of my msk exams came out normal. Apparently the ddx portion is 60% of the ice grade which really worries me.
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