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  #1  
Old 04-24-2016
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Default Question: What can slow people sacrifice and still pass?

Hi guys!
I know that there are 3 components in the exam and we have to pass all of them. What I still don't get, is what is considered enough to pass CIS and ICE.

For example I am one of the more slow people, and I am afraid that I will not be able to ask ALL the questions AND CAGE AND counsel on all the subjects (sex, drugs and rock-n-roll, sorry, smoking). So is there something that I may sacrifice for the lack of time and still pass?

The same question applies to the Patient Note. I am typing and typing but still unable to squeeze it all in 10 minutes. May I wright in the field of Physical examination only the relevant systems and not to wright there about chest and heart when the Chief complaint is lower abdominal pain for example? Or may be some other things that I can skip?

I will be grateful for any ideas....
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  #2  
Old 04-25-2016
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Hi. Yeah, 15 mns, it's really short! So you have to go inside with a plan, having written like 2 or 3 diagnosis possible according to what you found on the door information. And you go from there, helping yourself with the mnemonics. Of course be flexible, if the patient give you one very important information making another diagnosis more probable, then check this clue too. But stay organize ( your blue worksheet divided in 4, mnemonics...) and be aware of the time, there is 2 clock in the room, and so keep the time on check.
Same for the physical exam: it's a targeted physical exam, not an exhaustive one. It means check what you need to give you some more clues on the diagnosis. And don't try to do everything, keep time for a good closure: look in FA the example with the interview of the lady with ectopic pregnancy. You want to have time to explain everything the patient need to know, address his/her concerns, etc (look carefully the patient behavior)...
Don't CAGE everybody if there is no need, it may actually play against you. Counsel but don't take too long on that too, and offer support, tell them you can schedule an appointment for that if they tell you they want to quit, give them information paper on quitting as they leave (well, your personal secretary will give them , remember, you have everything available: secretary, social worker...).
For the Patient note, I'm average at typing (35wpm), and so I tried to use a lot the more common abbreviations. I did practiced A LOT using the free patient note form from the usmle, and also Uworld. I also knew that the history was taking lot of time, so I usually began by the diagnosis and exams, then physical exam then last the HPI...
Remember, they are judging your overall performance.
Good luck!
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  #3  
Old 04-25-2016
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Thank you ramennoodles for the detailed answer!

I want to ask your (and other forum members) opinion about Physical Exam in the First Aid cases.
Quote:
Originally Posted by ramennoodles View Post
Same for the physical exam: it's a targeted physical exam, not an exhaustive one. It means check what you need to give you some more clues on the diagnosis.
I seems to me that physical exams in the FA are too long and sometimes include unnecessary systems. Like CV and lung exam in almost all cases, except back pain.

Am I wrong?
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Old 04-26-2016
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Quote:
Originally Posted by Olala View Post
Thank you ramennoodles for the detailed answer!

I want to ask your (and other forum members) opinion about Physical Exam in the First Aid cases.

I seems to me that physical exams in the FA are too long and sometimes include unnecessary systems. Like CV and lung exam in almost all cases, except back pain.

Am I wrong?
Ok, so let me tell you my experience.
I went throught Kaplan cases and FA. I memorized differentials in mini cases. I simulated PE and tried to make it as quick as possible. (I did not study with a partner, so this was a little tricky, but still doable). I made sure that I could examine lungs, heart and abdomen in circa 3 minutes. I also practiced the rest of the exams, so I could do them relatively fast. Just take a timer and practice. Remember, your exam is supposed to be BRIEF and FOCUSED. Forget weird maneuvers. I did abd+lungs+heart on (almost) everyone. I added other systems, if it was necessary.
I guess the fact that I "practiced" the PE under time pressure helped a lot. I was a little robot-like during the examination, but I was able to counsel and close every case.
I did not look at the clock on the wall. I guess it's a waste of time. The 5 minute announcement should be your only guide. You should be about halfway through your PE when you hear it.
About history - let the patients talk without interruption as much as possible. It's faster. Have your mnemonic ready on the paper and just write what the patient is telling you. After that, ask all the relevant questions you have left.
I didn't use CAGE at all in the exam. In fact, I did only SIQQORAAA PAMHRFOSS (or any other mnemonic you use) plus appropriate associated symptoms.
Counseling was my nightmare. I always counseled drugs/sex and tried to give the patient a general idea of tests and likely diagnoses. I did not go into details once. Practice explaining common procedures in lay terms.
I didn't practice note writing very much and I think it was a mistake. Make sure you are comfortable with the character limits in history and PE. Otherwise you will lose valuable time. Always start from the bottom - labs, differential, PE and then history. Also, practice writing normal PE findings.

I had a rather bad experience, because I was so nervous. I was absolutely clueless in 2 cases, forgot to ask about abuse in one case, told a patient with a simple problem that he's got cancer (thought of the most likely diagnosis when I came out of the room). I also made one patient furious (I guess it was scripted, but I guess I should have been more cautious with my words) and I made another patient cry - in this case, the time ran out before I could calm her down.
Despite all this, I comfortably passed. None of the scores were anywhere close to borderline zone.

All in all, I think you should:
- practice the PE to be as quick as possible
- practice note writing with normal findings
- cram all the differentials, so you don't waste time during note writing
- always, always, always use gloves. washing hands takes a lot of time
- relax. freaking out slows you down.

Sorry for the long post. I kind of got carried away.
Good luck!
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  #5  
Old 04-26-2016
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Quote:
Originally Posted by quacky.mcquacky View Post
Ok, so let me tell you my experience.
....
Sorry for the long post. I kind of got carried away.
Good luck!
That was a lot of valuable information! I really appreciate sharing your experience, it makes a lot of sense, and also helps to relax.
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