Order what will rule-in or rule-out your diagnosis. When ordering work-up tests don’t take into account the expense. Also, it keeps it spicy to keep your differential broad so don’t expect to find many positive findings from your physical exam. I also get the impression that it’s hard to find reliable actors for simulated patients. I got the impression that there are only so many ailments the can be simulated. If you did something, regardless if negative or positive, document it. A big part of CS is showing that you can communicate electronically to other providers. You don’t have time to type every abbreviation out. A real doctor reads your notes so if the abbreviation is in common usage go ahead and use it. If unsure just write it out but you really don’t have time to type all of them. Just use abbreviations that you know or have seen. There is an abbreviation list but it is not helpful. I found the real life version even crappier as their were scrolling windows inside other scrolling windows. You have 950 characters and 15 lines max. Confirm the patient name and how they want to be addressed shake their hand ask open ended and closed ended questions ask “What else would you like to talk about today” and set the agenda early don’t interrupt (They are trained and will only drone on needlessly if you interrupt) ask about ETOH, Smoking, sex and counsel if indicated (May be totally unrelated to vignette!) wash hands after the history and before physical (No, washing on entry does not count – the hand gel is the fastest IMO) if patient denies you performing the physical exam, explain why a physical is needed and ask again don’t attempt anything through the drape (Move it) close the encounter by repeating the important bits and asking if that sounds right (They can correct you!) tell them everything you want to do as work up in lay-language and why and what concerns they have thank them and GTFO. Easy to miss, have a system (I liked the popular SIQORAA and PAMHRFOSS best – I previously tried SAMPLE and OPQRST from my EMT training and too often forgot important bits). There are things you need to get every.I found the focused physical exam the most challenging to get down. Timing will vary but try to get all history bits in 4 minutes, be halfway done with physical at the 5 minute warning, don’t forget to close the case. Take less than a minute to read the vignette and jot down your mnemonics (The vignette is typically too vague to get a narrow differential diagnosis anyway). Tell the patient what you think it might be and that you need to run additional tests. CS is gauging your ability to communicate, collect, and workup disease. You neither need to discuss a treatment plan nor do you need even think about treatment. They are not testing on your ability to treat. Here is a list of the top few things I ducked up and missed during my first round. Oh and since there is no meaningful feedback in the event of failure maybe you just need somewhere to start. Okay, so you are studying for CS or maybe you failed it and you don’t have a lot of time to figure out what happened.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |