COMLEX PE Reassurance 2019

[PittDO1787]

Hey guys,

Figured I'd write this post, since a lot of people seem to panic a bit after the PE (understandably so.)

After the PE, I walked out feeling OK. Felt pretty good about the humanistic portion, and managed to finish all of my notes. However, as time went on, I began to remember all of the mistakes I had made.

Here's a list of some of the things I remember:
-Did not always lead with an open-ended question
-Forgot to address vitals with patients when I certainly should have
-Forgot what setting I was in a couple of times, so I would tell patients something as if we were in an office setting when we were actually in the ER
-Forgot to wash my hands once (caught myself after I had already done a portion of the physical)
-Had a couple of tricky cases, so my assessments and plans weren't very great for those. One case I had no idea what to do...didn't figure out what was most likely going on until after I submitted my note
-Forgot to order a lot of obvious tests for patients
-Did not drape a patient when I should have
-Physical exams were OK, but could have definitely been more thorough

I could go on and on.

A couple of other things. There is no need to drape every single patient, only drape the ones where it is absolutely necessary (i.e. abdominal exams.) I've seen debates on whether or not you should pull the gown down to listen to the heart versus going through the side of the gown. I had the patient lower their gowns....as long as you explain what you're doing/ask for permission, you will be fine.

You will not fail this exam for forgetting to wash your hands once. You will not fail for not knowing everything. And you will certainly not fail for not remembering to do everything with your patients. If you are empathetic, if you explain what you are doing, if you truly make an effort with all of your patients, and if you finish the majority of your notes....then you will most likely be just fine.

Take the exam seriously, and trust what you know. Good luck to everyone waiting for scores and to everyone waiting to take the exam!

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[Sardonix]

Gonna repost what I said like a month ago because it's a very similar experience:


If you're like me, before and after your COMLEX PE you helped simultaneously feed and soothe your neuroses by googling various internet strangers' experiences. So I guess as a personal debrief and in order to impart whatever (little) wisdom I have, here's mine:

I absolutely hated this exam. Hated, hated, hated it. It was a money sink--$1400 to register 8mos in advance as well as money to get there and money to stay in a hotel nearby and money to get Lyfts etc. On top of that, knowing that most people pass yet still ALSO knowing that failing would be a large, unnecessary red flag on my app stressed me out for months. I will say that despite my huge anxiety for the exam, I do feel like being forced to practice for it DID help shift my mind from "I'm just a student" to "Dang, I'm going into M4 and need to think like an actual diagnostician." Do I think that was worth the cost and the stress? No, I'd rather be pimped by my IM attending any day. But I do think it helped me "put it all together" in the long run.

The testing staff themselves were very nice and aware of how stressful the whole situation was and did everything they could to make the experience organized and predictable. The NBOME of course talked up how amazing the patient actors were, but actual experience showed them to be rather wooden/robotic in their interactions. However, the patients DID attempt to help me out toward the end of my patient encounters. Just by asking "Is there anything else you think I missed?" toward the end triggered a particularly helpful patient to give me a clue that basically saved my differential. Props to you, guy!

Here are my aforementioned nuggets of wisdom (rants):
1. The Truelearn COMBANK PE videos with Dr. Kauffmann were very helpful (even if they tell you to prepare for a standard way higher than reality). Some of the example SOAP notes and patient interactions, while not perfect, are useful and I would even recommend you watch them throughout 3rd year if you have a COMBANK subscription. Kauffmann also writes a COMLEX PE book and I assume that's basically the same thing as the videos. Either seems to work relatively well. Do NOT use Step 2 CS books to prepare for this. They are entirely different tests with different grading systems/requirements. Just don't. I know the cool thing to do is to crap on COMLEX while worshipping USMLE, but not having to retake PE in order to graduate is even cooler so suck it up and deal with it.

2. The post-test anxiety is absolutely real. I walked out totally fatigued and/or concussed so I didn't have many immediate concerns. But over the next two weeks my "retrospectoscope" worries peaked and I was repeatedly struck with moments of panic and doubt even though I knew I had adequately prepared for an exam that boasts a 93-95% national pass rate. Even though the actual exam didn't seem (objectively) that hard, the worrying in the 7-8weeks afterwards was definitely the most miserable thing I've had to deal with this year.

3. Overall you DO need to prepare for this exam. As much as you'll want to write it off and study for Step 2/Level 2, putting time in will prepare you for it and put your mind (at least a little) at ease leading up to it and afterward. Personally, I would much rather feel like I had over-studied for PE rather than be absolutely sure I failed while trying to study for my written boards afterward.

4. On that note, this test is NOT seeking perfection. This will not be like your OB/Gen Surg rotations where even the slightest mistake at 3am on a Friday morning will bomb your eval. They are looking for ADEQUATE, MINIMUM competency to let you progress toward M4/residency. The reason that every COMLEX PE thread is filled with "I failed to do ____ but I still passed" comments is because that stuff is absolutely true. You may bomb one patient interaction, but then make up for it elsewhere. Your score is averaged over all of your encounters so the goal is to bomb as little as possible while accepting the fact that you will make stupid errors here and there given the time constraints and nervousness. So long as you have reasonable data gathering, physical exam, and note writing skills you will likely pass. Meanwhile, being a jerk, not preparing, making REPEATED/SYSTEMIC errors on every encounter, or lying about your data collection are the fastest ways to actually fail.

5. Communication and "empathy" for the patient and all the little tips and tricks they say to use DO pay off. If you are nice/sympathetic to your patient and you can speak plain English to them you've already won half the battle. The acting staff sit in those rooms for 8hr shifts and by the end of the day it starts to show. I have no doubt aside from the checkboxes they are required to check, being a likable/normal person probably goes a long way toward them rounding up your score vs. looking for reasons to bomb you. Even if you have no idea what the diagnosis is, explaining your A/P with (somewhat) confidence and treating them like a human being is all you really need.

And that's my rant. Moving on.

 

[BorntobeDO?]

Since this forum is much more frequented I will get on the repost game:
Yep just got it I passed as well. So relieving to have it done.
Without getting too specific as I don't want a violation my advice is basically watching all the kaufmann videos, he really helped me think of stuff for many of the presentations. I did OMM on almost half my patients and it felt like too much. In fact, I actually turned down one guy doing the whole 'can you do something?' cause I thought it was inappropriate. After all the cases I had done at that point and I could hear Kaufmann saying that OMM is not appropriate for every case and obviously it worked out. I did explain my thought process to every patient.

For future students, things I did wrong and still passed:
I forgot to ask medications on at least 2 patients
I called two differents patients a variation of honey/sweetie/dear a couple times, I mentally facepalmed each time and said I wouldn't, but it was like an old habit kicking in.
I stayed in one room only like 8 minutes or something, and realized I probably should have spent more time later.
I didn't always recheck every disfunction I treated. Man my OMM must have been ugly, but I did do 2 techniques a patient.
I did other stuff but I just can't remember.

Helpful hints: I didn't do heart and lungs on every patient. I did basically no special tests outside of rebound tenderness and maybe obturator.
I did do the Kaufmann 'can I lower your gown thing' every time I did a lung or chest exam tho. I did 6 posterior and 4 upper anterior (above breasts) for lungs. You don't have time to do heart and lungs on every person. Do a focused exam first.

Make sure you know some basic wellness/physicals for both adults and adolescents. I think the Fed Tacos thing was great that Kaufman did, almost always brought up something extra for the differential. Also make sure you read the lab results before you go in the room. Don't make assumptions about the results being a good or bad thing, let the patient tell you how they feel.

Talk about your differentials as you are thinking them up. Discuss with the patient why and what you think they may be having as your finishing your physical. And if you hear that two minute warning, immediately jump to a rushed physical and then plan. Always make time for 'any other questions?' while sitting and looking at the patient. Its better to cut off half a physical than to skip that test.

I kept my ROS very short. 2-4 systems at most. one or two questions a system besides the general ferver, chills, weight loss, fatigue etc. Don't waste a lot of time on this and do it immediately after HPI. Then move on.

The Chicago site is very close to O'Hare and they give you lockers to store your carry on bag. I suggest you check out the morning of the exam and just bring your bags to the testing site and uber from there to O'hare (about $16). I was really worried about being able to make a 1650ish flight, so I booked a late night one. However, with uber pool and the close location I was able to get to the airport prior to 1530, so I actually moved my later flight up. If you are worried about traffic and similar things, I think its easy to make a 4:50 flight off of the morning session. Also O'Hare has lots of delays on flights out, especially on American, so you will be okay.

Thats all I got for now.

 

[Giovanotto]

Since this forum is much more frequented I will get on the repost game:
Yep just got it I passed as well. So relieving to have it done.
Without getting too specific as I don't want a violation my advice is basically watching all the kaufmann videos, he really helped me think of stuff for many of the presentations. I did OMM on almost half my patients and it felt like too much. In fact, I actually turned down one guy doing the whole 'can you do something?' cause I thought it was inappropriate. After all the cases I had done at that point and I could hear Kaufmann saying that OMM is not appropriate for every case and obviously it worked out. I did explain my thought process to every patient.

For future students, things I did wrong and still passed:
I forgot to ask medications on at least 2 patients
I called two differents patients a variation of honey/sweetie/dear a couple times, I mentally facepalmed each time and said I wouldn't, but it was like an old habit kicking in.
I stayed in one room only like 8 minutes or something, and realized I probably should have spent more time later.
I didn't always recheck every disfunction I treated. Man my OMM must have been ugly, but I did do 2 techniques a patient.
I did other stuff but I just can't remember.

Helpful hints: I didn't do heart and lungs on every patient. I did basically no special tests outside of rebound tenderness and maybe obturator.
I did do the Kaufmann 'can I lower your gown thing' every time I did a lung or chest exam tho. I did 6 posterior and 4 upper anterior (above breasts) for lungs. You don't have time to do heart and lungs on every person. Do a focused exam first.

Make sure you know some basic wellness/physicals for both adults and adolescents. I think the Fed Tacos thing was great that Kaufman did, almost always brought up something extra for the differential. Also make sure you read the lab results before you go in the room. Don't make assumptions about the results being a good or bad thing, let the patient tell you how they feel.

Talk about your differentials as you are thinking them up. Discuss with the patient why and what you think they may be having as your finishing your physical. And if you hear that two minute warning, immediately jump to a rushed physical and then plan. Always make time for 'any other questions?' while sitting and looking at the patient. Its better to cut off half a physical than to skip that test.

I kept my ROS very short. 2-4 systems at most. one or two questions a system besides the general ferver, chills, weight loss, fatigue etc. Don't waste a lot of time on this and do it immediately after HPI. Then move on.

The Chicago site is very close to O'Hare and they give you lockers to store your carry on bag. I suggest you check out the morning of the exam and just bring your bags to the testing site and uber from there to O'hare (about $16). I was really worried about being able to make a 1650ish flight, so I booked a late night one. However, with uber pool and the close location I was able to get to the airport prior to 1530, so I actually moved my later flight up. If you are worried about traffic and similar things, I think its easy to make a 4:50 flight off of the morning session. Also O'Hare has lots of delays on flights out, especially on American, so you will be okay.

Thats all I got for now.

Do we need an ROS? Kauffman's notes don't include ROS.
Any good resources for wellness exams for adults/teenagers? kauffman only has sports physical in his videos, thanks!

 

[PittDO1787]

Do we need an ROS? Kauffman's notes don't include ROS.
Any good resources for wellness exams for adults/teenagers? kauffman only has sports physical in his videos, thanks!

Yes, do a ROS. I always did general, heart/lung, and then whatever system they had a complaint about. I would recommend looking at the sample note on NBOME's website. I pretty much adhered to that.

As for wellness exams.....just go through the HPI/PMH/PSH/meds/allergies/family history/social history/ROS like you would for any patient, regardless of age. Then do a physical exam. For patients without acute complaints, I made sure I asked them if they had any questions or concerns/wanted to discuss anything that was missed. That's a good way to pull out important information if you happened to have missed it.

 

[BorntobeDO?]

Do we need an ROS? Kauffman's notes don't include ROS.
Any good resources for wellness exams for adults/teenagers? kauffman only has sports physical in his videos, thanks!

Sports physical is the kind of thing I was talking about or general wellness for adult. These are pretty much fedtacos time in my mind.
Physicals are pretty much heart and lungs on wellness.

 

[Giovanotto]

Sports physical is the kind of thing I was talking about or general wellness for adult. These are pretty much fedtacos time in my mind.
Physicals are pretty much heart and lungs on wellness.

I thought you pretty much always did fedtacos....
Gotcha. Also, on PE, did you document you only listened to posterior lung sounds? Or did you only do posterior but documented you listened throughout?

(and thank you everyone for answering my N^10th questions about this exam)

 

[PittDO1787]

I thought you pretty much always did fedtacos....
Gotcha. Also, on PE, did you document you only listened to posterior lung sounds? Or did you only do posterior but documented you listened throughout?

(and thank you everyone for answering my N^10th questions about this exam)

No worries! I did not specify that I only listened to the posterior lungs. I just wrote "CTA bilaterally."

 

[NecFasc92]

I thought you pretty much always did fedtacos....
Gotcha. Also, on PE, did you document you only listened to posterior lung sounds? Or did you only do posterior but documented you listened throughout?

(and thank you everyone for answering my N^10th questions about this exam)

I only listened to posterior. On all cases

 

[Sardonix]

Do we need an ROS? Kauffman's notes don't include ROS.
Any good resources for wellness exams for adults/teenagers? kauffman only has sports physical in his videos, thanks!

Yes they do. Its the S in the CODIERS mnemonic.

In every case you can always ask constitutional screening questions: Fever/Chills/NS/Wt changes/Fatigue. Add specific ROS questions depending on the CC.

 

[Misery to Okay]

I made what seemed like a millions mistakes and still found out I passed two days ago. I even ran out of time twice and didn't finish my physical exam and had to duck out of the room mid sentence with an awkward "Well times up so I gotta go, thank you for coming in today." And even one where I finished with almost 9 minutes left and I just awkwardly did 3 more OMT treatments to fill in the time and left with more than 5 min left. And all the weird moments where I tried to connect and failed...

 

[Giovanotto]

Yes they do. Its the S in the CODIERS mnemonic.

In every case you can always ask constitutional screening questions: Fever/Chills/NS/Wt changes/Fatigue. Add specific ROS questions depending on the CC.

I don't see ROS anywhere on his SOAP. He is doing associated symptoms, but not ROS, unless I'm going blind.

 

[Sardonix]

I don't see ROS anywhere on his SOAP. He is doing associated symptoms, but not ROS, unless I'm going blind.

That's the same as ROS. You always ask constitutional symptoms, and then ask about any other associated (CC related ROS) symptoms they may have.

 

[samac]

I don't see ROS anywhere on his SOAP. He is doing associated symptoms, but not ROS, unless I'm going blind.

He doesn’t do an ROS section, he sticks it in a sentence in the end of his HPI. From his book on the shoulder pain case: “He denies fever , chills, weakness, numbness, tingling, chest pain, shortness of breath, or cough.”

I chose to separated it on my note. I know people who did it his way and also passed.

 

[AlteredScale]

Can you say on the SOAP Note under diagnoses "4) No tart changes noted"? I'm not sure if everyone uses TART changes as a screening tool for OMM.

I wouldn’t put that. Assessment is for things you want to work on and putting negatives doesn’t seem right.

For OMM, my cases were very VERY explicit on if they wanted it. I refrained from doing OMM screens on anyone else.

 

[BorntobeDO?]

I thought you pretty much always did fedtacos....
Gotcha. Also, on PE, did you document you only listened to posterior lung sounds? Or did you only do posterior but documented you listened throughout?

(and thank you everyone for answering my N^10th questions about this exam)

I did it on most patients. Sometimes I skipped sexual. I documented how they sounded, not what side I listened at.

 

[AlteredScale]

Just took my PE the 20th, would appreciate some feedback on my main concerns:

assesments always had at least 3 along with full O and S components per pneumonics OLPPQRSTA/CODIERS, fedtacos, ect.
Plan was usually between 3-5, in one case I had one bullet but 5 things. Plan didn’t always address each ddx fully beyond the main ASsesment

one was an emergent case where I was vague with patient as I was unsure and stated beyond some minor abnormal vitals for them Not to be concerned and I’d like to get a fuller picture andwork up with text x,y,z. I was unsure at first and attempted omm to now Avail and left the room and realized the severity of the case and added that to my plan, but didn’t have time to discuss omm in the note. Patient wasn’t in acute distress or anguish beyond sob. I said no red flags to me beyond abnormal vitals but I want a further work up (was probably a PE). Should I have said ur having a PE maybe? I didn’t want to exacerbate concerns. My big thing is I said “ no red flags”. Which idk of graders would not like

other cases with omm went well and indicated. I’m sure I’m missing a lot but those were my chief concerns, along with not always counseling patients or rechecking abnormal vitals

There's no way we can tell you what you should have or shouldn't have said. We have no clue if saying "no red flags" is going to count against you. What's done is done. As long as you documented accurately and weren't rude to the patient I think you stand a fair chance of passing.

So the patient was sobbing but wasn't in acute distress? How does that work?

If this is a PE, the LAST thing you should be considering is OMM. You should be thinking about where to admit this patient and what kind of Rx you will be providing them if you are suspecting for it, and if not, what tests you should be ordering to confirm your current working diagnosis (CTA vs. d-dimer)

 

[Sardonix]

Meant shortness of breath, they were not uncomfortable or sobbing. But calm. I didn’t realize it was for sure a PE until after I left the room. That’s when I indicated in my note CTA, ekg, ect to r/o. I told the patient I wanted to get a more clear picture so I’d get an ekg, Ct of the chest, ect

If that's the only thing you're worried about, chill. If you miss a dx in the room but remember it while writing the note, you make up for it by documenting something along the lines of "Oh, s*** but actually if it's this, here's what I would totally do LOL" in the note. And it sounds like you did that.

As I said above, you're expected not to be perfect, just competent. Your score is averaged over all encounters so even if you bomb 1-2 of them, the others help carry you through. So long as it wasn't a systemic error like forgetting to wash your hands 50% of the time or insulting the patient you're good.

 

[ARK1234]

Honestly, I feel like you did so much better than I did. When I took it during third year, I felt like I bombed maybe close to 1/3 to almost 1/2 of my cases, and I made way more mistakes than you did. Still ended up passing. Just trust that there is more leeway in this exam than you think, and that despite your mistakes, there are also many things that you did right in this exam.

 

[Osteoguy1994]

Honestly, I feel like you did so much better than I did. When I took it during third year, I felt like I bombed maybe close to 1/3 to almost 1/2 of my cases, and I made way more mistakes than you did. Still ended up passing. Just trust that there is more leeway in this exam than you think, and that despite your mistakes, there are also many things that you did right in this exam.

And thank you for the positivity, truly, it helps more than I can express while I wait

 

[sdhere1234]

Question for something I'm confused about. How do you document abnormal physical exam findings when you're examining standardized patients that don't actually present with the symptoms of the case?

For instance a patient presents with SOB and its an asthma case or something. And you should hear wheezing in the lungs, but on physical exam you hear clear breath sounds since it's an SP.

Do you document what you actually find? Or document what you would find in the case.

 

[sunshinefl]

Question for something I'm confused about. How do you document abnormal physical exam findings when you're examining standardized patients that don't actually present with the symptoms of the case?

For instance a patient presents with SOB and its an asthma case or something. And you should hear wheezing in the lungs, but on physical exam you hear clear breath sounds since it's an SP.

Do you document what you actually find? Or document what you would find in the case.

M3, haven’t taken PE yet: I always document the true exam findings. At my school sometimes they drew stuff on like rashes or smeared lipstick in a psych case, or act a finding they have control over like tenderness, tears, or work of breathing. I think the PE is similar but I’m not sure.

TLDR: I document the actual findings to include any findings faked on the SP’s end.

 

[Sardonix]

So I guess the question is how aggressive are they on accuracy of plan

In my experience, if you're in the ballpark of the "right" diagnosis, your plan somewhat reflects the diagnosis you're committing to, and you mention any discrepancies between what you told the patient and what you inevitably remembered the second you left the room, you're good. Remember they're looking for COMPETENCY not excellence.

 

[Sardonix]

While my assessments were always reasonable enough and there were 3, sometimes my planes were lacking, ie- hotflashes at 48 w/perimenapause. But was an active heavy smoker so like i had gynecology referral, blood work for hormone levels, ect in the plan, but my ttx literally said like estrogen contraindicated poss ocp to control sx, frankly I just forgot that first line is estrogen, second line is ssris. Those are the spots where I worry they’ll like nail me. And in Hindsight I’m pretty positive of anything OCPs are more contraindicated in that case than estrogen lol. But like I haven’t even had gyno yet and haven’t seen that presentation much in primary care

So like with a case like this I’d totally see me being marked down for plan, but like how much would they tank it

The fact that you're overthinking it this much tells me you'll be just fine.

 

[Ho0v-man]

Hey y’all. I have mine tomorrow and have a quick question: how do y’all do omm documentation?
In the objective is it “somatic dysfunction” or I.e. “sacrum R/ROA”?

what if you’re going to just do something like soft tissue on a stiff c-spine? Would you list an omm dx or could you list something like “stiffness and tenderness of the posterior cervical spine musculature “?

 

[hallowmann]

Hey y’all. I have mine tomorrow and have a quick question: how do y’all do omm documentation?
In the objective is it “somatic dysfunction” or I.e. “sacrum R/ROA”?

what if you’re going to just do something like soft tissue on a stiff c-spine? Would you list an omm dx or could you list something like “stiffness and tenderness of the posterior cervical spine musculature “?

TART, T10 F SrRr or T5-8 SrRl, etc. Actually specify the diagnosis. You could always say restriction to x-movement at y-location, BLT applied, etc.

Man, I had to channel some old school OMM thoughts to remember that stuff.

 

[Neopolymath]

TART, T10 F SrRr or T5-8 SrRl, etc. Actually specify the diagnosis. You could always say restriction to x-movement at y-location, BLT applied, etc.

Man, I had to channel some old school OMM thoughts to remember that stuff.

I better start practicing for my PE coming up. I haven't thought about OMM in like 8 months.

 

[Ho0v-man]

I better start practicing for my PE coming up. I haven't thought about OMM in like 8 months.

Mines tomorrow and this is the most I’ve ever known about omm.

 

[Prehealth1011]

Just to add some more panic in this thread..
For Physical exam, i know people usually do heart + lungs + organ in question on all patients. How bout the HEENT part? Did you guys actually check eyes and ears of every patient?

 

[hallowmann]

Just to add some more panic in this thread..
For Physical exam, i know people usually do heart + lungs + organ in question on all patients. How bout the HEENT part? Did you guys actually check eyes and ears of every patient?

Sometimes? It depends. It was part of my routine to always check eyes and mouth, but not necessarily ears on everyone, not just for my PE, so that's what I did. Do what you normally do as long as you have a sufficient number of systems in there given the complaint.

 

[sunshinefl]

Just to add some more panic in this thread..
For Physical exam, i know people usually do heart + lungs + organ in question on all patients. How bout the HEENT part? Did you guys actually check eyes and ears of every patient?

No I don’t routinely do HEENT. Only if related to case.

I do: vitals, General, heart, lung, relevant, osteopathic

Edit: that’s how I chart objective. I don’t do anything particular for general or retake vitals.

 

[IsWhat]

I’m a firm believer that you really need to show gross incompetence to fail this exam. I took it during a sub-I near one of the testing centers kind of on a whim (an earlier date popped up and I literally took the test the next day when I was actually planning to take it a month later). No studying, I trusted my programs first year preparation and just went in and took it. Don’t get me wrong, I was sweating bullets wondering if I should have studied...Passed.

 

[IsWhat]

While my assessments were always reasonable enough and there were 3, sometimes my planes were lacking, ie- hotflashes at 48 w/perimenapause. But was an active heavy smoker so like i had gynecology referral, blood work for hormone levels, ect in the plan, but my ttx literally said like estrogen contraindicated poss ocp to control sx, frankly I just forgot that first line is estrogen, second line is ssris. Those are the spots where I worry they’ll like nail me. And in Hindsight I’m pretty positive of anything OCPs are more contraindicated in that case than estrogen lol. But like I haven’t even had gyno yet and haven’t seen that presentation much in primary care

Is that gross incompetence lol ^^^^

If those are the kinds of mistakes you made then you are fine. Sure, you’ll get dinged for what you described, but as long as you showed good thought process for the majority of your patients then you are going to pass.

Here’s an analogy, say a long paved road in the middle of the desert is the perfect PE score. Veering off the road is losing you points. You aren’t going to fail until you have gone so far off-road they can’t see the dust cloud coming up from your vehicle anymore (from the paved road). I swear I was driving through the mountains out in the distance at times, but they could still see my dust cloud.

Like has been said before, you absolutely don’t need to be perfect. Smile, be personable, come up with some diagnoses and a plan somewhere within sight of high powered binoculars, and send the person with life threatening illness to the ED.

 

[ortnakas]

I didn't read all of the panicked posts, but: everyone I know left that exam feeling like they definitely failed, and almost every single one of them passed. Chances are good you're fine.

Also, you likely remember all the little things you got wrong, and you've forgotten all the things you did right. Try not to dwell on it so much.

 

[Espressso]

Exactly when do you have to recheck BP on a patient? Or any vitals for that matter? Some of the Kauffman videos, the SP is hypertensive but he doesn't recheck BP. Is it only when it's at the HTN Urgency range?

 

[AlteredScale]

Exactly when do you have to recheck BP on a patient? Or any vitals for that matter? Some of the Kauffman videos, the SP is hypertensive but he doesn't recheck BP. Is it only when it's at the HTN Urgency range?

I had 2-3 cases with high BP. I did not recheck BP in any of them. It's a time sink to do it and with the nerves probably do it improperly.

For those cases, I just listed in the plan to recheck BP before they left.

 

[AlteredScale]

Anyone willing to post some “miracle” pass stories lol?

Not a miracle, but for some of the cases I did listen to heart sounds over the gown because it was too tight and I didn't think about loosening the gown at the time. But did it multiple times so I thought may be enough to fail me but I didn't.

Does the order in which u do ur exam matter? Like let’s say it’s mainly a case of concern ie, am I “this”. And the patient already had a urine “blank” test. And u first start with reassurance and what options there may be if they are “this” AND THEN move onto the physical exam And assessment and plan

No one knows if order matters for the sake of scoring. But doing what you stated is confusing. Ask them why they are there. Do an ROS. Get what you need for the pertinent history. Perform a focused physical exam to the problem (so if it's lipid check do a cardiac exam, etc). Then from there talk about results, talk about what you plan to do and how they feel about it. Keep it simple, keep it similar on each case so you don't confuse yourself.

 

[Osteoguy1994]

When do the scores usually drop for Pe?

 

[Sardonix]

There should be a release date schedule you can look up.

 

[Spectreman]

Took it today and man, the next 2 months are gonna be loooooong

 

[WorriedDO]

I failed my original PE.
So long story short I retook it last month and feel I did worse than the first one.
I spent more time on the "Humanistic" area- but less on the SOAP notes. I finished most of them, but I left out a few key exam findings on 2 of them. So maybe I failed the Biomed part too. YEAH! At the same time, the "humanistic domain" and the standardized patients really irked me. The SP's were more awkward (bad acting, becoming FRANTIC , bad portrayals of their ailments) this time around. I felt like these SP's made it harder to ask humanistic questions but alot easier to be nervous. I really feel like I failed it again.

 

[Spectreman]

I failed my original PE for that all so elusive "Humanistic" domain.
So long story short I retook it last month and feel I did worse than the first one.
I spent more time on the "Humanistic" area- but less on the SOAP notes. I finished most of them, but I left out a few key exam findings on 2 of them. So maybe I failed the Biomed part too. YEAH! At the same time, the "humanistic domain" and the standardized patients really irked me. The SP's were more awkward (bad acting, becoming FRANTIC , bad portrayals of their ailments) this time around. I felt like these SP's made it harder to ask humanistic questions but alot easier to be nervous. I really feel like I failed it again.

That’s crazy! Man I can think of so many little things I forgot to do and stuff I forgot to put in my soap. Like I checked thyroid on a bunch of people where it was relevant and totally forgot to comment on it in my soap. Lots of that junk. Super nervous.

 

[hallowmann]

I failed my original PE for that all so elusive "Humanistic" domain.
So long story short I retook it last month and feel I did worse than the first one.
I spent more time on the "Humanistic" area- but less on the SOAP notes. I finished most of them, but I left out a few key exam findings on 2 of them. So maybe I failed the Biomed part too. YEAH! At the same time, the "humanistic domain" and the standardized patients really irked me. The SP's were more awkward (bad acting, becoming FRANTIC , bad portrayals of their ailments) this time around. I felt like these SP's made it harder to ask humanistic questions but alot easier to be nervous. I really feel like I failed it again.

Those honestly don't sound like you'll fail the biomed part. People forget things all the time. With the Objective, it's more about just having enough things written. A few systems and vials and you're fine. Most of the points are likely in the Subjective and Plan anyways.

That’s crazy! Man I can think of so many little things I forgot to do and stuff I forgot to put in my soap. Like I checked thyroid on a bunch of people where it was relevant and totally forgot to comment on it in my soap. Lots of that junk. Super nervous.

Like I said above, as long as you have "enough" things for the objective, you don't need to worry. They're not going to take off points for not writing stuff you diff if you have enough other things there.

 

[Spectreman]

Like I said above, as long as you have "enough" things for the objective, you don't need to worry. They're not going to take off points for not writing stuff you diff if you have enough other things there.

Honestly I followed Kaufmann pretty hard. Managed a solid CODIERS/SMASHFM/FEDTACOS into every case (obv not asking certain elements if irrelevant). My timing was good, finished every SOAP - nothing blank and no glaring chunks missing. I didn’t do specific meds (unless it was like stopping a reported med or switching one) and def didn’t do dosing, but my plans were pretty reasonable I think. OMM was fine, junk like that. Man those post exam jitters are real though. So much freaking money, all the travel and hassle for it too. Really praying everyone did fine!

 

[sunshinefl]

Honestly I followed Kaufmann pretty hard. Managed a solid CODIERS/SMASHFM/FEDTACOS into every case (obv not asking certain elements if irrelevant). My timing was good, finished every SOAP - nothing blank and no glaring chunks missing. I didn’t do specific meds (unless it was like stopping a reported med or switching one) and def didn’t do dosing, but my plans were pretty reasonable I think. OMM was fine, junk like that. Man those post exam jitters are real though. So much freaking money, all the travel and hassle for it too. Really praying everyone did fine!

Sounds like you killed it!

 

[WorriedDO]

Honestly I followed Kaufmann pretty hard. Managed a solid CODIERS/SMASHFM/FEDTACOS into every case (obv not asking certain elements if irrelevant). My timing was good, finished every SOAP - nothing blank and no glaring chunks missing. I didn’t do specific meds (unless it was like stopping a reported med or switching one) and def didn’t do dosing, but my plans were pretty reasonable I think. OMM was fine, junk like that. Man those post exam jitters are real though. So much freaking money, all the travel and hassle for it too. Really praying everyone did fine!

What about that humanistic, though? IDK what those SP's want!!

 

[Spectreman]

What about that humanistic, though? IDK what those SP's want!!

Only thing I think I could have done better is explaining the pros and cons of my plan, which is something nobody taught us at my school. We were drilled saying “I’m sorry to hear that” and “how is this affecting your life?” were key. Personally I think dressing well, clean shaved, fluent English, you’re already way over half the humanism stuff. Always drape, always help them lay back and sit up, ask to untie and help retie their gown. Tell them the made the right choice coming in. I honestly can fathom how one fails the humanism unless you don’t shave that day, or don’t wear a tie, or your English is not great and you get dinged off the bat by EVERY patient.

 

[Epilepsy365]

Only thing I think I could have done better is explaining the pros and cons of my plan, which is something nobody taught us at my school. We were drilled saying “I’m sorry to hear that” and “how is this affecting your life?” were key. Personally I think dressing well, clean shaved, fluent English, you’re already way over half the humanism stuff. Always drape, always help them lay back and sit up, ask to untie and help retie their gown. Tell them the made the right choice coming in. I honestly can fathom how one fails the humanism unless you don’t shave that day, or don’t wear a tie, or your English is not great and you get dinged off the bat by EVERY patient.

Not true. See my checklist to see how you can fail.

 

[Spectreman]

Not true. See my checklist to see how you can fail.

I read it thoroughly before my exam. Good stuff, very helpful. The humanism Kaufmann vídeo talks about how an issue with dress/appearance or a heavy accent can burn you because it’s an automatic hit on every encounter. That’s why he harps ok ironing your white coat and acting like you’re getting ready to meet the President. I get why you made your comment though, you certainly can still fail even if you hit those few basic things.

 

[Epilepsy365]

I read it thoroughly before my exam. Good stuff, very helpful. The humanism Kaufmann vídeo talks about how an issue with dress/appearance or a heavy accent can burn you because it’s an automatic hit on every encounter. That’s why he harps ok ironing your white coat and acting like you’re getting ready to meet the President. I get why you made your comment though, you certainly can still fail even if you hit those few basic things.

This is my bias opinion. But if you’re Caucasian with 9-10/12 of your SPs being white, you really have to try hard like Kauffman explanations to fail hummanism.

But, if you’re a minority like me even with perfect spoken English, you will be graded to that checklist. Failure to consistently ask open ended Qs, rushing on your closing, and having a perhaps stoic tone will fail you in humanism.