Passed! Thanks be to God! AMG, took in Chicago in late December during a gap year between MS3/MS4. Had minimal clinic volunteering to keep me up to speed with exam skills, went through FA one time thoroughly, one time quickly with partners for about 3 weeks. Nothing in borderline, but pretty widespread range of X's (11). ICE just barely outside the borderline area (the furthest left X was beside the borderline area, but not in it). CIS in the middle. SEP "higher performance."
For future people, bad things I did and still passed:
- Started to gel my hands when I realized I wanted to examine a patient's eyes. I got gloves on, but was asking questions while I got them on.
- Had a bit of an awkward moment when I tried to create small talk while washing my hands, couldn't tell if the topic was taboo
- Only counseled ONCE during closings regarding ANYTHING preventative
- Answered a challenge question in 10 seconds as I was walking out the door
- One case I had NO CLUE what was going on, to the point where I went down four rabbit trails, only one or two of which were related to the chief complaint, but all of which were relevant to how the patient was presenting. I could not for the life of me figure out if there was a trick to the case I was missing, but nevertheless, got through it and typed up a DDx related to the CC.
- Forgot OBGYN hx when it was relevant on one case
- Another case I felt completely out of it, asked the same questions multiple times, felt like I was pulling teeth and getting nothing relevant.
- Was only able to complete a full cranial nerve exam once; oftentimes, only got through only a few before moving on to another relevant neuro exam, although I was only able to get through everything I wanted in a neuro exam once.
- Forgot HEENT exam components I wanted to do a few times
- Quickly jumped to a definitive conclusion on challenge comments made by patients due to overzealous empathizing, rather then hedging first on some cases that had more nuanced issues.
- Forgot obvious "next steps" for common diagnoses a few times
- Forgot which exam findings correlated with which diagnoses a few times
Suggestions for the future:
- Come in with a plan and stick to it. I had an established rhythm for asking FHx, SHx, PMHx, and HPI before preparing, so I simply enhanced it by preparing for possible ROS scenarios and adding a bit of supplemental Q's for the previously established areas.
- Prepare with a partner. I don't think I would have gotten the pace of the cases quite right otherwise, plus it allowed me to get some physical exam patterns down.
- Mini cases in FA are gold. I did a quick review prior to the exam just to get in the zone of what sort of DDx and work up I should do for a given CC. Scribble a few of those down to jog your memory in case you run out of questions prematurely.
- If something funky happens, roll with the punches and move along. Two of the cases I had I shook my head after trying to figure out what I could have done. Take a deep breath, write the note to the best of your ability, and take on the next case.
- Ask about your patients' lives when washing your hands. It can help you relax, build some communicative trust, and also gives you space to think out your physical exam strategy.
- I always did a basic core exam, i.e., auscultation heart/lung, just in case. Gives you time to plan next moves, while also demonstrating a "thorough" exam.
- GET SOME REST before the exam to the extent that you can! I am horrible about this, but it really helps if you want to avoid overly caffeinating yourself during breaks, thus leading to frequent restroom stops
Hope all goes well to those still waiting!
