Step 2 CS question

[Muncus]

Sorry if this questions has been asked before:

How different can your DDx and workup from the closure be to the note? While practicing cases I sometimes come up with more relevant DDx's/workup once I start writing my note that I did not present to the patient, even though the DDx/workup I presented to the patient were totally fine as well.

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[Muncus]

Bump...

 

[Muncus]

No, I refuse to believe I am the only one who has had this question in the history of Step 2 CS test taking.

Anybody who has done CS - have you ever changed something in your note from what you said in your impression? As I understand it the information of the patient note (data interpretation) is never compared to the information you've gathered from the patient encounter (data gathering) as these are scored separately for the ICE section. Seriously, anybody?

 

[bluemagik5]

Took CS recently and I did exactly what you are asking in your question. My goal was to extract as much information from the standardized patient, provide 1-2 differentials along with 1-2 test/procedures, and leave the room. On a couple of cases I added a couple more differentials as I typed the note that I did not mention to the patient. However, I did make sure to perform the physical exam maneuver that would justify my differentials. Here is an example (example provided was not encountered on the exam-legal disclosure): Lets say a patient came in and had difficulty hearing. I would perform the physical exam involving aspects regarding hearing. I would then provide 1-2 DDX and 1-2 test/procedures. I would then go type my note and add, lets say, 1-2 more DDx IF it was warranted and could be related to the case along with additional test/procedures.

 

[Muncus]

Took CS recently and I did exactly what you are asking in your question. My goal was to extract as much information from the standardized patient, provide 1-2 differentials along with 1-2 test/procedures, and leave the room. On a couple of cases I added a couple more differentials as I typed the note that I did not mention to the patient. However, I did make sure to perform the physical exam maneuver that would justify my differentials. Here is an example (example provided was not encountered on the exam-legal disclosure): Lets say a patient came in and had difficulty hearing. I would perform the physical exam involving aspects regarding hearing. I would then provide 1-2 DDX and 1-2 test/procedures. I would then go type my note and add, lets say, 1-2 more DDx IF it was warranted and could be related to the case along with additional test/procedures.

Thank you, that is really helpful. I mean this is what we do with real patients as well, and of course updating our patients on what additional diagnoses and workup we are considering (which we of course can't do here since we only get one meeting).

Another question, how soon after the final prompt to leave the room do we have to leave? I always try to squeeze in a nice general PEARL point at the very end, is there time for this? The instructions video says we have to leave immediately but what does that mean, 5 seconds or 15 seconds?

 

[bluemagik5]

Thank you, that is really helpful. I mean this is what we do with real patients as well, and of course updating our patients on what additional diagnoses and workup we are considering (which we of course can't do here since we only get one meeting).

Another question, how soon after the final prompt to leave the room do we have to leave? I always try to squeeze in a nice general PEARL point at the very end, is there time for this? The instructions video says we have to leave immediately but what does that mean, 5 seconds or 15 seconds?

No problem. So from my understanding, we had anywhere from 5-10 seconds to tell the patient thank you for your time if the announcement saying "Your encounter is now over" came on. I don't think you were allowed to say more than that because it could be considered "irregular behavior." Honestly, the day went so fast that you don't really have time to think about anything else than the task at hand. I think I only had two cases where I was cut off by the announcement just as I was closing. I always made sure to give them my impressions, ask if they had question/concerns, and bounced quickly to type my note. I promise that you will need every minute to type the note because you will be anxious and forget little things or just not type as fast because the encounter may have rattled you.

 

[Jayhawkdoc91]

1. Hey all, just wanted to see what you guys thought of the mistakes I made during the exam.
   
   In one encounter, pt told said he had an allergy to something but in my haste on the note, wrote that he had none...
   
   In another patient I wrote that lungs were clear bilaterally in haste and bc of carelessness but when I was listening to lungs, the exam was hindered by a particular sign/symptom. Otherwise I documented the exam accurately. How much would they ding me for this?
   
   So frustrating to think about all the little mistakes...

 

[Unknowny67]

Cs partner needed in Michigan. Email me [email protected]