Remember to take a minute to read the entire 'doorway information sheet' which will provide the location (ER, clinic, urgent care, etc.), vitals, test results, etc. I found it beneficial to write down some of this information on the SOAP note prior to entering the room (e.g., A #yo female/male presents to ___ with c/o XYZ, and vitals). Sometimes you can get a slot or two filled on your differential by reading/interpreting the labs/imaging provided. That being said you should review common laboratory result normal ranges.
Go into each encounter the same way: always ask PMHx, Family Hx, Social Hx. Most of the time it will be a very easy diagnosis, but without asking the full history you'd miss a vital component. Use a mnemonic and have a layout prepared for your blank computer paper sheet. Always ask each question of the mnemonic used.
- OLDCARTS
- SMASH FM: Social hx (see below), Medical hx, Allergies, Surgical hx, Hospitalizations, Family hx, Medications
- FEDTACOS: Food, Exercise, Drugs, Tobacco, Alcohol, Caffeine, Occupation, Sex
Stop what you're doing when the two minute bell rings. You will get docked points if you don't discuss the diagnosis and plan - it's part of the actor's assessment of you. It's better to get the points you need than to spend the next two minutes frantically going through the rest of your physical - write down in the objective or plan portion of the SOAP note what you would have liked to perform but didn't on the physical. Use the time spend performing OMM to discuss the diagnosis and plan because treatment usually takes a few minutes and there otherwise may be awkward silence.
Grip the pen properly when writing notes. Your hand will be dead by the end of the day and will hurt if you hold it improperly. They provide the pens.
You can't wear watches, rings, or have anything (wallet) in your pockets.
You cannot turn off the lights to perform an ophthalmic or other examination.
Do we always have to make small talk?
While not required it will be highly beneficial. Do this while washing your hands and talk about the weather, recent events, etc. Helps break the ice and actually will make you (more so than the actor) feel better about the encounter before it starts.
I am nervous about this because I am an international grad and worried about getting dinged just for looking/sounding different (yep, life is not fair). So, I appreciate all the help I can get on this forum. My Engrish is pretty good, I need to make sure not to miss subtle cues etc.
For those who have difficulty speaking English I would highly recommend more one-on-one practice with a partner to better verbalize your words. NBOME says "The clinical skills tested include:
physician-patient communication, interpersonal skills and professionalism, medical history-taking and physical examination skills, osteopathic principles and osteopathic manipulative treatment, and documentation skills (including synthesis of clinical findings, integrated differential diagnosis, and formulation of a diagnostic and treatment plan). ... The ability to communicate in the English language is required in each clinical encounter."
