Comlex PE preparation

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skinknee

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wow, after listening to the horror stories of the Comlex PE, I realize it's not worth blowing this off. I'm not gonna wing it.

I wanted to ask everyone, whats the best way to prepare for COMLEX PE? Are there any review books?

And I have little info on the format of the exam. How long is the encounter? 10 min? 20 min? And how much time do we have to write our SOAP note? Is that timed separately or part of the encounter?

From others on this board, I got some great pearls (mostly common sense but we can easily forget) :

-List 3-5 differentials (most ppl saying 3 should suffice)
-Wash hands before examining
-Offer to tie their gowns or untie their gowns
-Before concluding ask if they have any questions
-Always emphasize to smokers the importance of quitting

Appreciate your input. I totally do not want to fail this exam! I don't even wanna come close!

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I haven't taken it yet, but here are some pearls of wisdom I got when I attended the practice PE at school-
-OMM should be from 3-5 minutes to get credit. If a patient needs OMM and you don't have time, at least make sure to write it in your plan.
-Be very sympathetic. If a patient sneezes or is crying, offer them a Kleenex. If a patient is a single parent, ask about resources to care for the child and other family support.
-Ask permission to examine them
-Always knock on the door before entering the room
-Sum things up at the end of the encounter
-Auscultate on skin, not through the gown
 
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Well then I failed b/c I did not do OMT for more than 2 min or so on anyone. If they don't give me credit that is complete bs. I don't see how they cannot give you credit as long as you make a diagnosis, do some myofascial, and then reassess. If you are are only treating one area of the spine, that should take no where near 5 min . . .
 
All of the OMM I did during the entire exam maybe added up to 3-5 minutes. I don't think that alone is a pass-fail issue.

This is the problem with the PE. So much misinformation out there because the NBOME doesn't say what they expect. So one school may say one thing and another says something else. So take what you hear with a grain of salt. I agree with DrMom on the OMM - the NBOME people said during orientation it is not expected to treat until a release or therepeutic level due to timing limitations (to best of my blurred memory) and never mentioned anything about specific time except it SHOULD NOT BE MORE THAN 3-5 minutes (not at least 3-5 minutes).
 
I took PE exam early June, found out I passed last week!
These are the books I used:
1. First Aid USMLE Step 2 CS
2. Review Savarese and First Aid for COMLEX
3. First Aid CS Checklist

You have 14 mins to see the patient and 9 mins to write your SOAP. If you didn't use all the 14 mins, you can use that for your SOAP in addition to the 9mins. You will have a total of 12 encounters. Broken into 3 session, ie 4 encounters per session. After the first session, you will have 30 mins break, meal provided. Then go for the next 4, another 15 min break and finally the last 4. I strongly suggest you look at NBOME Orientation Guide and the Instructional Video. Go to NBOME main website and scroll all the way to the bottom. This will give you some idea how the testing center look like and all the prompts they will be using.

Always be polite, knock before going in. Then introduce yourself and proceed with the questioning. Before the PE, be sure to ask permission if you can examine them, then proceed by washing your hand first. I was told by my collegues that one of the re-taker took it the second time just because he didn't ask for permission prior to the PE. After PE, be sure to summarize your findings and plans with the patient. Then asked if they have any questions before thanking them for letting you examine them.

As far as the type of encounters, they are those you see in general FM or Urgent clinic. Out of 12 encounters, 25% will be OMT based. Don't worry about that because the SP will hint you if OMT is to be done on them. Just be sure to use appropriate technique, NO HVLA and reassess after treatment. I mostly used soft tissue and muscle energy. I even showed one of the patient how to do Gallbreath on himself. If they are a smoker, asked if they thought about quitting. If so, offer helps...like Chantix, patch, etc...
If they are alcoholic, be sure to ask the CAGE questions.

For DDX, write at least 3. I try to write 5 because that's the amount of lines they gave you in the SOAP form. Overall, don't sweat it. Just be yourself, be polite, wash your hands, and treat them as if they are real patients in real settings. All the best! PM me if you have any other questions.
 
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Just a suggestion to those of you that are worried about time because it is probably the biggest issue on this test (not the OMM contrary to popular belief). The OMM ones are the easy ones! They will ask for it and you can pretty much just jump right to it after ruling out some cardio complaints if its chest pain vs. rib with hx and a brief physical etc.

When you get to your SOAP note you may want to immediately put down 3-4 Assessments and 3-4 plans before even doing family hx, CC etc.

This is JUST MY OPINION- and I did pass.....
When you are freaked out on the test it is easy to get caught up in trying to write down a full family hx, allergies, social hx etc. 9 mins is NOT long time as you will see. In my humble opinion if you forget/run out of time and don't put down family hx or allergies they might take off some points. But if you run out of time and saved the A/P (the bread and butter) for the last min and you put down one thing or nothing- that is not good! I would imagine that is major point deduction NO DX and NO TX plan!

So if you come out of the room and immediately write down:
1) Appendicitis
2) GB
3) Pancreatitis etc. and then your plan to work each one up i.e. CT, US, HIDA, LFTs etc. at least you will get the bread and butter points.

My friends and I used this strategy and we passed....
 
I just read through the orientation stuff on the nbome.com site. It was helpful. However, the link for the instructional video doesn't work. Did anyone have this problem?

I went to www.nbome.com which then directed me to this site for the online video, http://iris.nyit.edu/nycom/Academics_NBOME.htm and at the bottom it says "NBOME PE video, click here" Nothing happens! Is it just my computer? I tried the computer labs...same problem. help!
 
when doing your actual PE on the SP, how do you recognise physical findings? Are there physical findings since these SPs are only role playing?

People in the past told me that you are only going through the actions. you're not actually listening to the heart, lungs, abd. Would you ever hear a murmur? or wheezing? Someone told me the patient will make a noise orally when you put your stethoscope on a designated area to indicate a murmur, wheezing, etc.

Can anyone confirm this?
 
Yes. "Patients" make the noises that would correspond to a murmur, wheeze, bruit etc. As for auscultating...make sure you do it on the skin & not over gown.
They even have marks on them to correspond to prior surgeries etc. Some of the actors may have had actual surgeries but you still have to ask them about ALL scars.
 
For the galbreath you just stabilize the head and then essentially use myofascial starting at the mandible and releasing anteriorly right? I don't think I've ever used this technique! I know, I'm a terrible osteopath. But, if they're going to ask for it by name, I better know what I'm doing!
 
I don't think they're going to ask for specific techniques... highly doubt it.
 
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They do have patients that say "My neighbour is a DO and he once did this thing with my shoulder. Could you do that as well"

I believe the above poster was concerned about them asking for specific techinques by name... which I highly doubt will happen. If they say shoulder, any OMM is fair game - no specifics.
 
Are we supposed to bring our own lunch? I assume so, but I've also heard that lunch is provided. Anyone know? I'm making the long trip tomorrow. Surprisingly, the only thing that concerns me is the OMM. I don't use it nearly enough, and I'm afraid I'm not very technically sound right now. Oh well, it's only like 25% right?
 
No you do not have to bring your own lunch. They will provide sandwiches, salads and other stuff. But try and get in line quick as the good stuff will go fast!

Don't worry so much about the OMM. I find it hard to believe that the actors have been trained in all the techniques and the cameras are way in the corner. So I can't believe that people are failing due to OMM. If the patient feels comfortable when you do the technique and you "look " like you know what you are doing you should be fine. I want to repeat that while you should not take the omm lightly, people should really focus on the timing of the SOAP note and the humanistic aspects: wash your hands, ask them if they are comfortable, tell them to stop smoking and drinking and tell them you are so sorry they are in pain! That is the stuff that THEY can take points off for. Just my humble opinion...

BMW_


Are we supposed to bring our own lunch? I assume so, but I've also heard that lunch is provided. Anyone know? I'm making the long trip tomorrow. Surprisingly, the only thing that concerns me is the OMM. I don't use it nearly enough, and I'm afraid I'm not very technically sound right now. Oh well, it's only like 25% right?
 
Is anyone able to access this video on the nbome website? TIA


YES..it is working. Just ran it on my computer. Make sure you have Windows Media Player installed on your computer. There is a link for that just before the "Click here to access NBOME PE"
 
I'm freaking out that I may have failed this exam. I just felt too rushed, which was my own fault. This is going to be a long 8 weeks. I keep reading about people who have no idea why they failed, and I keep thinking of things I should have spent more time on or done differently. This test sucks.
 
I'm freaking out that I may have failed this exam. I just felt too rushed, which was my own fault. This is going to be a long 8 weeks. I keep reading about people who have no idea why they failed, and I keep thinking of things I should have spent more time on or done differently. This test sucks.
I think the NBOME should provide us with guidelines... their own First Aid for USMLE CS. Why are we left in the dark? Why not teach us how the NBOME feels osteopathic medicine should be practiced, and then test us on it? I don't like how they just throw us in there and say lets see what you can do...
 
wow, after listening to the horror stories of the Comlex PE, I realize it's not worth blowing this off. I'm not gonna wing it.

I wanted to ask everyone, whats the best way to prepare for COMLEX PE? Are there any review books?

And I have little info on the format of the exam. How long is the encounter? 10 min? 20 min? And how much time do we have to write our SOAP note? Is that timed separately or part of the encounter?

From others on this board, I got some great pearls (mostly common sense but we can easily forget) :

-List 3-5 differentials (most ppl saying 3 should suffice)
-Wash hands before examining
-Offer to tie their gowns or untie their gowns
-Before concluding ask if they have any questions
-Always emphasize to smokers the importance of quitting

Appreciate your input. I totally do not want to fail this exam! I don't even wanna come close!

Wanna know how to prepare for the PE? Easy. Throw out every single book and board prep material that says it will prepare you to pass this test. Buy a magic eight ball and ask it, "Will I pass this test?" Yes, I'm being sarcastic, but for good reason. There are no clear cut standards for this test. Honestly, how can you test or more or less, standardize the habit of being yourself? This test does absolutely nothing to assess how well or how poorly you will be as a physician. How else do you explain *****holes and complete ****ups who can pass on the first time around and genuinely nice, and possibly valedictorian level med students failing, maybe more than once? It's a travesty that this crap is now required for graduation. It's nothing more than an additional $1100 medical degree tax ($2200 if you're really screwed, not including airfare, hotel, etc.). I'm sure it does wonders for the local economy of that $hitbog borough, Conshohocken.
This is de facto RACKETEERING. When you purposely put up obstacles in front of people and make them pay additional money in order to pass through, not providing the means or the standards to pass, and arbitrarily failing others without a thorough explanation as would be expected by any professional organization, that's RACKETEERING.

Honestly, I've seen better returns on my investment from scam artists than from these jokers.
 
Have you noticed that there are NO MD posts/complaints about the USMLE CS? It's hilarious. The CS exam was created back in the 1980's to ensure the public that IMG's would be able to communicate with the public; not to test the validity of someone's education. Knowing a few individual cases in which people have taken the exam THREE times and still don't know if they passed, I suspect lawsuits may be flying shortly.
 
23 schools nowadays? 150 average graduates per class? Roughly 3,500 students per year? $3,850,000 gross revenue. Not too shabby given the cost to train and pay those "actors", lease that suite, and paying the administrators in Conshohoken can't be too bad ... How about a testing center in the center of the country? Or one a little more West than Conshohoken? They say they can't do that because they'd like to make this as least expensive as possible for students... OK!!!
 
taking it this thursday.....quick question...

for vitals....can I just write VSS and/or WNL as they do in First Aid CS?....or do I have to re-write them all from the door information?
 
Remember that you can stand outside the door for as long as you want (this time DOES come off your 14 minutes)
I used that time to copy down the vitals, think of a differential & Qs I wanted to ask them
 
Remember that you can stand outside the door for as long as you want (this time DOES come off your 14 minutes)
I used that time to copy down the vitals, think of a differential & Qs I wanted to ask them
copy them down


thanks for the advice

-small point...but...do we get to take that door sheet in w/ us (ie as our scrap sheet) or is it like a laminated thing that stays on the door?
 
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You get to take BOTH in w/ you BUT they are very particular about making sure there are no marks on the doorway info sheet.
The 3 pieces of paper you have are doorway info, scrap sheet & your SOAP note sheet (on which you should have already copied your VSs)
Just use the doorway sheet initially to get the person's name & CC & then set it aside so you don't put any stray marks on it.
 
You get to take BOTH in w/ you BUT they are very particular about making sure there are no marks on the doorway info sheet.
The 3 pieces of paper you have are doorway info, scrap sheet & your SOAP note sheet (on which you should have already copied your VSs)
Just use the doorway sheet initially to get the person's name & CC & then set it aside so you don't put any stray marks on it.

So you actually have all 3 pieces of paper for the begining? I thought you only get the scrap and doorway sheet. The SOAP note sheet is waiting for you once you leave the pt's room. right?
 
See below for my post from February.

"Well, I am one of the folks who failed this ummm-hmmm some years ago (3 to be exact), and I am now finally retaking it. Why the delaY? Finances (and a little procrastination). And that it was scheduled 7 MONTHS out to register once I scraped up the cash.

In studying for this exam this time around, I realized a few of my mistakes, and I am really really angry that I was not prepared to take this test. I did well on my school's mock patient exams THAT I TOOK EVERY YEAR from the first year on, and I did well on my patient interactions per my evaluations with preceptors....

So what did I miss? (I failed the humanistic portion)
1. To shake hands with each patient.
2. The damn draping.
3. To call everyone Ms. or Mr. so-and-so.
4. To summarize some history with the patient.
5. To summarize my plan at the end (with the patient). (This was my biggest downfall. I had NO IDEA I HAD TO DO THIS.)
6. To be very nebulous when asked "Do I have some horrible disease?"

I also was so paranoid about getting the notes done that I cut short time with each patient (we were done, btw), so I didn't think that would hurt. Now I know differently. I will at least end every encounter with "Did I answer all of your questions? Is there anything else you'd like to tell me?" My notes and biomechanics were fine.

My OMM was scored highest (I don't remember the term used, I think they may be using new terms these days), and I DID NOT do OMM or an osteopathic exam on everyone. In fact, I really kind of winged my way through some of it because I knew that no one on a camera would be able to verify my diagnosis or treatment efficacy.

In any case, I hope the schools are preparing people better now-a-days. I just was so angry to realize I missed on total crap, when I know I could have passed initially had I just been prepared adequately. (The books that were out were utter crap, since the test was so new.) At least now the First Aid for CS is better and useful. "

I did pass the second time. And I did screw up one encounter - I totally forgot to listen to a dizzy lady's heart (I am pretty sure), but wrote down heart exam stuff anyway. It was my next-to-last patient and I really couldn't remember if I had done it. I don't think I did, in retrospect. Oh, and I totally forgot to write down the vitals on my first patient. I also did not drape 2 people as they were males and had on gowns that WENT TO THE FLOOR and draping would have been silly and useless. I also probably still was under time on half the patient interactions, and I left anyway to write the note after I asked if there was anything else I could do for the person. I did OMM on 4 patients each test.
 
So you actually have all 3 pieces of paper for the begining? I thought you only get the scrap and doorway sheet. The SOAP note sheet is waiting for you once you leave the pt's room. right?

Sorry....you're right. SOAP sheet is outside the whole time.
Just make sure not to write anything on the doorway info sheet.
 
YES..it is working. Just ran it on my computer. Make sure you have Windows Media Player installed on your computer. There is a link for that just before the "Click here to access NBOME PE"

Strange, I click the link and it works. But then it asks me for a username and password!!?? Now what? This is so strange. This can't just be happening to me?

http://iris.nyit.edu/nycom/Academics_NBOME.htm

That the site. The link is at the very bottom to access the "instructional PE video". I hope its not that important.
 
I've been there in the summer, as well as the winter. Hated both. Of course that's just me, as well as I'm sure anyone else that was forced to travel there against their will for a completely unnecessary exam.
And honestly, a philly cheese steak is not entirely something to rave over either.
:thumbdown: :thumbdown: :thumbdown:

im not denying the fact that the exam is useless. nor am i saying a cheesteak is the greatest thing since sliced bread, but calling conshohocken a shiitebog is hardly an accurate description.
 
so weird...

the video decided to work today! It didn't ask me for a username and password and it just started running when I clicked on it.

Definitely good to view. For example, I didn't realize that they will supply you w/ reflex hammer and tuning fork. Thats good to know. I highly recommend people to watch the video. Kinda relieved some of my anxiety. Although I'm still really nervous. Failure would cost another thousand bucks plus! uggh....
 
Let's all make a pact right now to not subject any more students to this stupid exam.

Also, don't stay at the Residence Inn by Marriott unless you are deaf or sleep incredibly soundly... there's a lot of train noise.
 
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Let's all make a pact right now to not subject any more students to this stupid exam.

Also, don't stay at the Residence Inn by Marriott unless you are deaf or sleep incredibly soundly... there's a lot of train noise.

I'm with you on the pact... count me in. I had a different experience with Marriott Residence Inn... I heard the train two times during my entire 2 night stay and was able to walk to the center in 5 minutes. Gorgeous room with living room, kitchen and seperate bedroom. And the walk up the main street in the evenings for beers and pizzasteak was nice. But back to the more important things, LET'S GET RID OF THIS EXAM!! Wasn't it made for the USMLE due to foreign grads not being able to communicate well in English? How did the COMLEX justify this again 3 years ago :confused:
 
Let's all make a pact right now to not subject any more students to this stupid exam.

Also, don't stay at the Residence Inn by Marriott unless you are deaf or sleep incredibly soundly... there's a lot of train noise.


Count me in! It's a waste of everyone's time. Isn't this why we have preceptors everyday in clinic? I know evaluations are subjective, but you can't fool everyone all the time. I hope that people who can't interact with patients are getting bad evaluations at some point.

As for the Residence Inn, I was impressed with their service. They were very friendly and even sympathized with me having to take this dumb test. I can sleep through anything, so the train didn't bother me. But I guess if you're a light sleeper some good earplugs may be required!
 
How many times did the train pass? and how long did it take.Just wanting to know before I book.
 
ok it may be obvious, but how do you drape patient? You put drape on their lap?

See! This is exactly MY POINT!!! Why the hell aren't we taught to drape appropriately IF IT IS SO ESSENTIAL!!!

Anyway, yes, the drape goes in their lap.
 
Remember to crack your knuckles before performing any osteopathic manipulations.

If not, points could be deducted.
 
Here is a letter that a friend requested from me to simply summarize what the PE has cost me, so please do not take this test lightly, and yes some of you do know who I am, and yes I am still waiting, just not making any noise this time.....so shut up, roll over and take the test, because there is nothing you can do. Sad thing is I am prob. one of the few DOs that plan to use OMT:
I am one of the medical students that failed the Osteopathic PE, and am not able to start my residency until I reconcile my score after the 10-week grading period. I write this letter in an effort to let you know that this is not a simple hardship case but one that is happening as I type. I was an average, and I mean very average medical student, however, I had been in the medical field for over a decade as a radiologic technologist, mainly doing surgery, ER and CT. I only state this as to let you know that I am not new to medicine and that I had a previous well paying occupation. I worked on the weekend at this occupation even through my first two years of medical school. The extra income was needed because I also have three kids and just because school started does not mean the bills stopped. I passed every class, step 1, step 2 and excelled at my rotations. I did this while others in my class got kicked out of rotations, held for peer review, failed multiple classes and one who did all those and failed step 1. I will not mention names, but the PE exam was supposed to be able to pick out these people, correct? People who could endanger patients? I have always had a great relationship with my patients, and have had no complaints filed. This new requirement has put me in a very awkward position. I was accepted by my first choice to come to Alaska for a family medicine residency. I picked up my family, sold almost everything we owned, and headed north. I had a deadline to be in Anchorage by the 16th of June. On the 13th of June at Whitehorse in the Yukon Territory, I found out that I failed. This was devastating, not only had we been uprooted from our home, but we had been hit by a hail storm and tornado coming through Kerney, Nebraska on the way. So, as we pull into Anchorage with two trucks that are trashed, one with a smashed windshield, and two trailers, one a fifth wheel, we were totally at a loss as for what our future would hold. We have been stuck in the fifth wheel trailer, due the to the lack of funds or job to purchase or even rent a home. I had to pay another $2400 to fly back to the only place we can take the test. So here we wait in approximately 280 sq ft of living space on Ft. Richardson. It has been almost 3 months since we found out, and we still have another month before the test results come back. I have spent our entire life savings with the move; I am not enrolled and am not eligible for student loans. I have worked for this position for almost 12 years and here I am $300k in debt, almost broke again and facing an unknown testing procedure that cannot even hit a predicted 50% mark on who should pass or fail. I am not eligible to become an x-ray tech again because I put my license into retirement after my second year of medical school. No one will hire me because I am over qualified, and have only been able to work as a handyman and small construction jobs because they do not require a resume. The cost of moving alone was over $12k. However, with all this, we are still making it day by day. My biggest concern is what if I don’t pass again? They did not even tell me what I did wrong the first two times. I have read three books practiced with multiple residence, and yet, what if? We had 14 people out of our class who did not pass the first time; I was the only one to write a formal complaint to the school about not having adequate information on how to correct the situation. And funny enough, I was the only one not to pass. This was also after a confronting a NBOME board member who was vice president of our school, because this was not in the contract we signed when we entered medical school. I feel as if there is no one else to hear the issues with the high stakes testing methods. I know I cannot be the only student out there with these hardships. What I can say is that the testing cannot predict which students will have poor patient communication from the papers Gimpel wrote. I will not get into the blaming game, I simply would like to know what I need to do to get by this test. I simply wish to move on. I don’t know if I have been black balled because of the issues I brought up, but if I have, I will have no option but to leave medicine. My life long dream, almost 12 years in the making, gone; so here I sit in limbo knowing if I don’t pass this time I will have to leave Alaska because my residency spot will be forfeited, and move again back to the lower 48, uprooting my kids and family again. However, this may not be for some time due to financial restraints. Then what? Take it again? What would be the point if I don’t even know what I did wrong? As I see it I have already lost $34,800 on this test with moving cost, travel, testing fees, and lost wages, and it does not include the wages I am losing because of the time lost from graduation. How much longer can I afford to do this? I cannot even file bankruptcy like a normal person because they are student loans…. Please let me know if I am wrong, but my situation seems dismal at this point. Oh and did I mention that they have contacted me about deployment to Kosovo? All because of a test that has a correlation coefficient of 0.38 and 0.41 and founding papers coauthored by a board member of EMS (Educational Management Solutions) Arcadia, who just by chance is the company that designed the testing facility and testing system. So anytime anyone says it is just a test, it is definitely more than just a test to my family and myself. Please let me know if there is anyway to convert to the MD world or have the AMA review the situation.
 
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