- Joined
- Jan 30, 2008
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- 53
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I guess I'm in the bottom 4% of people who fail the exam.
The reason I failed was the ICE portion. My interpersonal skills and english were graded very highly.
I did badly on both the "patient note" portion as well as the "data gathering" section. I really wish they would give me a more detailed score breakdown, because data gathering is both history and physical so I dont know if one was worse than the other or not.
The patient note section was graded as borderline pass/fail. I thought my notes were OK, I didnt realize they were so bad.
Looking back, I can understand how I failed:
1) I had a depression patient and only asked 2 of the SIGECAP questions.
2) I didnt have any alcoholics, but I had about 5 people who said they had 1-2 drinks per week and I didnt ask CAGE questions on any of them. I thought CAGE was just for people who identified a heavy drinking habit, not 1-2 drinks per week.
3) I asked most of the LIQOR questions related to each complaint, but I didnt consistently ask all of them.
4) I didnt get an OB/GYN history on every woman. I only asked for those with abdominal pain or STD complaints.
5) I didnt get a detailed sexual history on every patient, only the abd pain or STD patients. If a pt told me they were married, I just left it at that, and didnt ask about sexual orientation, sex with same gender, # of sexual partners in last year, etc.
6) For physical exam, I didnt elicit any specific signs (i.e. Homans, Kernigs, Murphy, Dix-Hallpike, etc). I was able to do basic CV, lung, abd exams on every pt regardless of complaint, and for the neuro patients I was able to do about 95% of the neuro maneuvers.
7) I think I might have lost points for not doing some of the PE maneuvers exactly right. For example on lung exam I listened to 4 positions on posteriorly and 2 positiosn anteriorly, its possible SP didnt give me credit for it because I didnt listen to 6 and 4 respectively.
8) I didnt do any inguinal lymph nodes or femoral pulses on anybody, even for those with CV, GI or STD complaints.
9) On the patient note, I wrote all physical exam findings as normal. I thought that they were just checking to make sure I did all the maneuvers, I didnt realize they were looking for REAL physical exam findings on the patient, even though it had nothing to do with their diagnosis (i.e. gastritis patient with mildly diminished extremity position sensation).
10) On the patient note and history taking, my ROS was very very limited. For example if they had a headache I asked about nausea, vomiting, diplopia, stiff neck but didnt ask about a bunch of other stuff such as dizziness, vertigo, gait difficulty. And I didnt ask ANYTHING about other systems such as leg swelling, rhinorrhea, cough, diarrhea, etc.
11) Had a depression patient and didnt do a MMSE. Did you guys do this on all neuro/psych patients or just the standard AO x 3 stuff?
The reason I failed was the ICE portion. My interpersonal skills and english were graded very highly.
I did badly on both the "patient note" portion as well as the "data gathering" section. I really wish they would give me a more detailed score breakdown, because data gathering is both history and physical so I dont know if one was worse than the other or not.
The patient note section was graded as borderline pass/fail. I thought my notes were OK, I didnt realize they were so bad.
Looking back, I can understand how I failed:
1) I had a depression patient and only asked 2 of the SIGECAP questions.
2) I didnt have any alcoholics, but I had about 5 people who said they had 1-2 drinks per week and I didnt ask CAGE questions on any of them. I thought CAGE was just for people who identified a heavy drinking habit, not 1-2 drinks per week.
3) I asked most of the LIQOR questions related to each complaint, but I didnt consistently ask all of them.
4) I didnt get an OB/GYN history on every woman. I only asked for those with abdominal pain or STD complaints.
5) I didnt get a detailed sexual history on every patient, only the abd pain or STD patients. If a pt told me they were married, I just left it at that, and didnt ask about sexual orientation, sex with same gender, # of sexual partners in last year, etc.
6) For physical exam, I didnt elicit any specific signs (i.e. Homans, Kernigs, Murphy, Dix-Hallpike, etc). I was able to do basic CV, lung, abd exams on every pt regardless of complaint, and for the neuro patients I was able to do about 95% of the neuro maneuvers.
7) I think I might have lost points for not doing some of the PE maneuvers exactly right. For example on lung exam I listened to 4 positions on posteriorly and 2 positiosn anteriorly, its possible SP didnt give me credit for it because I didnt listen to 6 and 4 respectively.
8) I didnt do any inguinal lymph nodes or femoral pulses on anybody, even for those with CV, GI or STD complaints.
9) On the patient note, I wrote all physical exam findings as normal. I thought that they were just checking to make sure I did all the maneuvers, I didnt realize they were looking for REAL physical exam findings on the patient, even though it had nothing to do with their diagnosis (i.e. gastritis patient with mildly diminished extremity position sensation).
10) On the patient note and history taking, my ROS was very very limited. For example if they had a headache I asked about nausea, vomiting, diplopia, stiff neck but didnt ask about a bunch of other stuff such as dizziness, vertigo, gait difficulty. And I didnt ask ANYTHING about other systems such as leg swelling, rhinorrhea, cough, diarrhea, etc.
11) Had a depression patient and didnt do a MMSE. Did you guys do this on all neuro/psych patients or just the standard AO x 3 stuff?