freefall,
does your school video tape you for osce's and their graduation CSA??
i also did well in clerkships for the same subjective reasons that you did, but i was shocked when i failed an osce after a rotation (i thought i aced it!)
me and a couple docs went over the taped encounters (painful by the way to watch yourself, especially when people are watching it with you with a critical eye!), but it really helped me see some stuff that i didn't know i was doing (kind of like those axis 2 personality disorders where you don't see the problem cause you lack insight). If you do have taped encounters; i suggest you go over all of them with some older docs even though you passed them. i'm sure they'd be more than willing/
also, it is impossible to not have transferrence rxn's in such an artificial environment. with different actors, you would have likely passed.
i agree with posters on each side of the argument with the posting of credentials. I think that if i had your credentials it would be extremely difficult to not develop a little bit of pride/ego and i think that the fact that you mentioned them in your origianl post does say something. a slight sliver of ego could lead to a failed encounter (the public is very fed up with Minor Deity syndrome, and borderline comments that could go either way will be interpretted as egotistical).
i also agree that a white male with a good physique is highest risk for failing (other than the 1% or so who cant speak english). i also would like to add that attractive people are more likely to fail ( do you understand why?? )
the actor advice that your dean gave you is dead on too. couple of my favorite tips to sway the transference rxns in your favor:
1) use sir and ma'am with every patient (classic southernplayalistic trick) - a lot of northerners don't do this (culture thing) picked it up in undergrad when i noticed that southerners use it ruthlessly, get what they want, but often have no respect for who they are addressing as sir/ma'am.
2) validation: awesome and underused. get brief initial CC and a few details of the history and then say "first of all, I think that it's great that you took the initiative to come in! it shows that you really care about your health and I'm looking forward to assisting you with your situation!" HA! i also like, "LOTS of people would feel the way you feel if they were in your position!"
3) showing humbleness and modesty by admitting that you don't know something. we had a guy who thought his son had ADHD. in this encounter, i was instructed to be a primary care pediatrician. i didn't happen to know all of the criteria and if i did, i'm not sure i would have gotten too much into it. instead i told him that although i know about the condition, it is not my specialty so i will be referring you to a child psychiatrist and WE will all be working on this as a team with follow-up from both of us. People who knew the 7/7/7 criteria did not do as well and came off robotic by just firing out q after q rather than sympathizing.
just a few tips. you seem really bright, so you probably used all 3 of those. just a few of my personal favs & trying to help others who may not know them. i'm sure you kicked ass in the match too,.. so congrats.
in conclusion, i think it's great that you took the initiative to post and ask for help. lots of people would feel the way you feel and i'm looking forward to assisting you in your situation. see that?? I'm actually ASPD (king of axis 2!) and don't give a crap about you!!!!
later doc.
Firion451 said:
You all have to realize WHY we have to take this test to begin with. It is approximately 1% to weed out IMG's who can't speak English but 99% as a political move to soothe the lay public who are fed up with doctors who are short with them and only give them like 2 seconds of face time. This is abolutely verified becaue there were several articles in the lay press commending the NBME for now making new doctors "pass the test of bedside manner" before graduation.
When dealing with stupid liberal $hit like this, you really have to go out of your way to play the game (as other posters have already mentioned). You have to coddle the patient like they're a friggin 2 year old, ask them like 5 times if they need pain medication, ask them what they think is wrong with them or what they feel they want done, keep yes/no questions to a minimum, and try to unearth the patient's "dirty secret" (e.g. business exec with CP is actually a cocaine user).
I am convinced that the SP's are trained to detect cockiness, standoffishness, and arrogance in an examinee and that's really what this test is about. And by the way, they are the WORST actors and interpreting physical findings is very unclear. This test blows, will not improve health care, and underscores the fact that liberals suck.