Clinical performance exams before M3

[Red Beard]

---

Members do not see this ad.

How many of you have to take clinical skills exams before starting M3? We have to take an exam where we see 5 standardized patients, do the H&P, and write our notes for grading. The standardized patients grade us on the touchy-feely stuff, and they make sure we asked all the right questions and did the relevant physical exam via video.

Took mine today and....meh. One 'case' was a battered woman, the others were sort of standard fare...

 

[XoQo]

How many of you have to take clinical skills exams before starting M3? We have to take an exam where we see 5 standardized patients, do the H&P, and write our notes for grading. The standardized patients grade us on the touchy-feely stuff, and they make sure we asked all the right questions and did the relevant physical exam via video.

Took mine today and....meh. One 'case' was a battered woman, the others were sort of standard fare...

Yep. Had to take an OSCE before third year. It's not too bad. I think the point is to make sure you guys review all the physical exam stuff/patient interview stuff before starting third year. It's good practice...nothing beats practice for most of that stuff anyways.

 

[pseudoknot]

We do. There are two in M1, and I think two in M2 but don't know for sure since I haven't gotten there yet. The first one was just the interview, HPI and either medical, family, or social history. The second one we had to do the HPI, focused physical exam, and write a note. I think it progressively increases from there.

 

[lilnoelle]

We had 4 patients, one of which was a battered woman. I actually enjoyed the experience. One of the patients required a full general physical as well.
I wish we got more feedback though. We got a grade, but that was about it.

 

[Red Beard]

We had 4 patients, one of which was a battered woman. I actually enjoyed the experience. One of the patients required a full general physical as well.
I wish we got more feedback though. We got a grade, but that was about it.

So we had about the same thing. I don't know what it is, but I really struggle with standardized patients. I do ok with simple H&P in the clinic or ER, but have a hard time with someone who I know is acting, something about it just throws me off.

With the battered woman case, all I could think about was 'what are the magic words this SP is waiting for me to say? What is the grading rubric for this?' We hadn't really been trained on anything more than the reporting rules for that.

EDIT: PS: cute kid!

 

[lilnoelle]

With the battered woman case, all I could think about was 'what are the magic words this SP is waiting for me to say? What is the grading rubric for this?' We hadn't really been trained on anything more than the reporting rules for that.

EDIT: PS: cute kid!

Thanks 🙂

I don't think there are magic words to say. My SP was a great actress. She was crying real tears the whole time.
I think the big thing in that situation is to present the patient with her various options and try to find the one that works the best for her. My patient wasn't willing to report her husband for the abuse, she wasn't willing to leave her husband, but she was willing to have a social worker go to her house and talk to her husband with her - especially after I told her that doing such wouldn't mean her husband was "in trouble" with the law.
Another classmates patient was willing to have her husband come in to her office the next day with her husband so we (the physician plus social worker) could all talk about it. In my situation, the patient hadn't talked to her husband about the issue yet and so that was the next step.

 

[DrKitty]

So we had about the same thing. I don't know what it is, but I really struggle with standardized patients. I do ok with simple H&P in the clinic or ER, but have a hard time with someone who I know is acting, something about it just throws me off.

With the battered woman case, all I could think about was 'what are the magic words this SP is waiting for me to say? What is the grading rubric for this?' We hadn't really been trained on anything more than the reporting rules for that.

EDIT: PS: cute kid!

Had 3 CCE exams yesterday, and I have to agree that I also have trouble with standardized patients. Maybe it's the fact that I know they are acting and I am acting, and that I am being videotaped and graded according to some rubric, really throws me off. I generally do poorly on them and am so disappointed. I am only finishing second year, but in my previous exposures to patients in real life I had no problems interacting with them. I am really frustrated, and frankly it undermines my confidence.

 

[nimbusadjust120]

Had 3 CCE exams yesterday, and I have to agree that I also have trouble with standardized patients. Maybe it's the fact that I know they are acting and I am acting, and that I am being videotaped and graded according to some rubric, really throws me off. I generally do poorly on them and am so disappointed. I am only finishing second year, but in my previous exposures to patients in real life I had no problems interacting with them. I am really frustrated, and frankly it undermines my confidence.

I am working as a standardized patient mainly because of the pay. The pay is good and the job is part time. Do you need any of my advices? I know what i should be looking for. The SP trainer taught us to pay attention to you guys(medical students) and evaluate you after that. I don't feel good when med students are trying so hard to conduct a medical examination while the stupid video camera was rolling at the back.😡 They are going to show the videotapes to the next batch of students and also to use the tapes during CME (showing to all the real doctors)..👎thumbdown

Makes me (standardized patient) and the medical student soooo uncomfortable during the entire process!!😡😡

 

[atyourservice]

Yep, we have a MS2 CSE exam at the end of the year--it was so long that hypoglycemia was setting in. There are about 9 stations with questions on our differential dx after each station too. I think it's a great exercise to help us prepare for 3rd year--we have clinical skills exams at the end of each year, and at the end of family medicine too. While these exams are definitely not like seeing real patients, but they are a decent way to make sure that the med students the have basic clinical H&P skills for when we go into patient encounters on the wards. The reason why I think they have limited use is that the standardized patients purposely hold back extremely important information until you ask a specific question about that topic. Real patients usually want to offer as much information as possible so that their doctor can better help them. But all in all, it's probably for the better that we aren't evaluated by multiple choice tests alone during the first 2 years. Maybe they should have a station with some food for the students that normally don't go 5 hours without eating That would make it better for sure.

 

[soeagerun2or]

Generally the OSCE experience is a load of crap. The patients are bad actors and their feedback is biased as they aren't actually ill. Also, the time limit is erroneous as it doesn't exist in "real" clinical medicine. Perhaps a better solution would be to incorporate promptness/sticking to appointment times in the grading as well as ability to diffuse an upset patient. CS is even more of a joke, especially at ~$1000

 

[Depakote]

I agree that the OSCE is pretty much a waste.

If they're going to throw a complex patient with significant underlying social problems at you and expect a complete Hx with PMH, Social, and Preventative medicine, that isn't going to happen in 12 min. The student that manages to make it happen is either cutting corners or skipping something.

 

[DocPsychosis]

We've had a few sprinkled throughout this semester: a full physical, a full history + write-up, and most recently a focused history, physical, and SOAP note. I've had good SPs for all of them, and I feel like they go well. I'm much more comfortable doing histories and physicals on patients in the homeless clinic now 😎

 

[Pontifex Maximus]

In first year, we had 3 SP encounters where we just took histories, and one touchy subject. ROS as needed, or not included. This year we had just one SP for the head to toe. And the GUDAs for GYN and GU exams. None of this is really graded, per se. Just rated on the experience.

 

[tacrum43]

GW has "Patient Based Exams" at the end of each semester in first and second years. They start out easier, and then get more complicated over time. There's a mix of interviewing and physical exam skills with standardized patients. You definitely do have to include ROS at GW, at least for the full interview. They even take off for not asking about wearing seatbelts or using a smoke detector in your home. We don't have to write any kind of note afterwards though.

I think it's good practice for 3rd year and for the CS part of Step II (but then I haven't experienced either yet, so what do I know). On the minus side, they are really nit-picky about doing the physical exam *exactly* as we were taught. Real doctors in practice develop their own styles. I guess it's to make it easier to grade on a standardized basis.