COMLEX Level 2 PE Fail - Humanistic Domain DO's and DONT's

[FLdoc2be]

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hi,

i just found out that i failed the COMLEX level 2 PE humanistic domain portion only.... so i'm curious to get advice from COMLEX Level 2 PE passers as to what they did for the humanistic domain. not interested in the obvious "be nice, wash your hands, drape, thank them for their time, ask if they have any questions, help them ungown etc etc" stuff because i did all of that already. more looking for random little details that may or may not cause one to lose points on humanistic domain.

so with that said, to those who PASSED the level 2 PE....

1) did you shake hands with the patient AT THE END of the encounter? not talking about the beginning... i mean at the end after you finished the H & P and told them the plan, right before walking out the door to type your SOAP note.

2) did you make small talk with the patient about other stuff that had nothing to do with the case? i think perhaps the standardized patient gets offended if you don't make small talk... however you are also very pressed for time so there isn't much time to engage in small talk about weather, sports, job, kids, etc.

the above 2 are things i did not do... and i'm wondering if that is reason enough for humanistic domain failure. if the comlex level 2 pe PASSERS can answer the above 2 questions i would really appreciate it!!! thanks for any advice!

 

[D.O_More]

You should consider other things like "how has that been effecting your home life" " will you need a work note for ___" " I'm sorry to hear you're feeling bad" " Here is what I am thinking___ what do you think about that plan" "What do you think is going on right now" " That must be scary/frustrating/(insert any empathetic comment)"

My understanding is that the humanistic domain is graded more in a way that they are looking for certain comments directed at certain areas not so much things you do. For example you should probably make more than one comment about incorporating SP opinions into the plan, and asking their perspective.

 

[FLdoc2be]

Super helpful!! thank you for the response, exactly what i was looking for. I did not say or do any of those things so maybe that had an impact on the scoring...

 

[katiemaude]

I did not shake hands at the end of the encounter.

I did make small talk briefly at the beginning (weather, traffic, something thenpatient says about work or a sport).

I doubt that helps you pass. However where is what I think does... I naturally respond with “I’m sorry to hear that/that happened to you/you were waiting” when presented with information about a death in the family, an accident or a complaint. And I always ask how whatever process is going on affects their work, family life, home life or express empathy (ie “that must be difficult”) and offer a potential solution or more help where I can. Making sure to include them in the plan and ask if they have any questions is also important, on the test and IRL.

Hope that helps. I know it feels like a mystery. Those other things you were doing are correct as well.

 

[D.O_More]

Super helpful!! thank you for the response, exactly what i was looking for. I did not say or do any of those things so maybe that had an impact on the scoring...

This occurred to me later, but also don't forget to use 3 open ended questions to start the encounter and then use transitions in between the different segments of the hx such as "I am going to ask some more questions to get a better idea of whats going on" then "I'm going to ask some more questions about your past medical hx" then "I'm going to ask some more personal questions to get some information on your social hx"

 

[smukke]

1) No
2) No

I thought the COMBANK PE videos were pretty spot on, I thought some parts of it were over the top but it did give me something to measure my "humanistic" approach to. Didn't really practice with anyone, had my family listen as I ran through a few practice scenarios and went through the motions, read through some of FA CS to have a game plan for work up for each area.

Couple rules I followed:
1) Don't waste time making forced small talk unless it's while I'm doing something else (ask how their day is going while washing my hands)
2) If they mention something that sounds like small talk/tangential, address it at least briefly. (that sounds fun, I'm sorry to hear that, that must be scary, how has that been affecting you, etc)
3) Have a plan for a standard summary (chief complaint, dx/ddx, plan, does it sound agreeable, do you have any questions, do you need a note, do you want me to talk to X)
4) If patient is angry, acknowledge and apologize about it briefly at the beginning and apologize again briefly at the end (I'm sorry to keep you waiting, I'm here now and you have my undivided attention; again sorry you had to wait today, you came today because of chief complaint, ddx, plan, etc)
5) Don't stack questions (ie any nausea/vomiting/diarrhea/constipation/problems with urination)
6) Worst case scenario: ask them to follow up in a week
7) Soft tissue or muscle energy

I think many get too caught up in getting the correct diagnosis when what really matters is having a reasonable approach that the patient agrees with. I had several scenarios where I just listed a couple of possibilities and asked the patient to come back in a week in after getting labs/imaging so we could refine it some more.

 

[Desired Member]

I think that perhaps eye contact helps too

 

[Neopolymath]

1) No
2) No

I thought the COMBANK PE videos were pretty spot on, I thought some parts of it were over the top but it did give me something to measure my "humanistic" approach to. Didn't really practice with anyone, had my family listen as I ran through a few practice scenarios and went through the motions, read through some of FA CS to have a game plan for work up for each area.

Couple rules I followed:
1) Don't waste time making forced small talk unless it's while I'm doing something else (ask how their day is going while washing my hands)
2) If they mention something that sounds like small talk/tangential, address it at least briefly. (that sounds fun, I'm sorry to hear that, that must be scary, how has that been affecting you, etc)
3) Have a plan for a standard summary (chief complaint, dx/ddx, plan, does it sound agreeable, do you have any questions, do you need a note, do you want me to talk to X)
4) If patient is angry, acknowledge and apologize about it briefly at the beginning and apologize again briefly at the end (I'm sorry to keep you waiting, I'm here now and you have my undivided attention; again sorry you had to wait today, you came today because of chief complaint, ddx, plan, etc)
5) Don't stack questions (ie any nausea/vomiting/diarrhea/constipation/problems with urination)
6) Worst case scenario: ask them to follow up in a week
7) Soft tissue or muscle energy

I think many get too caught up in getting the correct diagnosis when what really matters is having a reasonable approach that the patient agrees with. I had several scenarios where I just listed a couple of possibilities and asked the patient to come back in a week in after getting labs/imaging so we could refine it some more.

Is the bolded a big no-no? That's absolutely how I was planning to go through ROS (with an explanation/permission to do so of course).

 

[Rekt]

Is the bolded a big no-no? That's absolutely how I was planning to go through ROS (with an explanation/permission to do so of course).

You can, the patients are just extremely annoying in how they answer. "Have you had any nausea or vomiting?". "No nausea".

...

"What about vomiting". "No vomiting".

Just another useless thing NBOME does to try and make you miss stuff that doesn't echo real life encounters at all.

 

[Neopolymath]

You can, the patients are just extremely annoying in how they answer. "Have you had any nausea or vomiting?". "No nausea".

...

"What about vomiting". "No vomiting".

Just another useless thing NBOME does to try and make you miss stuff that doesn't echo real life encounters at all.

As someone who is by all accounts congenial/social/anormalfreakingperson, I am pretty worried about this exam because it seems like they just take drunks off the street to **** with you, but you can't speak to them like you would in any real clinical setting or my past work experience.

 

[samac]

Is the bolded a big no-no? That's absolutely how I was planning to go through ROS (with an explanation/permission to do so of course).

You absolutely can’t do this. They’re trained to answer the first questions.
You can go “Any SOB or chest pain?”
And they’ll say no. They could be having chest pain. It’s ridiculous.

 

[ortnakas]

As someone who is by all accounts congenial/social/anormalfreakingperson, I am pretty worried about this exam because it seems like they just take drunks off the street to **** with you, but you can't speak to them like you would in any real clinical setting or my past work experience.

They train the people really well for the most part, but they don’t train them to answer questions like normal patients. (NBOME is to blame, but my MD coresidents say the USMLE version isn’t much better). They only answer questions they’re explicitly asked— if they randomly volunteer a piece of information, it’s very possibly a cue for you to show your humanistic side. They also only answer one question at a time. I’m not giving away state secrets; this is information my school shared at our PE review session.

That said, if you learn/know a system (CODIERS SMASH FM or pick your favorite acronym), you practice a bit to do it efficiently, and you recognize moments that you’re supposed to respond to with a kind response or OMT, you will probably be okay.

 

[Giovanotto]

Just signed up for this exam. How is it even legal to charge 1,300.00 USD for an exam that requires you to travel to a different state. My sincere sympathies OP, I hope a large windfall comes your way, I'd be furious.

 

[FourniersGreenGang]

You absolutely can’t do this. They’re trained to answer the first questions.
You can go “Any SOB or chest pain?”
And they’ll say no. They could be having chest pain. It’s ridiculous.

Real patients do this all the time too. I swear the number of times that has happened to me in the hospital is ridiculous. Makes you question how "with it" most people are.

 

[FLdoc2be]

thanks guys! good luck to all taking it now, or whoever took it recently or plans to take it some time in the near future.

 

[DOFOSHO]

a couple things i did that no one said yet:
asked ROS in groups of 2; e.g., any nausea or vomiting? any cp or sob? etc.
asked the patient whether they understood the plan and if they could summarize it for me.

Also, check the trashcan when you walk in - if you're stuck and don't know what to do, remembering seeing a tongue depressor or ear funnel thing may help direct you towards an ENT exam. Kaufman videos were worth every penny - that dude could charge WAY more for his videos.

 

[samac]

a couple things i did that no one said yet:
asked ROS in groups of 2; e.g., any nausea or vomiting? any cp or sob? etc.
asked the patient whether they understood the plan and if they could summarize it for me.

Also, check the trashcan when you walk in - if you're stuck and don't know what to do, remembering seeing a tongue depressor or ear funnel thing may help direct you towards an ENT exam. Kaufman videos were worth every penny - that dude could charge WAY more for his videos.

You’re not supposed to ask the ROS in groups of 2’s. They’re trained to answer the first question like we were talking about.
But great idea about the trashcan.

 

[DOFOSHO]

You’re not supposed to ask the ROS in groups of 2’s. They’re trained to answer the first question like we were talking about.
But great idea about the trashcan.

I asked them in groups of 2s and they were cool with it. and i passed.

 

[ortnakas]

I asked them in groups of 2s and they were cool with it. and i passed.

Glad this worked out for you but I wouldn’t recommend it; you got lucky (either with patients who didn’t follow NBOME instructions or when the answer fortunately was yes or no to both questions in the pair).

 

[DOFOSHO]

All my patients were able to answer in the affirmative to one or the other options when given as a pair. "do you have CP or SOB?" "No chest pain but I have been short of breath for several hours." And they were even able to tell me a different symptom without me asking: "any N or V? "No just abdominal pain." It could be that all my patients were having their first day... or they may have changed the rules since 2016.

 

[samac]

I can officially say you definitely don’t want to group questions.
A couple times doing ROS I grouped “any swelling in your hands or feet?” together out of habit.
The response would be “no swelling in my feet”.

 

[chizledfrmstone]

not interested in the obvious "be nice, wash your hands, drape, thank them for their time, ask if they have any questions, help them ungown etc etc" stuff because i did all of that already. more looking for random little details that may or may not cause one to lose points on humanistic domain.

The random details are rarely what cause someone to fail.

Are you sure you did the things you listed correctly?

What sort of exam were you trying to perform that required you to help them ungown??