COMLEX PE and handwashing

[aliDO]

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I took the PE last week and washed my hands when I entered the room, not before the physical but before taking history. I felt I did good for the most part but I'm now freaking out. Do you think this one mistake will cause me to fail?

 

[aliDO]

I also put a few things in plan (like additional testing, ect.) that I did not discuss with the patient but then when writing the note decided needed to be done. I did not write anything in the history or physical that I did not ask or do. That's OK, right?

 

[aliDO]

anybody? calming down but still worried. 6-9 weeks left!

 

[coffeeeandtea]

I took the PE last week and washed my hands when I entered the room, not before the physical but before taking history. I felt I did good for the most part but I'm now freaking out. Do you think this one mistake will cause me to fail?

lol no, i think i've heard of someone who completely forgot to wash their hands for the entire encounter and still passed.

I also put a few things in plan (like additional testing, ect.) that I did not discuss with the patient but then when writing the note decided needed to be done. I did not write anything in the history or physical that I did not ask or do. That's OK, right?

as long as you wrote it in the "Plan" section and not the H&P section you're fine.

seriously, don't worry. i thought for sure i was going to fail because i felt awful after the exam - wasn't sure i wrote down enough, i forgot a bunch of stuff. with my first patient i was so flustered i almost forgot to ask the PMH/PSH, and on one patient whose IT band hurt and asked for OMM i had no idea what to do and improvised a technique on the fly. and yet i still passed! you're good, just try to forget about it for the next few weeks..

 

[Soccer171983]

No not at all. I know people who screwed up big and passed. You'll be fine.

 

[aliDO]

thanks guys! feeling better. I keep thinking of stupid things I said or did but overall really felt good about it. I'll be at a total loss if I fail. Moving on to the written test now.

 

[Soccer171983]

Good luck with everything!

 

[Dciple]

I take the PE on Wednesday 6/20 and have been wondering when is the appropriate time to wash your hands? Do you do it upon entering the room and before shaking their hand? Or shake their hands and wash after taking the History? I was going to do the latter, but would be pissed if I got dinged points for something stupid like this.

Any consensus on the appropriate hand-washing technique?

Thanks

 

[aliDO]

from what people have told me now, you wash after taking a history but don't want to shake their hand if you haven't washed. so, either wash your hands twice or don't shake hands.

 

[Doctor4Life1769]

I washed like twice. Actually, I just hand-sanitized like twice.

 

[p30doc]

I used the hand sanitizer upon entering, then did the h&p without re-sanitizing. Seems kosher to me as long as you don't touch your hair or drop something on the floor and pick it up. I am still waiting for my grade though.

 

[Altruist]

Any consensus on the appropriate hand-washing technique?

I don't think there's any consensus on this. My PE instructors were strict about washing hands on entering the room, shaking hands, and going from there, so that's the habit I got into, and what I did on the PE. (I don't have my score yet.)

The specific review book you can get for PE (by Kauffman--odds are you can find a friend who has it) says to wash your hands at the start of the encounter before shaking hands, then again before the physical exam if you "re-contaminated" your hands by touching your face, moving the chair with your hand, picking a pen up from the floor, etc etc; but just because it's in that book, that doesn't mean it's the right answer, or the only right answer. I'm not sure how necessary the handshake is, apart from attempting to build rapport.

Given that you can use the alcohol hand scrub pretty quickly, I don't think you'll lose much time washing your hands with it twice--on entering and before physical exam--so I think that strategy makes sense. But it sounds like people have done it different ways and passed.

Good luck.

 

[bleeker10]

I don't think there's any consensus on this. My PE instructors were strict about washing hands on entering the room, shaking hands, and going from there, so that's the habit I got into, and what I did on the PE. (I don't have my score yet.)

The specific review book you can get for PE (by Kauffman--odds are you can find a friend who has it) says to wash your hands at the start of the encounter before shaking hands, then again before the physical exam if you "re-contaminated" your hands by touching your face, moving the chair with your hand, picking a pen up from the floor, etc etc; but just because it's in that book, that doesn't mean it's the right answer, or the only right answer. I'm not sure how necessary the handshake is, apart from attempting to build rapport.

For the PE I sanitized my hands after doing the HPI, before the physical. I had one patient that I started to do the physical, then realized I didn't sanitize my hands, apologized to the patient for this, sanitized my hands, then finished the physical. I passed the PE. The Kaufman book is good for review, but don't pay attention to everything it says. It was written by a prof at my school and while it is good, it seems a bit overkill. Another of the profs, who is on the NBOME committee for the PE, said to just wash your hands before you start the physical. You don't have time to wash your hands twice and every time you contaminate yourself.

I thought First Aid for USMLE CS was a great book to review. It goes through a differential for each case as well as which test to order. The Kaufman book doesn't do that.

 

[Altruist]

I thought First Aid for USMLE CS was a great book to review. It goes through a differential for each case as well as which test to order. The Kaufman book doesn't do that.

I didn't look too hard at that First Aid for USMLE CS book, so can't speak to that, but I agree the Kauffman PE review book isn't perfect. It was decent, but I think there's an open niche for a review book that mentions the osteopathic diagnoses you might run into on the exam, and a few suggested treatments. The last (and largest) section of the PE review book is scripts for reviewing with a friend, which were helpful to go through, but it just kind of stops at "xyz somatic dysfunction" and leaves the treatment to you. Savarese or your old OMM notes can fill that in for you, but I think they could have done better, and tried to write more of an all-in-one review book.

Anyway, I guess bleeker10 answered Dciple's question, and I probably overdid it. My score report may have an asterisk with "Candidate appears to have OCD" behind it. 🙂

 

[Dissected]

Just use hand sanitizer after taking your history. Ask to examine them and drape them and you are good to go on the formality points.

Just got the 'pass' this week. Glad to have this incredibly expensive/inconvenient hurdle behind me before audition/interview season.

Good luck everyone!

 

[Uranium678]

Anyone know what to bring to the PE? Do we need to bring otoscope, stethoscope.. ect?

 

[Altruist]

Anyone know what to bring to the PE? Do we need to bring otoscope, stethoscope.. ect?

For the PE, you need: Your white coat, and a stethoscope. That's it. (Well, apart from pants. Dress professionally.) You also need an ID to get in, but you have to put that in a locker before you start.

They ask you to take all the flair off of your white coat, and won't let you take in anything apart from a plain (non-amplified) stethoscope. Not a watch, not a pen, nothing. No phone, no wallet--they go in the locker. You have to use the pens they give you. There are extra at each writing station.

There are wall-mounted oto & ophthalmoscopes (standard welch-allyn, not pan-optic or anything fancy), and a bp cuff. There are tongue depressors, q-tips, a reflex hammer, tuning fork, a spare pen, and maybe a penlight on the counter in each room, plus a drape for use during the physical exam portion.

Watch the video in the Level 2 PE section on the NBOME.org website. It will go over all of this, and show you the standard set-up of wall instruments you'll have in each room.

Seriously, watch the orientation video. It will answer most questions you might have.

 

[Bacchus]

I just took the PE. I've never even seen 12 patients in less than 6 hours. Ugh. As far as handwashing, I sanitized (didn't wash) before the physical portion only and never got dirty looks, requests to wash my hands, etc. You can do either by either soap/water or sanitizer, just don't recontaminate your hands.

There were cases where I, as well, included things in my plan I didn't tell the patient. Oh well. You only have so much time. If I had any doubt at all, regarding documentation, I didn't include it because I figured I was better off.

 

[aliDO]

well, I passed, so I guess the handwashing wasn't a deal breaker for me.

 

[Dissected]

well, I passed, so I guess the handwashing wasn't a deal breaker for me.

Congrats