COMLEX PE Failed

[jacksparrow69]

Guys, I really need positive thought right now!!! Just redid the exam and I am really nervous of how I did. I have done 2 big mistakes and random mistakes that I am really worried about! I know it is water under the bridge now but I would still like your opinions:

I understand that I cannot disclose anything and I have tried my best to do so. If there are any questionable materials, please tell me!
Things that I did bad on:

1. The biggest thing: Unfortunately, in one OMM case, patient was so excited that I lost sight what I need to do so I just proceed to do my PE exam, OMT, debrief, closure and everthing. But at the end, after I walked out, I remember that I forgot to ask about PMH, PSH, Meds, All, FH and SH. So, in essence, anything after CC, HPI and ROS. I am feeling good about my OMT and everything. As well, I believe I was very thorough about HPI and ROS. The only thing that I can do at that time is to just put in that I will return to complete my history in a moment.

2. In one other station, I don't think I did my OMT that well or properly introduced OMM to patient well either. The patient just has so many co-morbidities and was rather strange in giving info. I was running out of time at the end. For all my troubles, patient just said 'that feeling abit better now doctor. Once again, while I have asked patient everything, I was not able to completely type up the SOAP at the end. It was horgwarsh at best.

3. These are more of running sores: I am a slow typer! Generally, I, more or less, completed patient note. I have at most, I think, 3 other notes that I did not complete well. Miss some components of Social history.

4. In some cases, I forgot to ask a couple of questions but I obviously cannot write them down here.

5. I don't know whether that is unacceptable or not, but I did heart and lung exams on all my patients and the pertinent system. Whenever I did my heart exam on a patient, I always asked them to lower their gowns for me and they just dropped it down. With male, I don't think that is a big deal but with female now I am worried! I read somewhere that it is inappropriate to ask patients to drop gown to do heart exam, especially on female. I asked all my patients to lower their gowns and if female, to lift their left breast up so that I can listen to the Tricuspid and Mitrial post! So, in essense, all the female patients' breast were exposed. The only good thing is that after I finished I immediately lift their gown back up and tie it for them! What do you guys think?

6. I was feeling so rushed on a couple stations and I just don't remember whether I have done a good job

Things that I think I did good on:

1. I was generally able to build rapport with all my patients.
2. More importantly, this time I am feeling as if I am more thorough with my notes and my HPI and ROS, hence I was having difficulty typing them up.
3. I felt like my notes were a lot better but who knows?
4. I am able to come up more than 3 plausible differential and couple of problems for the assessment.
5. My PE was more extensive and better written than the last time.
6. Except for that one OMM case I mentioned about, I closed all my cases and allowed the patient to ask any questions and tried to involve them in my plan.
7. I think my OMM was correctly done and noted in my SOAP.
8. I foamed my hand everytime and re-foamed if I touched their feet. Asked them how they want to be addressed everytime
9. While my OMM is kind of iffy, I made sure to do at least 2 techniques every OMM
10. I draped all my patient and was very respectful.
11. I tried very hard to be empathetic: Said sorry when their complaint came up or someone died, asked them about how it affected their lives, do they want me to talk or write any notes,
12. In all cases, I gave them return plan and asked everyone whether they have any questions
13. I am almost certain that I counselled everyone about something or congratulate them on good things they did
14. I made sure to ask their permission for any activities and said out loud what I am doing

I am just so nervous about the PE and what happened now. Also, I really don't think 9 minutes are enough!!!

Can people please comment on what I just wrote and give me their opinions?

I walked out of a case and realized I completely forgot MASHFM. Passed. One case will not sink you. Repetitive mistakes across all cases will. I think you're fine.

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[Sleepingdoc]

Guys, I really need positive thought right now!!! Just redid the exam and I am really nervous of how I did. I have done 2 big mistakes and random mistakes that I am really worried about! I know it is water under the bridge now but I would still like your opinions:

I understand that I cannot disclose anything and I have tried my best to do so. If there are any questionable materials, please tell me!
Things that I did bad on:

1. The biggest thing: Unfortunately, in one OMM case, patient was so excited that I lost sight what I need to do so I just proceed to do my PE exam, OMT, debrief, closure and everthing. But at the end, after I walked out, I remember that I forgot to ask about PMH, PSH, Meds, All, FH and SH. So, in essence, anything after CC, HPI and ROS. I am feeling good about my OMT and everything. As well, I believe I was very thorough about HPI and ROS. The only thing that I can do at that time is to just put in that I will return to complete my history in a moment.

2. In one other station, I don't think I did my OMT that well or properly introduced OMM to patient well either. The patient just has so many co-morbidities and was rather strange in giving info. I was running out of time at the end. For all my troubles, patient just said 'that feeling abit better now doctor. Once again, while I have asked patient everything, I was not able to completely type up the SOAP at the end. It was horgwarsh at best.

3. These are more of running sores: I am a slow typer! Generally, I, more or less, completed patient note. I have at most, I think, 3 other notes that I did not complete well. Miss some components of Social history.

4. In some cases, I forgot to ask a couple of questions but I obviously cannot write them down here.

5. I don't know whether that is unacceptable or not, but I did heart and lung exams on all my patients and the pertinent system. Whenever I did my heart exam on a patient, I always asked them to lower their gowns for me and they just dropped it down. With male, I don't think that is a big deal but with female now I am worried! I read somewhere that it is inappropriate to ask patients to drop gown to do heart exam, especially on female. I asked all my patients to lower their gowns and if female, to lift their left breast up so that I can listen to the Tricuspid and Mitrial post! So, in essense, all the female patients' breast were exposed. The only good thing is that after I finished I immediately lift their gown back up and tie it for them! What do you guys think?

6. I was feeling so rushed on a couple stations and I just don't remember whether I have done a good job

Things that I think I did good on:

1. I was generally able to build rapport with all my patients.
2. More importantly, this time I am feeling as if I am more thorough with my notes and my HPI and ROS, hence I was having difficulty typing them up.
3. I felt like my notes were a lot better but who knows?
4. I am able to come up more than 3 plausible differential and couple of problems for the assessment.
5. My PE was more extensive and better written than the last time.
6. Except for that one OMM case I mentioned about, I closed all my cases and allowed the patient to ask any questions and tried to involve them in my plan.
7. I think my OMM was correctly done and noted in my SOAP.
8. I foamed my hand everytime and re-foamed if I touched their feet. Asked them how they want to be addressed everytime
9. While my OMM is kind of iffy, I made sure to do at least 2 techniques every OMM
10. I draped all my patient and was very respectful.
11. I tried very hard to be empathetic: Said sorry when their complaint came up or someone died, asked them about how it affected their lives, do they want me to talk or write any notes,
12. In all cases, I gave them return plan and asked everyone whether they have any questions
13. I am almost certain that I counselled everyone about something or congratulate them on good things they did
14. I made sure to ask their permission for any activities and said out loud what I am doing

I am just so nervous about the PE and what happened now. Also, I really don't think 9 minutes are enough!!!

Can people please comment on what I just wrote and give me their opinions?

Sorry you have to go through this... Just relax, think positive thoughts... do your other stuff, there is no way to get rid of nervousness unless you get the scores back... It seems like you were ready and did your best.

 

[Lilyhopeless]

I walked out of a case and realized I completely forgot MASHFM. Passed. One case will not sink you. Repetitive mistakes across all cases will. I think you're fine.

I am glad that there is a happy result from your experience. It has calmed me somewhat and many people are correct that I will be very nervous until I pass the exam myself. Just to be clear, did you mean that you did not ask your SP any SMASHFM so you have nothing to write in soap note? Or, you just forgot to write them in your note? Also how long ago was your PE?

If this was my first time, I don't think I would freak out so much but as it is my second time and I got low performance on SOAP and data gathering, these are my sensitive topics. Especially since I am not even sure how far I have improved since my last exam. This exam just psyched me out so much.

I will try to not thinking so much about it (easier said than done) and thank you for sharing your experience!

 

[jacksparrow69]

I am glad that there is a happy result from your experience. It has calmed me somewhat and many people are correct that I will be very nervous until I pass the exam myself. Just to be clear, did you mean that you did not ask your SP any SMASHFM so you have nothing to write in soap note? Or, you just forgot to write them in your note? Also how long ago was your PE?

If this was my first time, I don't think I would freak out so much but as it is my second time and I got low performance on SOAP and data gathering, these are my sensitive topics. Especially since I am not even sure how far I have improved since my last exam. This exam just psyched me out so much.

I will try to not thinking so much about it (easier said than done) and thank you for sharing your experience!

I completely forgot to ask in the interview. When I got to my note i was like oh crap....I had nothing to write!

 

[Epilepsy365]

Study hard for this test and practice writing notes as well as enacting the 30 Kauffman cases in my head for the past 3 weeks. I hope that I pass this thing. Please pray for me.

 

[mathnerd88]

Study hard for this test and practice writing notes as well as enacting the 30 Kauffman cases in my head for the past 3 weeks. I hope that I pass this thing. Please pray for me.

Honestly, you only need a maximum of two days to study for the PE. If you've been seeing patients during your third year and wrote a decent number of patient notes, this exam should be semi easy to pass. The reasons I've seen people fail is because they fail humanism. If you just introduce yourself, shake hands, help the patient up from the exam table, drape the patient correctly, and then discuss a plan and ask if there's any questions by the end of it, you'll pass. Just generally be friendly with all your patients and don't be awkward. People also fail because they have done something that violated the rules like write physical exam findings in the SOAP note that they didn't perform, expose the patient inappropriately, not perform OMM in any station, etc.

I know my colleagues who have royally screwed up on the PE and still pass. They're looking to see if you can act professionally in the clinical setting and at least act semi confident that you know what you're doing (even if you don't know what the diagnosis is.)

Again, all you really need is CLODIERS (I learned OPQRST), ROS, SMASHFM, FEDTACOS, Physical Exam and Assessment/Plan to pass. If you can hit almost all of these, you're guaranteed to pass.

 

[Epilepsy365]

Honestly, you only need a maximum of two days to study for the PE. If you've been seeing patients during your third year and wrote a decent number of patient notes, this exam should be semi easy to pass. The reasons I've seen people fail is because they fail humanism. If you just introduce yourself, shake hands, help the patient up from the exam table, drape the patient correctly, and then discuss a plan and ask if there's any questions by the end of it, you'll pass. Just generally be friendly with all your patients. People also fail because they have done something that violated the rules like write physical exam findings in the SOAP note that they didn't perform, not perform OMM in any station, etc.

I know my colleagues who have royally screwed up on the PE and still pass. They're looking to see if you can act semi professionally in the clinical setting and at least act semi confident that you know what you're doing (even if you don't know what the diagnosis is.)

I’m not confident. Done everything right up to now. Did solid on Steps. Have 10+ university IIs and I am still fearing for my life.

 

[mathnerd88]

I’m not confident. Done everything right up to now. Did solid on Steps. Have 10+ university IIs and I am still fearing for my life.

You'll be fine. Everyone has PE jitters, myself included. It's okay to miss some things here and there. As long as there's no glaring issues that you've repeated on multiple stations, you'll pass. You don't have to pass all stations to pass the PE. They look at your performance as a whole, not just based on one station.

COMLEX-USA MYTHS and MISCONCEPTIONS | Level 2-PE — NBOME

www.nbome.org

 

[samac]

Honestly, you only need a maximum of two days to study for the PE. If you've been seeing patients during your third year and wrote a decent number of patient notes, this exam should be semi easy to pass. The reasons I've seen people fail is because they fail humanism. If you just introduce yourself, shake hands, help the patient up from the exam table, drape the patient correctly, and then discuss a plan and ask if there's any questions by the end of it, you'll pass. Just generally be friendly with all your patients and don't be awkward. People also fail because they have done something that violated the rules like write physical exam findings in the SOAP note that they didn't perform, expose the patient inappropriately, not perform OMM in any station, etc.

I know my colleagues who have royally screwed up on the PE and still pass. They're looking to see if you can act professionally in the clinical setting and at least act semi confident that you know what you're doing (even if you don't know what the diagnosis is.)

Again, all you really need is CLODIERS (I learned OPQRST), ROS, SMASHFM, FEDTACOS, Physical Exam and Assessment/Plan to pass. If you can hit almost all of these, you're guaranteed to pass.

Honestly it’s bad advice. I’m glad a couple days worked for you but especially for DO’s where the clinical experience is so vastly different across sites I think its important to give yourself at least a week or so to get everything down in their format, practice their timing and questions.

people do fail the biomedical domain. For various reasons.

 

[Epilepsy365]

Honestly it’s bad advice. I’m glad a couple days worked for you but especially for DO’s where the clinical experience is so vastly different across sites I think its important to give yourself at least a week or so to get everything down in their format, practice their timing and questions.

people do fail the biomedical domain. For various reasons.

Ditto. There’s a component to getting your timing down, being comfortable with the format, and writing the notes they want in a timely manner.

This is my second and it’s horrible. I honored IM and all my IM Subspecialty aways, so talking to patient isn’t exactly something that I don’t know how to do.

For the kids out there, do not take this exam lightly. You don’t want to be like me with 10+ university IIs and have to deal with this crap. I feel much better on my second trial now with the key quests and PE stuff that I need to do in most of my cases.

 

[mathnerd88]

Ditto. There’s a component to getting your timing down, being comfortable with the format, and writing the notes they want in a timely manner.

This is my second and it’s horrible. I honored IM and all my IM Subspecialty aways, so talking to patient isn’t exactly something that I don’t know how to do.

For the kids out there, do not take this exam lightly. You don’t want to be like me with 10+ university IIs and have to deal with this crap. I feel much better on my second trial now with the key quests and PE stuff that I need to do in most of my cases.

Nobody said to take this test lightly. All I’m saying is that there’s a reason why 96% of the people pass. If you fail you’re in the extreme minority and most likely for reasons I’ve listed.

It could also mean your school doesn’t prepare you well for it. My school has us do multiple timed OSCEs after every rotation block which you have to pass and we have a mock 8 patient PE at the end of third year which you also need to pass before you’re allowed to take the actual one. I’ve heard some schools allowing you to take the PE early in third year after FM which I think is a mistake.

I could see how one definitely would struggle without any form of preparation or guidance from the school on how to approach the PE.

 

[BorntobeDO?]

Nobody said to take this test lightly. All I’m saying is that there’s a reason why 93% of the people pass. If you fail you’re in the minority and most likely for reasons I’ve listed.

It could also mean your school doesn’t prepare you well for it. My school has us do multiple timed OSCEs after every rotation block which you have to pass and we have a mock 8 patient PE at the end of third year which you also need to pass before you’re allowed to take the actual one. I’ve heard some schools allowing you to take the PE early in third year after FM which I think is a mistake.

I could see how one definitely would struggle without any form of preparation or guidance from the school on how to approach the PE.

My school has added more osce time each year I have been here. The pass rate has actually dropped each year. More doesnt always equal better.

 

[mathnerd88]

My school has added more osce time each year I have been here. The pass rate has actually dropped each year. More doesnt always equal better.

Our school has a pass rate of 99% on the PE last year and this year I have heard none of my classmates fail the PE so far. I’ve heard failures at other schools though.

When you say osce time do you mean the time limit? Our school gives us a time limit of 15 min to gather history and physical as well as discuss an assessment and plan for the SP and 9 min for SOAP for all our OSCEs (which is sometimes four or more SPs depending on the rotation you are in.) These OSCEs count as much as COMATs do towards your grade and made it difficult to honor the rotation. They’ve also made the cases much more difficult and involved than the actual PE which is why they give just slightly more time.

I remember my first couple of rotations I had a rough time going through the SPs and barely or never finished before time was up. I can now understand if your school doesn’t adequately prepare you the PE can be quite difficult especially if you’re not used to 14 min encounters.

This is definitely school dependent and it’s unfortunate how some schools don’t train medical students as much for the PE and focus more on CE and CK rather than CS and PE.

Also, I’ve noticed that many programs are not sending out II unless you have a complete application, including the PE score submitted through ERAS. It’s now becoming an important part of your app. I’ve been denied several interviews because of this until my PE score was released to them. I’ve also heard from applicants that many programs (not all) are withdrawing interview invites once they found out you’ve failed the PE.

 

[Lilyhopeless]

Whoever will read this in the future, please DO NOT take it easy with this exam!!! NBOME is not your happy, kind and wise IM or FM attendings!!! If you forgot to do a key question or component, they will not pat you on your head and send you back into the room to get a better history. NBOME will fail you! I cannot emphasize enough that I would rather do 2 ce or ck, instead of PE. It is a massive red flag that will give you nightmare for no reason if you fail. While it is true, many PD seems to think the exam is a joke; you do not want to apply with a failed PE. You will be certainly screened out by various programs (I know I was) and it is not because PD is worried about you as a future doctor from a failed PE, it is just that they are not certain that you will graduate on time for them. This, guys, is the crux of the matter.

If you get nothing else from my entire thread, just get this: STUDY HARD FOR THIS BLASTED THING and once you are attendings, work to abolish this cash cow!!!

On another note, can someone please clarify for me whether I have made mistakes with my objective findings here?

In many cases where appropriate, I would write Skin: Warm, dry, (intact) no icterus and no pallor. Obviously, I did not do a complete head to toe skin exam, I just observed SP in the room when I did my normal heart, lung and sometimes abdomen exam. Does that consider misrepresentation? I don't even bother vocalizing that I am doing skin exam!!! Low-key freaking out right now!!!

As well, would these abbreviations consider bad ones? SOB (shortness of breath), CBC with diff (differential), BMP (basic metabolic panel) and CMP (Complete metabolic panel)!!! Kind of worried about CMP as there were a couple of cases where LFT should be ordered along with BMP so I just put in my plan as CMP.

 

[Epilepsy365]

Whoever will read this in the future, please DO NOT take it easy with this exam!!! NBOME is not your happy, kind and wise IM or FM attendings!!! If you forgot to do a key question or component, they will not pat you on your head and send you back into the room to get a better history. NBOME will fail you! I cannot emphasize enough that I would rather do 2 ce or ck, instead of PE. It is a massive red flag that will give you nightmare for no reason if you fail. While it is true, many PD seems to think the exam is a joke; you do not want to apply with a failed PE. You will be certainly screened out by various programs (I know I was) and it is not because PD is worried about you as a future doctor from a failed PE, it is just that they are not certain that you will graduate on time for them. This, guys, is the crux of the matter.

If you get nothing else from my entire thread, just get this: STUDY HARD FOR THIS BLASTED THING and once you are attendings, work to abolish this cash cow!!!

On another note, can someone please clarify for me whether I have made mistakes with my objective findings here?

In many cases where appropriate, I would write Skin: Warm, dry, (intact) no icterus and no pallor. Obviously, I did not do a complete head to toe skin exam, I just observed SP in the room when I did my normal heart, lung and sometimes abdomen exam. Does that consider misrepresentation? I don't even bother vocalizing that I am doing skin exam!!! Low-key freaking out right now!!!

As well, would these abbreviations consider bad ones? SOB (shortness of breath), CBC with diff (differential), BMP (basic metabolic panel) and CMP (Complete metabolic panel)!!! Kind of worried about CMP as there were a couple of cases where LFT should be ordered along with BMP so I just put in my plan as CMP.

Stop thinking about this. I'm praying for both you and me. Can't do crap anymore. Just got to wait for hopefully the good news in December. I'm sending you good vibes right now. Thanksgiving and X-mas season is coming up, and we deserve some good news right now considering the torture that both of us had to endure over this PE failure.

 

[BorntobeDO?]

Our school has a pass rate of 99% on the PE last year and this year I have heard none of my classmates fail the PE so far. I’ve heard failures at other schools though.

When you say osce time do you mean the time limit? Our school gives us a time limit of 15 min to gather history and physical as well as discuss an assessment and plan for the SP and 9 min for SOAP for all our OSCEs (which is sometimes four or more SPs depending on the rotation you are in.) These OSCEs count as much as COMATs do towards your grade and made it difficult to honor the rotation. They’ve also made the cases much more difficult and involved than the actual PE which is why they give just slightly more time.

I remember my first couple of rotations I had a rough time going through the SPs and barely or never finished before time was up. I can now understand if your school doesn’t adequately prepare you the PE can be quite difficult especially if you’re not used to 14 min encounters.

This is definitely school dependent and it’s unfortunate how some schools don’t train medical students as much for the PE and focus more on CE and CK rather than CS and PE.

Also, I’ve noticed that many programs are not sending out II unless you have a complete application, including the PE score submitted through ERAS. It’s now becoming an important part of your app. I’ve been denied several interviews because of this until my PE score was released to them. I’ve also heard from applicants that many programs (not all) are withdrawing interview invites once they found out you’ve failed the PE.

I meant they kept adding more and more osces, but it didnt matter cause the same instructors were running it. You mentioned doing osces after every rotation, and I was pointing out that doing more osces isnt the same as being prepared well at every school.

 

[BorntobeDO?]

Whoever will read this in the future, please DO NOT take it easy with this exam!!! NBOME is not your happy, kind and wise IM or FM attendings!!! If you forgot to do a key question or component, they will not pat you on your head and send you back into the room to get a better history. NBOME will fail you! I cannot emphasize enough that I would rather do 2 ce or ck, instead of PE. It is a massive red flag that will give you nightmare for no reason if you fail. While it is true, many PD seems to think the exam is a joke; you do not want to apply with a failed PE. You will be certainly screened out by various programs (I know I was) and it is not because PD is worried about you as a future doctor from a failed PE, it is just that they are not certain that you will graduate on time for them. This, guys, is the crux of the matter.

If you get nothing else from my entire thread, just get this: STUDY HARD FOR THIS BLASTED THING and once you are attendings, work to abolish this cash cow!!!

On another note, can someone please clarify for me whether I have made mistakes with my objective findings here?

In many cases where appropriate, I would write Skin: Warm, dry, (intact) no icterus and no pallor. Obviously, I did not do a complete head to toe skin exam, I just observed SP in the room when I did my normal heart, lung and sometimes abdomen exam. Does that consider misrepresentation? I don't even bother vocalizing that I am doing skin exam!!! Low-key freaking out right now!!!

As well, would these abbreviations consider bad ones? SOB (shortness of breath), CBC with diff (differential), BMP (basic metabolic panel) and CMP (Complete metabolic panel)!!! Kind of worried about CMP as there were a couple of cases where LFT should be ordered along with BMP so I just put in my plan as CMP.

I used CMP and CBC on my exam I am pretty sure. I also used SOB, I think I used Liver enzymes instead of LFT but that abbreviation is common so I dont think thats an issue. On the skin, I don't think I actually charted skin on anyone due to time, but warm and dry is easily assessed as long as you touched the patient. I passed my PE, so hopefully that helps.

 

[mathnerd88]

Whoever will read this in the future, please DO NOT take it easy with this exam!!! NBOME is not your happy, kind and wise IM or FM attendings!!! If you forgot to do a key question or component, they will not pat you on your head and send you back into the room to get a better history. NBOME will fail you! I cannot emphasize enough that I would rather do 2 ce or ck, instead of PE. It is a massive red flag that will give you nightmare for no reason if you fail. While it is true, many PD seems to think the exam is a joke; you do not want to apply with a failed PE. You will be certainly screened out by various programs (I know I was) and it is not because PD is worried about you as a future doctor from a failed PE, it is just that they are not certain that you will graduate on time for them. This, guys, is the crux of the matter.

If you get nothing else from my entire thread, just get this: STUDY HARD FOR THIS BLASTED THING and once you are attendings, work to abolish this cash cow!!!

On another note, can someone please clarify for me whether I have made mistakes with my objective findings here?

In many cases where appropriate, I would write Skin: Warm, dry, (intact) no icterus and no pallor. Obviously, I did not do a complete head to toe skin exam, I just observed SP in the room when I did my normal heart, lung and sometimes abdomen exam. Does that consider misrepresentation? I don't even bother vocalizing that I am doing skin exam!!! Low-key freaking out right now!!!

As well, would these abbreviations consider bad ones? SOB (shortness of breath), CBC with diff (differential), BMP (basic metabolic panel) and CMP (Complete metabolic panel)!!! Kind of worried about CMP as there were a couple of cases where LFT should be ordered along with BMP so I just put in my plan as CMP.

You’re totally fine. I wrote AAOx3, NAD in all my SOAP notes and did not actually ask the patient for their name, where they were, and the date. Sometimes these findings are just based on clinical observation only and it’s vague so they’ll accept it. The biggest mistake it to document things you did not do, such as write down an abdominal exam that you did not perform, heart sounds and lung sounds when you didn’t use your stethoscope at all.

I also wrote normocephalic, atraumatic on all my soap notes when I clearly didn’t palpate the head. These are minor things.

 

[Lilyhopeless]

Stop thinking about this. I'm praying for both you and me. Can't do crap anymore. Just got to wait for hopefully the good news in December. I'm sending you good vibes right now. Thanksgiving and X-mas season is coming up, and we deserve some good news right now considering the torture that both of us had to endure over this PE failure.

Hey there, positive thought and good vibe to you too! We now really deserve the pass as I am sure that we must have practiced much more than many people. It is just that this wait and the entire process are indeed very torturous and every day I will just remember new things that I should have done or order or new mistakes that I did!!!

 

[Lilyhopeless]

Thank you very much, every one, for your advice throughout this difficult time for me! I really appreciate it! I just would like your opinion about more mistakes that are giving me sleepless nights right now!

In the assessment during the PE, I just remember that I did not write down any obesity for any patients and there certainly were a few of them. The reason is, I think because I did not write down any BMI in the objective section so I never remember to talk about it either. This is due to time constraint and I will be honest, I don't know why I was not writing it really. The entire exam was just a blur and I was racing through all my notes and put down whatever assessment that came to mind at that moment.

The good news, I hope, was that I have made sure that tobacco or alcohol or sedentary lifestyles are included in my problem lists in addition to my ddx.

Lastly, one patient told me that he took a laxative (brand name) 2.5 mg and for the life of me, I just blanked out on that drug when I was typing my note and I wrote it as ACEI 2.5 mg. I am right now just kicking myself and really worried about it.

What do you think about these kind of mistakes? This exam is just so frustrating; everyday I will just remember new things that I should have done or new mistakes that I made. It is just torturous.

 

[samac]

Thank you very much, every one, for your advice throughout this difficult time for me! I really appreciate it! I just would like your opinion about more mistakes that are giving me sleepless nights right now!

In the assessment during the PE, I just remember that I did not write down any obesity for any patients and there certainly were a few of them. The reason is, I think because I did not write down any BMI in the objective section so I never remember to talk about it either. This is due to time constraint and I will be honest, I don't know why I was not writing it really. The entire exam was just a blur and I was racing through all my notes and put down whatever assessment that came to mind at that moment.

The good news, I hope, was that I have made sure that tobacco or alcohol or sedentary lifestyles are included in my problem lists in addition to my ddx.

Lastly, one patient told me that he took a laxative (brand name) 2.5 mg and for the life of me, I just blanked out on that drug when I was typing my note and I wrote it as ACEI 2.5 mg. I am right now just kicking myself and really worried about it.

What do you think about these kind of mistakes? This exam is just so frustrating; everyday I will just remember new things that I should have done or new mistakes that I made. It is just torturous.

I don’t think I ever brought up obesity. No big issue. Messing up 1 drug won’t hurt you either.

 

[sanset]

Hi,

Long time lurker here and I just found out that I failed PE on Biomechanical sections and passed on Humanistic. TBH, I was surprised by the result but then again, no one went into exam and expect a fail. To cut long story short, guys, please advice me what I need to do. Please be brutally honest regarding my matching chances. My stats are below:

-Above averaged DO student (pre-clerkship) at good DO school (whatever that means) but will need a visa
-Would like to match into IM at good community or academic center
-COMLEX level 1 598, level 2 599
-Step 1 233 and 238
-all passed on first attempt
-No skip year and no failed clerkship
-Strong LoR and Evaluation from attending
-Good extracurricular activities and has research

Really heartbroken right now and can barely function today. Set up a meeting with career guidance and exam review at my school
Need to ask you guys what are my chances; I am going to apply broadly (>100)

Also please tell me what should be the strategy for my application and retake!!!

Thanks in advance!

what resources did you use to prep? did you prep?

 

[BorntobeDO?]

Thank you very much, every one, for your advice throughout this difficult time for me! I really appreciate it! I just would like your opinion about more mistakes that are giving me sleepless nights right now!

In the assessment during the PE, I just remember that I did not write down any obesity for any patients and there certainly were a few of them. The reason is, I think because I did not write down any BMI in the objective section so I never remember to talk about it either. This is due to time constraint and I will be honest, I don't know why I was not writing it really. The entire exam was just a blur and I was racing through all my notes and put down whatever assessment that came to mind at that moment.

The good news, I hope, was that I have made sure that tobacco or alcohol or sedentary lifestyles are included in my problem lists in addition to my ddx.

Lastly, one patient told me that he took a laxative (brand name) 2.5 mg and for the life of me, I just blanked out on that drug when I was typing my note and I wrote it as ACEI 2.5 mg. I am right now just kicking myself and really worried about it.

What do you think about these kind of mistakes? This exam is just so frustrating; everyday I will just remember new things that I should have done or new mistakes that I made. It is just torturous.

One or two slipups like the drug names should not get you dinged. I mean I forgot to ask meds completely on a couple and still passed.

 

[Lilyhopeless]

This is the second score release day and I am still waiting!!! Urgh this is really stressing me!!! With that said, please send positive thought and best wishes!!!

 

[FuturePrissyMD4]

This is the second score release day and I am still waiting!!! Urgh this is really stressing me!!! With that said, please send positive thought and best wishes!!!

I’m in the same boat as you. Hopefully they will be released today. Try not to think about it & stay busy. That’s what I’m trying to do.

 

[Lilyhopeless]

This waiting sucks! I know I should stop thinking about it but this waiting game arouses all my fears and plays havoc with my emotion!!! Another question to the community: in 3 cases where I did CN nerves check: I accidentally wrote CNII-XII grossly intact for 3 cases. I am nervous about it now as I forgot to check the vision for any of them so it should have CN3 to 12. It is honest mistakes because I was rushing through my notes so much. What do you guys think?

Also, just talked with the school and I learned that the registrar will not know the result before you at all.

As well, to others who have been private messaging me, I am sorry that I have not been replying back to you. Presently I am beside myself waiting for my score that I know I am not a good person to talk to or asked for advices.

 

[Lilyhopeless]

Guys, grade is up and I passed!!! Thanks the blessed gods!!!

 

[Lilyhopeless]

Forgive me for a bit of show-off!!! I promised that I will write out my experience when I digested it properly!!! I still can't believe it and finally I can sleep at night!

Edit: Unfortunately, I couldn't fall asleep last night! I was too happy!

 

[LutGholein]

Guys, grade is up and I passed!!! Thanks the blessed gods!!!
View attachment 287443

Congrats! I’ve been following along this story— really happy for you!

 

[samac]

Fantastic!!!!

 

[Lilyhopeless]

One small question! I am, right now, writing the email to update all the programs that I have interviewed at as well as sending letter of interests to programs that I haven't heard from!

Who is the appropriate person that I should send to? My friends think that, for LOI, I should just send them to the PD and cc the coordinators. There are nothing for me to lose if I pissed them off at this junction now. My first instinct is just to send to coordinators in hoping that they will update the PD.

Lastly, for updating the programs, who should I send it too? I am thinking of sending my score report to the coordinators and cc the PD. Or, do you think this is a bit much?

 

[BorntobeDO?]

One small question! I am, right now, writing the email to update all the programs that I have interviewed at as well as sending letter of interests to programs that I haven't heard from!

Who is the appropriate person that I should send to? My friends think that, for LOI, I should just send them to the PD and cc the coordinators. There are nothing for me to lose if I pissed them off at this junction now. My first instinct is just to send to coordinators in hoping that they will update the PD.

Lastly, for updating the programs, who should I send it too? I am thinking of sending my score report to the coordinators and cc the PD. Or, do you think this is a bit much?

I would send to coordinators and let them forward to PDs.

 

[samac]

I’m with Born here.

 

[Spectreman]

Hooray!!!!!

 

[Lilyhopeless]

I have promised myself that when I passed, I am going to write about my experience with this horrid exam! Please bear with me as it will be long. Also, I will be trying my absolute best to make sure that there will be no mention of cases that I have seen during my exam. However, if there are, please tell me so I can remove it.

To pass this exam, you should know its rule! It is not that important as many people passed without knowing it. However, for those who failed, I hope this will be helpful! Also, please take whatever I said with caution, regardless of everything I failed it the first time!

First thing first, I failed my first attempt with the Biomechanical/ Biomedical domain, supposedly the easier part of the exam and I felt greatly devastated by it! I talked to my Dean and during one of our conversations, he made a mention that I took it as an afternoon at an IM clinic and he said that this is not a correct mindset! He said to look at it as a game in which your objective is to get as many points as you can. The only problem is that it is subjective and you have no clue what actions are considered acceptable for points!

So, when I studied again for the PE, I decided to view it as a game as my Dean said. And every gamer knows (I am a very committed gamer) that all games, even subjective ones, have rules. I just have to figure out the rules. How did I do it? I am embarrassed to say that I read up on all their pseudo-research papers regarding their PE and their master blueprint to figure out what they want from me!

1. Let us talk about how you will be graded in this exam! As you all know that there are 2 components to this exam:

Humanism​	Biomechanical and Biomedical domain​
1. Professionalism	1. Data gathering
2. Inter patient-doctor communication and relationship	2. OMT
3. Communication and listening skills etc...	3. Soap note

HUMANISM


According to this research paper (1), regarding humanism, it is scored by the SP using the global patient assessment tool, a holistic Likert-type scoring instrument regarding the following qualities professionalism, respect, eliciting information, giving information, empathy and listening. Where did I get all these qualities from? a. it is in the research paper.

Then what is a Likert-scale? It is a really basic scale either 1-5 or 1-7 used commonly for surveys where 7 often strongly agrees and 1 strongly disagrees. What does it mean then for the PE? I speculated that after our encounter and during 9 minutes, the SPs will filling out surveys similar to this below:

On the scale from 1 to 7, where 7 (or 5) means you agree strongly and 1 means you disagree strongly to the following the statements:
1. The applicants expressed respect in dealing with me and were mindful of my dignity and modesty in their actions
2. So on and so forth regarding all the qualities

Therefore, I am of the opinion that there is actually no checklist at all for the Humanism component. It is just a personality survey. It is why I believe there are so much speculation on what would appear on the checklist because the checklist never existed in the first place. It is why I reckon why there are so many different people who keep saying the following and they still passed: Never summarized the HPI (me included), forgot to wash hands on many stations, forgot to introduce self or announced the SP names etc and etc...

On the other hand, since it is a personality survey, it is also why there are so many people who swear that they did all the above and still failed the humanistic component! My conclusion is that it is not whether you have done it or not that matters, it is how you do it that matters!!!

So, my speculation about it is that even if you were to do every little thing in existence, you will still fail humanism if you were being robotic, rude or being an dingus about it! So, I will now issue my blanket statement that you will not fail Humanism if you are a candidate that SPs want to hug at the end of the encounter. So, go in there and give them the sweetest and fakest smile and voices you can summon (it doesn't the matter that it is fake, so is OMT and so is the PE). If the SPs are not diabetic by the end, you are doing it wrong.

Back to the topic of scoring then, after you did all 12 encounters, your survey scores of each component from each encounter will be averaged over 12 and added up together to give you your total composite grade. You will pass if you are over their cutoff.

BIOMEDICAL

This is what I failed on and I am still pissed over it. If you have read my previous posts, I failed on Data gathering and Soap note. Again, according to this research paper (1), data gathering is scored by the SPs on a percentage metric based on the number of history questions and PE maneuvers correctly performed during the encounter and Soap notes are scored by attendings once again using a Likert-type holistic instrument. While OMT is scored by another attending using a different Likert-type holistic tool.

Data Gathering: As you have read above, this is what can arguably be said to the most objective of the whole exam. The best way for us to attack this section then is to gather as many points as we can when we are in the room with the SP. Once again, when we exit the encounter, the SPs must be busy filling out case-specific checklists. For example, did the candidate ask about constipation? If so, did the candidate follow up with whether there is blood in stools? So on and so forth! Your first job then is to ask as many questions as you can (but be mindful of time limit and your humanism points as you may annoy the SPs), you will not be penalized at all if you asked wrong questions and just as well, you will not be penalized at all you forgot to ask something. You will just not be rewarded points. My opinion is that SPs are not trained in medicine so they would not know what is critical to ask! Your second job is to help the SPs to check the boxes for you by asking each question slowly, clearly and one by one. You don't want the SPs to forget that you ask the questions because you were unclear or disorganized! The same thing, I believe, should also apply to the Physical Exam maneuvers! Your first job, once again, is to do as much as you can regarding your case so that you can be awarded all the points! Your second job, again, is to help the SPs to check all the boxes for you by announcing as loud and clear as you can on what you are doing so that there is no confusion!

OMT: It is graded by attendings using likert-scale by watching our video. I am not going to delve much into OMT as by this point, we all should know how to mime and fake our way thought OMT! My motto throughout med school so far regarding OMM is to fake it till I make it and so far I am still faking it. My only advice is to do at least a couple of justifiable OMT. You will want to get as high a grade as possible in this section to compensate for any poor forms in other sections. I know we all love to bash OMT. I do too. However, in this exam, it is the only part of exam that you hold the answers and, more importantly, you can make up your answers!!! As long as your technique is okay (please hide your hands) and you announce loud and clear what you are doing for the mic, you should be able to get points easily from this section. You just want the attendings to think you are half-competent, by 4th year we should be good at faking ourselves in front of the attendings. So, don't be terrified of these stations, they are your best friends here.

SOAP Note: This is also graded by attendings and is graded again subjectively. You do not need to write the most perfect IM-inpatient note ever! It just has to be sane, logical, full-sentences and honest. You only want the attendings, when they read your notes, to give you a 4 or 5 on their survey scales. I speculated that the grading they use most likely have things like:

On the scale from 1 to 7, where 7 (or 5) means you agree strongly and 1 means you disagree strongly to the following the statements:
1. This note is logical and comprehensible
2. You understand the candidates' decision-making process from this note

Therefore, and again it is only my speculation, it is why we can make so many mistakes with SOAP notes and still passed. It is the compensatory effect of the other 2 components as well as the fact that attendings believe that they can see potential in you to write notes for them in the future! As a ref case, I made a big mess of 2 of my notes completely: 1. One note I had nothing at all in SMASHFH FEDTACOS. 2. The other note's subjective must have been one ugly pig; I have misspelled so much in the CC, HPI and ROS. I created a new surgical procedure for my patient that did not exist before then. I mislabeled the drug name. I did not get to write down the FH and SH where they were pertinent for the case! People can attest that I was really freaking out about these mistakes!

Lastly, you cannot talk about SOAP without talking about mis-documentation or fraud! My advice is don't do it! It is not worth it and you guys know attendings' personalities in real life, they hate it. Even if they will not mark you down fraud, they might just fail your note just because they hate it!!! It is better to have lower rating that failing the note completely by missing to do something rather than faking it.

Regarding grade then from the Biomedical domain, each component will have their average over 12 encounters and then sum up to give your final global grade. This then will compare to the cutoff for pass or fail of this section.

I hope that this has been helpful and explain the principle and rule of this exam!

Ref: Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

I will talk more about misrepresentation, how I prepare for mine and my mistakes and what cases you can expect to have (don't worry I will not talk about my cases, I will only talk about what I learned from reading the papers and their blueprints) when I have more time and my fingers less aching!

 

[Lilyhopeless]

On MISDOCUMENTATION, my advice would be to not risk it ever. Like I mentioned above, it is ground for failing the specific soap note easily and, rarely the entire PE with irregular behaviour. The benefit is just so minimal that it is not worth it. From my speculation above, at worst, if you forget to do something major or critical, the corrector attending is just to going mark your note down. However, if you lie in your note, they might be annoyed enough to fail it.

With that said, what happened if you made the mistakes of writing down unintentionally? Generally, I think you will be okay. I, unfortunately, wrote alert and oriented (should be alert and awake) in all my notes when I did not check anyone their mental state at all. Furthermore, I wrote CNII-XII grossly intact in 3 to 4 separate cases. I did not check CNII at all. It seems to be fine.

Also, if you want proof that you might just be alright and most likely won't be hit with irregular behaviour if you have made mis-documentation in your notes, I have proof of that for you too! From one of their published papers, it seems to me that their screening tools for fraud are very lenient!

It is from this paper: Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE

The flagging method they used consists of the following:

Potential SOAP note misrepresentation is identified by raters and by algorithm. Raters are osteopathic physicians who undergo case-specific training and who are familiar with the facts of the case. Therefore, they are able to identify if an error has occurred in documentation (eg, “No allergies” is written on the medical record of a patient with a known penicillin allergy). Raters are expected to flag SOAP notes that have 2 or more discrepancies in either the subjective or objective section. Second, a heuristic algorithm is employed to review records for the given month. Candidates with lower than average data gathering (checklist) scores and higher than average scores on the S, O, or both parts of the SOAP note are most likely to be selected by this process for further review. These candidates' individual encounter level scores are then reviewed by physician staff. Candidates with disparate scores on individual encounters are noted and only those candidates with encounter-level discrepancies are further screened.

Regardless of the flagging method, a physician staff member reviews a minimum of 3 notes from the flagged candidate and compares the notes from the corresponding video recordings of SP encounters.9 If 2 of 3 patient notes are found to contain misrepresentation of clinical findings, or if 1 note is found to contain multiple examples of misrepresentation, all 12 SP encounters are reviewed by staff physicians and compared with their corresponding SOAP notes. Then, the candidate records are forwarded to a subcommittee of physicians for adjudication.

As you can see, it is very lenient! Also, they will be on the lookout for things in the Subjective and Objective portion; not at all in the A and P. I hope this info will help reassure someone in the future.

With that said, I strongly advise against any fraud! Like I mentioned previously, as soaps are graded on subjective likert-scale, even if the attendings will not flag you for irregular behaviour, they might fail your soap anyway from sheer annoyance.

On to WHAT CASES YOU CAN EXPECT, this is, by no means, exhaustive but I want to give people ideas what they can expect to see.

From their blueprint (1), this is what they said!

This info is actually very helpful! In addition, to telling us what will appear, it also tells us what will not appear on our exam! From above, as an example, if you have a case that is fatigue, it is more likely something that is along the line of anemia, depression or cardiovascular problem rather than hypothyroidism! Endocrine after all, in the current blueprint, is not the preferred testing material.

The same can also be said about integumentary system (skin, derm)! If you have something derm-ish, it is possible that this is not what they were looking for. It behooves you to dig in a little deeper!

So, during the exam, if you are faced with very weird or vague cases, try to remember what they prefer to test on or what they prefer not to test on can be helpful!

Finally, regarding how I prepared for my retake, it is very simple really. My friend shared with me the Kaufmann video to watch how the pro does it. He kind of overkill it, IMO. You don't need all the details that he put in. I practiced all 40+ cases in CS books with a trusted friend who can critique me honestly. Then, I typed out the notes in the NBOME website. Afterward, I screenshot it and sent them to my senior residents, friends, attending professors and a couple of SDNers who offered to check my notes for me!

Whenever I have free time, I will also try to practice the 50+ cases the Kaufmann book has in my head. The last 2 weeks before exam I just reread the CS book one last time to make sure that I have everything ready.

TBH, do I think that all these exercises necessary? NO, many people pass without prep at all. And, this is not them just saying it to make themselves sound smart. It is actually the truth in many cases. Case in point: my roommate passed on first try without any prepping but watching 2 to 3 Kaufmann videos and practiced like 2 cases with her boyfriend!!!

However, I failed the first time so I want to make sure that it is just not possible for me to fail the second time. As they said, PDs seem to be fine with failing once, but certainly not twice. Many PDs told me and I hope it is the truth that they just want to see my P before they rank me. Beyond that, they just thought the PE is so subjective to the point of useless anyway.

When I have more time, I will write down my script that I followed almost to the T on the exam day and hopefully, it can help someone.

 

[Spectreman]

Such a well done summary of all the relevant info out there and from the perspective of a student who conquered this after a stumble. Thank you for putting in the time to help us! These are the kind of gestures I think PDs need to know about. Sure you want the high achievers, but those who look out for their colleagues should be a major gold star imo.

 

[BorntobeDO?]

Such a well done summary of all the relevant info out there and from the perspective of a student who conquered this after a stumble. Thank you for putting in the time to help us! These are the kind of gestures I think PDs need to know about. Sure you want the high achievers, but those who look out for their colleagues should be a major gold star imo.

Lol, if PDs knew about SDN and cared what we did, there would be a whole lot of fights to get that 'verfied expert' checkmark. I still have no idea how someone becomes an expert other than being a mod or goro.

 

[Lilyhopeless]

Such a well done summary of all the relevant info out there and from the perspective of a student who conquered this after a stumble. Thank you for putting in the time to help us! These are the kind of gestures I think PDs need to know about. Sure you want the high achievers, but those who look out for their colleagues should be a major gold star imo.

Thanks for your kind words! I am trying to pay it forward, really! I have received a lot of help from the forum and my close friends so this is my act of good karma. Hopefully, someone will find what I post useful. It is my hope that I have helped someone to pass it on their first attempt!

Also, it is not entirely altruistic of me either trying to make sure people pass the PE on the first try! I am pissed at the NBOME and I am trying to stick it to them. The more people pass on the first attempt, the less money they can make from any one of us having to redo it!!!

 

[Lilyhopeless]

Lastly, this is what I did during my practice and also what I did during the real PE!!!

First of all, I used 2 mnemonics for my HPI: CODIERS and LOPPQRSTA. CODIERS is a much better one especially if it is not pain. However, at my school, I was trained with LOPPQRSTA so I don't want to rock the boat too much.

So, what I did, when they said "Begin the encounter", I read the encounter sheets and made decisions whether I should us CODIERS or LOPPQRSTA. If it is pain or MSK, I always always stick with LOPPQRSTA. They work every time. If it is vague or weird complaint, I will use CODIERS as it is more broad.

0:00 The intercom announces "begins the encounter": I read the encounter sheets and made a note about any abnormal VS and chief complaint. Then, I wrote the mnemonics horizontally with SMASHFM. I also wrote MOTHRR for the plan at the bottom of my paper too. Lastly, just before I knocked and entered, I read the name one last time so it sounds natural when I walked in. (If you made the mistakes of forgetting their name or mispronounce their name, it is fine as I am sure that it is a very small component and they are likely not to notice it if you act confident!)

0:40 I walked in and pumped the sanitizer immediately as well as announced with the most cheerful smile possible: Hi, Ms. Whatever, my name is so-so, a 4th-year medical student and I am here to assessed you. (Let them say Hi!). What would you like to be called today? Whatever! Hi, whatever, let me finishing up washing my hands! (The foam takes forever! So, I just asked them how was the drive-in or so and regardless their responses, I just said I am glad that you could make it). When the foam dries, I just shake their hands and said nice to meet you today.

1:00 Now I started the interview: So, whatever, I did read your file but I would like to hear from you what brought you in today?
(Whatever their complaint is) Oh, I'm sorry to hear that. Can you please tell me more about it?

I then just went with my mnemonics completely and crossed them out I go. Generally, I don't interrupt them at all and let them say their pieces. Mostly, I just said Uh-huh or please tell me more. If they complain, I said: I am sorry that this has happened, it must have been tough. Or ah it must have been frustrating for you. It would have been if I were in your position.

5:30 I finished my HPI! Then, I will start my ROS: Thank you for sharing! I am now going to ask you a couple more questions to have a more complete view of why you are here today okay?

I always always ask the following: Fever, chill, headache, chest pain, SOB, N/V/D and one or two other systems not related at all to the chief complaint system! For example, if someone comes with chest pain, I will ask them about GU and GI.

You can do this part very fast! As a matter of fact, generally, I don't write anything down here unless it is positive and I investigated it more, I practiced my script so much that I just remembered it.

6:00 to 6:30 I started now to ask them about their past medical history. Alright, whatever, I would like now to get a better sense of your medical history, okay?

Then I just bombarded them with PMH, PSH, Meds, All, FH and SH. The FH is very important, they are the bulk of the humanistic points. They will have someone die or my parent divorced when I was very young so I don't know my dad or my mom med history blah blah blah.

Whenever they said anything like that, I put my pen down and look up at them and give them the teariest eyes I have: "I am sorry that your dog fufu died when you were 2 years old. It must have been tough for you!" JK aside, what I am saying here, you can never be too sweet or sympathetic.

With that said, however, be natural and don't be robotic when you are saying these kinds of stuff. You have to be believable. Don't say it without looking up. Don't say it monotonously and obviously, don't say it with a big smile on your face.

The SH part is just as critical! It is the part where you can counsel patients and generally every SP will have at least one vice! Be it I smoke weed, doc or I eat like a pig or I am a sloth! Generally, I just counsel my patient right then and there, because I know that I will forget it if I do it at the end.

Also, I don't always ask all the letters in my FEDTACOS, generally I concentrate on things that pertinent. However, everyone will get a Job, exercise, diet, tobacco, alcohol and drugs, even the dying patient in the ED.

However, if they have nothing at all in this section, you can still say things like: "Good job! Please keep up the good work! I really wish that all my patients are like you!" It may sound really fake, however, this is actually not so far from the truth! When I am in the ward, I just wish all my patients will eat healthily, have a job, have sex 3 times a week, exercise once in a while and deny any vices except a glass of wine with dinner every day.

8:00 to 8:00 But this point, I finished everything with the Subjective: Thank you, whatever, for sharing! Now I am going to do the exam, okay? However, before I start, is there any question or concern you want to share with me right now? Almost everyone will have one and you must make sure to catch it. Whatever they said, I always respond in almost the same manner: I understand why you are stressed out or thinking that way, at this point in time, I don't have a lot to answer yet. However, please let me do the physical exam and hopefully I will have more answers for you then or at least, a way forward from here.

For the physical exam, I always start with lung then the heart and then whatever the chief complain is, followed by abd or secondary system.

So generally, I just told the SPs that: Generally I like to start with listening to your lung first okay? Let me help you to untie the gown if that is okay? (they always said yes). Please breath in deeply for me when you feel my stethoscope. (Do 6 listening posts post, I never bothered with lateral since it is rather awkward and I often forget). I am now listening your upper lungs, okay? All sounds good and clear to me. Now, I would like to listen to your heart. Can you please lower your gown for me? (Then I will listen the A and P valves) Now, could you please lower the gown and hold your left breast up for me? (Female obviously, and I just listened like that. You don't have to dig or put it even at the correct location. They won't know! Just mime it. I always thought the side entry or drop down the scope is just so awkward)

As well, for the PMI, I never check on any female even when it is pertinent and the case is heart case. I sacrificed that point since it can be rather awkward to do it with females. I just check the pulses and listen to their carotid.

If I was also going to do the abd exam, I just said to them that: I would also like to do an abd exam, okay? Let me drape you first before you lie down. Could you please lift your gown for me? Thanks! (Inspect and if you see any scar, just ask them) I am going to listen to your tummy, okay? (Auscultate) Sounds good to me! Alright, I am now going to tap your tummy, okay? Please tell me if it is painful! (Percuss) Sounds normal to me! I am now going to check for any mass, okay? So I am going to push in and if it is painful, please tell me! (Palpate deep and shallow immediately and then I will just do a very shoddy murphy and spleen check) I want to check your liver and spleen okay? (Just ask the patient to breath in and press into both sides) All looks normal to me and that is good! Please lower the gown and when you are ready, let me help you sit up!

My physical exam was shoddy at best and a travesty at worst. I did not do any special tests! At most, I do rebound test and if my SP gets to walk, it must have been something very bad! The point is, however, going through the motion and tries to look very concentrated. The SPs will not have any positive signs and symptoms, except the very prominent one i.e the chief complaint itself. Even if they do, no one will know about it anyway! You cannot be faulted for horrible hearing and not knowing what to hear for murmur! As well, don't worry if you do a maneuver wrong, the SP will not know that it was done wrong anyway. They were not trained in medicine! Even if they were shown the correct technique, the physical exam can be done in so many different ways that this can be just one of its variants!

By the end of my PE, I almost always hear the 2-mins warning! I will just drop everything and do my wrap up! I have 2 versions: One for the ED and one for the clinic.

12:00

For the ED and if the case is MI, for example:

"Based on my examination and history, I am concerned that you may have a problem with your heart and heart attack is a possibility. However, this could be something as simple as reflux too. To be certain, I would like to order a couple of blood tests. I would also like to do an EKG that checks the rhythm of your heart and Chest Xray which is like taking a pic of your heart. When I have more information, I will update you more on what we together can do. Does this plan sound reasonable with you? The patient will say: whatever you think best, Doctor! Alright then, presently do you have any questions or have I addressed all your concerns? If you have played the game right, they should have nothing right now and they will say: No, everything is good. Alright then, whoever, we will talk more later okay? In the meanwhile, if you have any questions, just flag one of the nurses and they will come to get me! Thank you for coming in today and I hope we can help you feel better soon."

For the garden variety case in the clinic and let's say it is URI!

"Based on my examination and history, it is likely that you have an infection of your upper respiratory tube. It can be either due to viral or bacteria. Most likely, it is viral and unfortunately, there is nothing really to cure it beyond symptom relief but time. The chest pain that you are feeling can be due to the cough you have been having these past few days. However, your cough could be caused by your reflux too. To be certain, I would like to order a couple of blood tests. I would like to do a Chest Xray which is like taking a pic of your chest. I would also like to swap your throat to rule out some infection. When I have more information, I will update you more on what we together can do. Also, for your congestion, I can prescribe you some decongestant to help you. Does this plan sound reasonable with you? The patient will say: whatever you think best, Doctor! ! Alright then, presently do you have any questions or have I addressed all your concerns? If you have played the game right, they should have nothing right now and they will say: No, everything is good. Good, would you need any notes for work or school at all for your visit today? (Just do whatever the SPs say) Okay, that will be it from me for today! I hope you will feel better soon! And let us have you coming back in 1 week for further checkup okay? Whatever you think is best, Doc! Very well, thank you for coming in again, whatever! Shake hand!

Normally, I tried to leave the room by 13:00 or so minute! I am a slow typer and I need an extra 30 secs to 1 min for typing! When I typed my SOAP notes, I always my A and P first. They are the easiest to do. Then I do my O and lastly my S. I regret doing it that way and I would suggest people do the S first then the O. The S has more component to it that can be easily forgotten or seems to worth more than a random comment in the objective section like: No edema.

There you go!

 

[Epilepsy365]

Lastly, this is what I did during my practice and also what I did during the real PE!!!

First of all, I used 2 mnemonics for my HPI: CODIERS and LOPPQRSTA. CODIERS is a much better one especially if it is not pain. However, at my school, I was trained with LOPPQRSTA so I don't want to rock the boat too much.

So, what I did, when they said "Begin the encounter", I read the encounter sheets and made decisions whether I should us CODIERS or LOPPQRSTA. If it is pain or MSK, I always always stick with LOPPQRSTA. They work every time. If it is vague or weird complaint, I will use CODIERS as it is more broad.

0:00 The intercom announces "begins the encounter": I read the encounter sheets and made a note about any abnormal VS and chief complaint. Then, I wrote the mnemonics horizontally with SMASHFM. I also wrote MOTHRR for the plan at the bottom of my paper too. Lastly, just before I knocked and entered, I read the name one last time so it sounds natural when I walked in. (If you made the mistakes of forgetting their name or mispronounce their name, it is fine as I am sure that it is a very small component and they are likely not to notice it if you act confident!)

0:40 I walked in and pumped the sanitizer immediately as well as announced with the most cheerful smile possible: Hi, Ms. Whatever, my name is so-so, a 4th-year medical student and I am here to assesed you. (Let them say Hi!). What would you like to be called today? Whatever! Hi, whatever, let me finishing up washing my hands! (The foam takes forever! So, I just asked them how was the drive in or so and regardless their responses, I just said I am glad that you could make it). When the foam dries, I just shake their hands and said nice to meet you today.

1:00 Now I started the interview: So, whatever, I did read your file but I would like to hear from you what brought you in today?
(Whatever their complaint is) Oh, I'm sorry to hear that. Can you please tell me more about it?

I then just went with my mnemonics completely and crossed them out I go. Generally, I don't interrupt them at all and let them say their pieces. Mostly, I just said Uh-huh or please tell me more. If they complain, I said: I am sorry that this has happened, it must have been tough. Or ah it must have been frustrating for you. It would have been if I were in your position.

5:30 I finished my HPI! Then, I will start my ROS: Thank you for sharing! I am now going to ask you a couple more questions to have a more complete view of why you are here today okay?

I always always ask the following: Fever, chill, headache, chest pain, SOB, N/V/D and one or two other systems not related at all to the chief complaint system! For example, if someone comes with chest pain, I will ask them about GU and GI.

You can do this part very fast! As a matter of fact, generally, I don't write anything down here unless it is positive and I investigated it more, I practiced my script so much that I just remembered it.

6:00 to 6:30 I stated now to ask them about their past medical history. Alright, whatever, I would like now to get a better sense of your medical history, okay?

Then I just bombarded them with PMH, PSH, Meds, All, FH and SH. The FH is very important, they are the burk of the humanistic points. They will have someone die or my parent divorced when I was very young so I don't know my dad or my mom med history blah blah blah.

Whenever they said anything like that, I put my pen down and look up at them and give them the teariest eyes I have: "I am sorry that your dog fufu died when you were 2 years old. It must have been tough for you!" JK aside, what I am saying here, you can never be too sweet or sympathetic.

With that said, however, be natural and don't be robotic when you are saying these kinds of stuff. You have to be believable. Don't say it without looking up. Don't say it monotonously and obviously, don't say it with a big smile on your face.

The SH part is just as critical! It is the part where you can counsel patients and generally every SP will have at least one vice! Be it I smoke weed, doc or I eat like a pig or I am a sloth! Generally, I just counsel my patient right then and there, because I know that I will forget it if I do it at the end.

Also, I don't always ask all the letters in my FEDTACOS, generally I concentrate on things that pertinent. However, everyone will get a Job, exercise, diet, tobacco, alcohol and drugs, even the dying patient in the ED.

However, if they have nothing at all in this section, you can still say things like: "Good job! Please keep up the good work! I really wish that all my patients are like you!" It may sound really fake, however, this is actually not so far from the truth! When I am in the ward, I just wish all my patients will eat healthily, have a job, have sex 3 times a week, exercise once in a while and deny any vices except a glass of wine with dinner every day.

8:00 to 8:00 But this point, I finished everything with the Subjective: Thank you, whatever, for sharing! Now I am going to do the exam, okay? However, before I start, is there any question or concern you want to share with me right now? Almost everyone will have one and you must make sure to catch it. Whatever they said, I always respond in almost the same manner: I understand why you are stressed out or thinking that way, at this point in time, I don't have a lot to answer yet. However, please let me do the physical exam and hopefully I will have more answers for you then or at least, a way forward from here.

For the physical exam, I always start with lung then the heart and then whatever the chief complain is, followed by abd or secondary system.

So generally, I just told the SPs that: Generally I like to start with listening to your lung first okay? Let me help you to untie the gown if that is okay? (they always said yes). Please breath in deeply for me when you feel my stethoscope. (Do 6 listening posts post, I never bothered with lateral since it is rather awkward and I often forget). I am now listening your upper lungs, okay? All sounds good and clear to me. Now, I would like to listen to your heart. Can you please lower your gown for me? (Then I will listen the A and P valves) Now, could you please lower the gown and hold your left breast up for me? (Female obviously, and I just listened like that. You don't have to dig or put it even at the correct location. They won't know! Just mime it. I always thought the side entry or drop down the scope is just so awkward)

As well, for the PMI, I never check on any female even when it is pertinent and the case is heart case. I sacrificed that point since it can be rather awkward to do it with females. I just check the pulses and listen to their carotid.

If I was also going to do the abd exam, I just said to them that: I would also like to do an abd exam, okay? Let me drape you first before you lie down. Could you please lift your gown for me? Thanks! (Inspect and if you see any scar, just ask them) I am going to listen to your tummy, okay? (Auscultate) Sounds good to me! Alright, I am now going to tap your tummy, okay? Please tell me if it is painful! (Percuss) Sounds normal to me! I am now going to check for any mass, okay? So I am going to push in and if it is painful, please tell me! (Palpate deep and shallow immediately and then I will just do a very shoddy murphy and spleen check) I want to check your liver and spleen okay? (Just ask the patient to breath in and press into both sides) All looks normal to me and that is good! Please lower the gown and when you are ready, let me help you sit up!

My physical exam was shoddy at best and a travesty at worst. I did not do any special tests! At most, I do rebound test and if my SP gets to walk, it must have been something very bad! The point is, however, going through the motion and tries to look very concentrated. The SPs will not have any positive signs and symptoms, except the very prominent one i.e the chief complaint itself. Even if they do, no one will know about it anyway! You cannot be faulted for horrible hearing and not knowing what to hear for murmur! As well, don't worry if you do a maneuver wrong, the SP will not know that it was done wrong anyway. They were not trained in medicine! Even if they were shown the correct technique, the physical exam can be done in so many different ways that this can be just one of its variants!

By the end of my PE, I almost always hear the 2-mins warning! I will just drop everything and do my wrap up! I have 2 versions: One for the ED and one for the clinic.

12:00

For the ED and if the case is MI, for example:

"Based on my examination and history, I am concerned that you may have a problem with your heart and heart attack is a possibility. However, this could be something as simple as reflux too. To be certain, I would like to order a couple of blood tests. I would also like to do an EKG that checks the rhythm of your heart and Chest Xray which is like taking a pic of your heart. When I have more information, I will update you more on what we together can do. Does this plan sound reasonable with you? The patient will say: whatever you think best, Doctor! Alright then, presently do you have any questions or have I addressed all your concerns? If you have played the game right, they should have nothing right now and they will say: No, everything is good. Alright then, whoever, we will talk more later okay? In the meanwhile, if you have any questions, just flag one of the nurses and they will come to get me! Thank you for coming in today and I hope we can help you feel better soon."

For the garden variety case in the clinic and let's say it is URI!

"Based on my examination and history, it is likely that you have an infection of your upper respiratory tube. It can be either due to viral or bacteria. Most likely, it is viral and unfortunately, there is nothing really to cure it beyond symptom relief but time. The chest pain that you are feeling can be due to the cough you have been having these past few days. However, your cough could be caused by your reflux too. To be certain, I would like to order a couple of blood tests. I would like to do a Chest Xray which is like taking a pic of your chest. I would also like to swap your throat to rule out some infection. When I have more information, I will update you more on what we together can do. Also, for your congestion, I can prescribe you some decongestant to help you. Does this plan sound reasonable with you? The patient will say: whatever you think best, Doctor! ! Alright then, presently do you have any questions or have I addressed all your concerns? If you have played the game right, they should have nothing right now and they will say: No, everything is good. Good, would you need any notes for work or school at all for your visit today? (Just do whatever the SPs say) Okay, that will be it from me for today! I hope you will feel better soon! And let us have you coming back in 1 week for further checkup okay? Whatever you think is best, Doc! Very well, thank you for coming in again, whatever! Shake hand!

Normally, I tried to leave the room by 13:00 or so minute! I am a slow typer and I need an extra 30 secs to 1 min for typing! When I typed my SOAP notes, I always my A and P first. They are the easiest to do. Then I do my O and lastly my S. I regret doing it that way and I would suggest people do the S first then the O. The S has more component to it that can be easily forgotten or seems to worth more than a random comment in the objective section like: No edema.

There you go!

Please give me your script for a Neuro exam. I finish mine very quick with all info but I’m very scared that I’m getting auto fail on humanism for not confirming permission with everything.

 

[Lilyhopeless]

Please give me your script for a Neuro exam. I finish mine very quick with all info but I’m very scared that I’m getting auto fail on humanism for not confirming permission with everything.

As I have mentioned, I really don't think that there is any checklists at all for humanism. I speculated that there is only a personality survey. As well, unless you did something very egregious during your PE like slapping their cheeks during their HEENT, I wouldn't think you have done anything terrible at all with your PE. It is easier said than done, as long as the SP like you by the end of the encounter. I don't think you would fail your humanism.

TBH, I still don't understand what you mean when you referred to permission so I hope what I wrote below will help you.

For my neuro and it was shoddy (I did only 3 as I don't like this exam; easy to make mistakes with and many components so generally I tried not to do it if I can),

I would like to do a neuro exam, okay? First, I am going to draw an H in the air and please follow my finger with your eyes. (Draw an H) I am now going to bring my finger close to your face (Convergent test) Good! I am now going to rub my finger next to your ears to check your hearing, okay? Please tell me if you can hear it or not. Left ear? (Rub my finger) Right Ear? (Rub my finger) I am now going to touch your face and please tell me whether you can feel my finger or not, okay? (Forehead, cheeks and chin) All good? Good! Can you please close your eyes every tightly for me and don't let me open them? Good! I want you to open your eyes now very big and frown your forehead, okay? (I tend to frown with them to show them how to do it) Good! Can you puff your cheek out? Good! Can you open your mouth and put your tongue out like this? (I tend to demonstrate it to my patient and it helps them to not feel silly) Can you push your tongue side to side? Good! I want to check your neck muscle okay? Can you push your head into my left hand? Good! How about my right hand? Good!

That is it for my CN nerve exam! If I also want to check upper and lower motor and muscle strength, I would say thing like:

Can you hold your hand as if you want to make a muscle for me, please? (I demonstrate what I want from them) Thanks! Can you push up against my hands? Can you push out against my hands? Good! Can you push down against my hands? Good! Can you new squeeze my hands very tight? Good!

I am now going to your legs' muscle, okay? Can you push up against my hands? Can you push out against my hands? Good! Can you push down against my hands? Good! Can you push your legs in against my hands? Good! BTW, do you feel my finger on your shins? Equal on both sides? Good! Can you push your toes down for me against my hands? Can you push your toes up for me against my hand? Good!

Thank you very much, whatever! They all look normal to me! Now, I would like you to walk for me, okay? Here, let me help you get up! Just walk over there and walk back. (Patients do it) Good! Please sit down!

While the SPs are walking, I just wash my hands again as I contaminated myself by touching their feet. I did not do any DTR as I am not good at it and they just take so long so I just skipped it. I felt that I have all that I need anyway.

As you can see, my neuro exam is very simple and I can't just imagine what would they look for as humanism in what I just wrote. Hence, I can't think of any reason why it would be important.

 

[Lilyhopeless]

People have been asking me on how and what to improve in your note. Like I have mentioned above, you do not need to write the most perfect IM-inpatient note ever! It just has to be sane, logical, full-sentences and honest.

You only need to write a note that an attending can follow and understand your medical reasoning and decisions. And obviously, you should NEVER EVER make anything up in your note. That is one of the surest ways to fail it!!!

What I find very helpful during my note practices was typing them in the NBOME site under a time constraint and then I screenshot it to send it to people to help critique it. I have sent them notes to anyone that passed the PE that offered, really. @bogle8 was very gracious and generous with his time to do for me!

With that said, I can understand where people are coming from, you are just now unsure of yourself and starting to question everything. It is probably the first fail you have ever encountered ever in your life (of course, if we discounted the fact that we are in DO schools, jk Chin up, it is okay and it is alright to be terrified! I was very terrified myself a few weeks ago and I am still nervous about it all. But the thing is we are still young and we are allowed to make mistakes! It is the recovery and our graces under our mistakes that will define us, not this one setback that we won't even remember 3 years from now!

Here are some wise words from one of the audition hospital PDs that I worked with and I hope it helps someone. In some darkest moments, they have helped me tremendously!

Failure is an event, it is not a person and certainly not you! This is part of growing up and becoming a better person, you are learning from your mistake. You stumbled but you must get up, dust yourself and try again to do better tomorrow!

I do not ask for the best resident ever. My program is not the best in the nation. But, I am utterly certain that I am trying my best to make it better. I can only hope that any residents that I train will be the kind of people who can learn from their mistakes and try again to do better.

I will admit that I was so close to tears when I was talking with this PD at the time and, aside from my family, I have come to admire this PD very much!!!

 

[Select All That Apply]

@Lilyhopeless Went through your posting history to basically attribute a "like" to represent how meaningful it was for you to spend this much time and energy to contribute back after overcoming a serious mulligan.

 

[sunshinefl]

***There are currently 2 December dates in Chicago and 1 December date in Pennsylvania!!!!***

(Sorry if you see this on a couple threads about PE failure, but trying to help people out that were looking for dates.)

 

[Osteoguy1994]

Just took my PE the 20th, would appreciate some feedback on my main concerns:

assesments always had at least 3 along with full O and S components per pneumonics OLPPQRSTA/CODIERS, fedtacos, ect.
Plan was usually between 3-5, in one case I had one bullet but 5 things. Plan didn’t always address each ddx fully beyond the main ASsesment

one was an emergent case where I was vague with patient as I was unsure and stated beyond some minor abnormal vitals for them Not to be concerned and I’d like to get a fuller picture andwork up with text x,y,z. I was unsure at first and attempted omm to now Avail and left the room and realized the severity of the case and added that to my plan, but didn’t have time to discuss omm in the nite

other cases with omm went well and indicated. I’m sure I’m missing a lot but those were my chief concerns, along with not always counseling patients or rechecking abnormal vitals

 

[hallowmann]

Just took my PE the 20th, would appreciate some feedback on my main concerns:

assesments always had at least 3 along with full O and S components per pneumonics OLPPQRSTA/CODIERS, fedtacos, ect.
Plan was usually between 3-5, in one case I had one bullet but 5 things. Plan didn’t always address each ddx fully beyond the main ASsesment

one was an emergent case where I was vague with patient as I was unsure and stated beyond some minor abnormal vitals for them Not to be concerned and I’d like to get a fuller picture andwork up with text x,y,z. I was unsure at first and attempted omm to now Avail and left the room and realized the severity of the case and added that to my plan, but didn’t have time to discuss omm in the nite

other cases with omm went well and indicated. I’m sure I’m missing a lot but those were my chief concerns, along with not always counseling patients or rechecking abnormal vitals

You probably passed. I wouldn't worry about it.

 

[Osteoguy1994]

You probably passed. I wouldn't worry about it.

Ty! Time will tell. It was an ER case and answer I’m confident know was like “PE” But didn’t realize until I left the room. I just can’t believe I used OMM lol. And It just worried me saying “there’s no red flags except some abnormal vitals” that I want to work up instead of saying like “I think ur having a PE blah blah blah

 

[AlteredScale]

Ty! Time will tell. It was an ER case and answer I’m confident know was like “PE” But didn’t realize until I left the room. I just can’t believe I used OMM lol. And It just worried me saying “there’s no red flags except some abnormal vitals” that I want to work up instead of saying like “I think ur having a PE blah blah blah

Was the patient in distress?

 

[Osteoguy1994]

SoB and discomfort but answering questions and not Moving around as if in acute daze/distress