COMLEX PE HELP

[GTP]

---

Members don't see this ad.

Hi Everyone,

LEVEL 2 PE is rapidly approaching for me, and I bought the Kauffman book. It seems very nit picky about certain things that I am not used to doing normally. I feel like even if I practice these things for a couple of days, because I haven't done them for the past 8 months, my nerves will make me revert back to how I usually do them. 🙁 Can anyone please comment on if the following things are serious enough to warrant failure?

Lungs - not auscultating above clavicles anteriorly and laterally? I've never seen anyone do this in practice. I just auscultate the 6 quadrants in the back
Eyes - cardiac - it says to do this supine but it's just so unnatural
Hand washing - it consistently takes me longer than 15 seconds to wash my hands. I just want to make sure that quick hand sanitizer is okay.

Can anyone also comment on whether the COMBANK PE videos are essential? Is it also essential to go through all the cases in Kauffman? I was just going to go through half of them, practice with friends, and watch the NBOME videos.

Also, I encountered a case in Kauffman that was in the ED setting. Does this happen on the exam too or is everything outpatient/ambulatory?

Thanks everyone

 

[WonderBoy]

I was nervous about the test and after having some friends fail the test, I decided to go for the Kauffman videos. I did all of them over 2wk period, went thru all the cases in the book more than once and practiced a few times with friends taking the test. Yea I over prepared but I didn't wanna fail this test, because going thru it a second time is hell. Spending $1200 again along with the cost and anguish of going down there to take the test again, I decided to get the videos.

They videos helped calm me down about the humanistic part and some of the cases from the video repeated on test day, so I rocked those cases. I would recommend highly recommend the videos because he focuses on the humanistic part which is 50% of the test.

Yes, there are cases which tell you that you are in ED. I had one and you have to approach it differently compared to an office case. Students may miss that point cause you are nervous and it will impact your grade because your approach is different in ED.

If you can't afford the videos, just do all the cases in the kauffman book at least and focus on humanistic thats where more people fail. Also practice and do note writing because you have only limited time on test day.

I just used the hand sanitizer. Did heart and lungs on everyone (on skin). Good luck!

 

[GTP]

I was nervous about the test and after having some friends fail the test, I decided to go for the Kauffman videos. I did all of them over 2wk period, went thru all the cases in the book more than once and practiced a few times with friends taking the test. Yea I over prepared but I didn't wanna fail this test, because going thru it a second time is hell. Spending $1200 again along with the cost and anguish of going down there to take the test again, I decided to get the videos.

They videos helped calm me down about the humanistic part and some of the cases from the video repeated on test day, so I rocked those cases. I would recommend highly recommend the videos because he focuses on the humanistic part which is 50% of the test.

Yes, there are cases which tell you that you are in ED. I had one and you have to approach it differently compared to an office case. Students may miss that point cause you are nervous and it will impact your grade because your approach is different in ED.

If you can't afford the videos, just do all the cases in the kauffman book at least and focus on humanistic thats where more people fail. Also practice and do note writing because you have only limited time on test day.

I just used the hand sanitizer. Did heart and lungs on everyone (on skin). Good luck!

Thanks for your response. Regarding the humanistic part, you are just referring to the following right?

Saying I'm sorry if someone has a death in their friend/family circle
Being polite/draping
Asking permission before you touch a patient
Asking if they need doc note for school/work
Asking if they want someone to be called like friend/family member?
Offering coupons/free samples for medicine if they say they cant afford it

Am I missing anything?

Thanks! Now you are making me nervous and I'm about to fork over $130 for these bloody videos.

 

[WonderBoy]

Thats a good start, I didn't know some this stuff before I started the videos. When is your test? I would know the cases because some will repeat on the real test.

Also try stay inside with the patient even if you finish early, the note can be done in the allotted time. But the longer you stay in and ask questions (show concern and empathy) the more points you get for humanistic part. I believe the patients grade you on the humanistic portion (not 100% I read it somewhere in kauffman or nbome site), so they control you grade.

Also offer a rectal, if they say yes tell them you will will come back with an assistant afterwards.

At the 2min mark drop make sure to start discussing your assessment and plan with the patient and ask them if they have any questions (part of humanistic). Thank them and exit.

You can use the discount they have on their facebook page if you do choose to get the videos, it was like $109 when I bought them. If you don't get them, please practice and know the cases in the book, also time yourself. There are some Kauffman combank videos on youtube if you wanna look at them.

Even with all the prep I was still nervous lol, but after the first few cases it settled down and it wasn't too bad. If the first few cases are shaky, remember you can still make it up with the rest of the cases, there are 12 after all.

 

[GTP]

Thats a good start, I didn't know some this stuff before I started the videos. When is your test? I would know the cases because some will repeat on the real test.

Also try stay inside with the patient even if you finish early, the note can be done in the allotted time. But the longer you stay in and ask questions (show concern and empathy) the more points you get for humanistic part. I believe the patients grade you on the humanistic portion (not 100% I read it somewhere in kauffman or nbome site), so they control you grade.

Also offer a rectal, if they say yes tell them you will will come back with an assistant afterwards.

At the 2min mark drop make sure to start discussing your assessment and plan with the patient and ask them if they have any questions (part of humanistic). Thank them and exit.

You can use the discount they have on their facebook page if you do choose to get the videos, it was like $109 when I bought them. If you don't get them, please practice and know the cases in the book, also time yourself. There are some Kauffman combank videos on youtube if you wanna look at them.

Even with all the prep I was still nervous lol, but after the first few cases it settled down and it wasn't too bad. If the first few cases are shaky, remember you can still make it up with the rest of the cases, there are 12 after all.

Geez. THat's only a good start? How much more humanistic can I be ? lol

 

[primadonna22274]

Dr K is my adviser at LECOM and I previewed the PE videos as a favor to him. They're worthwhile I think for someone who needs significant brushing up, or reassurance that they're "doing it right".
Keep in mind that Dr K is a PA who went back to med school (so am I). PA schools emphasize meticulous physical exam techniques and we are kinda fanatical about the H&P. You don't have to do it his way (shhhhhh!! I didn't either) but the point is you should be comfortable with your techniques. I will recommend that you get in the habit of auscultating anterior lung fields though--especially tracheitis and bronchitis won't sound so nasty on posterior fields exam, but upper airway noise is important in your Ddx.
I had been doing H&Ps for 15 years on many thousands of patients and I still was nervous for my PE--just the idea of being recorded and critiqued for a $1250 exam that I didn't want to take again (EVER!) had me wound up. Honestly though the test center staff go out of their way to make you more comfortable and they WANT you to pass.
Good luck 🙂 oh, and review your OMT. I needed it on almost all of my cases.

 

[GTP]

Thanks guys. I watched a sample of the combank video on YouTube and also the nbome video. I did 10 more scenarios and i feel much better. I think not jumping into things right away on exam day and having the 50 min orientation will also help calm my nerves.

 

[WonderBoy]

The mnemonic dr K gives helped me be organized. I would write it down before beginning every encounter. Do that so you don't miss stuff like giving the Dx, yea I almost did that. It keeps you organized during the chaos of the test.

I did rudimentary PE exam, nothing special, but I made sure I got a good Hx for all the cases.

As far as OMT, the patients actually ask for it a few times. If your OMT is not that great stick to massaging honestly lol, keep it simple and explain why you are doing it as you are doing it, better than awkward silence.

 

[GTP]

Yeah my OMM Is questionable. I can wing muscle energy, myofascial and effleurage but that's about it. Hope I don't get any rib scenarios. It's hard enough trying to remember when they raise up their arm, if I do it from the front or back, if im pushing up or down, etc when im not being timed or filmed. Geez. I'll make sure I take my beta blocker before this test.

 

[scummie]

Yeah my OMM Is questionable. I can wing muscle energy, myofascial and effleurage but that's about it. Hope I don't get any rib scenarios. It's hard enough trying to remember when they raise up their arm, if I do it from the front or back, if im pushing up or down, etc when im not being timed or filmed. Geez. I'll make sure I take my beta blocker before this test.

You have gotten some really good advice on this thread. Even though it's a test with a supposed ~95% pass rate, you don't want to be the person that effs it up. I have never heard of anyone doing ribs but would definitely make sure you know techniques for every part of the body.

Kaufmann is total money and what I ended up using. The Kaplan book was also helpful even though it's for the CS. What I liked about it was the practice cases so you could get a friend to practice with and then tell you what questions you should have asked.

Also, write your acronym on the paper before you go into the room. Really love on those patients bro. Summarize, ask if they need water, Oh I'm so sorry your rabbit died, don't interrupt, anything you can do to, blah blah blah.

I definitely stressed out about the physical exam part and what to cover. I listened to lungs on the front and back and did the heart right before/after. Kept them draped for the front but if did anything in the back, untied.

Always ask to untie the gown!!

 

[WonderBoy]

Is it normal to leave the test center feeling numb, "what just happened?", "I don't know if I passed?", "should have done this/said that", difficulty adjusting to life and getting back into a routine after comlex pe? I really am not depressed. No need to ask SIGECAPS on me but I felt better coming out of USMLE step 1/2, and comlex tests. I prepped via comlex pe review book (highly recommend) and combank videos (highly recommend 2 week purchase) and practiced about 20 cases. I think that was enough prep but still felt awful leaving conshohocken.

Perfectly normal response. Everyone goes thru the same process, good luck!

 

[CrileDO]

Do we really need to re-check all elevated blood pressures and pulses as Dr. Kauffman says in his videos? I'm pretty worried that I'm going to get nervous and take a lot more time to perform a BP check than I would need to, especially since they tell us that the values are the real ones.

 

[SLC]

Do we really need to re-check all elevated blood pressures and pulses as Dr. Kauffman says in his videos? I'm pretty worried that I'm going to get nervous and take a lot more time to perform a BP check than I would need to, especially since they tell us that the values are the real ones.

I didn't recheck any vitals, for the same reason.

I also haven't gotten my score back yet so...

 

[CrileDO]

I didn't recheck any vitals, for the same reason.

I also haven't gotten my score back yet so...

I'm especially worried since he says that there is like a 5-6 step "appropriate" process for checking BP, which I've never seen done before, and I am afraid that I would screw that up and lose points anyway for re-checking a vital sign I'm not sure I need to redo.

 

[Tizoc]

Do we really need to re-check all elevated blood pressures and pulses as Dr. Kauffman says in his videos? I'm pretty worried that I'm going to get nervous and take a lot more time to perform a BP check than I would need to, especially since they tell us that the values are the real ones.

I didn't for any of my patients and I passed.

 

[Helen Wheels]

I didn't recheck BP or any vitals either and I passed. That being said, if the door sheet had a crazy high BP on it you should probably recheck it.

 

[CrileDO]

Do most people coming out of this test feel like they failed? There are so many things I feel like I forgot to ask/say/put in SOAP notes.

 

[WonderBoy]

Do most people coming out of this test feel like they failed? There are so many things I feel like I forgot to ask/say/put in SOAP notes.

Normal feeling for everyone I have seen post exam.

 

[microshar88]

I'm just wondering, if 2 minutes remain, and you are still doing an essential part of the exam (like abdominal), should you try and talk to the patient while doing the exam and tell them what the diagnosis is&offer to talk to family or should you forego that component and sit them up so you can talk to them while seated?

I know you must be thinking, should you be able to get all of this done in 14 minutes, but when you are nervous, you tend to think slower. I failed the humanistic domain, and I was exceptionally nice to all the patients (even my OSCE's said this about me), but I failed and I think it may be due to not thoroughly discussing the dx and offering to talk to family. Although, I will never know for sure as I will never get specific feedback.

For all I know, this could be part of an error as they did with COMLEX 2CE scores recently, but for now I'm going to have to shell out another $1800 to take this exam again. I'm trying not to think about it. 🙁

 

[BigSib]

I'm just wondering, if 2 minutes remain, and you are still doing an essential part of the exam (like abdominal), should you try and talk to the patient while doing the exam and tell them what the diagnosis is&offer to talk to family or should you forego that component and sit them up so you can talk to them while seated?

If the 2 minute buzzer goes off and you have not yet spoke with the patient regarding the diagnosis and plan you should drop everything and do that. You will otherwise lose some major points if you don't discuss this. Additionally, OMT may be indicated for the case and this would leave you with little time to complete this. If OMT is indicated you should start to do it and discuss the diagnosis and additional treatment (e.g., pain meds, etc.) during the therapy.

 

[microshar88]

If the 2 minute buzzer goes off and you have not yet spoke with the patient regarding the diagnosis and plan you should drop everything and do that. You will otherwise lose some major points if you don't discuss this. Additionally, OMT may be indicated for the case and this would leave you with little time to complete this. If OMT is indicated you should start to do it and discuss the diagnosis and additional treatment (e.g., pain meds, etc.) during the therapy.

I did this and still failed. Oh well, I guess I just need to accept this failure and move on. This is proabbly going to cost me a lot in terms of chances of landing a good program. 🙁

 

[microshar88]

Since I'm applying without any USMLE scores, to ACGME and AOA. Should I include an addendum note saying that I plan on retaking it and should I tell them that I have no idea what went wrong as my OSCE's were all passing and I got high marks on the interpersonal skills section?

 

[slash75]

I am a 67 y/o physician and have practiced in a small town for 33 years. I had a busy practice in both the office , hospital, and two nursing homes. I also delivered babies until the malpractice stopped us.
I was considered by the other physicians a good diagnostician. I was Chief of staff three times and never had a adverse report from the hospital and have never had a malpractice suit. I had to retire in 2009 due to a disability and am now ready to go back . Physically I am good as a lot who are a lot younger and after surviving the 70s surprised my mind is still fairly sound as Willie says. I have been out over 3 years so have to pass the PE2 which I have failed twice.. The first time I was totally unprepared and was told by someone who was supposed to know it was like the old SOAP notes we did in school. It was just a visit like a the office. Of course I failed. The second I used Kaufman and had text of OMT that was not useful Nelsons Somatic Dysfunction of Osteopathic Medicine. I also had to learn to type which I tried to do everyday for more that 9 months. I learned on a lap top and when I got there they had a regular keyboard with a toggle. I did not know how to start a second column and it went down hill from there. All I could think was I can not do this. I have not had any body to practice with because I am in the "Country" of South Ga.
I was hoping I could get guidance from some of you. They do not let you know enough from the results to correct anything. I read some of your comments and if you are having trouble then I am in trouble.
I need a remedial course or some guidance. The PCOM GA campus might be where I need to check. Any help would be appreciated.

 

[Sloow]

I am a 67 y/o physician and have practiced in a small town for 33 years. I had a busy practice in both the office , hospital, and two nursing homes. I also delivered babies until the malpractice stopped us.
I was considered by the other physicians a good diagnostician. I was Chief of staff three times and never had a adverse report from the hospital and have never had a malpractice suit. I had to retire in 2009 due to a disability and am now ready to go back . Physically I am good as a lot who are a lot younger and after surviving the 70s surprised my mind is still fairly sound as Willie says. I have been out over 3 years so have to pass the PE2 which I have failed twice.. The first time I was totally unprepared and was told by someone who was supposed to know it was like the old SOAP notes we did in school. It was just a visit like a the office. Of course I failed. The second I used Kaufman and had text of OMT that was not useful Nelsons Somatic Dysfunction of Osteopathic Medicine. I also had to learn to type which I tried to do everyday for more that 9 months. I learned on a lap top and when I got there they had a regular keyboard with a toggle. I did not know how to start a second column and it went down hill from there. All I could think was I can not do this. I have not had any body to practice with because I am in the "Country" of South Ga.
I was hoping I could get guidance from some of you. They do not let you know enough from the results to correct anything. I read some of your comments and if you are having trouble then I am in trouble.
I need a remedial course or some guidance. The PCOM GA campus might be where I need to check. Any help would be appreciated.

I dont know how any Resident let alone someone who has been practicing for that many years cant pass the PE. My only guess is that you are not writing a correct SOAP note and so you are losing massive points for not including certain things. The presentations/cases should be things you have seen over 10,000 times each over your years in practice so I hope that isnt the cause....


Subjective- Ask them COLDERASS- Character, Onset, Location, Duration, Exacerbating factors, Relieving factors, Associated Signs and Symptoms

Thats your HPI,

Then ask:

Past Medical History, Past Surgical History, Family History, Social History, Allergies, Meds


Then your Objective

Put down their Vitals, and then do a Physical Exam......


Again, for someone who is even 1 year out of med school this stuff is routine, I can only assume you are just not including the Check Boxes that they want for grading....