Comlex PE help

[pandnana]

Just took my PE. My notes were terrible! Does anyone know if spelling and typos are counted against you? Also I pretty sure I gave the wrong diagnosis for like 4 of my pts. I didnt ask all the right ROS basically.

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[Kerosene Hat]

If it was minor mistakes of a letter or two and you didn’t have any truly bizarre abbreviations, I wouldn’t lose any sleep.

 

[67552931811]

Dude I didn’t even finish TEN notes. Ten.... I think having something will net you more points than it being blank...

Just try to relax

 

[poppaguap]

For two cases I didnt complete the assessment and plan. Other plans were inadequate. Really worried that might be enough to fail. Also ran out of time for two cases and didn't get to finish the physical. Anyone else have a similar experience?

 

[phagocytosis41]

For two cases I didnt complete the assessment and plan. Other plans were inadequate. Really worried that might be enough to fail. Also ran out of time for two cases and didn't get to finish the physical. Anyone else have a similar experience?

I take the PE next month.. Any advice guys..?

 

[osteomedstudent2021]

I would do Assessment First, then Plan then Objective then Subjective when doing your notes.

 

[samac]

I would do Assessment First, then Plan then Objective then Subjective when doing your notes.

I gotta disagree. While typing the subjective I occasionally realized I had the wrong primary diagnosis when I was nervous in the room and was able to better formulate my assessment as I did that.

 

[osteomedstudent2021]

I gotta disagree. While typing the subjective I occasionally realized I had the wrong primary diagnosis when I was nervous in the room and was able to better formulate my assessment as I did that.

That method helped me with the timing, of the note, but I can understand where you are coming from. I usually took the 14 minutes in the room so when I got out there was really only 8 min 45 seconds left to do the note by the time I got to the computer. I believe that majority of the points for the SOAP note come from Assessment and Plan rather than the subjective which I believe the Standardized Patient grades that component based on the questions you ask. With my method, I was usually at 4 min 45 seconds-5 minutes for the subjective. When I personally did it Subjective, Objective, Assessment and then Plan, I ran out of time when I got to Assessment and Plan since I took too long on Subjective.

 

[mathnerd88]

That method helped me with the timing, of the note, but I can understand where you are coming from. I usually took the 14 minutes in the room so when I got out there was really only 8 min 45 seconds left to do the note by the time I got to the computer. I believe that majority of the points for the SOAP note come from Assessment and Plan rather than the subjective which I believe the Standardized Patient grades that component based on the questions you ask. With my method, I was usually at 4 min 45 seconds-5 minutes for the subjective. When I personally did it Subjective, Objective, Assessment and then Plan, I ran out of time when I got to Assessment and Plan since I took too long on Subjective.

I completely mirror your experiences. Keep in mind PE is not about finding the right diagnosis, but how you approach it. It's okay to miss a key diagnosis, because that's a minor point in the grading scheme. As long as you had at least three reasonable differentials you will be okay.

Also, each section of the SOAP note is weighted equally, meaning that if you didn't have anything in the assessment and plan, you will have 0 points that is worth 50% of the SOAP note grading. That's why I always put A/P first, because they're short and can net you points that are already worth 50% of the SOAP note grading. They’re also the ones that require more critical thinking. Subjective and objective are basically cut and paste from what you’ve written down. You can always shorten the subjective and missing a small minor detail won't affect it as much either. It's really about how efficiently you can get the most points with the least amount of typing. 9 minutes isn't a lot of time.

IRL in the hospital I go in order of SOAP. On the PE, I do A/P first (which also allows me some time to think of more differentials and plan and if you forget to do something during patient encounter, can include in plan), then start Subjective by the 5 min mark (Includes HPI, ROS, FEDTACOS, SMASHFM), then Objective by the 1:15-1:30 min left mark. This has a nicer flow for me because I would rather have the easy cut and paste part at the end instead of freaking out thinking of more assessment and plan at the end if I did it in order of SOAP. Again, practicing makes perfect in this aspect.

 

[Sardonix]

I completely mirror your experiences. Keep in mind PE is not about finding the right diagnosis, but how you approach it. It's okay to miss a key diagnosis, because that's a minor point in the grading scheme. As long as you had at least three reasonable differentials you will be okay.

Also, each section of the SOAP note is weighted equally, meaning that if you didn't have anything in the assessment and plan, you will have 0 points that is worth 50% of the SOAP note grading. That's why I always put A/P first, because they're short and can net you points that are already worth 50% of the SOAP note grading. They’re also the ones that require more critical thinking. Subjective and objective are basically cut and paste from what you’ve written down. You can always shorten the subjective and missing a small minor detail won't affect it as much either. It's really about how efficiently you can get the most points with the least amount of typing. 9 minutes isn't a lot of time.

IRL in the hospital I go in order of SOAP. On the PE, I do A/P first (which also allows me some time to think of more differentials and plan and if you forget to do something during patient encounter, can include in plan), then start Subjective by the 5 min mark (Includes HPI, ROS, FEDTACOS, SMASHFM), then Objective by the 1:15-1:30 min left mark. Again, practicing makes perfect in this aspect.

Jumping on this train to ALSO say that I wrote Assessment --> Plan --> Subj --> Obj

The best or most accurate diagnosis really is not the point other than satisfying your insecurities afterward. You have a patient who claims they have anxiety and fit MOST of the symptoms... so you diagnose them with GAD and explain the plan relatively well to them. But then you get out of the room and OH DANG you remembered that they said they drink 20 monsters a day? You would still put GAD down as the main diagnosis, with excessive caffeine intake/substance use disorder as the secondary. So long as it's all REASONABLE suspicion it's fine, even if one is wrong.

Rethinking your diagnosis while writing your note is risky because you not only have to couch all the changes with "WOULD/WILL do differently/next time," but also your thought process is thrown off and your panicky mind will be very tempted to fudge details to make your story fit the new narrative. You don't have time to think while writing the note--you only have time to write the note. It's all risk of increased errors or even accidentally lying, with very little reward.

 

[samac]

Jumping on this train to ALSO say that I wrote Assessment --> Plan --> Subj --> Obj

The best or most accurate diagnosis really is not the point other than satisfying your insecurities afterward. You have a patient who claims they have anxiety and fit MOST of the symptoms... so you diagnose them with GAD and explain the plan relatively well to them. But then you get out of the room and OH DANG you remembered that they said they drink 20 monsters a day? You would still put GAD down as the main diagnosis, with excessive caffeine intake/substance use disorder as the secondary. So long as it's all REASONABLE suspicion it's fine, even if one is wrong.

Rethinking your diagnosis while writing your note is risky because you not only have to couch all the changes with "WOULD/WILL do differently/next time," but also your thought process is thrown off and your panicky mind will be very tempted to fudge details to make your story fit the new narrative. You don't have time to think while writing the note--you only have time to write the note. It's all risk of increased errors or even accidentally lying, with very little reward.

See I guess my big thing is it never made a big difference to what I said in the room. I never gave a straight up diagnosis, I told them I would run some labs, get an EKG, do whatever and then I’ll let them know the results and follow up in a week. I’d say I’d call as soon as the results are in and if we need to follow up sooner I’ll let you know.
I would havessed up an assessment and plan realllllllly bad if I didn’t do my normal order on one patient, but I also never struggled with time. I’m a get out of the room at least a minute early kind of person.

but the best advice I can give someone for the Pe is the Kaufman book/video and practice some SOAP notes. I had a case that mirrored one in the book exactly and a few others that were similar. Great resource.