Comlex PE thread

[cheruka]

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Hi,
I did not see a thread for this so, thought I would start one. I have it in a few days. I know most of you are done taking it so, hopefully there are still a bunch of us still waiting to take it.

 

[cheruka]

Do we always have to make small talk? I am by nature not very extroverted. So, I have to work on this. Also, what do you say when the patient says "do you think I am going to die/loose my breast/how long do I have to live/need a transplant/am I having a stroke?"

 

[211519]

Do we always have to make small talk? I am by nature not very extroverted. So, I have to work on this. Also, what do you say when the patient says "do you think I am going to die/loose my breast/how long do I have to live/need a transplant/am I having a stroke?"

You mean small talk with the fake patients? Treat them like you would treat a real patient. It wholly depends on the context of the complaint, personality of the patient, etc.

Same goes for anything they ask. If a patient with a cold asks if they are going to die, it is a different response than a patient you suspect might have cancer asking the same thing. By this point, you should have finished all your 3rd year rotations and part of 4th year rotations, so you should be fine.

 

[cheruka]

I want to keep the following in mind when I do the humanistic part:
Greet them warmly, introduce self as studentdoctor xxxxx.
Confirm the patient's name, ask how they like to be called.
Ask how their drive in was, if they have a busy day planned.
Start the interview while maintaining eye contact. Ask open ended questions.
Show empathy if they say they don't have insurance etc.
After the interview, ask permission for doing a physical and go wash hands.
drape them properly asking for permission to touch areas under the breast etc.
Complete the physical, wash hands.
Give the patient the brief version of plan and assessment, ask if they have any questions.
Thank them for coming, exit the room.

Do I have a complete list? I am nervious about this because I am an international grad and worried about getting dinged just for looking/sounding different (yep, life is not fair). So, I appreciate all the help I can get on this forum. My English is pretty good, I need ot make sure not to miss subtle cues etc.

 

[thepoopologist]

I want to keep the following in mind when I do the humanistic part:
Greet them warmly, introduce self as studentdoctor xxxxx.
Confirm the patient's name, ask how they like to be called.
Ask how their drive in was, if they have a busy day planned.
Start the interview while maintaining eye contact. Ask open ended questions.
Show empathy if they say they don't have insurance etc.
After the interview, ask permission for doing a physical and go wash hands.
drape them properly asking for permission to touch areas under the breast etc.
Complete the physical, wash hands.
Give the patient the brief version of plan and assessment, ask if they have any questions.
Thank them for coming, exit the room.

Do I have a complete list? I am nervious about this because I am an international grad and worried about getting dinged just for looking/sounding different (yep, life is not fair). So, I appreciate all the help I can get on this forum. My English is pretty good, I need ot make sure not to miss subtle cues etc.

You don't need to use the faucet. Hand sanitzer works too.
Your interview questions should go straight down the list. HPI down to Social History. Do a physical on everyone, including those who come in for lab results and depression.
One of the things I did when I was interviewing them, is if they did something like cough or clear there throat or whatever, to ask them if they were alright. Other than that I think you have everything.

 

[cheruka]

Thanks, poopologist.
With the OMM stuff, has anyone gone thr' the tender points to prepare? I don't have much expertise in them, but feel like it won't hurt to have a few in my back pocket.
Also, is it ok to say to the patient something along the lines of "your abdominal pain must be interfering with your life, we both together will come up with a plan for you on how we can deal with it and get to the bottom of it".
Regarding hand washing, the comlex PE book says to wash right after entering the room but I am thinking I should do it before the PE so I have a chance to connect with the patient upon entering the room in stead of turning my back on him to wash.

 

[cheruka]

So, I guess I am talking to myself. I must be the only one who has not finished this test😱

 

[bleeker10]

If you are talking about the PE book by Kaufman, ignore a lot of what it says. Wash your hands before the physical exam. No need to do it upon entering the room. Use the sanitizer instead of soap and water. Also you don't need to repeat blood pressures or anything like that. You won't have time to do that. Do the HPI and PE just like you would if this was a real clinic and these were real patients.

 

[cheruka]

Thank you so much, bleeker. I am hoping I will not miss the opportunities prevent disease and be empathetic. Other than helping them with physical exam and saying things like "I know you are in pain, but just bear with me for a couple of min because I need to do the exam", "I know how it must be affecting your life", "I am sorry to hear about xyz", are we expected to do anything else? I ask because I do very well in real situations but find it hard to say it to actor-patients.

 

[bleeker10]

Thank you so much, bleeker. I am hoping I will not miss the opportunities prevent disease and be empathetic. Other than helping them with physical exam and saying things like "I know you are in pain, but just bear with me for a couple of min because I need to do the exam", "I know how it must be affecting your life", "I am sorry to hear about xyz", are we expected to do anything else? I ask because I do very well in real situations but find it hard to say it to actor-patients.

I'd avoid things like "I know how it must be affecting your life" or "I know what you are going through" unless you actually have gone through it. Just say something like "I know this is tough news but we will do everything we can to get you the proper care".

If a patient interrupts you to ask if they are going to die, don't blow them off. Answer to the best of your ability. If a patients asks you anything, don't blow it off.

 

[JamesPhilly]

I want to keep the following in mind when I do the humanistic part:
Greet them warmly, introduce self as studentdoctor xxxxx.
Confirm the patient's name, ask how they like to be called.
Ask how their drive in was, if they have a busy day planned.
Start the interview while maintaining eye contact. Ask open ended questions.
Show empathy if they say they don't have insurance etc.
After the interview, ask permission for doing a physical and go wash hands.
drape them properly asking for permission to touch areas under the breast etc.
Complete the physical, wash hands.
Give the patient the brief version of plan and assessment, ask if they have any questions.
Thank them for coming, exit the room.

That's good, except to add what others have already said: use sanitizer, at the start of the interivew shake hands, at the end of the interview ask them if they need a doctor's note for work or if they want you to call someone (ie family member) to update them on your situation. I feel that goes over really well. Then **incorporate that into the plan** in your SOAP note. It doesn't hurt to use the COMLEX PE review book to practice timing some notes so you get into the flow of things. A little practice now will make test day a lot less stressful, and I did not leave any notes empty because of a few hours of studying I did.

Obviously you already took your exam, which I hope went well. I am posting this for future students: follow these steps and you will most likely be ok! Good luck to all

 

[cheruka]

That's good, except to add what others have already said: use sanitizer, at the start of the interivew shake hands, at the end of the interview ask them if they need a doctor's note for work or if they want you to call someone (ie family member) to update them on your situation. I feel that goes over really well. Then **incorporate that into the plan** in your SOAP note. It doesn't hurt to use the COMLEX PE review book to practice timing some notes so you get into the flow of things. A little practice now will make test day a lot less stressful, and I did not leave any notes empty because of a few hours of studying I did.

Obviously you already took your exam, which I hope went well. I am posting this for future students: follow these steps and you will most likely be ok! Good luck to all

Yep, passed. 👍

 

[EMH Mark V]

Third year here. I took it back in February and got my passing grade. Just want to acknowledge how much this thread helped. I also only used hand sanitizer which seemed to be fine. My school also forced us to use alcohol wipes before using our stethoscopes on patients, however the NBOME site doesn't have them. It didn't seem right for me not to do anything about it, so I just showed and verbalized to the patient that I was applying some alcohol sanitizer on the stethoscope diaphragm as well. Weird I know, but it worked out fine for me. Guess you could also cover it with a latex glove, but I fail to recall seeing them provided in the examination rooms.

Probably overkill, but I only used my school's OMM videos, Kaufman's comlex PE book, and Core Concepts for USMLE STEP 2 CS.

 

[BigSib]

Remember to take a minute to read the entire 'doorway information sheet' which will provide the location (ER, clinic, urgent care, etc.), vitals, test results, etc. I found it beneficial to write down some of this information on the SOAP note prior to entering the room (e.g., A #yo female/male presents to ___ with c/o XYZ, and vitals). Sometimes you can get a slot or two filled on your differential by reading/interpreting the labs/imaging provided. That being said you should review common laboratory result normal ranges.

Go into each encounter the same way: always ask PMHx, Family Hx, Social Hx. Most of the time it will be a very easy diagnosis, but without asking the full history you'd miss a vital component. Use a mnemonic and have a layout prepared for your blank computer paper sheet. Always ask each question of the mnemonic used.

• OLDCARTS
• SMASH FM: Social hx (see below), Medical hx, Allergies, Surgical hx, Hospitalizations, Family hx, Medications
• FEDTACOS: Food, Exercise, Drugs, Tobacco, Alcohol, Caffeine, Occupation, Sex

Stop what you're doing when the two minute bell rings. You will get docked points if you don't discuss the diagnosis and plan - it's part of the actor's assessment of you. It's better to get the points you need than to spend the next two minutes frantically going through the rest of your physical - write down in the objective or plan portion of the SOAP note what you would have liked to perform but didn't on the physical. Use the time spend performing OMM to discuss the diagnosis and plan because treatment usually takes a few minutes and there otherwise may be awkward silence.

Grip the pen properly when writing notes. Your hand will be dead by the end of the day and will hurt if you hold it improperly. They provide the pens.

You can't wear watches, rings, or have anything (wallet) in your pockets.

You cannot turn off the lights to perform an ophthalmic or other examination.

Do we always have to make small talk?

While not required it will be highly beneficial. Do this while washing your hands and talk about the weather, recent events, etc. Helps break the ice and actually will make you (more so than the actor) feel better about the encounter before it starts.

I am nervous about this because I am an international grad and worried about getting dinged just for looking/sounding different (yep, life is not fair). So, I appreciate all the help I can get on this forum. My Engrish is pretty good, I need to make sure not to miss subtle cues etc.

For those who have difficulty speaking English I would highly recommend more one-on-one practice with a partner to better verbalize your words. NBOME says "The clinical skills tested include: physician-patient communication, interpersonal skills and professionalism, medical history-taking and physical examination skills, osteopathic principles and osteopathic manipulative treatment, and documentation skills (including synthesis of clinical findings, integrated differential diagnosis, and formulation of a diagnostic and treatment plan). ... The ability to communicate in the English language is required in each clinical encounter."

 

[Desidoc2010]

Any one who took PE exam recently (2012-2013), how was your experience like?
So far ppl I've talked to haven't had any peds pts (<5yoa). Two students had 18yo coming in for physical exam. How common is it to get peds pts?
How about other case scenarios such as....
pt coming in for lab follow up or recent ekg done... and you've to come up with A&P.
Meds allergies or side effects??

Is it okay to do OMT on those pts who specifically asks you to do so and for rest just write it down in your plan?

How do they evaluate students on accuracy? I sometimes feel like "I've no idea wat's wrong" --- how badly does this look? Is it like an automatic failing grade?

 

[DO3]

Everyone signs a confidentiality oath prior to taking the exam. Answering the questions that you've asked would violate that oath. My suggestion would be to use the COMLEX PE book and practice with friend to prepare for it. Run through some practice cases, right some SOAP notes, and review some basic omt techniques and you will be fine.

Also, no one knows for sure how you are graded.

 

[Desidoc2010]

I understand your perspective. However, I'm not asking to disclose any specific case details or types of pts you had on your exam.
I just want to how different case scenarios are from USMLE. Above points I've made are common in USMLE but not sure about comlex. I went through entire COMLEX PE book and no single case was related to peds/interpreting labs.

I think it'll be very very helpful to all the future students vising SDN to at least get a general idea on what is a fair deal. Especially when some schools don't even bother to provide proper information or for those who are taking it in the middle of the 3rd year.

 

[Trogghunter]

No one knows how it's graded. Just try to act like a good, caring physician. Wash and drape, get a complete, thorough history with ppqrsta plus full social/FAM/medical. Its like a FP rotation...console them, give tissues, ask if they're comfortable or need anything. Always close the encounter by asking if they have questions, tell them that you're gonna be there for them, and followup in a week, month, etc. If you've had an outpatient IM or FP rotation, just try to emulate one of the nicer physicians. Be the doctor that you'd want to treat your mother.

Physical exam? Who knows...but listen to heart/lungs in everyone.
Omm? Do it where you see fit, check CTL and recheck after treatment. No need to bust out fancy techmiques--stick to what you know. ME ST

Note? Don't write anything you didn't do. DONT WRITE ANYTHING YOU DIDNT DO. Its better to leave something out than include something not performed. Don't tunnel yourself into one diagnosis, and rule out red flags first and foremost. If you forget anything, just put it in the plan.

I took this exam after not having seen a patient for over a month, and I thought about every little mistake for the 8wk waiting period but I passed because I simply remembered to treat it like one of the IM rotations that I had. After a couple of cases, I ceased remembering that it was an exam and treated it like a day on rotation where I wanted to impress my attending and help my patient.

I believe that is the objective of this exam. Good luck to all, and enjoy a Philly cheese steak from Pat's, not Gino's. One wiz with.

 

[min27]

On 3 of my cases, I forgot to wash my hands before starting the PE, which I never forgot to do during practice. I caught myself somewhat early each time and ran to the hand sanitizer, but like an idiot, I didn't verbalize that I was going was wash my hands. Does this still count? or am I screwed?

Also, I got some OMM cases I wasn't expecting, so my technique was pretty bad. If i were to somehow miraculously pass all the other categories but fail OMM, does that automatically fail me?

 

[Trogghunter]

On 3 of my cases, I forgot to wash my hands before starting the PE, which I never forgot to do during practice. I caught myself somewhat early each time and ran to the hand sanitizer, but like an idiot, I didn't verbalize that I was going was wash my hands. Does this still count? or am I screwed?

Also, I got some OMM cases I wasn't expecting, so my technique was pretty bad. If i were to somehow miraculously pass all the other categories but fail OMM, does that automatically fail me?

still washed, still counts. check the rubric on the website. your pass for the note/omm/etc (non patient interaction part) is averaged together with the note and a/p etc etc etc.

 

[DO3]

Scores up through May 31...

 

[absolutdokta]

One wiz with.

I was in Philly visiting family. seeing as how this was my first trip here my brother educated me on the proper way to order your cheese steak. I totally would have asked....what kind of bread do you have? with or without? with or without what? apparently the vendors don't like that

 

[pipe dream]

Anyone know when the next batch of scores go up and any chance they'll include July scores?

 

[Roberie]

Anyone know when the next batch of scores go up and any chance they'll include July scores?

Hopefully soon. I'm still waiting for my June 6th score.

 

[Desidoc2010]

HI guys
I passed my PE and this thread really helped. So thought I should contribute something..
Based on talking to multiple ppl who took the exam and personal experience, I would say comlex PE book is 100% worth it.
Hint Hint.... will assure you a passing grade if you know how to ask relevant qs, know your ddx, tx and obviously show compassion toward each pt.
I ended up doing all the case scenarios with my roommate. Worked on DDx and treatment plan for each case. Having this done came really came handy 2 days before the test.
The case scenarios varied from consulting OCP to teenagers to ER situ like stroke, diverticulitis.
Easy OMM... just know all ME and soft tissue technique 'cause it's hard to predict which part of the body you'll have to treat.
and Thank GOD.....
NO peds (<5yoa)

Be ready to answer qs like... doctor am I going to die? I stop taking my pills 'cause insurance no longer covers it... can you help me out any other way?

 

[absolutdokta]

8 solid weeks and still no score. must need congressional approval to release them or something.

 

[WhitJord85]

8 solid weeks and still no score. must need congressional approval to release them or something.

according to a friend who called this week.... july scores are coming out someday this week

 

[TrimtheChute]

Scores came out this afternoon through July! Finally can put this thing behind me!

 

[Roberie]

8 solid weeks and still no score. must need congressional approval to release them or something.

Finally got my score on week 10. Some classmates received theirs in far less than 8. Just depends on when you take it relative to that batch of candidates. So happy I didn't get "invited" back to Conshohocken for another visit.

 

[absolutdokta]

Finally got my score on week 10. Some classmates received theirs in far less than 8. Just depends on when you take it relative to that batch of candidates. So happy I didn't get "invited" back to Conshohocken for another visit.

yeah, I can think of plenty of other things to do with 1200 bucks

 

[rkaz]

Scores came out this afternoon through July! Finally can put this thing behind me!

Yep, I took my test at the very end of July.... didn't expect to get my score back today, after only 6.5 weeks.

Sooo very happy that I passed!! 😀 😎 One stressor out of the way.... now on to finishing ERAS and taking COMLEX level 2 CE.

 

[microtome]

For those who have taken the PE, do you recommend draping the patient before your begin the exam (i.e., placing the drape in the lap) or waiting until the patient is supine for the abdominal exam?

Also any recommendations for auscultating the mitral valve on female SPs? Best to go though the top of the gown or around the side of the gown?

Thanks!

 

[BigSib]

For those who have taken the PE, do you recommend draping the patient before your begin the exam (i.e., placing the drape in the lap) or waiting until the patient is supine for the abdominal exam?

It may not be a bad idea to place the drape in the lap. Doing that would also ensure that you don't forget the drape if you perform an abdominal exam. However, it's not something I've ever done. Whatever you do, just make sure you get into a routine. Overall it doesn't matter if you wait until the abdominal exam.

Also any recommendations for auscultating the mitral valve on female SPs? Best to go though the top of the gown or around the side of the gown?

Simply ask them to lift their left breast and do it around the side of the gown. Dumping your stethoscope down someone's shirt is just weird to me. Some women will lower the top portion of their gown down to expose their sports bra, while others will slip one arm out of a sleeve entirely.

 

[TrimtheChute]

For those who have taken the PE, do you recommend draping the patient before your begin the exam (i.e., placing the drape in the lap) or waiting until the patient is supine for the abdominal exam?

Also any recommendations for auscultating the mitral valve on female SPs? Best to go though the top of the gown or around the side of the gown?

Thanks!

I draped the patient for the abdominal exam when placing the patient supine.

For auscultating the mitral valve on female SPs, I went around the side of the gown and just asked permission to listen. Got close enough but didn't worry if I couldn't actually hear. I agree with BigSib that it seemed awkward to go through the top of the gown. However, one of my classmates used the drop down the gown approach and thought it was easier. My advice would be to practice on someone to see which is better for you.

Good Luck!

 

[danaling12]

Any word on the next release date for scores?

 

[Superman DO]

Scores are available up through August 31. . .passed! 😱 Seven weeks of anxiety finally relieved!

 

[Roger T]

Has anyone heard when the next Comlex pe release will be? we are approaching 10 weeks for those first week september takers

 

[Phlame217]

Has anyone heard when the next Comlex pe release will be? we are approaching 10 weeks for those first week september takers

I emailed them about 1.5 weeks ago and got a response along the lines of "Comlex scores are released 8-10 weeks from the first test date after this most recent release. In this case, the next release should be in the first two weeks of November barring any unforeseen circumstances."

So I would say to expect them next week.

 

[StudentDoc331]

Hi,

Does anyone have a COMLEX PE date within the next week or so that would be willing to switch? I did not know my school is requiring me to take it ASAP! WILL GENEROUSLY COMPENSATE $$$!! Please, thank you so much!

 

[WonderBoy]

Check the nbome site constantly, every few hours in the meantime. I did and was able to switch my date from jan to an earlier date. People drop these things late at night as well. It gets immediately updated on the site once someone drops so you have to be ready to pick it up asap. Also don't take the test lightly.

 

[Euthymia]

My school recommended that we take the PE by Dec 31st, that way if you fail you can still retest and graduate on time. But I was just thinking today that if you take the exam in November/December, you will only get one shot, right? Scores wouldn't be back until maybe Jan-Feb, and you wouldn't have a second chance to retest before the match. So a failure would mean sitting a year out, no? Seems they should be encouraging students to take the PE earlier. #scary

 

[Trogghunter]

Uh yeah. If you fail this exam during your 4th year, then you shouldn't be a physician in the upcoming few months.

 

[WonderBoy]

My school recommended that we take the PE by Dec 31st, that way if you fail you can still retest and graduate on time. But I was just thinking today that if you take the exam in November/December, you will only get one shot, right? Scores wouldn't be back until maybe Jan-Feb, and you wouldn't have a second chance to retest before the match. So a failure would mean sitting a year out, no? Seems they should be encouraging students to take the PE earlier. #scary

Our school told us at least my Jan 31 on the year you are graduating, a little too close for my comfort. Take it early and don't take it lightly.

 

[francheezy]

Anyone know if all SOAP notes are being typed now versus hand written? I purchased the COMBANK PE video series and Dr. Kauffman states that starting in 2014 everything will be typed but I was not sure if this has already taken effect. Taking the exam in 2 days so please help!

 

[BigSib]

Anyone know if all SOAP notes are being typed now versus hand written? I purchased the COMBANK PE video series and Dr. Kauffman states that starting in 2014 everything will be typed but I was not sure if this has already taken effect. Taking the exam in 2 days so please help!

They just posted something about this on the NBOME homepage. There's a tutorial and practice note for typing.

 

[BigSib]

You used to be able to start the note whenever you wanted, but based on that tutorial video it seems like you'll always have 9 minutes. Anyone know if you'll have more if you start early?

 

[WonderBoy]

Anyone know if all SOAP notes are being typed now versus hand written? I purchased the COMBANK PE video series and Dr. Kauffman states that starting in 2014 everything will be typed but I was not sure if this has already taken effect. Taking the exam in 2 days so please help!

Computer version is beginning in June or July 2014 I believe, so you will have to write yours by hand.

You can start your note as soon as you come out of the encounter, once you are out of the room you can't return. But if you come out early, that time is added to the already allotted 9 mins of note writing.

I would recommend to stay in the room as much as possible, the note writing doesn't count as much for grade as humanistic portion which is half of the exam grade, so talk to your patient and be nice!

 

[SukoonAkhira]

My school recommended that we take the PE by Dec 31st, that way if you fail you can still retest and graduate on time. But I was just thinking today that if you take the exam in November/December, you will only get one shot, right? Scores wouldn't be back until maybe Jan-Feb, and you wouldn't have a second chance to retest before the match. So a failure would mean sitting a year out, no? Seems they should be encouraging students to take the PE earlier. #scary

I was wondering the exact same thing. Just saw your post. I don't know if the NBOME opens up dates in like March, April, May, so M4's can take the exam again if they need it to graduate. It is scary. No student should have to waste an entire year just because they could not register for an exam a second time. If anyone has information on this, that would be fantastic. Thanks.

 

[WonderBoy]

I was wondering the exact same thing. Just saw your post. I don't know if the NBOME opens up dates in like March, April, May, so M4's can take the exam again if they need it to graduate. It is scary. No student should have to waste an entire year just because they could not register for an exam a second time. If anyone has information on this, that would be fantastic. Thanks.

They have special reserved dates for retakers.

 

[Euthymia]

They have special reserved dates for retakers.

But that doesn't change the fact that you may still not have a passing PE score by match day, and many places I interviewed said a passing score is required to be ranked.