COMLEX PE - worried :/

[UnoMas]

I just took mine today and I'm really worried there were a few times I documented "cranial nerves 3-12 intact" and didnt realize til thr last few cases that i had forgotten to check either cranial nerve 8 or 11 on some of them but I still documented it out of habit. I was so nervous I didn't even realize until the end. Is this a violation?

I think you are fine as long as you actually DID check the cranial nerves on some of them but MISDOCUMENTATION is actually a pretty big thing for COMLEX PE according to my dean. No point worrying about it now.

For future PE takers: Heart, lungs + 1 more simple test, don't go checking cranial nerves on ANYONE that is unwarranted. I suck at doing neuro exam so I avoided doing it at all during my test, even on a STROKE case and I passed. It's a MINIMALLY COMPETENCY exam, be thorough with your HISTORY, be COMPASSIONATE. For the physical exam my philosophy was the less I do the less they can take points off. Physical exam isn't my strong suit

Then again I took my exam almost 8 months ago

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[paldev12]

I think you are fine as long as you actually DID check the cranial nerves on some of them but MISDOCUMENTATION is actually a pretty big thing for COMLEX PE according to my dean. No point worrying about it now.

For future PE takers: Heart, lungs + 1 more simple test, don't go checking cranial nerves on ANYONE that is unwarranted. I suck at doing neuro exam so I avoided doing it at all during my test, even on a STROKE case and I passed. It's a MINIMALLY COMPETENCY exam, be thorough with your HISTORY, be COMPASSIONATE. For the physical exam my philosophy was the less I do the less they can take points off. Physical exam isn't my strong suit

Then again I took my exam almost 8 months ago

I def did the cranial nerves on those patients but fir example on one I did all except 11 because I forgot but documented "CN3-12 INTACT" out of habit not even realizing I forgot to check 11 too after the fact

 

[UnoMas]

I def did the cranial nerves on those patients but fir example on one I did all except 11 because I forgot but documented "CN3-12 INTACT" out of habit not even realizing I forgot to check 11 too after the fact

ah I see, that's nothing dude, you passed. That's a tiny weeny mistake, I doubt they'd catch it or cared if they did. I thought you meant you documented it but never did it at all on patients. Relax

 

[blah2468]

Can I withdraw my test from scoring after I took it? I can just retake it and not get the "F".

I feel like I failed. I really do.

I used medical jargon, which I could tell annoyed patients. I also failed to properly relate to patients who were pretending to be in pain - like in the ED setting. I failed to see them as real patients. Also often skipped a lot of stuff in the history - like asking the surgical history or parts of the social history which I felt were less relevant. Sometimes skipped the heart and lung exam due to lack of time.

I really might have failed. I am also a minority and I felt that some of the patients didn't really like that. It was an uphill battle everytime to get the patients to like me. = /

Hey I ended up accidentally using medical jargan multiple times as well. I also forgot to re sanitize my hand after inspecting someone's foot. Did you end up passing?

 

[Giovanotto]

What's the deal with the SOAP A&P on this exam. The Kauffman SOAPs are very bare-bone, and lot of them don't have any lifestyle on them.

Are people putting obesity, caffeine use, etc. on their assessment? I.e.

Assessment: chest pain
1) GERD
2) PUD
3) esophageal webs
4) obesity
5) caffeine use

?

 

[NecFasc92]

What's the deal with the SOAP A&P on this exam. The Kauffman SOAPs are very bare-bone, and lot of them don't have any lifestyle on them.

Are people putting obesity, caffeine use, etc. on their assessment? I.e.

Assessment: chest pain
1) GERD
2) PUD
3) esophageal webs
4) obesity
5) caffeine use

?

There is no time for in depth thinking. You’ll see. In typical nbome fashion it’s a race, start to finish.

 

[Sardonix]

What's the deal with the SOAP A&P on this exam. The Kauffman SOAPs are very bare-bone, and lot of them don't have any lifestyle on them.

Are people putting obesity, caffeine use, etc. on their assessment? I.e.

Assessment: chest pain
1) GERD
2) PUD
3) esophageal webs
4) obesity
5) caffeine use

?

You won't be able to finish a couple of your notes due to time constraint, if you're like many test takers (me included). Just get down what you can.

FYI still passed.

 

[Giovanotto]

You won't be able to finish a couple of your notes due to time constraint, if you're like many test takers (me included). Just get down what you can.

FYI still passed.

I rarely struggle with finishing a note, I am very fast typer (thanks cs 1.6) and have gotten good reviews on all my soap notes so far. Where I really struggle with time is the actual patient encounter.

 

[Sardonix]

I rarely struggle with finishing a note, I am very fast typer (thanks cs 1.6) and have gotten good reviews on all my soap notes so far. Where I really struggle with time is the actual patient encounter.

That's good then. But still plan accordingly and assume you're not gonna be operating at peak efficiency. Objectively speaking, if you didn't know you were being graded the PE is pretty boring and easy. There's a huge "panic" factor involved though that fries your brain a little bit. And by the 8th clinical encounter you have to fight not to be on autopilot. Just take into account **** happens and you'll prepare correctly.

 

[zero0]

There's still one thing I don't get. I know we're not supposed to document things we didn't ask or parts of the physical exam we didn't do, but what about if we didn't discuss a certain part of the plan with the patient but decide to document it later? Like for one of my patients I forgot to tell him I'd refer him to a counselor but later wrote in my plan section that I would. Thinking back I might have changed my plan a couple of times last minute and I'm not sure if I discussed it with the patient.

 

[PittDO1787]

There's still one thing I don't get. I know we're not supposed to document things we didn't ask or parts of the physical exam we didn't do, but what about if we didn't discuss a certain part of the plan with the patient but decide to document it later? Like for one of my patients I forgot to tell him I'd refer him to a counselor but later wrote in my plan section that I would. Thinking back I might have changed my plan a couple of times last minute and I'm not sure if I discussed it with the patient.

I did that a few times. Ordered tests and recommended referrals that I didn't necessarily mention to the patient, and I passed!

 

[Giovanotto]

For anyone who had a patient with a hip/gluteal/upper leg pain, what treatment did you do? And was doing standing flexion test enough for diagnosis? Or did you also have to check sacral base, ILA's, etc.?

 

[PittDO1787]

For anyone who had a patient with a hip/gluteal/upper leg pain, what treatment did you do? And was doing standing flexion test enough for diagnosis? Or did you also have to check sacral base, ILA's, etc.?

I did not do a structural exam. So for example, if someone had gluteal pain, I focused on that area without doing any sort of diagnostic tests. I used the myofascial technique for all of my OMM cases.

 

[samac]

There's still one thing I don't get. I know we're not supposed to document things we didn't ask or parts of the physical exam we didn't do, but what about if we didn't discuss a certain part of the plan with the patient but decide to document it later? Like for one of my patients I forgot to tell him I'd refer him to a counselor but later wrote in my plan section that I would. Thinking back I might have changed my plan a couple of times last minute and I'm not sure if I discussed it with the patient.

Just to note I didn’t realize the diagnosis on a couple cases until I was out of the room and typing it out. So I didn’t discuss the main differential and added tests.
I also didn’t discuss things very specifically with patients. I’d say things like “blood work” and give a general thing like “for your heart, for your liver, etc” and put the actual tests in the note. I passed.

 

[Oh_Gee]

There's still one thing I don't get. I know we're not supposed to document things we didn't ask or parts of the physical exam we didn't do, but what about if we didn't discuss a certain part of the plan with the patient but decide to document it later? Like for one of my patients I forgot to tell him I'd refer him to a counselor but later wrote in my plan section that I would. Thinking back I might have changed my plan a couple of times last minute and I'm not sure if I discussed it with the patient.

you're supposed to do that. see pg 13

https://www.nbome.org/wordpress/wp-content/uploads/2017/03/COMLEX-USA_L2PE_Orientation_Guide-website-20192020.pdf

 

[Giovanotto]

you're supposed to do that. see pg 13

https://www.nbome.org/wordpress/wp-content/uploads/2017/03/COMLEX-USA_L2PE_Orientation_Guide-website-20192020.pdf

Correct, Kauffman has videos where he does this. he runs out of time and his practice SOAP notes show that he wrote "should have offered smoking cessation, plan for next visit". And he also has things in his notes that he didn't always discuss with the patient.

 

[Giovanotto]

Question: if you're referring the patient to the hospital/ED for further work up, under plan, do you still need to put tests and treatments? I noticed Kauffman does this, but it doesn't make sense since the admitting hospital will be the one to ultimately decide what to do. Would it be inappropriate to simply put, "referred to the ED for further work up, return to clinic pending completion of work up".

 

[PittDO1787]

Question: if you're referring the patient to the hospital/ED for further work up, under plan, do you still need to put tests and treatments? I noticed Kauffman does this, but it doesn't make sense since the admitting hospital will be the one to ultimately decide what to do. Would it be inappropriate to simply put, "referred to the ED for further work up, return to clinic pending completion of work up".

I would probably try and be a bit more specific. For example, if you had a patient who you thought could be having a heart attack, you could say "referred/sent to ED for EKG/cardiac enzymes." Obviously not how it would occur in the 'real world'...but it shows that you know what you're talking about.

 

[BorntobeDO?]

For anyone who had a patient with a hip/gluteal/upper leg pain, what treatment did you do? And was doing standing flexion test enough for diagnosis? Or did you also have to check sacral base, ILA's, etc.?

I wouldn't do anything to do with hip. I would do a psoas treatment then maybe myofascial. no sacral diagnosis is a good thing IMO.

 

[BorntobeDO?]

Correct, Kauffman has videos where he does this. he runs out of time and his practice SOAP notes show that he wrote "should have offered smoking cessation, plan for next visit". And he also has things in his notes that he didn't always discuss with the patient.

I actually did a lot of 'plan to come back' or plan to offer next visit.

 

[Giovanotto]

if the CC is unrelated to the lungs, is it acceptable to just listen to the posterior lung sounds? Or did everyone do 6 front, 2 mid, 6 back for all patients?

 

[shadowlightfox]

if the CC is unrelated to the lungs, is it acceptable to just listen to the posterior lung sounds? Or did everyone do 6 front, 2 mid, 6 back for all patients?

I only listened to the lung sounds in the back if they weren't lung related. Of course I can't promise you I didn't have points deducted for that in my PE but I had that approach for every single patient encounter outside of my PE as well and no one bat an eye at me for it.

 

[hallowmann]

Question: if you're referring the patient to the hospital/ED for further work up, under plan, do you still need to put tests and treatments? I noticed Kauffman does this, but it doesn't make sense since the admitting hospital will be the one to ultimately decide what to do. Would it be inappropriate to simply put, "referred to the ED for further work up, return to clinic pending completion of work up".

Except you do that in the real world. If you are sending someone to the ED from clinic, its good practice to say what you're concerned about and what you think is worth evaluating. Sure, the ED physician will make the final call on what they order, but if you send someone to the ED with an acute problem, but think they need this imaging study or lab test, then you should mention it in the note or when you call the ED to give handoff (ideally you're able to do this).

In clinic, its likely you know the patient more or were able to spend more time with the patient than the ED doc will. Its in their best interest to be as helpful as possible.

 

[zero0]

you're supposed to do that. see pg 13

https://www.nbome.org/wordpress/wp-content/uploads/2017/03/COMLEX-USA_L2PE_Orientation_Guide-website-20192020.pdf

Cool, cool guess I'll find something new I did to mentally torture myself about, like my piss poor OMM technique or wondering if I smiled enough........

 

[BorntobeDO?]

Cool, cool guess I'll find something new I did to mentally torture myself about, like my piss poor OMM technique or wondering if I smiled enough........

If my omm technique was suffient, then anyones is. I am embarassed to say I actually did cranial on a case. And I passed.