CS2 exam tips/experience

[vitaminny]

4/2010 update to this post: I passed!! Borderline marks in sharing information, so missing out on those summaries hurt me there but was not in danger of failing. Good luck to all about to take it!

Since I was furiously searching the blogs just a few days ago, trying to find any and all help for the CS2, I thought I would post a little about my experiences while it is still fresh in my mind. I'm a "need to know" person so I appreciated all the previous posts! Will come back in a few months to let you know how successful it was

I've been off rotations X2 months (and after surgery where--let's face it--exams are about 5 minutes if that), and studied FA book (all minicases, PE/DDx pointers on Practice Cases) with some USMLEWORLD. I watched all the PE videos on the site, and did ~10 cases on my parents along with typing the note on the web sample program, all with strict timing. For all those who are wondering (like I did), this web page is very close to the real experience. I did run out of space in the History section several times, but I had written a lot already. FYI you lose space if you hit return to start a fresh line, so I just did run-on lines (ie. PMH: none. Hosp/Surg: none. Allerg: none. etc). Halfway through the actual exam I realized I was spending too much time on the History section, so I changed my note strategy to DDx and Investigations --> PE --> History. Still forgot several times to put down PE findings that I spent precious time getting! Definitely helped to simulate real timing, as I finished early in practice and either didn't or just barely finished in real time. If you handwrite the note you will see the computer clock, but if you type you lose the clock. Watches are completely banned. I felt I had a good sense of the timing from the practice, though.

As far as the actual exam, I took it in Houston, and the experience was very like the video on the website. There's about 60 min of check-in/orientation, and then they line you up in order and file you into the hall with the exam rooms. You stand in front of the door, wait 30" for the SPs to prepare, and then you start. You get 12 scraps of paper, which you CANNOT write on before time starts (I had hoped to write my crib note earlier to save time--you will get a warning and then be reported if you write!). My strategy was to write the pt name in the upper L corner, followed by "PTBR(=P.T.Barnum Returns) to note any significant VS (if WNL I skipped), then the CC, age and sex. This helped when I typed up the note, I didn't need to check for this info again. Then I drew a quick line, and on the R margin I wrote up-and-down "GULSex(=Gee U Look Sexy") for Gi/diet/wt-Urinary-LMP/OB-SexHx. Another line, and then 3 columns: PMH-H/S(hosp/surg)-FH, A-M (allerg-meds), and C-A-D-Soc ("AM cig, alcoh, and drugs are Social"). The only history I missed using this was Meds on one patient (although I think I asked and just forgot it and didn't write it), got all other info down. I didn't write the LIQORAAA mnemonic though, and missed some of the easy intensity/location/radiation, etc...points. I'm the type that forgets in the heat of the moment, so I need a checklist!

I always sat on the stool in front of the SP, which made sure that I draped b/c you would sit on the drape unless you move it. I also asked them if I could write notes while we chatted. I took very long histories, and still started the PE before the 5 min start, but really didn't get to do closure with very many of the SPs. When finishing the History I would try to restate (but didn't do it so often), and would ask "is there anything else you would like to tell me or ask?" Sometimes this prompted the SP to tell me info I hadn't asked for! This usually also allowed them to ask their Gotcha question, which I tried to answer. Sometimes it was a diagnosis ?, and then I gave several possibilities with the caveat that of course we have to do the physical and get tests. Not sure if that will lower my score, but then if I ran out of time I had at least done some counselling.

I did EtOH counselling where I felt it was excessive, smoking cessation on all but the first (I was going to do it at the end but ran out of time, after that did it when the SPs told me), asked Sex Hx ?s but didn't really counsel since all my SPs said they were monogamous. On my PEs I tried to be focused, and if I couldn't think of anything I would start with the CV/Lung exam. I recommend practicing a quick neuro, or quick syncope, or HTN exam, etc. If you have practiced the motions you won't lose time thinking, like I did!

And of course there were lots of things I realized I should have asked and didn't, I felt a real connection with only a few of the SPs (but by the end of the day I could tell they were ready to get this over too), and more than half the time I was stopped for time in the middle of a sentance or even the PE. I used gloves, always undid the tie and tied it back, asked the SP to pull up the gown while I held the drape for the abdom/supine CV exam. Helped them all lay down/sit up/stand up, had a running commentary while doing the PE ("now I'm going to check your legs for swelling, and check your legs for pulses...etc). I'm not such an outgoing person, so excessive smiling is not something I do well. Hopefully they detected warmth and empathy anyway...

So I don't feel great about my performance, and if the stars align badly I think I could have failed, but I just have to hope for the best! To all those about to take the exam: good luck, and whatever happens at least the day flies by!

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[Knicks]

Good thread, and nice post.

I was just about to make a thread to ask the following, so I guess I could just ask here:

Where can we write the information we get during the history-taking? The above post said that we're supplied with 12 pieces of scrap paper. Can anyone else confirm this?

One other question: when it comes time to write the patient note, how/where do we write it? On a blank piece of paper? On a computer (if so, how does that work)? The OP mentioned something about a web sample program..... anyone know what that is?


And a question to the original poster, you mentioned something about watching "all the PE videos on the site"? What site?


Thanks in advance.

 

[Frugal Traveler]

I would read and check out the materials on the website:
http://www.usmle.org/Examinations/step2/step2cs.html

You should bring your white coat, steth, scheduling permit, and valid ID.

They give you two pens, a clip board, 12 pieces of paper, and two pieces of paper with a safety pin have a number that you clip to your white coat for ID purposes (like # 2). You can write during the exam with the given scrap paper with use of the clipboard.

You can look at the above orientation materials for the computer thing the OP was mentioning. It is just like the interface on the exam.

They explain everything on the day of the exam! It is good to get an idea of what to do from the official USMLE site because you will be nervous the day of the exam.

For the PE videos, the OP may be talking about USMLEWord practice for Step 2CS???

 

[Knicks]

^^ Thanks for that input.

 

[vitaminny]

Sorry, the site with PE videos was USMLEWORLD for CS2, they have a whole series of ~1min videos detailing different physical exam skills. If you don't want to pay tho Youtube has tons of videos, they just weren't nicely categorized in a complete list.

And everything the pinchhitter post up there said is correct RE your other ?s. I highly recommend that you watch the orientation video on the USMLE web site, it really calmed my nerves and is almost exactly like the real thing. Good luck!

 

[Knicks]

Thanks,

another quick question: we aren't required to reach and state a definitive diagnosis to the patient, are we?

 

[mdc848]

nope. they just give you space on the differential to list your top 5, with the most likely dx at the top.

 

[Knicks]

^^ Thanks.

Another question:

When it comes time to writing the patient note, we have to include the vitals, correct? Can we just use that sheet that's on the entrance door and refer to that for the vitals? or do people usually jot down the vitals before even entering the room?

I just want to try to conserve as much time as I can.

Thanks in advance.

 

[Frugal Traveler]

People do it different ways.

I looked at the vitals before I went into the room. If they were all normal, then I wrote VS WNL (like most books say to do).

If there was an abnormal vital sign, I wrote:
VS WNL except BP 170/60.

Of course, you can write the VS on the note. Ex. BP 130/70, P 70, etc.

You can refer to the door placard after leaving the room, but I do not think it is necessary unless you forgot something.

Just like every OSCE, spending some time at the door information can help you out because you can think about what you want to do or your DDx before you enter.

Really the best thing to do is to check out the above USMLE Step 2CS official website, read the information, and watch the video.

Remember 97-98 % of AMGs pass the exam. It is very difficult waiting so long for the score and thinking of all the errors you made, but just relax and act like the SPs are normal patients! Everything will be covered in the orientation the day of the test as well.

 

[Knicks]

^^ Thanks.

I'll watch the video when I get a chance. I was reading the Blueprints book for the CS and I have some questions:

1- It says that at the end of the encounter, we must provide a general statement about the patient's prognosis. But why/how can we do this if we don't even tell the patient a definitive Dx?

2- It also said that we should have a smooth ending at the end of the encounter and to say something like, "Thank you for coming in today Mr. xyz. I will discuss our visit with a senior physician and get back to you".. This may sound like a silly question, but doesn't that break the doctor-patient confidentiality by discussing the visit with another physician?

3- When you enter the examination room, the SP is already sitting on the examining table, right? And so did you guys stand or sit while taking the history?

4- I'm really confused on this one: I thought we could use phrases/abbreviations like "within normal limits" or "WNL". But this Blueprints book says, "As a rule, you should not describe your physical exam findings using the word normal. The graders do not know if you know what normal is. Describe your findings instead, even if the description is that of a normal healthy organ system". <--- So can someone definitely clarify this for me?

5- How did you guys write down the information you got from the history on your paper? I mean, I've done it before by actually dividing the paper into certain sections and labeling every part of the page and then filling in the necessary info. But on the exam, I won't have time to label my paper. So is there an efficient way that you guys did it?

Thanks in advance.

 

[Frugal Traveler]

Best book I found was the Kaplan Step 2CS Book.


1. You basically say:
"Mr. X, you were telling me that you have difficulty of breathing for the past day, is this correct? On my exam, I found that on your left side that you were not moving air at the bottom of your chest.
I think you may have pneumonia on the left side of your chest, which is an infection in your chest. You may also have pulled a muscle among other things. Do you have questions? I want to take a picture of your chest and get some blood work to help figure out what is going on for sure. Is this ok. Do you have any questions?

I will order these things and return in 30 minutes to go over the results, etc.

Basically, you briefly summarize the Hx, PE. Then you tell a DDx (1-3 items). Then you tell in layman terms a brief work-up (does not have to be right). Make to sure ask if they have questions or concerns. Ask them "is this correct" after each blurb for points on communication.

This is in the Kaplan Step 2CS book.

2 - You can just above to summarize. Don't complicate things by talking about another doctor.

3- You will see in the video that there is a drape on your seat. Per the Kaplan Step 2CS book, drape the patient at the beginning of the interview. Then sit or stand... whatever your preference. Key point is to make eye contact though and act interested.

4 - Look on the Step 2CS website - they have a list of accepted abbreviations. WNL is accepted
http://www.usmle.org/Examinations/step2/cs/content/abbreviations.html

The main point is to use WNL because you have limited space on your note, and they are going to assume that vitals are within normal range.

That is why you put WNL or WNL Except BP 170/70

If you are describing a normal exam, then you need to write it. If you do a heart exam, then write what you would normally write:

RRR, Normal S1,S2, no m/r/c


5 - I wrote a mnemonic (PAMHRFOSS) per the Kaplan Step 2CS book on the paper when the encounter started. I wrote while talking to the patient. Do whatever works. Just inform the patient that you want to write during the encounter in order to be sure to get down all the information. Careful balance is required... your interaction score may suffer if you write and do not look at the patient.

You can probably write a quick mnemonic down, but it will take up too much time to divide out neatly the paper.

I think that looking at the official USMLE Step 2CS will answer many of your questions. Also check out the Kaplan Step 2CS book (which I used after getting frustrated with First Aid for Step 2CS). The above are general concepts from the Kaplan book.

 

[Knicks]

^^ Wonderful.

Thanks for the helpful input.

 

[StrawberryMD]

Thanks for the great input!

I have a question. . . in the cases where you should check for orthostatic vs (I am using the First Aid btw), do we measure their blood pressure again? The book puts in VS "no orthostatic changes". Should we just assume that the BP on the door was measured standing and sitting for those cases?

I am confused

 

[Frugal Traveler]

Thanks for the great input!

I have a question. . . in the cases where you should check for orthostatic vs (I am using the First Aid btw), do we measure their blood pressure again? The book puts in VS "no orthostatic changes". Should we just assume that the BP on the door was measured standing and sitting for those cases?

I am confused

You should assume that most vital signs are correct. You may even be able to put in your work-up "repeat vital signs including orthostatic BP."

Unless you think that the case involves it (like syncope), even then I would be wary wasting the time taking the orthostatic vitals. You will find during the exam that you have little time.

 

[Knicks]

And what about how to introduce yourself?

Do you shake the SP's hand as soon as you enter while introducing yourself? Is it wise to touch the patient like that before washing my hand? Or do you not offer a handshake and go straight into introducing yourself?

And about introducing yourself; what do we say? "Hello, Mr. xyz, I am Dr. John Doe"? or "Hello Mr. xyz, I am John Doe, a medical student"?

 

[Frugal Traveler]

And what about how to introduce yourself?

Do you shake the SP's hand as soon as you enter while introducing yourself? Is it wise to touch the patient like that before washing my hand? Or do you not offer a handshake and go straight into introducing yourself?

And about introducing yourself; what do we say? "Hello, Mr. xyz, I am Dr. John Doe"? or "Hello Mr. xyz, I am John Doe, a medical student"?

Read the Kaplan Step 2CS book or First aid.

Usually you say: "Hello. Mr. xyz, I am Dr. Doe, I will be taking care of you today." (hand shake).

In real life (just like on exams), they patient can be in acute pain, on a cellphone, angry, crying or whatever else. In that situation, use common sense. You may need to go up to the patient and say first: "Oh Mrs. Doe, you look like you are in pain. Tell me what is going on... by the way, my name is Dr. xyz, and I will taking care of you today."
In that instance, I would not shake the hand but rather express empathy at the sight of obvious pain.

You can introduce yourself as a medical student, student doctor, or whatever else. To keep things simple, I introduced myself as a "doctor." It does not really matter.

 

[Knicks]

^^ Thanks for the tips, man.

I'd read the Kaplan CS book, but I don't have it.

 

[Knicks]

I know we don't perform pelvic/rectal exams on the CS, but what about breast examinations (for the female SP's)? Do we defer those too?

 

[Frugal Traveler]

I know we don't perform pelvic/rectal exams on the CS, but what about breast examinations (for the female SP's)? Do we defer those too?

I'm glad to answer your questions as I would not wish failing Step 2CS on my worst enemy... but read the Step 2CS official website.

You do not perform breast exams on Step 2CS. If it is covered with underwear or a bra (with exception of femoral pulses, which I don't think many people bother with checking), then it is a no go.

By the way:
http://www.amazon.com/Kaplan-Medical-USMLE-Step-CS/dp/1607140632/ref=tmm_pap_title_0

The Kaplan Step 2CS book is $ ~26 on amazon.com... buy it, especially if you are an international medical graduate.

 

[Minion677]

what have you guys been doing for the patient in pain who is lying flat on the table? if you sit on the chair then you dont make great eye contact with them. do you just sort of stand hovering over them while you do the interview?

 

[mdc848]

what have you guys been doing for the patient in pain who is lying flat on the table? if you sit on the chair then you dont make great eye contact with them. do you just sort of stand hovering over them while you do the interview?

I would stand next to them and do the interview. Eye contact, if it is even an issue if the patient is doubled over in pain on the bed, is much easier that way.

 

[Knicks]

Do we have to wash our hands at the end as well? (before we leave the room)

 

[Frugal Traveler]

Do we have to wash our hands at the end as well? (before we leave the room)

No. Just before you touch the patient.

The easiest thing to do (and it helps you save time as well) is to glove up for every encounter (you get your points whether you wash your hands or put on gloves).

 

[-Goose-]

I agree this is probably the most efficient thing to do, but it also seems a little weird to me and could be off-putting to the SP.

Just a thought.

 

[Frugal Traveler]

I agree this is probably the most efficient thing to do, but it also seems a little weird to me and could be off-putting to the SP.

Just a thought.

If you put on the gloves before the physical exam (not before the interview starts), then it is equivalent to washing the hands. The SPs do not care... it is a check box either way. It is not going to affect your rapport/professional manner score as long as you don't make remarks like "I'm going to double-bag this s#@$#t."

 

[-Goose-]

It is not going to affect your rapport/professional manner score as long as you don't make remarks like "I'm going to double-bag this s#@$#t."

Hahahaa!!!

 

[Knicks]

What if you can't come up with all 5 Differential Diagnoses and Workups? Let's say you got 3-4,,,,,,,,,,,,, would that be a serious faux pas?

 

[Frugal Traveler]

What if you can't come up with all 5 Differential Diagnoses and Workups? Let's say you got 3-4,,,,,,,,,,,,, would that be a serious faux pas?

If you look at the First Aid or Kaplan book especially for pediatrics, it will say:

"Normal adolescent/child behavior" and that is all you might need to put for a peds phone case per those books.

If you can come up with 3-4, then you are fine. You do not need to always fill out all 5 boxes.

 

[mdc848]

Yea, I didn't come up with 5 all the time. Most times I think I had 4 or 5. I think I had 3 for one case I was coming up blank for.

 

[Knicks]

^^ Did you pass?

 

[Frugal Traveler]

^^ Did you pass?

Yes!

 

[mdc848]

I passed.

 

[Knicks]

Some other questions:

1- What if the SP says, "Doc! I'm in severe pain right now,,,, please give me something for the pain before interviewing me or before examining me!"? How would you respond to such a request?

2- In the PN, should we use EKG or ECG for "electrocardiogram"? Might seem like a trivial point, but I don't want to leave any stone unturned.

 

[Frugal Traveler]

Some other questions:

1- What if the SP says, "Doc! I'm in severe pain right now,,,, please give me something for the pain before interviewing me or before examining me!"? How would you respond to such a request?

2- In the PN, should we use EKG or ECG for "electrocardiogram"? Might seem like a trivial point, but I don't want to leave any stone unturned.

1 - You say something along the lines: "I understand that you are in pain. I need to first get an idea of what is going on by speaking with you about your symptoms and performing a brief physical exam. I will then try to help control your pain."
When you leave the patient encounter, tell them that the nurse will be in with some pain medication
Do not repeat painful physical exam maneuvers
Try to make the patient as comfortable as possible

2- It does not matter. EKG = ECG. Nowadays, more people are using ECG.

 

[Knicks]

^ Thanks. Here's another:

When ordering a CXR in the work-up section of the PN, can we simply write "CXR"? or do we also have to include the planes as well? ie: "CXR- PA and lateral".

Thanks in advance.

 

[Frugal Traveler]

^ Thanks. Here's another:

When ordering a CXR in the work-up section of the PN, can we simply write "CXR"? or do we also have to include the planes as well? ie: "CXR- PA and lateral".

Thanks in advance.

http://www.usmle.org/Examinations/step2/cs/content/abbreviations.html

CXR or CXR (PA and Lat)... either probably will receive credit.

 

[IM Substance P]

Do you think I can pass without any review books? I honored most of my third-year rotations, consider myself an above average student, etc.

I've gotten complacent about tests in the past, but I'd like to believe I'm a strong enough student to beat this thing without studying.

Any thoughts?

 

[Frugal Traveler]

Do you think I can pass without any review books? I honored most of my third-year rotations, consider myself an above average student, etc.

I've gotten complacent about tests in the past, but I'd like to believe I'm a strong enough student to beat this thing without studying.

Any thoughts?

If you are an American MD student and have OSCEs at your school, it is very likely that you can take the exam and pass without studying. However, there is a small risk (2-3%) that you could fail the exam. Since buying a $ 20 review book and spending 3 days of your time is much cheaper than taking the test twice, I think studying for the test is a good idea and conservative approach.

At minimum, I would look at the USMLE Step 2CS website to see how the exam works

To answer your question --> probably especially if your school has OSCEs.

 

[Knicks]

I read that a good technique to see whether or not you asked all the important questions during the history-taking is to think about them/mentally review the checklist of questions while listening to the SP's heart/breath sounds, since most of the vital signs will be normal and therefore we don't have to worry about missing any findings.

Sounds like a good idea, but what if the SP does actually happen to have a murmur but you inadvertently overlook it since you were focusing on thinking about the questions you did or did not ask during the history?

Advice?

 

[Frugal Traveler]

There can be simulated physical findings, but you can probably ignore them and pass just fine.

The time goes so fast in the room that you should just get through the PE as fast as possible and get to the closing. You are never going to get 100 % of the questions you should have asked.
Make sure to ask critical questions:
Medications
Medication allergies
Last menstrual period (if female)

 

[Knicks]

How about cardiac auscultation?

The 'proper' way to do it is with the patient supine and the head of the bed raised to 30 degrees, right? (RIGHT?)


But for STEP 2 CS purposes, what if the c/c isn't really related to the CV system,,,,, then can we just listen to a few auscultation areas while the SP is in a sitting position?


As a side note, I really have no feasible way to PRACTICE on someone at the moment, so I'm worrying about timing. I'm thinking about how long it would take to for example check the cranial nerves in addition to the rest of the PE.

 

[InternationlDoc]

Quick question to Frugal

so I am used to writing Chest: clear bilaterally, no wheezes or crackles.

I wrote that on the exam too for normal chest findings - is that ok??! I am freaking out since proper term is 'clear to auscultation bilaterally"

would the physician grader fail me for that?

NERVOUS!??!!

 

[Frugal Traveler]

How about cardiac auscultation?

The 'proper' way to do it is with the patient supine and the head of the bed raised to 30 degrees, right? (RIGHT?)


But for STEP 2 CS purposes, what if the c/c isn't really related to the CV system,,,,, then can we just listen to a few auscultation areas while the SP is in a sitting position?


As a side note, I really have no feasible way to PRACTICE on someone at the moment, so I'm worrying about timing. I'm thinking about how long it would take to for example check the cranial nerves in addition to the rest of the PE.

Really... I just did the exam however I could as fast as I could. I untied the patient's gown in the back, listened to the lungs posteriorly, then listened anteriorly. Then ausculated four sites, then pressed on the chest while saying "is it tender here." I also quickly looked the neck sometimes (for dyspnea) and said "I am looking for a vein in your neck but I do not see it."

You have to get through the exam fast because of time constraints. I would just make sure you put the steth in the right places. I did not do dynamic maneuvers or any of that business.

I really think that if you are in the US, then ordering the Kaplan book would be a great idea. It explains many of the questions you have and the logistics of the exam. I was fretting about alot of this stuff as well... but remember the exam rewards efficiency over thoroughness.

I seriously did some sketchy and quick PEs... got a star in that area, lol.

 

[Frugal Traveler]

Quick question to Frugal

so I am used to writing Chest: clear bilaterally, no wheezes or crackles.

I wrote that on the exam too for normal chest findings - is that ok??! I am freaking out since proper term is 'clear to auscultation bilaterally"

would the physician grader fail me for that?

NERVOUS!??!!

It should not be an issue. Auscultation is implied.

 

[InternationlDoc]

Thanks frugal

Yea i am kicking myself for the following

- forgot to wash hands on this one case
- forgot to put pelvic exam on a bleeding lady! (wth was I smoking)
- Forgot to cousel on diet (did etoh and smoke though)
- only wrote DTR's 2+ bilaterally (not upper or lower - assuming its ok frugal?).
- the above 'clear bilaterally' (guess should have paid more attention)
- having no idea on one case and making BS questions up (though wrote a War and peace H&P as unjustified compensation)

jeez, I hope my quick physical findings are not found 'annoying' lots of 'implication' on my PE. lol....dammit?

 

[Knicks]

.......I seriously did some sketchy and quick PEs... got a star in that area, lol.

This is extremely reassuring and I hope you're experience with that is the rule rather than the exception.

 

[Knicks]

FT, some questions about the Patient Note:

If we choose to type it, do we have the option of Bolding the text? I ask because I want to do: "HPI(blah blah blah)".

I also don't want to write the PN in a recipe/list format, meaning:

HPI.............

PMH............

ROS.............

All.........

Med...... etc....

I'd rather do it like this: "HPI.............. PMH........... ROS....... etc",, in other words, I want to write it "contiguously" so I can save space on the form,,,,, can we do it like this? If so, that's why I wanted to know if we can bold, because if I choose to do it contiguously, then I can make visual distinctions b/w HPI and PMH and etc by bolding them.

ie: HPI This is a 27 y/o WF complaining of abdominal pain... blah blah. PMH: Experienced this pain 4 days ago as well,,,blah blah. ROS: Denies nausea and vomiting.....blah blah. SH Smoked 1 PPD for 10 years...... and so on and so forth. (Notice the bolded words making a visual distinction from one section to the next).

That's how I want to do it..... is this acceptable?



Also, how was your timing on the patient note? How'd you feel about your performance on that? Any advice?

Thanks.

(I'd get that Kaplan CS book, but my exam is soon and I don't have time to buy it and read it).


EDIT: btw, I was reading the Blueprints book and it says that we should wash our hands before and after we touch the patient. Really? This is the 1st time I've read in any Step 2 CS review material about washing our hands after touching the patient. Can anyone clarify this?

 

[Frugal Traveler]

You can practice writing a note on the USMLE Step 2CS website. There is not a bolding feature. You can write the note contiguously if you want to... the physician is going to read it either way.

For hand-washing, I would just glove up before the physical exam to save time.

I had no problem with the patient note. I felt like the major issue is getting through the patient encounter and closing.

The predominant theme on the exam is politeness and efficiency. You can't do everything. You are going to make mistakes here and there. They are not looking for perfection. The cases are designed for the allotted time, so if you go through and ask the LIQQORAAA and PAM HR FOSS questions (or whatever variant of the mnemonic you use), then you get your points.

 

[Knicks]

Is this a good idea to do?:

After taking the history, asking something like, "OK Mr. xyz, thank you for answering my questions. Is there anything else you feel that I should know about?" Would that give the SP the impression that you didn't do a good enough job in taking the history, and that you're basically asking the SP to fill in the gaps for you?

 

[Frugal Traveler]

Is this a good idea to do?:

After taking the history, asking something like, "OK Mr. xyz, thank you for answering my questions. Is there anything else you feel that I should know about?" Would that give the SP the impression that you didn't do a good enough job in taking the history, and that you're basically asking the SP to fill in the gaps for you?

That's an excellent question... you can also say: "Is there anything that I have not asked about that you feel is important."

You will find that patients in both real life and OSCEs will tell you information that they forgot to mention early.

You can also use a summarizing technique and ask if they have any additional information to add.