Passed! Thanks be to God! AMG, took in Chicago in late December during a gap year between MS3/MS4. Had minimal clinic volunteering to keep me up to speed with exam skills, went through FA one time thoroughly, one time quickly with partners for about 3 weeks. Nothing in borderline, but pretty widespread range of X's (11). ICE just barely outside the borderline area (the furthest left X was beside the borderline area, but not in it). CIS in the middle. SEP "higher performance."
For future people, bad things I did and still passed:
- Started to gel my hands when I realized I wanted to examine a patient's eyes. I got gloves on, but was asking questions while I got them on.
- Had a bit of an awkward moment when I tried to create small talk while washing my hands, couldn't tell if the topic was taboo
- Only counseled ONCE during closings regarding ANYTHING preventative
- Answered a challenge question in 10 seconds as I was walking out the door
- One case I had NO CLUE what was going on, to the point where I went down four rabbit trails, only one or two of which were related to the chief complaint, but all of which were relevant to how the patient was presenting. I could not for the life of me figure out if there was a trick to the case I was missing, but nevertheless, got through it and typed up a DDx related to the CC.
- Forgot OBGYN hx when it was relevant on one case
- Another case I felt completely out of it, asked the same questions multiple times, felt like I was pulling teeth and getting nothing relevant.
- Was only able to complete a full cranial nerve exam once; oftentimes, only got through only a few before moving on to another relevant neuro exam, although I was only able to get through everything I wanted in a neuro exam once.
- Forgot HEENT exam components I wanted to do a few times
- Quickly jumped to a definitive conclusion on challenge comments made by patients due to overzealous empathizing, rather then hedging first on some cases that had more nuanced issues.
- Forgot obvious "next steps" for common diagnoses a few times
- Forgot which exam findings correlated with which diagnoses a few times
Suggestions for the future:
- Come in with a plan and stick to it. I had an established rhythm for asking FHx, SHx, PMHx, and HPI before preparing, so I simply enhanced it by preparing for possible ROS scenarios and adding a bit of supplemental Q's for the previously established areas.
- Prepare with a partner. I don't think I would have gotten the pace of the cases quite right otherwise, plus it allowed me to get some physical exam patterns down.
- Mini cases in FA are gold. I did a quick review prior to the exam just to get in the zone of what sort of DDx and work up I should do for a given CC. Scribble a few of those down to jog your memory in case you run out of questions prematurely.
- If something funky happens, roll with the punches and move along. Two of the cases I had I shook my head after trying to figure out what I could have done. Take a deep breath, write the note to the best of your ability, and take on the next case.
- Ask about your patients' lives when washing your hands. It can help you relax, build some communicative trust, and also gives you space to think out your physical exam strategy.
- I always did a basic core exam, i.e., auscultation heart/lung, just in case. Gives you time to plan next moves, while also demonstrating a "thorough" exam.
- GET SOME REST before the exam to the extent that you can! I am horrible about this, but it really helps if you want to avoid overly caffeinating yourself during breaks, thus leading to frequent restroom stops 😛
Hope all goes well to those still waiting!
