Failed comlex pe twice...what to do to PASS humanism domain?

[ARDS987]

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Hi all,
I took the comlex a second time during the summer, and failed the humanism part. Spent a lot of time practicing cases with friends, counselor, and standardized patients at my school. Everyone thought I was displaying humanism and unintentionally being "unhumanistic".
Fast forward to the PE exam, and I felt I was displaying humanism pretty well. I acknowledged when patients displayed their life issues.(I'm sorry to hear that., etc). I counseled patients on diet and smoking, addressed their concerns, etc. I made small talk with patients. I helped patients ungown and sit/lie down during the physical exam. I started closing statements with 2 minutes left. Yet my humanism is on the low end, and I failed it.

I know this might be a silly question, but what did you all do to get on the passing end of humanism on the PE? I feel like I'm at my wits end, and trying to scrutinize where I could have gone wrong...

 

[samac]

This test is a subjective mess and I’m sorry you’re going through this.

Are you being robotic about it? Are you draping every patient when you drop their gown?
Just saying I’m sorry to hear that and jumping into the next thing might seem callous.
Are you basically telling patients your fat and eat right? Or saying smoking is bad stop?
I didn’t counsel a single one on diet as it seemed kind of callous. I would ask if they were interested in smoking and if they weren’t say I was always available to help when they were.

I know I’m nitpicking here, I’m just trying to find something. Once again, I’m so sorry.

 

[ARDS987]

This test is a subjective mess and I’m sorry you’re going through this.

Are you being robotic about it? Are you draping every patient when you drop their gown?
Just saying I’m sorry to hear that and jumping into the next thing might seem callous.
Are you basically telling patients your fat and eat right? Or saying smoking is bad stop?
I didn’t counsel a single one on diet as it seemed kind of callous. I would ask if they were interested in smoking and if they weren’t say I was always available to help when they were.

I know I’m nitpicking here, I’m just trying to find something. Once again, I’m so sorry.

Thanks for the reply.

I'm draping all patients appropriately, asked for permission to examine different areas of body, and was always gentle with the SPs.

I tried not to be callous when talking to patients. For instance, if a patient was having peripheral artery disease, I would try to counsel briefly about diet in closing and suggest diet changes if it was at all possible. I always acknowledge that change isn't easy, but it can help prevent disease from getting worse. Something along those lines. Actually, it's hard to incorporate everything in closing within 2 minutes. On 2-3 stations, I got cut off by a sentence or two. I usually incorporate discussion about diagnosis, treatment, labs/imaging, counseling, plan, return, etc.

 

[Goro]

Hi all,
I took the comlex a second time during the summer, and failed the humanism part. Spent a lot of time practicing cases with friends, counselor, and standardized patients at my school. Everyone thought I was displaying humanism and unintentionally being "unhumanistic".
Fast forward to the PE exam, and I felt I was displaying humanism pretty well. I acknowledged when patients displayed their life issues.(I'm sorry to hear that., etc). I counseled patients on diet and smoking, addressed their concerns, etc. I made small talk with patients. I helped patients ungown and sit/lie down during the physical exam. I started closing statements with 2 minutes left. Yet my humanism is on the low end, and I failed it.

I know this might be a silly question, but what did you all do to get on the passing end of humanism on the PE? I feel like I'm at my wits end, and trying to scrutinize where I could have gone wrong...

Does your school video record you while doing OSCEs?

You should discuss all this with your clinical Faculty

 

[ARDS987]

Does your school video record you while doing OSCEs?

You should discuss all this with your clinical Faculty

I discussed this with SPs and the clinical faculty after the first fail. They recommended a few different changes. I also practiced with friends and a school counselor, who found no issues with me displaying my humanism effectively prior to taking the exam a second time. I'm just currently not sure what the PE is looking for in the humanism part anymore...

 

[shadowlightfox]

Are you actually properly introducing yourself and saying goodbye even if the time runs out? That's one of the most common reasons why people failed at least my school's mock COMLEX PE.

 

[Giovanotto]

This test is a subjective mess and I’m sorry you’re going through this.

Are you being robotic about it? Are you draping every patient when you drop their gown?
Just saying I’m sorry to hear that and jumping into the next thing might seem callous.
Are you basically telling patients your fat and eat right? Or saying smoking is bad stop?
I didn’t counsel a single one on diet as it seemed kind of callous. I would ask if they were interested in smoking and if they weren’t say I was always available to help when they were.

I know I’m nitpicking here, I’m just trying to find something. Once again, I’m so sorry.

What do you mean by this? If I'm dropping their gown to listen to the heart what is there to drape? Just wanted to clarify, thank you.

 

[ARDS987]

Are you actually properly introducing yourself and saying goodbye even if the time runs out? That's one of the most common reasons why people failed at least my school's mock COMLEX PE.

Yes. I made it a habit to introduce myself as student doctor, asked what they would like to be called, and sanitized my hands before shaking their hands at the start of every encounter. At the end of the encounter, I would have closing statements. Even at the end of the encounter, I would thank them for their time, if they had any questions, and shook their hands again before leaving to do my SOAP note.

 

[samac]

What do you mean by this? If I'm dropping their gown to listen to the heart what is there to drape? Just wanted to clarify, thank you.

Sorry I misspoke there.
Anytime you lay them down drape.

 

[deleted645092]

Honestly it sounds like you're doing almost everything right. But ideas about what could possibly be hurting you unintentionally and things I did that were well-received (the things I did were straight from my school's SPs, since I failed my school's clinical Capstone course and was able to get direct SP feedback during the remediation):

-How do you word your lifestyle modifications? I made a point to discuss my own struggles with things that I was counselling them on. Some were easier than others; If it has do do with diet discuss how difficult it is to make abrupt changes, and suggest small incremental changes. If I counselled on smoking I talked about how hard it was for me to quit (I used to chew tobacco) and talked about my challenges with it. If you tell them what to do and don't get their opinion on it and whether or not they think they can do it you'll get hit.

-When you counsel them absolutely make sure you're going off the face-sheet and not their actual weight. It sounds silly but if you're stressed and accidentally counselling an obese guy whose BMI on the face-sheet is 22 you aren't going to get any brownie points by pointing out he's fat in real life.

-When you're addressing lifestyle changes such as weight reduction is it relevant to the encounter? I didn't address weight if the patient was there for an acute complaint and didn't risk overloading them with plans.

-How do you come off to other people? You might sound condescending without meaning to, especially if you're in a stressful situation. I made a conscious effort to make my voice softer than it is in real life because the SPs at my school said it sounded "calm and reassuring".

-If you aren't doing it maybe ask the patient how their issue is affecting their home/ work/ academic life.

-If they have a lot of things they need to change maybe tell them you'll tackle one issue at a time. This ties in to what I said above about wording lifestyle modifications. Trying to do too much at once isn't going to work and can make them feel overwhelmed. I always said we would work on the most pressing issue first and address how we can get them additional help to address other stuff in the future.

Those are a few things that come to mind at the moment.

 

[hungrydoc710]

How did you do during SP's your first and second years of med school?

You have one more shot, right?
Take it again. You will pass.

 

[DennisReynolds]

You fake it.

You fake the smile.... the awkward "empathy" approach when they tell you what's going on... wash your hands.... practice your fake "sweet" voice.

I literally cracked the most stupid dad joke regarding the weather upon entering the room and giggled to myself while washing my hands for my last 4 patient encounters to just spice **** up.

Just be the most fakest, happiest fake doc you can be.

 

[Select All That Apply]

You fake it. You fake the smile.... the awkward "empathy" approach when they tell you what's going on... wash your hands.... practice your fake "sweet" voice. I literally cracked the most stupid dad joke regarding the weather upon entering the room and giggled to myself while washing my hands for my last 4 patient encounters to just spice **** up. Just be the most fakest, happiest fake doc you can be.

 

[Giovanotto]

It's all about the implication...

 

[DO2015CA]

Sorry I misspoke there.
Anytime you lay them down drape.

Lol I draped them no matter what. Used an excuse of like “I know it’s a bit cold in here”. Bam over their lap

 

[BorntobeDO?]

You fake it.

You fake the smile.... the awkward "empathy" approach when they tell you what's going on... wash your hands.... practice your fake "sweet" voice.

I literally cracked the most stupid dad joke regarding the weather upon entering the room and giggled to myself while washing my hands for my last 4 patient encounters to just spice **** up.

Just be the most fakest, happiest fake doc you can be.

I agree with this. If you cant get the empathy right, then its prob time to cheese it up. You need to become that doc who is nice to everybody even if it doesnt feel real to you. Give them the disney smile. If your not sure what that is
Although maybe tone it down a notch from there. The point is disney is 'the happiest place on earth' and always tells the employees to make it feel that way no matter how they feel. Thats what you wanna project when you walk in, before changing to match the patients concern.

The other thing people can do is mirroring. Mimic your patients posture and tone. Sit down, lean in, nod your head, say things like that must be tough and well lets see if we can make this better. Anyway, I got work so I gtg.

 

[bogle8]

Have you watched the Kauffman videos? I think he does the perfect amount of small talk (sucking up) to patients without going overboard.

 

[ARDS987]

I watch

Have you watched the Kauffman videos? I think he does the perfect amount of small talk (sucking up) to patients without going overboard.

I watched the new Kauffman videos. He seems to make lots of small talk. I tried it during the exam, but not sure how it was received. I am naturally introverted and stoic in general. I don't usually respond well verbally, especially under time stress comdition, but I have been improving overtime since start of clinical back in ms3.

 

[ARDS987]

Take the WV prep course if your school is like many others isn’t it three strikes and you are out? Not the time to be penny wise and pound foolish. Take a review course with good reviews

I would love to take that course. Unfortunately, earliest is November 1-2. If I take PE that late, I'm afraid I won't get the pass in time for getting interviews. Currently getting ready to submit apps for IM residencies.

 

[ARDS987]

I agree with this. If you cant get the empathy right, then its prob time to cheese it up. You need to become that doc who is nice to everybody even if it doesnt feel real to you. Give them the disney smile. If your not sure what that is
Although maybe tone it down a notch from there. The point is disney is 'the happiest place on earth' and always tells the employees to make it feel that way no matter how they feel. Thats what you wanna project when you walk in, before changing to match the patients concern.

The other thing people can do is mirroring. Mimic your patients posture and tone. Sit down, lean in, nod your head, say things like that must be tough and well lets see if we can make this better. Anyway, I got work so I gtg.

I hope I could do that. I'm not a great actor by any stretch....!

 

[BorntobeDO?]

I hope I could do that. I'm not a great actor by any stretch....!

Don't need to be great, just need to be better than you are and look like you care. I think you can do more than you think. You didn't get this far by being sucky.

 

[shadowlightfox]

I hope I could do that. I'm not a great actor by any stretch....!

That's fine. If you can't fake a smile, find a pic on the internet of the biggest smile you can get, print out a picture of it, and slap it on your face. Talk to them with that pic slapped on your face. Flawless strategy right here!

 

[DennisReynolds]

hahahahahaha

YES.

EXACTLY.

It's because of the implication... ya know?

I'm DEADDD. lmao

 

[ARDS987]

How many strikes till your out

3 times... The thing is that I have the PE scheduled for towards end of October to get scores back by end of November/beginning of December. Between after submitting my app on the 15th and the test date, I have adequate time to prep for the exam again after my "easier" rotations that I lined up. I'm reaching out to my counselor that I've been working with to prep for humanism... I know that I have the knowledge base down for the biomedical domain, but I can't help but feel that I need just a slight tweak for the humanism domain...

 

[DNC127]

Bro. Take the WV course. You tried it on you own and it didn't work. Pay the money and take the course. If you don't get it the 3rd time you are SOL.

That is your only solution at this point. DO NOT take this test again without a formal review that is NOT with your school / friends.

Sorry if it sounds harsh, but there is really no need to beat around the bush on this one. If you want to be a Dr. spend the money, and take the course. Yes it will push your apps back, but your apps will be permanently pushed back if you repeat your performance.

You got this.

 

[ARDS987]

Thanks for all the advice above. I do appreciate it.

With regards to the format of my encounters, what were your approach to each encounter?..I have been going at it like this.

Introduction - Introduce myself, ask how they'd like to be called, sanitize my hands until dry, and then shake hands with patients.

Start by asking what brings them in... and go through the OLDCARTS + pertinent questions to CC, ROS, health histories, etc. I always include transitions when going between different components of history (i.e from OLDCARTS to ROS to health histories, social history) When concerns are expressed, I acknowledge their feelings (i.e. I'm sorry to heart that...) and promise to work with them to help with their issue.

Physical Exam. I always verbally express what I would like to do before doing it. I always ask for permission for them to remove gown when listening to heart and lungs, and help them gown up afterwards. I always drape when doing any supine/abdominal/OMM exams. All exam maneuvers are done on bare skin.

Closing statements - I usually start doing this when the 2 minute buzzer is announced. I have to admit that sometimes I don't get everything I want to say across, but I pretty much get the big info down (i.e. diagnosis, treatment/management, labs/imaging, etc.). Every now and then, I may fumble/stutter with my words. I would also try to get input whether patient would agree with plan - usually they are like "okay, doc. I'll do whatever you recommend...etc." Every now and then, I get here before the 2 minute buzzer sounds.

 

[Giovanotto]

Thanks for all the advice above. I do appreciate it.

With regards to the format of my encounters, what were your approach to each encounter?..I have been going at it like this.

Introduction - Introduce myself, ask how they'd like to be called, sanitize my hands until dry, and then shake hands with patients.

Start by asking what brings them in... and go through the OLDCARTS + pertinent questions to CC, ROS, health histories, etc. I always include transitions when going between different components of history (i.e from OLDCARTS to ROS to health histories, social history) When concerns are expressed, I acknowledge their feelings (i.e. I'm sorry to heart that...) and promise to work with them to help with their issue.

Physical Exam. I always verbally express what I would like to do before doing it. I always ask for permission for them to remove gown when listening to heart and lungs, and help them gown up afterwards. I always drape when doing any supine/abdominal/OMM exams. All exam maneuvers are done on bare skin.

Closing statements - I usually start doing this when the 2 minute buzzer is announced. I have to admit that sometimes I don't get everything I want to say across, but I pretty much get the big info down (i.e. diagnosis, treatment/management, labs/imaging, etc.). Every now and then, I may fumble/stutter with my words. I would also try to get input whether patient would agree with plan - usually they are like "okay, doc. I'll do whatever you recommend...etc." Every now and then, I get here before the 2 minute buzzer sounds.

I'm taking the exam in a couple days, and from everything I've learned you seem right on the money.

 

[shadowlightfox]

Another pro tip: Always end with "Have I addressed your concerns?" and "Do you have any questions." I learned that that is a good way to gain some humanism points as well.

 

[NecFasc92]

Thanks for all the advice above. I do appreciate it.

With regards to the format of my encounters, what were your approach to each encounter?..I have been going at it like this.

Introduction - Introduce myself, ask how they'd like to be called, sanitize my hands until dry, and then shake hands with patients.

Start by asking what brings them in... and go through the OLDCARTS + pertinent questions to CC, ROS, health histories, etc. I always include transitions when going between different components of history (i.e from OLDCARTS to ROS to health histories, social history) When concerns are expressed, I acknowledge their feelings (i.e. I'm sorry to heart that...) and promise to work with them to help with their issue.

Physical Exam. I always verbally express what I would like to do before doing it. I always ask for permission for them to remove gown when listening to heart and lungs, and help them gown up afterwards. I always drape when doing any supine/abdominal/OMM exams. All exam maneuvers are done on bare skin.

Closing statements - I usually start doing this when the 2 minute buzzer is announced. I have to admit that sometimes I don't get everything I want to say across, but I pretty much get the big info down (i.e. diagnosis, treatment/management, labs/imaging, etc.). Every now and then, I may fumble/stutter with my words. I would also try to get input whether patient would agree with plan - usually they are like "okay, doc. I'll do whatever you recommend...etc." Every now and then, I get here before the 2 minute buzzer sounds.

Good luck waiting for your hands to dry. Hope you can fill that time in a non-awkward way because that crap takes foreeevvvvveeerrrrr to dry.

 

[samac]

Good luck waiting for your hands to dry. Hope you can fill that time in a non-awkward way because that crap takes foreeevvvvveeerrrrr to dry.

My secret was just getting half a pump.
Dried quickly.

 

[NecFasc92]

My secret was just getting half a pump.
Dried quickly.

That is true. Took me a few patients to have it click. Still don’t think it dried fully in what would be a normal time frame between pumping and shaking. So just apologized if my hand was still wet from the sanitizer

 

[Giovanotto]

hmm, how does one NOT fail this exam. Holy crap! Godspeed op. The empathy felt like the easiest part of this exam. I couldn't for the life of me finish in time for most encounters and half the time I had no idea what the dx was due to time.

 

[nwmedapplicant]

I'm sorry to hear that the NBOME is still ripping off their very own DO's still. For all the scrutiny and screening we went through to get INTO accredited medical schools, then clinicals within medical school - the ridiculous and subjective gauntlet that the PE represents, and the additional expense of airfare, hotel, and EXAM fee that they charge poor medical students is a slap in the face. And to think they subjectively FAIL people on top of it all - to have to spend all that money AGAIN?? I personally find it shameful. Make the exam $100 if you are going to make everyone fly and pay their own room and board for the exam. Or, better yet, make the test standardized (with known fail criteria) - and allow the exam to be remotely proctored with an additional school affiliated physician witness as well. But the fact that great medical students who are personable actually do fail this exam and it can be a dis-chargeable offense from medical school - is WRONG and unnecessary.

I never failed or did poorly on any of the medical school board exams (including the PE) - so this statement should squelch anybody who jumps to the "obviously defensive because you failed". No - I didnt fail, but I still think it's predatory and wrong to be doing to our future doctors who have already sacrificed so much and made it to their last two years of clinicals. Again, clinically dangerous or inappropriate people SHOULD be failed - but we all know - there are many instances where test takers werent inappropriate, or dangerous but for some unknown reason - they didnt pass. I remember a girl who was solid performer on exams, real kind personality and to my disbelief - failed it TWICE! She wasn't a young naive individual either - she was like 34 year old woman. Thank god she passed it her third time - so despite being ripped off a few thousand dollars (thanks NBOME!) -she at least wasnt robbed of a career she worked nearly a decade towards and forced into a lifetime of debt slavery.

Also - i've seen those videos - kind of a joke if you ask me. You watch a 15-22 minute video of this doctor talking to the patient and doing a physical exam and then realize 'wait - I have to do all this in HALF the time?' emmm K

 

[nwmedapplicant]

hmm, how does one NOT fail this exam. Holy crap! Godspeed op. The empathy felt like the easiest part of this exam. I couldn't for the life of me finish in time for most encounters and half the time I had no idea what the dx was due to time.

I thought about this exact thing in advance. So do what I did - it really helps: write down canned assessment and plans for common diagnoses two weeks before the exam. And practice re-writing them. Examples: pneumonia, chest pain, depression/anxiety/acute event (loss of job), abdominal pain, joint pain, shoulder injury, headache, vision changes, dizziness/balance, palpitations...etc All the common diagnoses you can think of - and then figure out which three or four lines of a plan for each. All figured out in advance. Although the actual exam will likely have deviations - you at least have a framework for similar system of concern or ailment and what you would do to initiate the workup. Always remember to have your follow up appointment to recheck on patient and management listed too!

 

[TheaterOfTheme]

hmm, how does one NOT fail this exam. Holy crap! Godspeed op. The empathy felt like the easiest part of this exam. I couldn't for the life of me finish in time for most encounters and half the time I had no idea what the dx was due to time.

Wow man--this is disappointing to hear given how much our school highly focuses on SP encounters 🙁
Best of luck to you and the OP.

 

[Splenda88]

Don't get discouraged OP. Take it again. If PE is anything like CS (I have a feeling it is), it's highway robbery. These exams show how corrupt these institutions are.