I always fail the biomedical domain. The best score I ever got was ...
Data Gathering: Needs Improvement
OMM: Needs Improvement
SOAP Note: Proficient
I feel I can bring up the OMM grade by watching the clock better and making sure it's not contraindicated. The main problem is data gathering. Before I walk in the room, I jot down 5 dx from the CC on the chart. Then I go in and ask questions to rule those dx in or out. I ask enough questions to get to the correct diagnosis. Maybe they are docking me on not asking every single letter of OLD CARTS. I think my physical exam is fine.
There are always 2-3 cases that I'm not sure of the exact diagnosis. Instead of stretching it to an accurate dx, maybe I should just generalize to a more basic dx. Or maybe I'm just thinking too hard. I think a more general differential that's SOLID would fare better than vague guesses.