Failed PE - what are my options

[SoontobeDO]

I must admit, I am furious about this. Who else has any experience with failing and can you petition for a re-grade?

Also, my school doesnt require passing the PE for graduation. When must I have a passing score as far as licensure is concerned? Do I need a passing score to start residency?

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[Sugar72]

I must admit, I am furious about this. Who else has any experience with failing and can you petition for a re-grade?

Also, my school doesnt require passing the PE for graduation. When must I have a passing score as far as licensure is concerned? Do I need a passing score to start residency?

I think you have to pass it before you can take step 3. It depends on the residency if they require a pass before you start. I think as long as you retake it before you start it will be ok. I don't think I would even mention it to the PD before starting. Chances are you won't fail it again. This test is so crazy.

I have heard people talk about getting it regraded, but I haven't ever seen anything written about it.

 

[SoontobeDO]

Do you get a breakdown of how you performed? Will they tell me in what areas I am grossly deficient? There must be something. Things that I can think of:

1) My OMT skills are not the best, and I did not perform OMT on every patient. Should I have?

2) I did a focused physical exam (i.e. no ears or throat if not indicated). Isnt this what they want?

3) I did not know the answer to some questions the patients asked, but I told them (and documented) that I would find out the answer and get back to them.

The only thing I can think of is OMT. I am surprised that someone would fail due to OMT, but thats all I can imagine. Any more thoughts?

 

[swaamedic]

Do you get a breakdown of how you performed? Will they tell me in what areas I am grossly deficient? There must be something. Things that I can think of:

1) My OMT skills are not the best, and I did not perform OMT on every patient. Should I have?

2) I did a focused physical exam (i.e. no ears or throat if not indicated). Isnt this what they want?

3) I did not know the answer to some questions the patients asked, but I told them (and documented) that I would find out the answer and get back to them.

The only thing I can think of is OMT. I am surprised that someone would fail due to OMT, but thats all I can imagine. Any more thoughts?

Yea, OMT bunch of crap especially on simulated pts. Anyhoo, personall feelings aside, when you retake the damn thing, which to my knowledge is only required to sit for step 3, do OMT on virtually everyone. In my eye there are a bunch of old timer hardcore DO's grading this thing who believe that every pt should have OMT (after all we are DO's). I even did OMT on my simulated Pulm Embolus patient. Would I do this in the real world--HELL NO, but I did for the sake of passing that damn exam. Every pt also got a heart lung abd etc. exam (against bare skin and everyone got a blanket befor I started), but I too did a focused exam so I doubt you lost points there. I would keep this hush hush to your PD at least untill you pass step 3, then feel free to blurt out your personal feelings.

 

[future_OB]

Yea, OMT bunch of crap especially on simulated pts. Anyhoo, personall feelings aside, when you retake the damn thing, which to my knowledge is only required to sit for step 3, do OMT on virtually everyone. In my eye there are a bunch of old timer hardcore DO's grading this thing who believe that every pt should have OMT (after all we are DO's). I even did OMT on my simulated Pulm Embolus patient. Would I do this in the real world--HELL NO, but I did for the sake of passing that damn exam. Every pt also got a heart lung abd etc. exam (against bare skin and everyone got a blanket befor I started), but I too did a focused exam so I doubt you lost points there. I would keep this hush hush to your PD at least untill you pass step 3, then feel free to blurt out your personal feelings.

Im sorry to hear about your situation. Is this the Step 2 CS? What is OMT?

 

[Sugar72]

Im sorry to hear about your situation. Is this the Step 2 CS? What is OMT?

This is the osteopathic CS (COMLEX not USMLE). I did rib raising on everyone and a lot more on one pt. I didn't do OM at all on one pt. I don't know if you looked at one of the CS books, but I found a lot of little things I might have forgotted if I hadn't read the book. Like draping, knocking and waiting for them to say come in, listening to heart in 3 spots, when to wash your hands. Hints for answering the "questions" you know the "am I going to die", "will I need surgery", "will my left arm turn orange".
I can't imagine anyplace worse than conshohocken to have to revisit - good luck!

 

[DrMom]

Do you get a breakdown of how you performed? Will they tell me in what areas I am grossly deficient? There must be something. Things that I can think of:

1) My OMT skills are not the best, and I did not perform OMT on every patient. Should I have?

I did OMT on all of the patients who mentioned it. I also did it on one patient who didn't but the presentation left me with nothing else to do

2) I did a focused physical exam (i.e. no ears or throat if not indicated). Isnt this what they want?

That's what I did. Heart, lungs, abdomen on everyone & focused additional exam depending on the presentation.

3) I did not know the answer to some questions the patients asked, but I told them (and documented) that I would find out the answer and get back to them.

Hmmm. I can't remember getting any questions that I couldn't at least give a reasonable answer off the cuff.

The only thing I can think of is OMT. I am surprised that someone would fail due to OMT, but thats all I can imagine. Any more thoughts?

Given what you've said, I'd guess it was OMT. The only OMT I did was soft tissue, some basic muscle energy, and articulation. It doesn't have to be anything too involved. Also, it may have to do with your evaluation of their somatic dysfunction rather than only in your OMT performance.


Good luck! I'm sorry you're stuck having to take that thing again.

 

[Dr.MISHKA D.O.]

I passed! Now I can speak my mind without jinxing myself. What a worthless, crappy, nonsense, no feedback giving waste of my time and hard borrowed money! I really feel no sense of accomplishment from passing besides saving the embarassment of failing and the pain in the butt of having to take it again.
Come on I mean give me some feedback. Tell me what I was good at and what I need to improve.

That being said, here is my attempt to be constructive on the matter, my strategy for passing:

My standard routine: knock, introduce myself and shake hands, "full focused history" - always say "i'm sorry to hear that or the like if pt had pain or painful memory - like father had CA." Wash hands, ask if pt comfortable, chat about weather, etc, drape pt, do exam (always heart, lungs, abd and extremeties, and focused to complaint.) follow up questions if any missed initially, counseling, and propose treatment plan. "Do you have any questions?" let pt know if you will "come back into the room" to do something, draw lab, etc.

Always end with something like "it was a pleasure to have the oppurtunity to care for you, or it will be a pleasure to take care of you in the future" (e.g. like for Preggers coming back for several check-ups - which I totally missed some routine screens on my plan for that one - jeez what an idiot!) I think this gets you a better empathy score from the pt.

I did my OMT during my physical as I found the problem, one muscle energy, one soft tissue, one OA decompression, and a umm ( i forgot what its called) that thing you do like in lab where you fake it like you can "feel the tissues uncoiling and releasing" anyway, must of been okay. Most pts who needed OMT asked for it blatantly. "I have this friend who saw this weirdo doc who beat on drums and danced around while he allowed my tissues to unwind like pushing a boat from the dock" (Damn what is that called?) "Do you think that would help me Doc?" (reframe from saying, no not really but I will bill you for it anyway - they mark off for that I AM SURE.)

Okay, so that is my rant I am just glad I passed.

Best Wishes

The Mish

 

[DrMom]

Myofascial

 

[Dr.MISHKA D.O.]

Also known as complete foolishness. Its MyoFFasial. Silly rabbit the extra f is for "fakin it."

Best wishes

The Mish

 

[corpsmanUP]

I got my results a few weeks ago and passed thank God! But to play devil's advocate, I have to say that I actually felt like the exam was very well structured and administered. The patients were reasonable actors, some better than others. It was reasonably challenging and the timeframe was tight. I used the format in First Aid for the USMLE CS. I read the big book and the quick review and found the scenarios almost exactly the same.

To the OP...I think you should refrain from trying to be too focused on your exam because there is literally enough time to do a general PE on each patient for the most part. That gives you more credibility and more things to document. You can't predict what they always want so try and do as much as possible. Move fast....practice....and make sure to have done all the scenarios in the books. They are excellent.

You can seriously do a near complete H&P on each patient. I did OMT on maybe half the patients...even if it was just an OA decompression while evaluating them.

Remember.....the most important aspect of this exam is your ability to be an even better actor than the paid actors!

 

[Dr.MISHKA D.O.]

Corps - this is the first time we have disagreed an anything. Your my hero man, I think I might cry. I need a hug.

Best Wishes

The Mish

 

[Ice-1]

I'm taking this rip off in April, but for those already through with it- how long does it take to get the results back? I'm just wondering if I will know before I graduate!

 

[DrMom]

10-12 weeks for most everyone

 

[raptor5]

The OMM professors at PCOM urge students to do OMM whenever they can in order to get credit for that station.

Quote from Alexander Nicholas, DO Chairman OMM Dept. PCOM during a lower extemity OMM lecture.
"I am not really allowed to say too much about the level 2 PE but the lower extremity OMT seems to be when I do the grading where most of the students kind of just didn't do any OMT and say just ice and (RICE) it and walk away and they don't get any credit and it is a OMT case which is kind of interesting."

 

[dr_almondjoy_do]

I had a lower extremity case, but to me it seemed more like a DVT than musculoskeletal...and I didn't think OMT would be a good idea since it could theoretically move the clot up into his lung/heart, so I suggested a venous doppler instead.

i really really hated doing that PE exam, and for a couple of patients, I didnt' raise the gown over the abdomen to examine it, but I did drape them. I auscultated heart and lungs on bare skin, and did a TON of counselling and preventive care. I tried to stay in the room until the timer went off....

I am not due to have my score for a while.. pray for me!

 

[Plinko]

I took the thing in January and should get my results back this week. Such an unpredictable test. I don't think any reasonable person, no matter how good a student they are, could walk out of there saying they knew for certain that they passed it. The whole premise of the test is ludicrous. They want us to make history taking decisions, diagnoses, etc. without any objective physical exam findings. That's like answering the question "How was your steak and potato dinner?" when the chef forgot to put the steak on your plate. Some of the clinical scenarios are absurd as well. Example: First question: What's the purpose of your visit today? Response: my husband says that I am forgetting things a lot more than usual. Second question: do you feel that you are forgetting things more than usual? Answer: I don't know. Third ?: can you tell me the kinds of things you seem to be forgetting and how often they occur? Answer: I don't remember any of them. I mean what the hell do you do with that patient. MMSE, which I certainly don't have committed to memory. No physical exam tests except for maybe a neuro CN 2-12, fundoscopic, and the standard heart and lungs. Maybe order a CT or MRI and order a referral to psych for cognitive testing. How do they expect you to fill up 14 minutes with that person? I'm sure I'll be bitter until I find that I passed (whenever, and after how many attempts that may be) at which time I'll delete all remembrances of that thing they call a test from my memory banks.

To the OP: I probably shouldn't be giving advice because I could very well be in the same boat as you come this week, but I would say that the most return on your studying investment would be on OMT. You can read the First Aid CS book but I haven't heard of many people who found it all that helpful. You have two years of clinical experience under your belt. By the time you take it again you will have even more. Your skills as a clinician are not going to change all that much despite how much studying you do. You know the fundamentals of the test. Brush up on your OMT and there is almost no way that they will fail you again.