Doctor Bagel

so cheap and juicy
Moderator Emeritus
15+ Year Member
Sep 26, 2002
10,919
1,119
from the ministry of information
Status
Attending Physician
I'm taking CS in a week and am wondering about a few things. I've been studying with FA, and I'm getting the impression from that book that you get more points by closed ended questions. It seems like you start out with the "what's going on today" thing and then immediately switch to the onset/location, etc. focused questions. Normally in clinic, I followed up the "what's going on" questions with "can you tell me more about that," but I'm thinking that's not a good strategy for CS. Thoughts?

Also, I was confused by the last OSCE we did at school because people were putting all sorts of treatment info into the diagnostic workup, which I wasn't doing. Based on FA and the wording of the computer screen, it seems like they just want tests, not treatments. Is that right?

And last, the FA differentials and workups are freaking ridiculous. I'm guessing that it's good to come up with 2 to 3 good differentials, and the rest can pretty much be preposterous. And don't get me started on the testing. FA has you do CT/MRI for pretty much everything and lots of borderline ridiculous labs. So do yo play the game by coming up with 5 tests even though you know in real life you probably wouldn't do those tests? From reading FA, I'm guessing the graders don't really expect us to have the best clinical judgment and that that's OK. True or not?
 

Law2Doc

5K+ Member
Moderator Emeritus
10+ Year Member
Dec 20, 2004
30,981
9,886
Status
Attending Physician
I'm taking CS in a week and am wondering about a few things. I've been studying with FA, and I'm getting the impression from that book that you get more points by closed ended questions. It seems like you start out with the "what's going on today" thing and then immediately switch to the onset/location, etc. focused questions. Normally in clinic, I followed up the "what's going on" questions with "can you tell me more about that," but I'm thinking that's not a good strategy for CS. Thoughts?

Also, I was confused by the last OSCE we did at school because people were putting all sorts of treatment info into the diagnostic workup, which I wasn't doing. Based on FA and the wording of the computer screen, it seems like they just want tests, not treatments. Is that right?

And last, the FA differentials and workups are freaking ridiculous. I'm guessing that it's good to come up with 2 to 3 good differentials, and the rest can pretty much be preposterous. And don't get me started on the testing. FA has you do CT/MRI for pretty much everything and lots of borderline ridiculous labs. So do yo play the game by coming up with 5 tests even though you know in real life you probably wouldn't do those tests? From reading FA, I'm guessing the graders don't really expect us to have the best clinical judgment and that that's OK. True or not?
FA is pretty much on the money. 1. start broad and then focus in on patients problem -- you don't want them to stray because you have such a short amount of time. 2. tests are what they want, not a specific pain or hypertensive med or antibiotic etc. 3. I don't think the tests are preposterous, but not always cost effective. Go with an MRI if thats the best test even if it wouldn't be the cheapest.
 
OP
Doctor Bagel

Doctor Bagel

so cheap and juicy
Moderator Emeritus
15+ Year Member
Sep 26, 2002
10,919
1,119
from the ministry of information
Status
Attending Physician
FA is pretty much on the money. 1. start broad and then focus in on patients problem -- you don't want them to stray because you have such a short amount of time. 2. tests are what they want, not a specific pain or hypertensive med or antibiotic etc. 3. I don't think the tests are preposterous, but not always cost effective. Go with an MRI if thats the best test even if it wouldn't be the cheapest.
Not so much preposterous but not what you would do in the clinic at first evaluation. I feel like I almost have to fill out the diagnostic workup section as if I knew less than I actually do, which is where I'm getting the idea that the test isn't so much to evaluate true clinical judgment.

And now I'm getting bugged with my school for leading us astray at our OSCEs. My school does have an above average fail rate on this exam, so I did know not to trust their info more than FA. :thumbdown:
 

DragonWell

Moderator Emeritus
10+ Year Member
Nov 20, 2004
1,682
10
45
Status
Attending Physician
On a somewhat related note, did anyone list a follow up appointment or "return visit in x number of days" under the workup section?

I didn't do this on the mock CS we took and one of our professors wrote that I had abandoned the patient on each of my write ups, however, none of the books I'm using seem to show this.
 
OP
Doctor Bagel

Doctor Bagel

so cheap and juicy
Moderator Emeritus
15+ Year Member
Sep 26, 2002
10,919
1,119
from the ministry of information
Status
Attending Physician
On a somewhat related note, did anyone list a follow up appointment or "return visit in x number of days" under the workup section?

I didn't do this on the mock CS we took and one of our professors wrote that I had abandoned the patient on each of my write ups, however, none of the books I'm using seem to show this.
Yeah, FA makes no mention of f/u appointments. I plan on trusting FA and not doing it. Honestly, who knows, though. This is where this test is frustrating.
 

MSKalltheway

I got the magic stick
10+ Year Member
7+ Year Member
Jan 16, 2007
832
3
Status
Resident [Any Field]
L2D is on point. The tests in FA sometimes seem like overkill or just plain random, but it seems the point is that they just want to know that you would order something that might help in dx and management would be my assumption. Since you dont get a f/u visit with them, i guess they just want you to put everything out on the table right then and there.

You could throw something in there about f/u on every pt, like make up x # of weeks or a month or something. It will probably help with rapport if you tell them to call your office if there are any further questions or concerns.