- Joined
- Jun 24, 2015
- Messages
- 48
- Reaction score
- 28
It was a rough 2 months waiting for my CS score, because I kept having flashbacks to mistakes that I made, questions I forgot to ask, and things that I should have written in the note or wrote in the wrong way. I was prowling through all these SDN threads trying to find evidence that people had messed up as badly as me and still passed, and I took comfort from many of them, but also felt like maybe these people didn't make as many mistakes as me. So I thought it was only fair that I post my experience, in hopes that it will reassure some others who are fretting over mistakes and awkward moments that they remember. For me, I was much more worried about the ICE component than CIS. I'm a native English speaker, so for me that was a non-issue. I was much more nervous than I expected, and felt like I wasn't acting like myself at all, for at least the first 3 encounters, but it started to get a little better after that.
ICE concerns:
1. I put 1 genuinely ridiculous diagnosis as my FIRST dx in one case. It was a brain-fart moment. I had good supporting evidence (it was a form of cancer), but I listed the wrong anatomic structure! In another case, I put a much less likely diagnosis first that I was kicking myself about. Also in one I made what was essentially a spelling mistake, but which changed the diagnosis and made it look like I didn't know what I was talking about.
2. I forgot to write in the note that I did a thyroid exam and a lymph node exam in 2 cases where these were essential components.
3. I forgot MANY very relevant pertinent positive/negative questions. For example: forgot to ask travel history, unusual foods, etc in a case of a sick kid where these were important. Didn't ask about urine color, dyspareunia, QUALITY OF PAIN, type of cough, and many other things in other cases when they were important to know for ddx. As I was writing the note, I would start kicking myself and wondering how I could have forgotten to ask these basic things that I can't imagine I would have forgotten in real life.
4. I forgot to mention a very obvious diagnosis in one case, even though the 3 I put were reasonable.
5. There was one case where the patient was being intentionally difficult, asking me to repeat everything, and I missed asking her MANY relevant questions. I really thought I bombed that case, because I also wasn't as empathetic as I could have been.
6. One case had NO positive findings and only 1 positive history point that I was able to ellicit, so all of my diagnoses had only one supporting point--that 1 positive history point for all! This same pt kept going on and on about his herbal supplements and I thought I was missing a clue, a drug interaction, etc, but I had no idea what he was getting at.
7. Forgot to ask pt's occupation in at least 5 encounters, and forgot to ask about smoking/drugs/alcohol in 2 or 3 cases.
8. I ran out of space in my HPI section a few times and this cost precious time trying to re-write it/edit things out, so the rest of the note suffered. (It's really ridiculous that they put a character limit there, no?)
9. I only asked 1 female patient about a menstrual history. Some were clearly post-menopausal but I didn't ask them anything about it.
CIS concerns:
1. I didn't shake hands with ANY patients before the encounter, and only one patient afterwards, because I could tell she wanted me to. I really think this is a non-issue and that shaking hands is not factored into the grading criteria, as long as you introduce yourself in a proper, friendly manner with good eye contact, etc. I never shake hands with real patients, because it's just not something I do or have ever expected from anyone, so it would have been artificial for me and probably appeared awkward. Also, after I took the exam, a former SP visited our school to give some advice and said that the handshake is a non-issue.
2. The drape fell off of a patient during an abdominal exam which was awkward but I just apologized and picked it back up. It fell off again. The patient just held it in place after that.
3. There was one very surly, unpleasant patient who pretended not to understand anything I was saying, and was clearly very bothered by something. I made some empathetic statements, asked her what was bothering her, etc, but was also worried about getting enough pertinent positives and negatives. I never did find out why she was so upset (she said it wasn't because of her pain) so I worried that I wasn't empathetic/probing enough.
4. I made some really awkward closing comments a couple of times when I ran out of time and felt the need to say SOMETHING to end. In one, I said "the nurse will be in to....help you and stuff." I don't know where that came from.
5. I often forgot to ask questions like "how is that affecting your life?" or "how have you been coping with that?" when I think it was probably expected/indicated.
6. In my first case, I got extremely nervous and had the DRIEST mouth imaginable, which I don't think has ever been an issue for me ever before. I was trying to talk to the patient and explain my impression and wrap up, and my mouth was so dry that my upper lip kept sticking to my teeth and was literally interfering with my ability to pronounce words. I had to keep licking my upper lip and I could see the patient looking at me weird.
I ended up passing with nothing too near borderline. My CIS was better than ICE. I hope this makes some of you feel better. Good luck to everyone!
ICE concerns:
1. I put 1 genuinely ridiculous diagnosis as my FIRST dx in one case. It was a brain-fart moment. I had good supporting evidence (it was a form of cancer), but I listed the wrong anatomic structure! In another case, I put a much less likely diagnosis first that I was kicking myself about. Also in one I made what was essentially a spelling mistake, but which changed the diagnosis and made it look like I didn't know what I was talking about.
2. I forgot to write in the note that I did a thyroid exam and a lymph node exam in 2 cases where these were essential components.
3. I forgot MANY very relevant pertinent positive/negative questions. For example: forgot to ask travel history, unusual foods, etc in a case of a sick kid where these were important. Didn't ask about urine color, dyspareunia, QUALITY OF PAIN, type of cough, and many other things in other cases when they were important to know for ddx. As I was writing the note, I would start kicking myself and wondering how I could have forgotten to ask these basic things that I can't imagine I would have forgotten in real life.
4. I forgot to mention a very obvious diagnosis in one case, even though the 3 I put were reasonable.
5. There was one case where the patient was being intentionally difficult, asking me to repeat everything, and I missed asking her MANY relevant questions. I really thought I bombed that case, because I also wasn't as empathetic as I could have been.
6. One case had NO positive findings and only 1 positive history point that I was able to ellicit, so all of my diagnoses had only one supporting point--that 1 positive history point for all! This same pt kept going on and on about his herbal supplements and I thought I was missing a clue, a drug interaction, etc, but I had no idea what he was getting at.
7. Forgot to ask pt's occupation in at least 5 encounters, and forgot to ask about smoking/drugs/alcohol in 2 or 3 cases.
8. I ran out of space in my HPI section a few times and this cost precious time trying to re-write it/edit things out, so the rest of the note suffered. (It's really ridiculous that they put a character limit there, no?)
9. I only asked 1 female patient about a menstrual history. Some were clearly post-menopausal but I didn't ask them anything about it.
CIS concerns:
1. I didn't shake hands with ANY patients before the encounter, and only one patient afterwards, because I could tell she wanted me to. I really think this is a non-issue and that shaking hands is not factored into the grading criteria, as long as you introduce yourself in a proper, friendly manner with good eye contact, etc. I never shake hands with real patients, because it's just not something I do or have ever expected from anyone, so it would have been artificial for me and probably appeared awkward. Also, after I took the exam, a former SP visited our school to give some advice and said that the handshake is a non-issue.
2. The drape fell off of a patient during an abdominal exam which was awkward but I just apologized and picked it back up. It fell off again. The patient just held it in place after that.
3. There was one very surly, unpleasant patient who pretended not to understand anything I was saying, and was clearly very bothered by something. I made some empathetic statements, asked her what was bothering her, etc, but was also worried about getting enough pertinent positives and negatives. I never did find out why she was so upset (she said it wasn't because of her pain) so I worried that I wasn't empathetic/probing enough.
4. I made some really awkward closing comments a couple of times when I ran out of time and felt the need to say SOMETHING to end. In one, I said "the nurse will be in to....help you and stuff." I don't know where that came from.
5. I often forgot to ask questions like "how is that affecting your life?" or "how have you been coping with that?" when I think it was probably expected/indicated.
6. In my first case, I got extremely nervous and had the DRIEST mouth imaginable, which I don't think has ever been an issue for me ever before. I was trying to talk to the patient and explain my impression and wrap up, and my mouth was so dry that my upper lip kept sticking to my teeth and was literally interfering with my ability to pronounce words. I had to keep licking my upper lip and I could see the patient looking at me weird.
I ended up passing with nothing too near borderline. My CIS was better than ICE. I hope this makes some of you feel better. Good luck to everyone!
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