Possible PE Failure?

[Albicans]

Hello,

I'm a 4th year student and I recently took the PE. I think I was humanistic enough but I would always run out of time and on quite a few of my patient encounters I would get the two minute warning right when I was beginning my physical exam or in the midst of it. As such, for many of my patient encounters my counseling was rather quick and I didn't get to fully explore the 'MOTHRR' mnemonic. Also on a good number, I only asked them if they had any questions, anyone to contact, and thanked them before heading out as my time had run out. On my SOAP notes, I would write all of the things I had forgotten to do in the room and I consistently forgot to give the patient a follow-up appointment on pretty much all 12 encounters but I wrote in my plan that I would 'Ask patient to return in XXX time for follow-up" so that I could still have my bases covered. Is this a problem? Also, on 2-4 of the patients, I'm pretty sure I got the wrong diagnosis and that my differential was off.

On the other hand, I think I gave the patients good eye contact, helped them sit up and down for most of the physical exams, and always asked them what name they would prefer to be called. I also expressed empathy when patients had pain or referred to family members' passing away.

I am worried about the biomechanical/biomedical domain as well since on nearly all of my SOAP notes I didn't finish the Subjective section. I would write the assessment, plan, objective, and then finally subjective. However, on a good number of the SOAP notes(majority?) I did not finish writing the social history and on 2-4 of the patients, I barely got past PSH or allergies before my time ran out. One of my HPIs were 3 sentences long. I asked patients all of the OLDCARTS(OPQRST) and associated symptoms and asked them all of FEDTACOS except for sexual history unless appropriate. In retrospect, I think asking them about diet, exercise, and caffeine really took away from my time during the encounter. I really do not want to fail as I have 11 ACGME interviews in my desired specialty and have not failed anything thus far. Would the graders realize that I knew what I had to write on my SOAP note based on my questioning during the patient encounter? It's just that I ran out of time(which is still bad)?

I am so stressed as I am very nervous about having failed. I am just about to begin interviews and my confidence level is at rock bottom right now. I won't know my score until November 30th at the earliest or December 10th at the latest. If I fail, will all the effort I put into interviews and the past 3 years of medical school not even matter? Would I even be able to retake and pass the exam before the ACGME rank lists are due? If so, would having failed it the first time but passing it on the second time still have me out of the running for most of the good programs I will be interviewing at?

This has really been eating away at me and I don't know how to calm down and focus on interviews and rotations for the next 2 months as I wait. What should I do? Thank you very much for your advice and help.

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[hallowmann]

There's nothing you can do about it now. It's possible you still passed and are just remembering all the things you did wrong. I honestly wouldn't worry about it, and I'd cross the bridge when you get there.

Don't worry about the PE affecting your ACGME interviews right now. Just focus on doing well on them. You already got the interviews, so you're in an OK position. If you did end up failing, your main goal will be to retake ASAP, so you can get a passing score by Jan/Feb when ROLs are going in. Whether that's possible really depends on how soon youcould schedule a retake. The programs will expect you to indicate that you passed by then so they can decide whether or not to put you on their ROL.

From what I've heard, ACGME programs (and most AOA ones) don't care if you have a failing PE, as long as they know you eventually passed it. The last thing they want is someone who can't start ontime because they failed the PE/CS.

 

[costales]

Yep, quit stressing. Act like you passed. Improve your clock management if you didn't, retake and you'll pass.

 

[Albicans]

There's nothing you can do about it now. It's possible you still passed and are just remembering all the things you did wrong. I honestly wouldn't worry about it, and I'd cross the bridge when you get there.

Don't worry about the PE affecting your ACGME interviews right now. Just focus on doing well on them. You already got the interviews, so you're in an OK position. If you did end up failing, your main goal will be to retake ASAP, so you can get a passing score by Jan/Feb when ROLs are going in. Whether that's possible really depends on how soon youcould schedule a retake. The programs will expect you to indicate that you passed by then so they can decide whether or not to put you on their ROL.

From what I've heard, ACGME programs (and most AOA ones) don't care if you have a failing PE, as long as they know you eventually passed it. The last thing they want is someone who can't start ontime because they failed the PE/CS.

Thanks for your advice guys! I will do my best to quit stressing as nothing I can do change it at this point. As you've mentioned the best thing for me would be to focus and do well on my interviews. However, if by chance I do end up failing the PE and in the worst case scenario, I do not know my result until December 10th(earliest is November 30th), that would mean I would have to retake the PE within 2 (3 is pushing it) weeks or less to be able to get my retake results back before February 24th which is the deadline to submit rank lists for residencies and applicants for this year. How can I even be certain that I will be able to secure a retake spot at the testing center within 2 weeks of getting my score? I just really need to get my mind off of this!

 

[hallowmann]

Worry about it if/when you get there. No point worrying now.

Even if you think of the very worst case scenario of failing the PE, not matching and scrambling or soaping into a position or internship, it's still not the end of the world. It would probably just delay you at most a year, if at all, depending on what positions you were looking for.

Everything might feel like the end of the world, but if you are even an average student with a good attitude, you will be able to find something you can be happy with. It's scary because it seems like no one else could be in that situation, but the truth is, I've met multiple residents on rotations that have stumbled along the way, but it still worked out for them.

 

[FutureDO2016]

From what I hear, if you failed, the NBOME website has a few spots each month open for those that failed and need to retake...not sure if you will be able to retake it in December since your score comes early Dec. but maybe early January and then your score can come late Feb:

October 1, 2015 - October 31, 2015 November 30, 2015 - December 10, 2015
November 1, 2015 - November 30, 2015 December 30, 2015 - January 11, 2016
December 1, 2015 - December 31, 2015 February 1, 2016 - February 9, 2016
January 1, 2016 - January 31, 2016 February 29, 2016 - March 7, 2016

I've heard of people failing PE, still match (program didn't notice PE failure as they only care about USMLE) and then pass PE after the match like in March or April...don't stress but hope you passed so you can avoid all the Conshohocken mess and all that money...NBOME is making so much money off students...

 

[Albicans]

From what I hear, if you failed, the NBOME website has a few spots each month open for those that failed and need to retake...not sure if you will be able to retake it in December since your score comes early Dec. but maybe early January and then your score can come late Feb:

October 1, 2015 - October 31, 2015 November 30, 2015 - December 10, 2015
November 1, 2015 - November 30, 2015 December 30, 2015 - January 11, 2016
December 1, 2015 - December 31, 2015 February 1, 2016 - February 9, 2016
January 1, 2016 - January 31, 2016 February 29, 2016 - March 7, 2016

I've heard of people failing PE, still match (program didn't notice PE failure as they only care about USMLE) and then pass PE after the match like in March or April...don't stress but hope you passed so you can avoid all the Conshohocken mess and all that money...NBOME is making so much money off students...

Thanks for the data and the advice! I thought rank lists are due on February 24th so wouldn't that mean that if I retake it in January, I will not be able to have a score by February 24th? I'd be happy to know that I'm wrong about this. Are rank lists from the programs due later than February 24th?

 

[hallowmann]

Thanks for the data and the advice! I thought rank lists are due on February 24th so wouldn't that mean that if I retake it in January, I will not be able to have a score by February 24th? I'd be happy to know that I'm wrong about this. Are rank lists from the programs due later than February 24th?

I think he's saying some programs won't even notice the PE failure, because they'd rank you without even knowing the result. Some programs would probably do that, but others might explicitly ask you about it. The safest thing to do is try for a date that would get you the result before the end of Feb, but if that's not possible, don't worry too much, just be sure to pass it and finish in time.

 

[FutureDO2016]

Does anyone know how many of the 12 cases you have to get a correct diagnosis to pass the PE? I mean I know you have to pass the humanistic domain (being empathetic and polite to the patient) and the biomedical & biomechanical (the physical exam, history taking and diagnosis and differential and SOAP note)...but is it based on getting the right diagnosis or a certain amount of points need to be obtained? I know only 11 of the 12 cases are graded as the book said one case is experimental.

 

[markb2]

Hello,

I'm a 4th year student and I recently took the PE. I think I was humanistic enough but I would always run out of time and on quite a few of my patient encounters I would get the two minute warning right when I was beginning my physical exam or in the midst of it. As such, for many of my patient encounters my counseling was rather quick and I didn't get to fully explore the 'MOTHRR' mnemonic. Also on a good number, I only asked them if they had any questions, anyone to contact, and thanked them before heading out as my time had run out. On my SOAP notes, I would write all of the things I had forgotten to do in the room and I consistently forgot to give the patient a follow-up appointment on pretty much all 12 encounters but I wrote in my plan that I would 'Ask patient to return in XXX time for follow-up" so that I could still have my bases covered. Is this a problem? Also, on 2-4 of the patients, I'm pretty sure I got the wrong diagnosis and that my differential was off.

On the other hand, I think I gave the patients good eye contact, helped them sit up and down for most of the physical exams, and always asked them what name they would prefer to be called. I also expressed empathy when patients had pain or referred to family members' passing away.

I am worried about the biomechanical/biomedical domain as well since on nearly all of my SOAP notes I didn't finish the Subjective section. I would write the assessment, plan, objective, and then finally subjective. However, on a good number of the SOAP notes(majority?) I did not finish writing the social history and on 2-4 of the patients, I barely got past PSH or allergies before my time ran out. One of my HPIs were 3 sentences long. I asked patients all of the OLDCARTS(OPQRST) and associated symptoms and asked them all of FEDTACOS except for sexual history unless appropriate. In retrospect, I think asking them about diet, exercise, and caffeine really took away from my time during the encounter. I really do not want to fail as I have 11 ACGME interviews in my desired specialty and have not failed anything thus far. Would the graders realize that I knew what I had to write on my SOAP note based on my questioning during the patient encounter? It's just that I ran out of time(which is still bad)?

I am so stressed as I am very nervous about having failed. I am just about to begin interviews and my confidence level is at rock bottom right now. I won't know my score until November 30th at the earliest or December 10th at the latest. If I fail, will all the effort I put into interviews and the past 3 years of medical school not even matter? Would I even be able to retake and pass the exam before the ACGME rank lists are due? If so, would having failed it the first time but passing it on the second time still have me out of the running for most of the good programs I will be interviewing at?

This has really been eating away at me and I don't know how to calm down and focus on interviews and rotations for the next 2 months as I wait. What should I do? Thank you very much for your advice and help.

Your experience sounds a lot like mine, and I'm still awaiting my score. Just curious did you pass?