I've been browsing through CS experience threads on this forum, but had a few specific questions about the mistakes i made and how detrimental they are. Im an AMG, but still scared as hell and hoping I passed this thing because retaking it would be a total nightmare.
1. My biggest mistake was rushing the physical exam. And i mean really rushing. For a pt presenting after LOC, I just asked name/place/person, did a few cranial nerves, listened to heart, lungs. Thats it. No MSK, HEENT, full neuro exam. I got really nervous and had to rush because the 5 minute warning was called out as I was finishing my history.
For a fatigue pt, my exam was also VERY abbreviated. I forgot the thyroid, lymph nodes, neuro, MMSE, everything. Just did heart/lungs because again I was pressed for time.
Same thing for another pt with a neuro complaint, a very very very crappy physical exam. I basically did not do a single HEENT exam the whole day except for a few thyroid/lymph node exams.
2. I really don't remember if I established rapport/expressed sympathy well enough. In about half of the cases, I asked "how has this affected you?" or "wow, that must be hard" or "I'm sorry you can't enjoy whatever activity anymore because of the pain" or "Hopefully we can figure out the diagnosis and soon and get you the appropriate treatment". Hoping this came off as genuine and was enough.
3. Not a whole lot of small talk with patients. I asked a few about their jobs or hobbies and tried to tie it in with their illness, but nothing more besides that. I really hope it didn't come off as me rapid-fire questioning the patients. Also did not use any transitions at all between sections
4. Some patients, I was definitely awkward during the closure because I got so nervous that I didn't do a full focused exam. Some gave me blank stares, and I tried to explain some more, after which they seemed to be smiling more? Some I told them we would do tests (like colonoscopy) which definitely wasn't warranted for the case. I didn't put these in my PN, but feel stupid as hell that I even brought them up during the closure. I may have repeated a few questions because I got nervous, and for one I made a stupid remark during the HPI that may have come off as me not paying attention to to the patient.
5. Did not give the pt with a cough a napkin or offered them water. He wasnt coughing all that much. Just a few times here and there, nothing too intense, so it completely slipped my mind. Also, I had some patients with CC of pain, although their acting didn't seem like it was severe pain. Didn't try to comfort them.
6. I was taking notes the whole time during the HPI and tried to glance up while I was writing, but hopefully I won't get docked points for lack of full eye contact. I saw the SPs were staring at my clipboard so I tried to cut down on this a little, but I wanted to take decent notes during the HPI so I could write a good note.
7. Didn't counsel many patients. Only 1 who was a smoker. 1 who did marijuana a few times. The rest of them didn't smoke or quit many years ago (which I congratulated them on). One i completely forgot to counsel on marijuana use. Didn't counsel one on diet/exercise where it may have been appropriate (didn't even ask her what her current diet or exercise routine was at the moment).
8. I thought the cases were straight forwarded and I'm pretty sure I got the right DDx/workup for at least 9/12 cases. Some were just all over the place for me, especially my first encounter. My Ddx/workup wasn't perfect but I don't think I made many major errors there....maybe just ordered a few extra tests or put down a differential that wasn't super likely.
I also made many other small mistakes (not pulling out foot rests for a couple, forgot to wash my hands in one case, forgot to ask about meds/allergies for one case, put down the wrong allergy for one pt, may have forgotten to document a couple exam findings, etc.)
Overall I'm praying that I did enough right things to pass I studied for this a week ahead of time too. Wish I had spent more time studying now, and had read up on grading ahead of time. Please help am I freaking out for nothing?
1. My biggest mistake was rushing the physical exam. And i mean really rushing. For a pt presenting after LOC, I just asked name/place/person, did a few cranial nerves, listened to heart, lungs. Thats it. No MSK, HEENT, full neuro exam. I got really nervous and had to rush because the 5 minute warning was called out as I was finishing my history.
For a fatigue pt, my exam was also VERY abbreviated. I forgot the thyroid, lymph nodes, neuro, MMSE, everything. Just did heart/lungs because again I was pressed for time.
Same thing for another pt with a neuro complaint, a very very very crappy physical exam. I basically did not do a single HEENT exam the whole day except for a few thyroid/lymph node exams.2. I really don't remember if I established rapport/expressed sympathy well enough. In about half of the cases, I asked "how has this affected you?" or "wow, that must be hard" or "I'm sorry you can't enjoy whatever activity anymore because of the pain" or "Hopefully we can figure out the diagnosis and soon and get you the appropriate treatment". Hoping this came off as genuine and was enough.
3. Not a whole lot of small talk with patients. I asked a few about their jobs or hobbies and tried to tie it in with their illness, but nothing more besides that. I really hope it didn't come off as me rapid-fire questioning the patients. Also did not use any transitions at all between sections
4. Some patients, I was definitely awkward during the closure because I got so nervous that I didn't do a full focused exam. Some gave me blank stares, and I tried to explain some more, after which they seemed to be smiling more? Some I told them we would do tests (like colonoscopy) which definitely wasn't warranted for the case. I didn't put these in my PN, but feel stupid as hell that I even brought them up during the closure. I may have repeated a few questions because I got nervous, and for one I made a stupid remark during the HPI that may have come off as me not paying attention to to the patient.
5. Did not give the pt with a cough a napkin or offered them water. He wasnt coughing all that much. Just a few times here and there, nothing too intense, so it completely slipped my mind. Also, I had some patients with CC of pain, although their acting didn't seem like it was severe pain. Didn't try to comfort them.
6. I was taking notes the whole time during the HPI and tried to glance up while I was writing, but hopefully I won't get docked points for lack of full eye contact. I saw the SPs were staring at my clipboard so I tried to cut down on this a little, but I wanted to take decent notes during the HPI so I could write a good note.
7. Didn't counsel many patients. Only 1 who was a smoker. 1 who did marijuana a few times. The rest of them didn't smoke or quit many years ago (which I congratulated them on). One i completely forgot to counsel on marijuana use. Didn't counsel one on diet/exercise where it may have been appropriate (didn't even ask her what her current diet or exercise routine was at the moment).
8. I thought the cases were straight forwarded and I'm pretty sure I got the right DDx/workup for at least 9/12 cases. Some were just all over the place for me, especially my first encounter. My Ddx/workup wasn't perfect but I don't think I made many major errors there....maybe just ordered a few extra tests or put down a differential that wasn't super likely.
I also made many other small mistakes (not pulling out foot rests for a couple, forgot to wash my hands in one case, forgot to ask about meds/allergies for one case, put down the wrong allergy for one pt, may have forgotten to document a couple exam findings, etc.)
Overall I'm praying that I did enough right things to pass
I studied for this a week ahead of time too. Wish I had spent more time studying now, and had read up on grading ahead of time. Please help am I freaking out for nothing?
