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- Dec 2, 2008
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Hi all,
Took Step 2 CS last week. I made a few errors, and am curious what you think about them.
- On the first patient, I was extremely nervous, and when auscultating lungs, I was moving the stethoscope while he was breathing normally. After 3 auscultation areas I realized what I was doing, said "I apologize, can you please breath deep for me?" and then re-started from the first area.
- On another patient during the abdominal exam I stopped after palpation. I did not perform percussion.
- On another patient, I stopped the abdominal exam after auscultation!!
- During a mental status exam, I did concentration, orientation, but completely skipped over the recall immediately/after 1 minute
- I failed to build rapport with some of the patients, but some of them just weren't having it. They were giving me nothing. Completely blank affects. Yes/no answers, volunteering some info.
- One patient reported seeing things as a side effect of what she was experiencing. I focused on what she was experiencing and didn't ask anything about the seeing things.
For every patient, I did this:
Knocked, "Good morning, Mrs. Jones?" .. "Hi I'm Dr. XXXX I'm a doctor here in the clinic. I'd like to talk to you and perform a physical exam." Then make them comfortable with draping, ask to sit down, and ask how I could help them. I frequently used their name during the encounter. I used transitional statements between HPI, PMH, FH, SH, Sex history, and my ROS. The only question I missed in the history on these patients was the severity of the pain on one patient.
I tried my best with empathy. If a parent died, I always told them how sorry I was for their loss. Felt bad about their CC. etc
I then asked to perform the physical, washed hands, and did a focused physical on the system that needed it. Afterwards I transitioned ("after talking with you and the physical exam" ......) I offered up two diagnoses for their chief complaint, being sure to immediately define the diagnoses, and then told them about two tests i'd like to order, and immediately defined the test. Made sure they liked the plan, and then counseled. Asked if any questions, etc. Then shook hand, thanked them, and walked out.
I was a little worried because sometimes after closing I'd say "Do you have any questions?" And they'd say "No." So normally I would then just leave. But If I said "Do you have any concerns?" (ie, asking them a second time if they have anything more to ask me) they'd then toss up another challenge question. Seemed strange.
Time wise, I finished some encounters a couple of minutes early, and the rest usually right at 15 minutes. On one encounter she was asking me a question after I closed and time ran out.
I felt good about it. A bit nervous about my mistakes on the physical. I was glad the encounter themselves went fine.
Do you think these are anything to worry about? I've read some of the horror stories from people who took CS, and then still passed.
Took Step 2 CS last week. I made a few errors, and am curious what you think about them.
- On the first patient, I was extremely nervous, and when auscultating lungs, I was moving the stethoscope while he was breathing normally. After 3 auscultation areas I realized what I was doing, said "I apologize, can you please breath deep for me?" and then re-started from the first area.
- On another patient during the abdominal exam I stopped after palpation. I did not perform percussion.
- On another patient, I stopped the abdominal exam after auscultation!!
- During a mental status exam, I did concentration, orientation, but completely skipped over the recall immediately/after 1 minute
- I failed to build rapport with some of the patients, but some of them just weren't having it. They were giving me nothing. Completely blank affects. Yes/no answers, volunteering some info.
- One patient reported seeing things as a side effect of what she was experiencing. I focused on what she was experiencing and didn't ask anything about the seeing things.
For every patient, I did this:
Knocked, "Good morning, Mrs. Jones?" .. "Hi I'm Dr. XXXX I'm a doctor here in the clinic. I'd like to talk to you and perform a physical exam." Then make them comfortable with draping, ask to sit down, and ask how I could help them. I frequently used their name during the encounter. I used transitional statements between HPI, PMH, FH, SH, Sex history, and my ROS. The only question I missed in the history on these patients was the severity of the pain on one patient.
I tried my best with empathy. If a parent died, I always told them how sorry I was for their loss. Felt bad about their CC. etc
I then asked to perform the physical, washed hands, and did a focused physical on the system that needed it. Afterwards I transitioned ("after talking with you and the physical exam" ......) I offered up two diagnoses for their chief complaint, being sure to immediately define the diagnoses, and then told them about two tests i'd like to order, and immediately defined the test. Made sure they liked the plan, and then counseled. Asked if any questions, etc. Then shook hand, thanked them, and walked out.
I was a little worried because sometimes after closing I'd say "Do you have any questions?" And they'd say "No." So normally I would then just leave. But If I said "Do you have any concerns?" (ie, asking them a second time if they have anything more to ask me) they'd then toss up another challenge question. Seemed strange.
Time wise, I finished some encounters a couple of minutes early, and the rest usually right at 15 minutes. On one encounter she was asking me a question after I closed and time ran out.
I felt good about it. A bit nervous about my mistakes on the physical. I was glad the encounter themselves went fine.
Do you think these are anything to worry about? I've read some of the horror stories from people who took CS, and then still passed.
