Exam Center: Philadelphia Exam Date: 20.April.2009 Result: Waiting Weeks for Result:   My Experience: A mixture of 12 cases that were too similar sometimes. I had to deal with a lot of GI cases (achalasia, GERD presenting as cp, cholelithiasis, gastroenteritis (asked for travel history, food and sick family members/coworkers)). The SPs were nice and easy to understand. Some gave more and better information than others. One case was a woman who had just tried to commit suicide due to postpartum depression. I felt kind of lost and definitely screwed that one up (I have very, very little psych experience). I could not think of any good questions and therefore just used the once I would normally use for a depressed pat. I carefully explored her relationship to her husband, family and friend support system, substance history as well as the psych history. Told her what I was going to do such as psych consult, group and drug therapy and told her I would sent the nurse in for surveillance. Of course, on my way back home I thought of all the questions I should have asked and all the work/up points that I should have mentioned (forgot the barium swallow in an achalasia case, can you believe it!! How stupid. But mentioned EGD, CT or a rectal exam incl OB stools or forgot stool leucocytes and culture in case of gastroenteritis but ordered CBC, elytes, ultrasound abdomen, rectal exam incl. stool for OB, ova, parasites). In one case of woman with chronic non productive cough I did not ask for any possible exposure to Tb. I was just out of the door when I thought of it (and I did not mention it to her either). So my only chance to make up for it was to recommend a PPD and x-ray of the chest or CT chest if necessary. In another case of chronic non productive cough that in my opinion was more related to chronic reflux disease (I learned that pat suffers from recurrent periods of heartburn that she treats with OTC antacids) I explained the whole GI work up (EGD, CT chest etc., X ray chest) to the pat but got so off the cough thing that I forgot to order a sputum incl culture and gram stain. I introduced myself in all cases, tried to be nice, open, understanding, identified my role and position, performed all necessary focused exams (in my opinion), washed my hands before the exams, made a nice quick summary in 9/12 cases, explained my initial plans and impressions (except in one case when I did not really have a clue), explained procedures such and EGD, counseled on alcohol use and earlier presentation to the hospital next time (2 times), answered all pats' questions and asked if the pat had any more questions. I asked for weight loss, changes in Bowel movements, night sweats dysuria whenever necessary and carefully explored PMH, FMH, SH (including sexual interactions except for once), allergies and medication. At this point I am mostly concerned about the accuracy of my patient's note. Did I mention everything that I thought was case related and important. Was I clear enough (Will it be clear that the statement .. y/o female c/o chronic, persistent non productive cough for about two months with worsening since last week..." includes no hemoptysis?)? What if one did not mention a rather important work up piece (such as barium swallow in my achalasia case) but listed others instead that make sense and are considered standard as well (such as EGD, CT chest)? How is that scored? Tell me about your opinion and what you think about my performance. My Advice & My Errors: cases, cases, cases. Time yourself for the pat encounter as well as for the PN. It helps to organize your work. Try to learn from your mistakes and try not to make them again. My Stay / Cost / Travel to Center: my boyfriend is a frequent traveler so I had the chance to use some of his hotel points. SORRY Name : Ricke

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