Exam Center: Houston Exam Date: 11.March.2010 Result: Waiting Weeks for Result:   My Experience: Total of 24 people mostly AMGs, about 5-6 IMGs including me and me being the only OLD OLD grad. Anyway got there on time, registration happened, we got our sheets..and pens. Do not DONOT write on papers before you are in front of your room, dont even try They showed us video and gave us two badges to put on, on on front one on side for SPs to see. Nothing in your pocket other than ID and some Cash or ID or a creditcard for any emergency, no tissues nothing. They started on time and line you up in front of your rooms. There were 24 rooms for 24 people so one row was 12 people that way you rotate in your own room row but they manage it pretty well so dont worry about the case number you are on and such. Announcements work just fine dont worry about looking at the clock just focus on patient b/c 15 min goes by fast and 10 min goes by even faster so DONT WASTE TIME SWEATING ABOUT TIME. Cases were pretty simple, nothing out of ordinary so just practice. It is a nice center, nice people, I have to emphasize in addition to practice do make sure you have your D/D, work up and counseling right, its not just handwashing being nice and such, you have to pass each component on its one. We were done at 3:30 There were 2 breaks, one after 5 patients for lunch, then after 4 patients for 15 min and then last 3 patients For me the only way to describe this test is....GRUESOME and painfully long. It may be b/c I flew almost missing my flights, didnt have a good night sleep just out of my place in hotel, so by the end of the day I was visibly tired and ready to leave. Do have a light breakfast b/c this test can take a mental toll and you will be exhausted by lunch time even with light breakfast so do eat something even if it is apple or a bowl of oatmeal The things I always did Knock, Smile, Intro, drape, ask to sit down, ask to take notes, good eye contact, hand shaking but not when they were in pain, show concern, show empathy esp. when they talked about death of parent, or spouse, complimented pt on medication compliance, other than 1 case always did smoking counseling, asked CAGE when appropriate, paraphrased, summarized, offered support, washed hands, dried hands, talked to patient while washing hands even if it was about how many kids do you have or do you like what you do, or how is life at home whatever I would remember to ask. I always told them before PE how would I start from head and listen to lungs etc, then we will walk or showed them how to perform certain tests, I always helped them off table, lie down get up, I said thank you repeatedly, I always draped in beginning, always asked permission to open gown never touched patient before I heard yes you may, I tied up all gowns, I always said let’s sit down and let me tell what I think, then summarize and plan out, did counseling in end always. All my patients asked me questions and I asked everyone did I answer your question after I answered. I always told my patient if a rectal or pelvic was needed, I offered social worker support in all cases where needed, I offered literature to read, I showed compassion for patient in pain and acknowledged when I saw pain upon entering the room rather than saying how are you doing today b/c of course he/she is not doing good sitting like that. I didn’t hesitate about asking questions between the PE if I remembered something I would ask this and say I am just trying to make sure we cover all bases. If I forgot something I didn’t hesitate asking “ did you tell me you smoked” and then say thank you for refreshing my memory, if a patient corrected me for something I would say thank you so much Mr/Ms this is so important that I know everything the right way. I gave them option to bring up something if it is bothersome while I am doing exam and at that point most would ask me challenging question. I would tell them I will try to not hurt them while doing exam. I always asked at end do you have any concerns, did I answer all your questions, do we have a plan, thank you mr/ms for talking to me today even though I know you are in pain but thanks for your patience I will be addressing your pain now, or lets set up room for rectal, pelvic, or let me bring back your new script etc. Very nice to meet with you, I would address males by thank you sir and females by thank you ma’am. I made a joke about medical gowns with a young girl while I was trying to tie it back and it was taking too long and she cracked up and said yes I agree. These SPs are not jokes, they are well trained, they look like real patients, they act like real patients and within 2 min in the room I would forget it was an exam, I did enjoy talking to them and may be paid more attention to them than there needs to be done so that might have been my mistake but well God forbid if I fail I am sure it won’t be on Interpersonal skills, I have no doubt in my mind that part was passed with flying colors in all encounters. I just hated the exam as is because it is long and it gets monotonous after about 4th encounter. So now I wait till April 21st onward to know my fate…I hope I forget by then what I have done wrong My worry is my PN in a few cases and the general fact that my note needed more room than given and then just some stupid mistakes I should have not made at all while history taking and then costing me 2 cases while making wrong preference in DD. My Advice & My Errors: I am not sure if i passed or not, when i came out yesterday I was happy but this morning I woke up and the first thing that came to my mind was OMG that was the wrong Dx on two cases and technically the wrong PN order of DX on those patients....So my confidence has gone way down now. It’s not that the cases were hard it’s just that I didn’t think about that thing while in the room, not until this morning My first 2 cases were a blur well not a blur but I was not comfortable yet. 2nd case was the one about which I freaked out this morning b/c I missed a HUGE HUGE point on history, even though I had said during exam "I need to ask her this" and then forgot and that one question was making the right Dx. That Dx is in DD, but at the end not at top like it should have been and I have ordered a test for it too but the fact that I didn’t ask the patient the question to rule it in ... is driving me nuts thinking how I could have missed that 4th case I ran out of time but had done already telling patient what it was and what tests will he need but had some imp points left to cover when they knocked on my door so I had to apologize and leave. All other cases I was well within time, left the room about 50 secs remaining and finished PN on time I wrote all my notes b/c I am not a very reliable typer. I like to narrate my history so I had to write carefully and I made sections for all my questions like PMH etc, if a section didn’t have anything I would write non contributory. So anyways here are my mistakes At least 2 cases order of DD is totally wrong, on one history didn’t include the question for dd and on one the PN doesn’t include the travel Hx the patient gave me for me to be putting that thing on top of DD Didn’t tell 2 patients that they might need admission (1 of them being the second case where I Think I messed DD order) even though they asked what if I have to take time off work and all i said was " well mr/miss ___ I understand your concern and I want to assure you that I am willing to talk to your employer with your permission/or write a letter to them explaining your situation should the need arise for you to take time off, but we need to figure out what is going on, so let’s start your work up and see what is going on. Till then please try to relax, I certainly appreciate your patience. Did I answer your question?" Ran out of time on 1 patient as I mentioned above didn’t do abdominal exam on a patient where I thought it would help some to see what was going on even though CC was not abdominal pain, I just thought it would help but forgot to do it Didn’t palpate chest in one case when I should have Didn’t ask smoking question in one case Forgot to counsel on smoking in one case My PN had cuttings, HPI section was pressed for space so I dunno how writing mish mash would affect that Didn’t write VS on about 6 cases and where I wrote VS I just mentioned WNL except and gave the abnormal finding On one case I forgot what side of chest what findings Sp was giving on exam so I am darn sure I wrote wrong PE findings on wrong side …. uggggh I think I have done good on about 7 PNs, 2 could have been better, 1 was so, so and 2 are the ones where my DD order is just not right (the 2 cases I mentioned above where I gave the most possible Dx at end) Just make sure you practice with time on. I think the reason i did so good on time was that I had practiced with time on. My goal was to start PE at or before 5 min announcement and majority of my patients other than 2-3 I was done with at least Heent by the time I heard 5 min. 2-3 patients i was just starting heent when I heard 5 min warning So practice with time even PN, at 2 min announcement I was almost always done and then re read in last 2 min Second thing would be just master your DD for major cases so when you are in front of door after reading the case you have at least 3 D/D in mind, I spent about 30 sec in front of the door, more than most of people did and I always made sure to write down pt name and age but always glanced at the name on door before stepping in other than that just master your dialogue, I had a dialogue that I had for all cases and some case specific, i didnt want to repeat what everyone else would say, or what we get from all websites like I will try my level best and all that, so while i said all that, I did it in my own way and since it was my own way I did feel comfortable saying it out loud to patient but thats just me, I just thought imagine them listening to same lines all day long. Do patient directed interview rather than repeating mnemonics. there is no harm in using mnemonics as long as they are just that and dont direct your encounter. Trust me patients give hints, if you let them lead the case, mine did and they gave me info on there own, I just made sure i ask all things other than of course 2 cases where I messed up b/c I was not paying attention ... and now i am kicking myself in the shin. the moment I put the coat on, I was the doctor, i am not acting they are!!!! My Stay / Cost / Travel to Center: I stayed at crowne plaza, nice hotel I got a good rate b/c of my job. Center was about 5 min walk from it. Cost me 118$ for a night but that is Govt rate b/c of my job. Walked to center 4-5 min. Air ticket 225$ there was a mcdonald and quiznos close by cost for food was 9$ for one day and next morning they gave me breakfast with room due to my State ID. Hotel was very nice Name : Drstethoscope

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