How to do well on the EOA CSE (End of Applications Clinical Skills Exam)

·  Preparation

o  Foundations and your clerkships constitute preparation for this program.

o  Mastering the OSCE CSA by Jo-ann Reteguiz and Beverly Cornel-Avendano (McGraw Hill) may be useful as a reference.

o  USMLE Step 2 Clinical Skills, Kaplan Medical, Simon and Schuster

o  First Aid for USMLE Step 2 CS, Tao Le et al.

·  General

o  Greet the patient and state your full name and role (3rd year medical student or student doctor).

o  Elicit or confirm the patient's name and age.

o  Never attempt to communicate with the patient other than as a physician to a patient. Always stay in your role as a medical student and allow the actor to stay in their role as your patient. Don’t say anything to them that you would not say to your “real” patients.

o  The more you are able to interact with the patients as “real patients” the more you will get out of the experience and the better you will do.

·  Focused History taking

o  Develop the chief complaint – remember LOCATES!

o  Begin by using open-ended questions (plural) and progress as needed to more directed questions.

o  Ask about past medical history, family history, social history, medication history & ROS etc. as it relates to the chief complaint.

o  Ask for a relevant review of systems, examples

·  If chief complaint is vertigo – need to ask about ENT, neuro systems

·  If chief complaint is lower abdominal pain – need to inquire about GI, GU, GYN systems

·  Focused Physical examination

o  Do a focused examination based on the patient's complaint, symptoms, and history.

·  Don’t leave out important organ systems.

·  When you do identify an important organ system to examine, perform an appropriate and relevant exam (eg – testing for motor, sensory, and vascular function may be important in an extremity injury.

·  Demonstrate good technique – standardized patients may have real findings related to or incidental to their current complaint.

o  “Foam in, Foam out” or wash hands in the room.

o  Tell the patient when you are going to begin the physical examination.

o  Always use patient gowns and sheet appropriately to drape your patient to maintain patient modesty and comfort, but never examine through the gown or clothing.

o  To auscultate or palpate the heart or examine a female patient’s lungs, you should move/lift the bra to allow palpation (for example of the PMI) or auscultation. Do not remove a patient’s bra.

o  Use the examination table extension when the patient reclines.

o  If you ask a patient to get off the examination table, offer to assist him or her.

o  Consider all parts of the encounter to be a part of the exam (for example, bruises, scars, anything out of the ordinary, etc.).

o  Do not perform corneal reflexes, gag reflex, sternal rubs, breast, pelvic, rectal or male GU exams. If they are a necessary part of the exam, verbally state that and then move on.

o  If inguinal nodes or femoral pulses are relevant, it is okay to perform these exams.

o  Do not use sharp objects to repeatedly test sensation on the same area. Test - and if the patient cannot tell whether it is sharp accept that - then move on to another area.

·  Communication

o  Make eye contact.

o  Sit down at a comfortable distance from your patient.

o  Ask clear questions and speak understandably.

o  If you use medical terms, explain them in simple terms.

o  Be direct and honest, but also be sensitive.

o  If you don't know the answer to an SP's question, say so.

o  Don't give false reassurance or a premature diagnosis.

o  Acknowledge the patient's concerns or worries.

·  Discussion

o  Note that there will be a time warning at the 25-minute mark indicating that you have five minutes remaining in the encounter.

o  Tell the patient the results of your examination

o  Tell the patient your plan for the diagnostic workup.

o  Deal with any communication or interaction challenges.

o  Ask for and answer any additional questions.

o  Discussing the case with your team or preceptor is not an acceptable part of your assessment and plan. You are managing the patients completely independent.

·  Clinical Reasoning & Note Writing

o  You will have 12 minutes following your patient interaction to complete a structured note in the computer.

o  Your differential diagnosis, work-up, patient counseling, treatment, etc. should be supported by your history and physical findings and be reflected in your note.

o  Your management plan should include a rationale for each order.

BOX/EOA/EOA2017/Students

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