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

  • Preparation

oFoundations and your clerkships constitute preparation for this program.

oOther helpful resources:

  • Mastering the OSCE CSA by Jo-ann Reteguiz and Beverly Cornel-Avendano (McGraw Hill) may be useful as a reference.
  • USMLE Step 2 Clinical Skills, Kaplan Medical, Simon and Schuster
  • First Aid for USMLE Step 2 CS, Tao Le et al.
  • General
  • Be as thorough as possible-if you don’t ask a question or perform an exam, we cannot judge whether or not you can do that skill.
  • Interacting with the Standardized Patient

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

oElicit or confirm the patient's name and age.

oAddress the patient formally (Mr., Mrs. Ms., etc.) or ask how the patient would like to be addressed.

oAlways stay in your role as a medical student and allow the actor to stay in his/her role as your patient. Don’t say anything to them that you would not say to your “real” patients. Do not talk to the camera or explain something for the preceptor watching on video. 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

oDevelop the chief complaint – ask all of the LOCATES questions and use your differential to guide you

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

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

oAsk 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

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

  • Make sure to include organ systems that pertain to the CC and DDX.
  • 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.

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

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

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

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.

Use the examination table extension when the patient reclines.

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

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

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.

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

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

Make eye contact.

Sit down at a comfortable distance from your patient.

Ask clear questions and avoid or explain all medical terms.

Be direct and honest, but also be sensitive.Acknowledge the patient's concerns or worries.

If you don't know the answer to a patient’s question, say so.

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

  • Wrap Up/Discussion

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

Use the remaining time to complete the most important portions of the exam that you have not done yet

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

  • Tell the patient the results of your examination and your plan for the diagnostic workup.
  • Deal with any communication or interaction challenges.
  • Ask for and answer any additional questions.
  • Clinical Reasoning & Note Writing
  • You will have 12 minutes following your patient interaction to complete a structured note in the computer.
  • Your differential diagnosis, work-up, patient counseling, treatment, etc. should be supported by your history and physical findings and be reflected in your note.
  • Your management plan should include a rationale for each order.

BOX/EOA/EOA2017/Students

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