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Jefferson Medical College Alpha Omega Alpha Guide to USMLE Step II: Clinical Skills and the OSCE

Exam Day Quick Tips

Under the time constraints and exam stress, it can be easy to forget to do simple, no-brainer things that you’ll realize later.  Here are some ways to remember them—they’ll earn you points and help you feel more comfortable during the exam:

  • If you developed history taking mneumonics, go over them.  As soon as you hear the announcment to start the case, you may write on the clipboard.  Write down the chief complaint and vitals from the door.  Also write down your mneumonics or a skeleton outline of the history on the blank sheet provided.  Some helpful mneumonics are:

         CHiP MASFeR (Chief complaint, History of present illness, PMH, Medicines, Allergies, Social, Family, ROS)
         COLD REARS SITS

  • Don’t expect the standardized patients to tell you everything after one open-ended question.  (That being said, definitely start with open ended questions.)  However, getting the information you need should not be like pulling teeth.  Many people report that the SPs will give you the answer if you ask a related question, allow for appropriate pauses, or seem like you’re genuinely interested in them and are listening.  So, if you ask for medicines and they only say one, stop there.  You don’t need to probe for every possible hereditary disease on family history.  Do a quick ROS tailored to the chief complaint.
  • The patients will generally not have extensive past medical histories or multiple unrelated complaints.  If they answer “yes” to one of your questions or tell you something, pay attention!  It will almost certainly influence the differential diagnosis.
  • Treat the SP like any real patient.  If you only think of them as an actor, you’ll miss the point of the exam.
  • Do simple but important things like shake hands, introduce yourself, ask the patient how they would like to be addressed, making eye contact, WASH YOUR HANDS before the exam, drape the patient, and pull out the footrest on the exam table.
  • If you’re feeling short on time, the time it takes to wash your hands is prime time to ask questions you’ve suddenly remembered.  It’s also a great time to ask the patient “other” social questions based on hints they’ve dropped during the more formal history taking time.  “How’s work”, “how’s the family”, etc.  Sometimes, they’ll open up about their concerns, fears, give you a chance to display your people-communication skills.
  • Dr. Berg will give you a handout of exam findings that standardized patients can feign (usually neuro or musculoskeletal findings).  Don’t spend 5 minutes trying to hear a murmur or abnormal breath sounds because the standardized patient won’t have them.  The exam may be completely normal for cardiac and pulmonery, but do all the steps!  Then, write what you find on exam, not what you expected to find.  However, specifically write that each manuever was “normal” so you can credit for including it.  (Don’t write, cardiac exam normal.  Write “Heart RRR, normal S1S2, no m/r/g, PMI not displaced, no JVD” etc.)
  • Never leave the room without asking the patient if they have any questions or concerns.  Also tell them what you think is happening and what you’d like to do next.  Be prepared for some more “difficult” questions.
  • When you start you write-up, fill out the differential diagnoses and work-up plan quickly and first.  There can be a disproportionate amount of points in those two sections, and you wouldn’t want to spend so much time on your history and physical write-up that you leave them blank.
Last updated: January 2007

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