How to pass with flying colors Overview of Exam O Ten to twelve cases O 10 are scored O Adults only O Pediatric cases will be parents O 15 minutes per clinical encounter O 10 minutes per progress note Overview of Exam O Grading O Integrated Clinical Encounter O Data-gathering O Progress Note O Communication/Interpersonal Skills O Spoken English Proficiency Clinical Encounter O Doorway Note (20 seconds) O History (7 minutes) O Physical (4 minutes) O Closure (4 minutes)
O Tip: Don’t shortchange the closure, this is
the primary means of evaluating communication skills Clinical Encounter O Doorway Note O Introduction O History O Physical O Differential Diagnosis O Workup O Answer questions O Provide counseling Progress Note O History O Bullet or narrative O Abbreviations are acceptable O Physical Exam O Be honest O Differential Diagnosis O Up to 3 items prioritized with H&P findings supporting each diagnosis O Work-Up O 3-5 items O Tip: if you are running out of time, start at bottom of the page Why do folks fail? O Vanderbilt students do not fail because they lack knowledge. O Vanderbilt students do not fail because they lack communication skills.
O Vanderbilt students DO fail because they fail
to meet the checklist requirements that the SP is looking for during the encounter. Common Errors O Failure to introduce yourself to patient O Use patient’s name, state name, handshake, explain role O Failure to perform a patient-centered interview/exam O Repeat back what you hear, reflect back emotion, summarize O Ask permission to perform touch patient, introduce maneuvers, explain findings O Use of jargon Common Errors O Failure to show compassion O Acknowledge patient’s pain O Acknowledge patient’s emotion (sadness, anger, etc) O Touch the patient appropriately O Keep the patient comfortable (help them sit up, lie down, draping) O Failure to Summarize O Must be done at least once Common Errors O Lack of clarity of differential/plan O Verbalize your differential diagnosis O Outline a clear plan O Failure to ask for questions O After answering them, ask again O Missed opportunities to counsel O Most encounters require some counseling O Failure to empower/collaborate w/ patient Common Errors O Missing or rushing through the “embedded concern” O Look for this in each patient (open ended question at the end) O Acknowledge the patient’s emotion (empathize with them!) O Answer honestly but reassuringly O Repeat the opportunity for them to ask further questions Final Tips O You don’t have to be perfect! O SPs are easier than real patients O There is a reason for everything you see