This is Part II in a series in which we put your mind at ease after you learn you failed one of the most important tests in your training. We know it’s not easy and lots of emotions are stirring, but since you will need to retake the exam, let’s dissect the most common questions so we can get you ready for the next one.
Why did I fail?
It’s the first question you’ll ask yourself and understandably so because you will want to improve on what you missed. However, for many students they clearly can’t understand why…..they performed the correct OMT modality, they completed their SOAP notes on time, they made the SP smile….so what happened? We may never know exactly why one fails their PE but it could include some of the following:
- Failure to greet the patient and thank them for waiting
- Failure to make them feel more comfortable if they are in distress
- Failure to respect their privacy when it comes to gowning and draping
- Failure to maintain good eye contact and reflectively listen
- Failure to allow the patient adequate speaking time to answer your questions, (i.e. interrupting or rapid fire questioning)
- Not “intervening” when they admitted to having a daily habit that could contribute to a health condition (i.e. smoking, alcohol use, poor diet)
- Not ensuring the patient understood the assessment or reasons for questioning
- Not appearing confident when one explains the assessment and plan
- Not suggesting to address the pain or distress in the plan
- Rattling on and not closing the encounter strongly.
- Failure to suggest modifications that can help them at work or home
- Failure to address other body systems by only concentrating on the chief complaint (i.e. a left shoulder pain complaint may also need questioning regarding chest pain in addition to musculoskeletal symptoms)
- Failure to ask associated symptoms or pertinent positives/negatives (i.e. in a patient presenting with back pain, inquiring about lower extremity numbness and tingling, incontinence, hematuria, etc.)
- Failure to address medical symptoms that may stem from a habit they have (i.e. urethral discharge if they partake in unprotected sex)
- Failure to address medical symptoms from a medication they may excessively take (i.e. abdominal pain or blood in the stool of a patient who takes NSAIDS often)
- Failure to examine the appropriate body parts that could be contributing to the illness, (i.e. thyroid and carotids in a patient presenting with dizziness)
- Asking “why” when they take excessive medication – they may be self treating another medical condition
- Asking “why” they came in for a physical (family member may have been worried about their memory)
- Failure to complete all four sections (S O A P) consistently in each case
- Failure to address the chief complaint in all four sections (i.e. if one presents with back pain, did the note address the subjective complaints, an exam of the back, differentials of what the back pain could be, and testing/OMM in the plan that addressed the back pain?)
- Failure to include associated symptoms (i.e. in a patient presenting with a headache, were they negative or photophobia and neck stiffness)
- Failure to document appropriate history and physical
- Failure to list the differentials that the presenting complaint could be (i.e. a patient presenting with fatigue may have depression, anemia, sleep apnea, hypothyroidism, antihistamine overuse)
- Failure to include OMM, testing, medications, work modifications, follow up in the plan.
- Failure to ask permission prior to performing the OMM
- Failure to explain what OMM is and why one is choosing to perform it
- Appearing “rough” in technique
- After performing the OMM, failure to ask how the patient felt and its effect on symptomatology
How soon can I retake the PE?
Although most students can go online and register for their retake, most academic institutions will have guidelines on when one should sign up for the retake and prove eligibility to remediating professors. We suggest you follow your school’s recommendations as retaking the test too soon could lead to an additional failure.
How many times can I take the PE?
According the NBOME website, students are allowed 4 attempts in a single year and 6 total. However, many academic institutions may have different guidelines, so review your school’s handbook to determine how many attempts they will allow before dismissal.
Is it better to take my retake in a different city than the first one?
We have not seen any data on switching test sites and its effect on passing one’s retake. For some students the familiarity of the testing city and neighborhood makes the retake easier. For others a fresh city with fresh SP’s offer the placebo needed to pass. Since the average SP doesn’t remember one student specifically or their score, the effect of seeing a repeating SP is negligible.
Will I not match into residency due to my PE fail?
Most students who retake their PE and pass, go on to match into a residency. Of course this could be more challenging if one picks a specialty that is highly competitive such as surgery. However, overcoming a test fail is often times looked upon positively by program directors. If the question comes up during the interview be honest and humble without blaming anyone or anything for the failure.
Will a PE failure prevent me for applying to residency this year?
Most schools have a timeline on what needs to be completed before entering the match and better yet, some have a fail-safe built into the curriculum to allow some time off for board remediation if needed. Most schools however, want all board scores passed before entering the match, and since test scores may take 6-8 weeks to comeback after taking the exam, discuss with your school on your time needed to remediate and when to schedule your retake.
Should I take a leave of absence (LOA) to study for the PE?
If you feel you need to concentrate your efforts on passing the exam, an LOA may be of huge benefit. However, other students use their clinical rotations to help them hone in on their PE skills and prefer to keep learning while preparing for their retake. This decision will be based on your school’s recommendations and the degree of your PE failure (i.e. one section vs multiple sections.)
Will I still be able to get letters of recommendation (LOR) from faculty if I failed my PE?
Yes….but make wise choices in choosing the faculty. Those with whom you closely worked during clinical rotations, research, or community service are good choices, especially if they liked you and you performed well around them.
Again, hang in there. We know you just received devastating news with your first failure, but remember most students who study, retake their PE and pass, go on to residency. It’s a bump in your long academic road but a small one and one that can be easily overcome. You got this!!
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.