Image above from CollegiateParent
The PE/CS are practical tests, examining one’s skill with a patient, and must be passed in order to graduate medical school and enter residency. For some students, they find the test of their hands-on skills easy. For others, stage fright can kick in and they worry they’ll forget everything they have learned.
Relax, review and rise to the occasion!! And if in doubt….the following tips may help:
- Greet the patient and thank them for waiting
- Make them feel more comfortable if they are in distress
- Respect their privacy when it comes to gowning and draping
- Maintain good eye contact and reflectively listen
- Allow the patient adequate speaking time to answer your questions, (i.e. no interrupting or rapid fire questioning)
- “Intervene” by offering them assistance when they admit to having a daily habit that could contribute to a health condition (i.e. smoking, alcohol use, poor diet)
- Ensure the patient understands the assessment or reasons for your line of questioning
- Appear confident when you explain the assessment and plan
- Suggest something to address the pain or distress of the patient
- Avoid rattling on and remember closing the encounter confidently and friendly.
- Suggest modifications that can help them at work or home if their complaints impede their job or home life.
- Remember to address other body systems that could be contributing to the chief complaint (i.e. a left shoulder pain complaint may also need questioning regarding the heart in addition to musculoskeletal symptoms)
- 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.)
- Address medical symptoms that may stem from a habit they have (i.e. urethral discharge if they partake in unprotected sex)
- Address medical symptoms from a medication they may take excessively (i.e. abdominal pain or blood in the stool of a patient who takes NSAIDS often)
- Examine the appropriate body parts that could be contributing to the illness, (i.e. thyroid and carotids in a patient presenting with dizziness)
- Ask “why” when they take excessive medication – they may be self treating another medical condition
- Ask “why” they come in for a physical (family member may have been worried about their memory, eating habits, etc.)
- Complete all four sections (S O A P) consistently in each case
- 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?)
- Include associated symptoms (i.e. in a patient presenting with a headache, were they negative for photophobia and neck stiffness, etc.)
- Document appropriate history and physical
- With the physical make sure 5-6 categories were documented (i.e. Vitals, General, Cardiac, Pulmonary, and then one or two more depending on their chief compliant – if back pain also include MSK and Neuro)
- 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)
- Include testing, medications, work/home modifications, OMM (DO students), and follow up in the plan.
OMM (for DO Students)
- Ask permission prior to performing the OMM
- Explain what OMM is and why you are choosing to perform it
- Do not appear “rough” in technique
- After performing the OMM, ask how the patient felt and its effect on symptomatology
Most students who study and practice, PASS their PE/CS and match, going on to residency. If you need help, reach out to your school, students who passed, or even me for tips. You got this!!