Posted in COMLEX 2 PE, Education, Health, medical school, news

Failed Your COMLEX 2 PE/Step 2 CS? Here Are Your Next Steps…..

Image above from Riverside Community College District

 

Failing an exam is not easy, especially if it’s one of your boards.  However, these tests have been failed many times before by multiple students who go on and become very successful in their field.  So what do you do when you get the crushing news?  We take it step by step…..

COMLEX 2 PE Failures: Your Questions Answered

 

Know You’re Not Alone

Considering the countless exams you’ve taken throughout your schooling, you’re sure to wind up stumbling on a few.  And none of the boards have a 100% pass rate. So there are numerous students right now in your same shoes.  The majority of them succeed on their next attempt so odds are in your favor.  Failing a set of boards should never stop your path of becoming a physician, because odds are you will succeed next time around.

 

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For The Boards

 

Expect to Go Through the Five Stages of Grief

As soon as you receive the failing grade you will immediately be in a state of denial.  As described above you will also feel isolated, but remember, you’re not alone.  Then you’ll become angry that a testing service or grader thought you were not worthy to become a doctor.  You’ll learn that’s not the case but it will still ruin your day, week, or month nonetheless.

Next you may go through a period of bargaining, thinking you could reach out to the testing center to appeal the grade, or pray the grade away, and when the score doesn’t change, you may fall into a depression. Finally you realize the grade is here to stay and you reach acceptance, which is a good sign and necessary to recover and eventually succeed.  Once you’ve accepted what has happened you can start planning how to rectify the situation.

Many students feel they shouldn’t go through the above stages, but how else will you begin to heal from a such a traumatizing incident?  Which brings us to….

 

Take a Moment for Yourself

Being told you fail a test hurts, and you’ll want to scream or cry. That’s normal, being you busted your butt in school for years and an exam is trying to get in your way of you reaching your goal.  But when we fall we need to get back up and brush ourselves off.   The most satisfying thing you can do at this stage is prove the testing centers wrong by passing it the next time around.  Remember you are in your final years of medical school and you overcame much bigger obstacles than this.   You got this. So now what do you do next…..

 

Notify Your School Immediately

Some programs are made aware of a time frame in which test scores come out but may not know what exact day scores are released.  So if you failed and are expecting to hear from them checking in on you, don’t. Reach out to them first but realize that not hearing from your medical school is not a sign of indifference.  Once they know you failed they can start setting up a remediation program if they have one or get you in touch with valuable resources.

 

humanism book cover final

Humanism Prep Guide For the Boards

 

Be Open To Criticism and New Instruction

Medical students are told their whole life how “smart” they are so we sometimes persist in the disbelief that we failed a test. However, if you failed, chances are you did something wrong.  So take instruction and learn from it.  Even if other doctors in your clinical rotations have taught you differently, those professors in your institution who understand the boards will have insight to help you pass the boards, which is your primary goal.

If you failed humanism/communications – practice bedside manner, confidence building, questions patient’s commonly ask their doctor, as well as making sure the patient understands what you’re thinking and about to order for them.

If you failed SOAP notes – practice typing speed, write out notes for multiple cases, have others grade your work to see what you’re missing.

If you failed data gathering, practice coming up with differentials or body systems and common questions to ask, and review cases of all chief complaints offered in study guides.

Passing a test is a game..it always has been. We learned how to play the game early on in our grade, middle and high school years but now we’re playing pro and the stakes are higher when it comes to medical boards.  Realize you need help and be open to it.

Phone a Friend

You will need support from those you love and have your back.  Don’t be embarrassed discussing this one stumble in a long line of schooling successes.  No one makes it through medical school alone, so leaning on someone is par for the course.  Plus you feel better opening up.  I’ve heard from countless students who failed their PE and CS and am here as well.

Medical students and professionals aren’t perfect and shouldn’t be expected to be.  But we are strong, resilient, and hard working.  So approach your board failure as you’d do anything in medicine.  Evaluate, assess and treat…….You got this!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

 

Posted in Education, Health, medical school

Data Gathering During a Patient Encounter Made Easy

A Peek into How Doctors Think – An Introduction to “Columns”

Anyone who is on their path to becoming a successful physician needs to be able to take a good history and perform a thorough physical.  However in this day and age, patient care is performed in a very speedily process and thus the boards test a medical student on how succinctly they can perform a patient history.

 

Thus students and licensed medical providers need to be adept at “data gathering” no matter what the patient presents with.  Our job is to figure out what’s going on, no matter how difficult the task, and do so quickly.  So how do we accomplish this?

We start by looking at the cause and then breaking down what could be occurring resulting in that cause, or in other words, forming a differential diagnosis.  So if someone has chest pain, one may form a differential consisting of heart attack, pericarditis and costochondritis. But other issues may be at play such as a pneumonia or an esophagitis.

So when we look at a person with chest pain, we consider all the body parts or causes that could be causing the symptoms.

Hence with a patient presenting with chest pain, one would consider a cardiovascular cause, pulmonary cause, gastrointestinal cause, musculoskeletal cause, and even psychiatric cause.

This is the basis of forming one’s columns. For every chief complaint we form columns either mentally or on paper and then ask associated symptoms (or pertinent positives or negatives) to determine which column we’re in.  Usually a few “power questions” will help discriminate which column you are in. Once you hit the correct column you will ask further questions along that line.

Data Gathering Prep Guide For The Boards

Data Gathering Prep Guide For the Boards

True there are many more questions we could ask than just the “power questions,” but during a time crunch we need to ask very specific ones to determine if we are on the right track.  If we receive multiple “no”s along a column, we know to move onto the next column.

Hence if a patient with chest pain denies dizziness and diaphoresis or sternal pain upon palpation but admits to cough, shortness of breath and sputum production, we have just narrowed down the chest pain patient to a pulmonary cause as opposed to assuming it was cardiac in nature. Then we would continue down the pulmonary column, thinking our differential may be a pneumonia/bronchitis/pulmonary embolism, and ask about hemoptysis, fever, chills, etc.

humanism book cover final

Humanism Prep Guide For the Boards

So for each patient one must create columns depending on the chief complaint and then ask power questions to help focus down your differential.

Now these columns can also assist with the physical exam component of data gathering.  If the above patient presenting with chest pain could have a cardiac/pulmonary/GI/musculoskeletal condition, one would examine his heart, lungs, upper abdomen and palpate the sternum and ribs.

For an added bonus, the columns can additionally assist one in forming their differential for the SOAP note. 

Chest pain r/o

  • Pneumonia
  • Bronchitis           
  • PE
  • MI
  • GERD
  • Costochondritis

If a case involves a not so clear-cut symptom, columns could be used as well.

For example a patient presenting with hair loss.  If one complains of hair loss, a variety of differentials could be at play.  One column could be an endocrinology source (such as hypothyroidism or diabetes), another could be psychological (such as stress or trichotillomania), a third could be medications (such as chemotherapy agents), and a fourth could include genetics.  Narrowing these down with power questions could exclude non-contributing columns.

So whether it’s a direct body system or cause, columns help one focus down the differential and allow an easy visual that enables one during a timed test to think quickly and know which questions to ask.

Again these columns are instituted after the History of Present Illness in which a student obtains onset/chronology, palliative/provocative factors, quality of symptoms, radiation, severity and timing (OPQRST).

They will be written down in the SOAP note after the HPI.  

Example:  Mary is a 25-year-old female presenting with acute onset right foot pain.  It began 6 hours ago after she went for a job. Ice provides some relief but walking on it worsens the pain.  The pain is sharp, constant with a severity of 7/10. She denies fever, chills, open wounds, swelling, redness, temperature changes, numbness or tingling.

Since during this step in the history most medical students find it challenging to know “which questions to ask.”  The columns and power questions simplify this.

To learn this method to improve one’s data gathering skills click here.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.