PCM2: General Examination Tips

=Exam Preparation=
 * OSCE is an acronym for Objective Structured Clinical Exam. OSCE is a commonly used evaluation tool provide some objective means to evaluate clinical skills--not just what you know.

=General Resources=
 * As a wiki site, we like the |OSCE resources on Wikiversity for OSCE exams. It's all there.
 * |Medical OSCE Skills
 * Watch the Physical Exam Videos and internalize those checklists. Don't forget pull out those BATHE, CAGE, Mini-Mental Status Exam, and Teach back skills.

Presentation Skills

 * It's not just what you know. It's how you present it and organize it!  Students should be prepared to present examination findings in three formats: Hospital admission note, a SOAP note format, and a full chief complaint (CC) and history of present illness (HPI).

SOAP Note

 * This is the format that is expected for oral presentations. The wikipedia article is good: SOAP NOTE.
 * Focus on the differences between subjective and objectives.
 * Review of symptoms should only include pertinent positives and negatives.

History of Present Illness

 * Considered the longer write up. This format is implied whenever a written response is requested.  Prose or other formats you have seen in other clinics are not appreciated.
 * Use underlined subject headings like CC for chief complaint or MEDS for medication. The format is reviewed in the article on Medical Interview.
 * An assessment and plan for each of the chief complaints should be added in addition to the history in the medical interview article.

Communication Skills

 * Patient Literacy: The new teaching is that you should approach the interview as a SOAP - UP note. That is, collect the usual SOAP note information.  Then Use a teach back technique, ie, "I want to make sure I have explained things well. Please tell me in your own words how you are going to use this medicine.”  Finally, Plan for health literacy interventions and other resources.

K07
Each OSCE station is evaluated for the skills checklist and also a "hidden" checklist known by the code "K07". K07 is the code for showing respect for the patient's point of view and covers general interpersonal skills. These factors should be part of every patient interaction.
 * Ask patient how they would like to be addressed.
 * Follow the "talk before touch rule"
 * Ask the patient for their perspective on their condition
 * Ask how things are going in general
 * Report results of the exam as your proceed with the exam
 * ie: "Your heart sounds are normal and healthy"
 * Leave time for the patient to ask questions

Introductions

 * Every patient encounter is evaluated for introductions.
 * Do you explain who you are and what you are doing?
 * Do you explain who you are working with?
 * Do you ask their permission to be examined/answer a few questions?
 * Do you wash your hands (20 seconds)?
 * Do you ask the patient what they would like to be called and address them by name?

History

 * Elicit the chief complaint & symptoms with the OPQRST acronym:
 * O: Onset, when did it start, how long has it been going on. Constant or intermittent?
 * P: Provocation/Palliation: what makes it better, what makes it worse?
 * Q: Quality: describe the pain to differentiate etiologies (shooting, stabbing, dull, etc)
 * R: Radiation:
 * S: Severity: on a 1-10 pain scale
 * T: Timing or temporal factors

=Previous Exams=

The PCM leadership asked that past station topics not be shared.

=About OSCE= OSCE is an evaluation of individual physical examination skills in a standardized patient setting. Students are evaluated primarily by the standardized patients themselves, though the interactions are video taped.
 * In the past, the test has consisted of 5 graded stations based on 3 patient encounters.
 * Patient encounters last 15 minutes and are similar to a GOSCE set up
 * One station consists of a oral report to an mock preceptor (actually a video camera) based on a previous patient encounter. The encounter is typically relayed as a SOAP note, including an assessment and plan.
 * One station consists as a written history based on a previous patient interaction.
 * The last station is notorious for video taping students while they write a paragraph for 20 minutes as a method to deter cheating.