samisyed1
Forum Junior
Topics: 5
Posts: 68
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i took pipe in aug and took cs in oct. they sent me a feed back on pipe. i got high score in data collection and low score to medium in interpersonal skills and low to average in spoken english. i am not sure wherei am standing.i consider average as the 50 percent of the space provided for evaluation. they didnt send any feed back in pt note. one thing i need to ask if some body knows. does data gathering include both hx taking and physical examination or it is only hx. i guess it is both. does anybody know if they are going to evaluate hx taking and physical examination together or they are going to be evaluated separately. From that i mean do we have to pass in the check lists of both hx taking and physical examination or their scores are going to be combined together. what i have seen there are very few check lists in physical examination and that can go against us. Also there are two pts in cs where we were not supposed to do physical examination. one was tel encounter and other was the female gyn patient.what i understand there are five different check lists 1 hx 2 physical examination 3 communication and interpersonal skills 4 spoken english which is not going to be evaluated by check lists but by sp's evaluation 5 pt note. do we have to pass in every single of those or there is some kind of combination like data gathering includes hx and physical exam. so their check list scores are going to be combined together and they add up that with pt note . that will be considered as clinical skills while spoken english and interpersonal skills and communication are going to be integrated together. If first is the scenario like u have to pass in every single check list then i think it may be little tough as u may perform very well in one but may not do good in other check list areas. does any body know about that . please let me know.
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| msashraf
Forum Senior
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Posts: 156
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hi as far as i think data gathering include both hx and physical exam.
to help u understand scoring on csa i am goin to copy from kaplan's csa book it says that for each case 4 scores will be given1. data gathering,2.pt note 3.spoken english, 4.interpersonal skills.The data gathering and pt note scores are combined and are averaged across the 10 scored cases to create a single score for the integrated clinical encounter(ICE).THE same is done with ur interpersonal skill and spoken english scores to create an overall communication score.To pass the CSA u must achieve a passing score on both the communication and ICE components.Bcoz the scores are averaged across the cases, u can compensate for poor performance on some cases by excellent performance on others.
I hope this would cleared things for u.
Goodluck with ur result.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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thanks mashraf.that is what i understood too but it was shattered by my friend who took kaplan workshops. he was saying that in cs the scores are evaluated in five different things and inorder to pass the exam u have to pass in all 5 areas.1 hx which is going to have 15 to 16 check lists.2 physical exam which is going to have only 5 to 6 check lists. 3 spoken english is going to be evaluated by score from 1 to 5. 4communication and interpersonal skills which is going to have 10 to 12 check lists and finally 5 pt note which is the only thing which is going to be evaluated by physicians and it is the least imp thing.Inorder to pass u have to pass in all 5 criteria but the feedback i received from ecfmg in pipe, they evaluated in 3 data gathering, communication and interpersonal skills and finallyspoken eng.they mentioned that they did not send any feedback in pt note. from their feedback i understand that data gathering is actually the combination of hx and physical exam.i have read what kaplan step2 cs book says and what first aid says. it is hard to understand. my exam is already over. i was just curious. i do not want to think about that too much.hopefully i'll pass inshaallah.thanks though.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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also i agree that each check list is going to be averaged in 10 patients.
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| msashraf
Forum Senior
Topics: 7
Posts: 156
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dont worry inshaAllah u will pass the exam.i didnt take the workshop but have the book.i am taking the exam on 23 nov. hope everything will go smoothly.did u have any telephone encounter? how did u manage that??
goodluck for ur result.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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the telephone encounter and female gyn were the easiest encounters because i didnt have to be worried about the time because there was no need for phy exam.In these cases however counselling plays very significant role.. In tel encounter u have to convince the mom that it is really very imp to bring the child for physical exam.the only thing u find inside the room is one tel. u have to push speaker button, then u will listen dial tone and then the mom will pick up. after greetings u can ask the open ended questions and the whole encounter is going to be on tel.remeber do not push the speaker button once again otherwise the encounter will be over. when u are convinced that u are ready to finish the encounter u can finish the speaker button once again and the encounter will be over and then u can leave the room. In atleast five patients I was struggling for time. time is key.do not waste too much time outside in writing all the vitals and patient name.just write the vitals which is significant and only last name , even u do not write outside it is ok, u can always see the same information on the side table inside the room.one thing i wrongly mentioned about the check list before.in physical examination it is going to be 6 to 8 check lists instead of 5 to 6 which i mentioned earlier.also my advice is do not try to leave early. make most of ur time inside.u will remember most outside when u start writing. and most of these patients are not going to have any physical findings. also my advice is not to waste too much time in writing notes inside.time is key.4 of the 5 things is going to be evaluated by sps. the inside encounter is most imp.all these encounters are carefully planned for 15 min.i did not take any kaplan course but i got good advice from my friend who took kaplan workshops and check list thing was mentioned by him. i knew only what kaplan book and first aid says. i was just curious.hopefully the result will come on time .already they are delaying a lot.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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also most of these cases have wide range of diagnosis. if u come out of the room early and u have only one or two diagnosis, think once again u might have missed the case entirely.so it is very imp to stay inside the room till the last second. the only two patients where i could not stay till last moment was female gyn patient and tel encounter where u were not supposed to do phys exam.it is just my advice. everybody is obliged to do what he thinks is right.
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| msashraf
Forum Senior
Topics: 7
Posts: 156
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thanx for the info, just one more question we arentt supposed to examine obgyn pt not even lung and heart auscultationa nd abdominal exam.?
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| dacis
Forum Junior
Topics: 1
Posts: 75
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You can examine ob/gyn patient . Just don't do gynecological and breast
exam . You can and should if necessary palpate and auscultate the abdomen , listen to lungs and heart and also examine the neck for thyroid if Pt. has irregular cycles or amenorrhea . If you suspect prolactinoma in Pt. with menstrual problems and headache don't forget to examine visual fields .
Good luck in exam .
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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dacis is right . If u are supposed to do physical examination in obs gyn patient, then u must do phys exam, u can do thyroid , abdo cvs , peripheral extremities,cns etc because most of these cases are going to have multiple d/d, just like case can be gyn but cause can be cns, abd or thyroid.. If the patient is pregnant and less than 20 weeks , u have to do abd exam.If she is more than 20 weeks (which is unlikely for this exam) u may do leopald maneuvre. Dont forget to auscultate heart and lung sounds in every patient even the case is not related . they are going to be in check list of every single patient. u can even check femoral pulses. Only thing which is forbidden is internal pelvic, corneal reflexes and per rectal examination. If they do not require physical examination then they will mention that and patient wont be in hosp gown, just like I had in my encounter. In these cases u are not supposed to do physical exam, they may mention the findings in their note.even the gag reflex is allowed but i dont recommend it.in their orientation they will mention what is prohibited and they mentioned only these three things.all the rest is allowed.u will do good. just remeber time is key. how do u manage, that will count. In three patients i could not counsel bec i did not have time.counseling is the part of check list in communication and interpersonal skills and u have to pass that too inorder to be passed.hopefully i'll pass inshAllah. i cannot wait for my result because i have to take step 3 very quickly.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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also they mentioned not to do breast exam, sorry not to mention before.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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if physical examination is not required, they will mention in their note that physical examination is not necessary.if u miss outside u can see the note inside on the side table. in these scenarios she wont let u examin anything anyway even u ask.
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| msashraf
Forum Senior
Topics: 7
Posts: 156
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dacis and samisyed1 thanx a lot for the info one more question what knid of qs do sps generally ask??
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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they can ask question or they can behave something weird, remember everything is planned, they just want to see ur response, for example, they may laugh at something , they may go to sleep during encounter, or they may be annoyed of being late..if they ask something remeber never to give false assurance, for example if serious patient is asking am i dying, never say u will be ok, that is a false assurance, that will go very negative.u can ask why are u concerned . even then he may insist u can say i 'll do every thing possible to make u comfortable but i am in the middle of gathering information, i may be able to tell after i'll collect all the information, they may ask will i be ok, something like, also they can check u from body language for example whatever u are saying he may not be listning like that. remember not to dispose anything on the floor. if u find anything on the floor it is better u pick up and put in the trash. communication and interpersonal skills is the most difficult part of the exam particularly for imgs. I did not perform very good in the pipe in that . hopefully i might have performed better in the real exam.good luck for ur exam.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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one more thing i have learnt about check list . u must have to do 60 to 70 percent of check lists area inorder to pass that. it can vary from 60 to 70percent but wont go less than that.also in the usmle bulletin they mention data gathering and physical examination separately.so i think discussions in kaplan workshops is right u have to pass in all 5 criteria inorder to be passed. and u have to have 60 to 70 percent of performance done in every single area.it is scary. hope we all will pass.
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| msashraf
Forum Senior
Topics: 7
Posts: 156
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thanx a zillion for ur help.I pray to God that we all pass this exam bcoz it is to expensive to retake.
Good luck for the result.
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| samisyed1
Forum Junior
Topics: 5
Posts: 68
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yes it is too expensive to retake, cannot afford to fail, u know in one check list every sp has to check that will u consider him ur primary physician.lol.scared and too anxious now.
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| asmi
Forum Hero
Topics: 1043
Posts: 4,609
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yes its on nerves for all of us ..hope we all pass it .
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