As part of my own preparation for the clinical exam, I attended a clinical course in Dunedin hospital, New Zealand. It was a week’s worth of intense clinical training, but definitely worth it. You could find out more about the course HERE.
So on that note, I would like to share with you some of the personal experience/feedback that I received from this course in the hope that you may not repeat the same mistakes that I did 😉
For the short case sessions:
• Follow the instructions as it is given to you. When asked to examine the hands, examine the Hands first, then proceed.
• Never forget the patient’s name.When presenting, remember to mention the patient’s name rather than referring to him or her as ‘the patient’
• Lying is a MAJOR sin…so NEVER EVER make up signs. Some examiners will fail you if you report signs that don’t exist.
• Make a draft of possible questions that could be asked by examiners in the short case.
• General observation is very very important. It could sometimes give you clues to the diagnosis.
• When observing patient at the start, stand from a distance. Don’t get too close to the patient.
• Don’t forget to ask permission before exposing the patient.
• Don’t examine thru clothing or “snake” stethoscope down shirts/gowns. Expose the patient properly.
• Look at the patient’s face from time to time to make sure that the patient remains comfortable.
• Tell the patient what you are going to do next and give clear instructions. For example, think about how you would get the patient to do a valsalva maneuver?
• Keep all equipment handy and out of pocket ready for use at any time.Be organized.
• Know your scars and when you see a scar, make it obvious to the examiner that you saw the scar by purposely pointing towards it.
• If you see a fistula, feel and hear for bruit.
• When doing a rheumatology hands exam, look at the hands properly. Don’t rush.
• When listening to the precordium, start from the apex.Listen with both bell and diaphragm.
• Feel the abdomen gently.Don’t hurt the patient. Hurt the patient and you’ll fail.
• Don’t percuss too hard.
• In a patient with polycystic kidney, there is usually a fistula present (but NOT always). Should be the first clue.There is usually a sense of fullness over the flanks.
• When doing a neuro exam, support the joint you are testing.
• When testing for power, compare each side as you go.
• Check soles of feet for sensation.
• Remember to fix joint when testing for power.
• When shown x ray films, do not touch the film (I’m not kidding!)
For the Long case sessions:
• Be concise and precise when presenting the long case. Don’t waffle. Stick to your time.
• When presenting the medication, group medications together according to their indication.
• You need to know what each medication is for.
• Find out how long they have been on the medication and if there has been a change in dosing.
• When presenting the examination findings, mention the general observations first.
• No need to mention the vital signs earlier on presentation of examination findings, rather you need to focus on explaining the finding of the relevant system.
• Find out the chronology of events.If medications were change, find out why?
• If the dose is unexpectedly low, ask why?
• Remember to screen for depression with SIG E CAPS.
• Ask about the patient’s expectation about the future.
• Be concise when presenting the patient’s initial presentation (make it into one sentence)
• Always put the patient’s perceived problem as problem number 1.
• Try and integrate patient’s social and family history together into the presenting complain (If relevant) as it would sound more matured.
• A past medical history consist of things that had happened in the past which is no longer an issue (inactive). Therefore, things like diabetes should never be in the past medical history.
• Avoid jargons and abbreviations.Use proper medical terms.
• Focus and practice on common topics (refer to set pieces and competing priorities by boutlis.com).
• If something doesn’t fit or doesn’t add up with the history or the drug list, ask why?
• Try to look at the ‘Big picture’. Think to yourself, why has the examiner chose this particular case as a long case. What is the crux of the issue
Have any comments or suggestions? We would love to hear from you.