Patient note scoring - letsallget99

[ArchivalUser]

Hello everyone, I'm taking the test in six days and I'm wondering if anyone knows of exactly how they score the patient note??? I'm comfortable with english and physical- but when it comes to differentials and orders I have problems getting five on each... Do the end differentials and orders score more then the HPI and all other History components??? If anyone knows any helpful ways of how to pass the patient note please share Thanks a million

[ArchivalUser]

this is the link for Neerajs cs notes. read the 1st few pages. u will get the idea.

password for opening the pdf file is test

http://www.filesend.net/download.php?f=4...0db16ca8b8

the download link will appear at the bottom left hand side of the page in 10 seconds. Best of Luck.

[ArchivalUser]

Thanks for the great link After reading the pdf file- I'm still unsure of how they grade the patient note....My main concern is what scores the most points....My current plan is to do the differentials/plan first then do HPI followed by physical...If I was to score it- I feel this order would be the most crucial....Any help is greatly appreciated...Thanks again flanker99

[ArchivalUser]

this is what i got from irfankhan, its a part of cs notes, but since u want only the scoring part, i am pasting only this portion here. these arent my notes. they were forwarded to me. think this might help u

Most important thing about this exam is to make yourself more familiar about this exam so you
don™t have anxiety when you appear in exam. We are anxious because we don™t know how it
begins and how they calculate points. No one knows exactly how they give you points in exam
but here is some useful calculation about this exam which will reduce your anxiety.

How to Pass: We must pass all 3 components of exam in order to pass this exam

ICE “ Data gathering (40%) (History & Examination) & Patient note (60%)
CIS “ Cover 90% of what I have written in communication skills and you will be fine
SEP “ If SP understands what you are saying, you pass in this component!!!

¢
You should get 58% or more in ICE and you will be fine. In exam, there are total 12
cases and they count only 11 but we don™t know which case is not going to be count so
assume all cases are going to be count. You don™t have to pass on each case but you need
to pass as an average that means if you made so many mistakes on one case that will not
be a problem for you so practice those cases more which you feel easy because everyone
will definitely forget something in hard cases so try to get as many points as you can in
easy cases so your average score reach at or beyond 58%!!! Good patient notes writing
is essential to pass ICE component of this exam as you can see the percentage of patient
note (60%) on ICE.
¢
Communication Skills :
1.
Knocked
2.
Dress, Hygiene
3.
Introduction
4.
Eye contact
5.
Attention & Concentration
6.
Respectful & Non-judgmental
7.
Draping
8.
Transition
9.
Empathy
10. Reassurance without interruption
11. Open ended question
12. Non-leading questions
13. One question at a time
14. Lay language
15. Listen & Paraphrased
16. Connected & purposeful
17. Summarized diagnostic plan
18. At ease / not alarming
19. Asked / Answered appropriately
S.S.Patel.
All rights reserved.


¢
So now when you look at the point system, you should notice that the main anxiety of
this exam is CIS, not ICE which involve history questions and physical examination
(only 40%). After board increase passing standard on CIS, result of FMG on step 2 CS
has been dropped a lot. It was 89% passing rate before but now it drops even more
whereas it is still same for US student (96%). So concentrate more on CIS. If you think
about history and physical examination then you can easily ask question about chief
complain and related questions to chief complains by using mnemonics SIQOR AAA
PAM HUG FOSS but when you don™t use appropriate sentence at appropriate place with
appropriate way, you will loose point in CIS in which you need your average score
around 90%!!!!! You can pass ICE by good patient note writing which weigh 60%!!!!!
¢
My strategy was: œDon™t be anxious in any situation. I know I will forget to ask few
things in exam so instead of stressing that I put more weight on closing in each case.
Why? Because closing will cover 4 points of CIS and if you do closing you will increase
your chance to pass this exam. I personally believed that. I did closing in 11 out of 12
cases on exam. After I came out from each encounter, I remember atleast 3-4 things that I
forgot to ask but I didn™t worry about that and I removed that from my mind before I
started next encounter. I practiced how to behave (not look anxious) in exam and I
found it very helpful. When you think a lot about what to ask or if I forget to ask what
will I do, you will become more anxious and will do more mistakes so forget thinking
about that and just be relax. Kaplan has 1 day course that is basically exam simulation. I
found it very helpful. You feel that you are in exam. After exam, you will get your result
with SP™s comments. I passed Kaplan exam because I put more weight on CIS and
Patient note writing. My CIS score was 94% and ICE score was 62%. I passed ICE on
patient notes writing and history. My physical examination average score in most of cases
were 55% but my history score average was 80% and patient note writing score average
was 60%. I missed lot of things on physical exam because I wanted to do closing in each
case. According to me, on real exam I did a little improvement on physical exam and note
writing. We get result as pass so I don™t know exactly what I improved but that™s what I
felt after I took real exam.
¢
I used First-Aid cases for my practice. I practiced as I was giving an exam. I noticed one
thing that whatever you do during your practice, you will do same in exam with a little
improvement so practice seriously and in timely fashion!!! I practice patient notes writing
in 8 mins mode instead of 10 mins.
¢
Practice, Practice and Practice is the key to pass step 2 CS exam. Continue practice
until you feel that you don™t look confuse on exam and whatever you are doing on
exam sounds like a physician is doing that, NOT a confuse person!!!
GOOD LUCK

[ArchivalUser]

and this is the patient note writing part. again, thanks to irfan

Patient Note Writing:

As you know by now that patient note writing is essential to pass ICE component, you should
practice it more. There are two ways to write patient note.

First Way: (paragraph format)

HPI: 30 yrs old F comes in with abdominal pain since 12 hrs which started around umbilicus and
slowly increasing in intensity and reaching at 7 now. It is sharp and began after eating a large
meal. There is no nausea or vomiting. Pain is getting worst by moving around. She also has fever
with chills and rigor since yesterday.
PMH: One episode of UTI in past. No hospitalization in past.
NKDA (no known drug allergy)
FH: no major medical problem in family
Obs&Gyn: LMP 3 wks ago
Sexual: she has multiple sexual partners. Use OCP for contraception
Social: no smoking, alcohol or recreational drug. She is working currently. No change in weight
recently

Second Way: (The most useful way as I believed) Divide history section in two parts
(imaginary, don™t draw any line) This is a point format which is very useful because we have
very limited space for writing and we want to cover as many point as we can and we also want to
look our writing neat and clean. For those who are weak in English, this is the most useful
format as you do not need to worry about grammar!!!

HPI: 30 yrs old F with c/o abdominal pain Social “ No smoking, alcohol, recreat
-sharp pain, 7-8 in severity ional drugs
-below umbilicus, all over lower abd. Obs&Gyn: LMP 3 wks ago
-Start after large meal Sexual “ multiple sexual partners
-Moving around make it worst use OCP for contraception
-No nausea, vomiting, bowel problem
-c/o fever with chill & rigors and burning

micturation
PMH: UTI in past, no other problem in past
NKDA (no known drug allergy)

Do NOT use this format if you are going to type because it will take so much time.

Important thing to remember about patient writing is: write your most likely diagnosis in
first space because if your first place diagnosis is matched with their diagnosis, you will get one
extra point for that.

There are 4 points for differential diagnosis and 4 points for appropriate lab work.

S.S.Patel. All rights reserved.


Whenever you are in doubt about vitals, write down as it is on doorway information instead of
writing WNL (so don™t loose easy points). Always describe about patient™s general appearance “
like in distress or not in distress (will get 1 point for it)

Do NOT write examination as normal but write normal examination as follow:

CVS: S1 & S2, RRR, no murmur, gallop and rub
RS: CTA B/L
GI: BS (+), no guarding, rigidity and tenderness. Rovsing sign, Psoas sign and Obturator sign (-)
HEENT: normocephalic, non-tender, PERRLA, EOMI, TM™s, pharynx “ WNL. No nasal
discharge. Thyroid is not enlarged.
Neuro: A&O . 3, CN 2-7, 9,10,12 nl. Light touch sensation intact & motor (5/5) all 4 ext. DTR
(2/4) nl. (patella, brachial), nl gait.

Above are an examples but you need to add points according to what you find on examination

Write down whatever you found on examination “ most of the time you will find normal
exam as they are not a real patient so write down normal examination without confusing with
patient™s chief complaint. You may find positive tests for abdominal pain and you should write
down whatever you find like positive tenderness, positive rebound, etc. [For abdominal exam,
never apply more pressure as these are normal patient and they will give you a positive finding
even with a little bit pressure. Hurting your SP means you are losing your points.]

If you write your patient notes second way then you will definitely get more points and you
will be easily passed your ICE components.

GOOD LUCK


S.S.Patel. All rights reserved.