July 2019 COMLEX LEVEL 2-PE WEBINAR

This is covered in depth throughout the webinar – view the recording here.

If you are prepared, take Level 2 PE as soon as your school allows. 

NBOME requires you to pass Level 1 before you can schedule to take Level 2 PE.  There is no connection between when you should take Level 2 CE and Level 2 PE.

Improper mindset: While you are taking an exam and seeing standardized patients, be in the mindset that these are your patients. Allow them to tell their story and treat them as your patients. 

Lack of critical thinking:  Pay attention to your patient! It is common that students rush through the exam and miss answers or clues.  

Not attending to the humanistic domain: Building rapport with the patient is vital to passing this domain. Try asking questions such as, “How is this impacting you and your family?” or “What kind of support system to do you have?”

The use of prompting. Demonstration of critical thinking. Osteopathic philosophy – using the terminology. Review of systems for CC and other systems, then prompting.

Timing is critical. You must get to each section both in the clinical encounter and the SOAP note. You can leave the room early for more time on the SOAP but beware.

Review NBOME website, just a general read through. Practice cases; check with your school or buy a Level 2-PE Board review book. Minimally three months before your boards, start the TrueLearn Level 2 PE series and utilize on a set schedule. Identify your weaknesses and ask your attendings to help you with the areas you need improvement with.

30 second data sheet review, write mnemonic, 8 minutes or less on History, 6 minutes or less on physical, 2 minutes on dx and treatment, unless OMM, anticipate less history and physical and do 4 to 5 minutes maximum in performing OMM

Watch the presentation – view the recording here.

There is no rubric for the PE as areas to be examined will differ each case. The Biomedical/Biomechanical section is divided into three areas; Data Collection, OMM and SOAP. So although the Data Collection would have many more points and is more complex, you must pass the SOAP section. If you had poor SOAP notes throughout all encounters, you could fail Biomed/Biomech alone and fail the exam.

For psych cases including dementia, dedicate more time to history and less to physical exam. These are big cases to ask to involve other family members (don’t be surprised if you find two people in the room). Asking how the patient’s life is being impacted is paramount. For the neuro exam, you have to go a screen with some cranial nerves, reflexes, strenght testing. You won’t be able to or be expected to do a full MMSE with a complete neuroexam. MSK – inspect bilaterally including Active and Passive ROM if indicated, palpation.

Focus on the primary care shelf exams. Primary care are what these cases derive from.

Stethoscope & pen.

Angry, crazy, tearful, screaming patients.

Case by case. If you discover the patient is depressed, 80% of your encounter will be talking with the patient.

They think it is easy. 

If you leave before the end of session warning. Unless you really need extra time for the SOAP, you are being assessed on the patient encounter. Ask things like, “is there anything else I can do for you today?” or “Did I give you a chance to talk about everything you want to?”

2/2/3 bilaterally

Very unlikely that they would present with multiple complaints as they are not trying to trick you, but if did run into a patient with a list, do exactly that, ask what is most important and bring them back in a few days.

Ask for permission to exam areas and preserve dignity.

Confidence, accuracy and a pleasing demeanor.

I recommend a brief heart and lung exam on everyone but you do not have time for a full PE. It has to be problem focused, so for a truely MSK shoulder complaint, e.g. I hurt it lifting weights, you would do MSK, heart, lung and upper extremity neuro.