Step 2 Clinical Skills

ExamHow to pass with flying colors

Overview of ExamO Ten to twelve cases

O 10 are scoredO Adults only

O Pediatric cases will be parentsO 15 minutes per clinical encounterO 10 minutes per progress note

Overview of ExamO Grading

O Integrated Clinical EncounterO Data-gatheringO Progress Note

O Communication/Interpersonal SkillsO Spoken English Proficiency

Clinical EncounterO Doorway Note (20 seconds)O History (7 minutes)O Physical (4 minutes)O Closure (4 minutes)

O Tip: Don’t shortchange the closure, this is the primary means of evaluating communication skills

Clinical EncounterO Doorway NoteO IntroductionO HistoryO PhysicalO Differential DiagnosisO WorkupO Answer questionsO Provide counseling

Progress NoteO History

O Bullet or narrativeO Abbreviations are acceptable

O Physical ExamO Be honest

O Differential DiagnosisO Up to 3 items prioritized with H&P findings

supporting each diagnosisO Work-Up

O 3-5 itemsO Tip: if you are running out of time, start at

bottom of the page

Why do folks fail?O Vanderbilt students do not fail

because they lack knowledge.O Vanderbilt students do not fail

because they lack communication skills.

O Vanderbilt students DO fail because they fail to meet the checklist requirements that the SP is looking for during the encounter.

Common ErrorsO Failure to introduce yourself to patient

O Use patient’s name, state name, handshake, explain role

O Failure to perform a patient-centered interview/examO Repeat back what you hear, reflect back

emotion, summarizeO Ask permission to perform touch patient,

introduce maneuvers, explain findingsO Use of jargon

Common ErrorsO Failure to show compassion

O Acknowledge patient’s painO Acknowledge patient’s emotion

(sadness, anger, etc)O Touch the patient appropriatelyO Keep the patient comfortable (help

them sit up, lie down, draping)O Failure to Summarize

O Must be done at least once

Common ErrorsO Lack of clarity of differential/plan

O Verbalize your differential diagnosisO Outline a clear plan

O Failure to ask for questionsO After answering them, ask again

O Missed opportunities to counselO Most encounters require some counseling

O Failure to empower/collaborate w/ patient

Common ErrorsO Missing or rushing through the

“embedded concern”O Look for this in each patient (open

ended question at the end)O Acknowledge the patient’s emotion

(empathize with them!)O Answer honestly but reassuringlyO Repeat the opportunity for them to

ask further questions

Final TipsO You don’t have to be perfect!O SPs are easier than real patientsO There is a reason for everything you

see