History Taking and Physical

The sample checklist items are examples of what may be relevant to the assessment of your performance.

For instance in a patient with a rash, .

  Communication Skills

• Skills in interviewing and collecting information
  • the clarity of your questions;
  • the effectiveness of your questioning techniques;
  • appropriate use of medical language;
  • your verification and summarization of information with the patients;
  • the effectiveness of your transitions between different parts of the interview.
    
    
• Skills in counseling and delivering information
  • the clarity of the information you give;
  • the effectiveness and sincerity of your counseling;
  • the thoroughness of the encounter closure;
  • the clarity and appropriateness of your speech;
  • the effectiveness of your summarization of information and how you link various information together.
    
    
• Rapport (connection between doctor and patient)
  • your attentiveness to the patients;
  • the appropriateness of your body language;
  • your confidence level and attitude;
  • the level of empathy and support you show the patients.
    
    
• Personal Manner
  • your manner of introducing yourself to the patients;
  • the appropriateness of how you expose and drape the patients;
  • your manner while conducting physical examinations;
  • the appropriateness of your demeanor.
    
    
• Spoken English Proficiency
  • your ability to communicate understandably;
  • your pronunciation and grammar;
  • your ability to correct or clarify your language when needed;
  • the amount of effort required by patients to understand you.

Communication Skills Rating Scale

The following scale is used by the SPs to rate your communication skills performance. A rating scale is completed for each of the eleven stations.

Item 1. Skills in Interviewing and Collecting Information

(clarity of questions; open vs. closed questions, verification, summarization, transitions)

Item 2. Skills in Counseling and Delivering Information

(giving information, counseling, closure, language and speech, summarization and connection)

Item 3. Rapport (connection between doctor and patient)

(attentiveness, body language, confidence, attitude, empathy and support)

Item 4. Personal Manner

(hygiene, draping, physical examination, demeanor, introduction)

Item 5. Spoken English Proficiency

(ability to communicate understandably, pronunciation and grammar, amount of effort required by patients to understand you)

Patient Note (PN)

Your final PN score is the average score you earned across the ten scored exercises.

Integrated Clinical Encounter (ICE) Score

The DG and PN scores are combined to form an ICE score. Your final DG and PN scores reflect your average performance across ten scored encounters. Therefore, you may compensate for poor performance in one encounter with excellent performance in another.

Communication Skills (COM)

Score Reporting

The Day of the Assessment

You cannot, during breaks or at any time, discuss the cases with your fellow candidates. Conversation among candidates in languages other than English about any subject is strictly prohibited at all times during these breaks. Examination proctors will be with you to monitor activity. To maintain security and quality assurance, each examination room is equipped with video cameras and microphones to record every encounter. Please conduct yourself as you would during a normal day in a clinic.

General Comments

• Greet the patient and state your name. (Hello Mr. Skeet (Name will be provided on the description sheet) I am Dr. Patel. How are you today?)
• Elicit or confirm the patient’s name. (I am told you are Mr. Skeet - is that right?)
• Never attempt to communicate with the patient other than as a physician to a patient. (Do not ask him - so have they trained you to be a patient? or any such thing not related to the enacted situation)
• Feel free to take notes during the encounter. (Blank paper will be provided.)
• Don’t make assumptions about what you will see in each encounter. (You may truly see people with real findings or some without real findings)
• There may be more than one case testing related or similar clinical entities. (E.g. you may see more than one case with GI bleeding or chest pain or other common problems) 
• Concentrate on the case on which you are working. (Do not despair that you may have messed up the previous one - focus on doing your best at the next one)
• Notify proctors of any problems.

History Taking

• Begin with broad questions and then focus your inquiries.
• Don’t rush the patient’s answers. (Allow them to complete their statement)
• Don’t cut the patient’s answer off with another question.
• Repeat your questions in different terms if necessary. (Your term used may not be the common term in the US - e.g. how are your waterworks in the UK is equal to Are you having trouble with your urine? or are you able to Pee alright?)
• Ask follow-up questions. (Like in a case with diarrhea, - how many bowel movements have you had in the last 24 hrs, is there any blood in them, is there any mucus etc.)

Physical Examination

• Do a focused examination based on the patient’s complaint, symptoms, and history.
• Wash your hands between patients, preferably before touching the patient or beginning the physical examination.
• Tell the patient when you are going to begin the physical exam. (Can I examine you sir? or Can I check you now?)
• Describe the maneuvers either before or as you do them. (I am now going to check your heart.....I am now going to listen to your lungs......Now take a deep breath in and out a few times...............Let me examine your liver area...... etc)
• Always use patient gowns and drapes appropriately to maintain patient modesty and comfort, but never examine through the gown.
• Use the examination table extension when the patient reclines.
• If you ask a patient to get off the examination table, offer to assist him or her. Pull out the step if not already pulled out.
• Look for physical findings.
• Do not perform rectal, pelvic, genitourinary, or female breast examinations.
• Tell the patient your initial impressions and your plan for the diagnostic work-up. (I feel you most likely have Gastro - enteritis and nothing major needs to be done at this point but there are other possibilities like an overactive Thyroid gland or mild colitis so one should do some preliminary testing involving a thyroid blood test called TSH and studying a stool specimen for the presence of bacteria that can be harmful and if need be one could proceed to test for malabsorption and a test where we look inside the colon called colonoscopy )
• Ask for and answer any additional questions. (Do you have any questions for me?)
• Note the time warning for 5 minutes remaining in the encounter.
• Close the encounter when the "End of Encounter" signal is given. (Thank you for choosing me as your doctor  or thank you. We should get to the bottom of your problem quickly and get you better soon - bye now)

Communication Skills

• Make eye contact.
• Ask clear questions and speak understandably.
• If you use medical terms, explain yourself.
• Be direct and honest, but also be sensitive.
• If you don’t know the answer to an SP’s question, say so.
• Don’t give false reassurance or a premature diagnosis.
• Acknowledge the patient’s concerns or worries.

Patient Note

• Approach the note as if you are communicating with another health professional.
• Write legibly.
• If necessary, refer to the notes you took during the encounter.
• Group similar data together.
• Write out information in a logical sequence.
• Clearly portray the patient problem.
• Be accurate.
• Be specific.
• Identify critical elements.
• Include pertinent positives and negatives.
• Make sure your plans for further diagnostic work-up are reasonable.
• Do not include treatment in your plans for diagnostic work-up.