*** The Mock Oral Exam is no longer administered; therefore, it is not part of your final grade. Since mock oral exams are frequently done during conference, the below info may help you better understand this important concept. ***
Mock Oral Exam
The following information is provided to the residents by Dr Harwood. It is a good summary for medical students rotating in emergency medicine to review what the mock oral does and what is looks for.
The real boards evaluate: 1) your knowledge of emergency medicine and 2) your facility with playing the oral board "game." You have at least 36 months to learn emergency medicine. The purpose of the "MOCK" oral boards is to improve your comfort with the "game" and improve your ability to play the "game."
Scoring
The exam is scored in eight areas:
Data acquisition
Problem solving
Patient management
Resource utilization
Health care provided (outcome)
Interpersonal relations
Comprehension pathology
Clinical competence (Overall)
The grading scale is: 1= Very Bad, 4=Fail, 5=Pass, 8=Perfect. In order to score a "5" and pass, you must complete all the critical actions for your case. Set expectations for residents are: EM-1's score a "4" on all cases with an occasional passing score. EM-2's are expected to pass ("5" or higher) 50% of the cases. EM-3's are expected to pass 6 or 7 cases. Graduates are expected to pass the real exam!
Rules of the Game
Like the real exam, you must be on time. If you are late, the clock will start without you. Even the best examinees will find it difficult to pass with a five minute handicap.
No talking or discussing the cases. It is only fair that all examinees be given a fresh chance to solve the cases. When your well meaning friend tips you off to the "easy case of strep throat", chances are you will also miss the retropharyngeal abscess.
Bring only a pencil. Scratch paper will be provided and must be left in the examiner's room.
Learning to Play the Game: Problems
Problem #1 Unnatural
The main problem with the "game" is that all the visual/auditory/olfactory clues you process instantaneously in real life, are missing from the exam. A real life patient that is hemiparalyzed (CVA), has ketotic breath (DKA) or is hot to touch (sepsis) can be sized up in 30 seconds. For the oral boards, this information must be methodically and specifically discovered.
Problem #2 Time
You may run into time problems. This is more common on the triple cases.
Problem #3 "Routine" Care
"Routine" Care at your hospital is never done on the exam. You must specifically order:
undress the patient
oxygen
pulse ox
oxygen saturation readings
IV's/Saline lock
Cardiac Monitoring
rhythm strip
Problem #4 Panic
It is easy to lose your way, become side-tracked, or find yourself in a dead end and then panic. This is especially true in the triple cases. Stay calm. You can pass many cases without actually getting the specific diagnosis.
Problem #5 Multiple Roles for Examiner
The examiner plays several roles including examiner, paramedic, patient, relative, nurse and consultant. Sometimes this is not done well and is confusing.
TIPS
Have an organized approach. After taking a side trip or ending up in a dead end, go back to where you left off and start gathering data from Hx, P.E., and tests.
Conserve time by cutting down on note taking. Write some notes in helpful. If you take extensive notes you may run out of time to take care of the test patients.
A suggestive approach is as follows:
At the very beginning of every case, before history is taken, get a mental picture of the patient. Ask "When I look at the patient, what do I see?" or "When I walk in the room, what do I see?" or "What is the general appearance of the patient?"
Before any history is taken, obtain a complete set of vital signs. The temperature may be omitted (on purpose). Getting a body weight and a pulse ox can't hurt.
Stabilize life threats (A-B-C-D-E)
Get an organized and systematic history from patient, paramedics, and/or relatives (don't forget medications, allergies)
Order monitoring (pulse ox, cardiac monitoring) and some tests (blood, urine, X-rays, CT's, ultrasounds, ABG's, EKG's)
Perform an organized and systematic physical exam (this is very unnatural and requires the most disciplined and practice).
Based on Numbers 1-6, get more history and tests as needed.
Establish the patient's problems and diagnoses.
Begin specific treatment.
Continually reevaluate the patient. After every order (a test or therapy), always ask for follow-up results. For example, after a hypotensive patient is given a fluid bolus, ask for repeat vital signs. If you order a Pulse ox monitor, immediately ask for the Pulse ox reading. If you don't ask, the information may not be given to you.
Listen to the examiner. His response may be a clue. If you ask for something and don't get it (a) you may be asking for it too soon and are supposed to manage the case on your own for a while, or (b) what you want is irrelevant. An examiner response such as "normal" or "negative" may indicate your question is about something that has little or no importance to the case. If the examiner asks you to "Be more specific" with a question, it might mean that the area in question has some importance to the case. If the patient gets worse, the examiner is probably telling you that something has been missed along the way. Stop, stay calm and think again.
Talk kindly to the "patient", "family", and "consulting physicians". Speak as if you are actually talking to them. You can speak "medical" to a consultant/RN, but should say "collapsed lung", not "pneumothorax to the patient/family member. This is part of your "Interpersonal Relations" grade-and free points from my point of view.
Think twice before discharging a patient home. In real life, if a patient has a sore throat, you would send him home. If a test patient has a sore throat, he should also be sent home and not admitted (Resource Utilization). However, make doubly sure you ar not overlooking some potentially life threatening problem. Make sure "just a sore throat" is not a paralyzed vocal cord, epiglottitis, an abscess, or diphtheria!
Scoring Criteria
Your score of the candidates's performance will be based on two criteria:
1. Critical actions- Each case is accompanied by a list of critical actions. The candidate must execute these actions to pass the case encounter.
2. Scoring components- You will also be evaluated in the following eight areas:
Data Acquisition- Did the candidate collect the appropriate data from the history, physical exam and laboratory to correctly diagnose and manage the patient, without going overboard?
Problem Solving- Did the candidate approach the clinical situation in an organized manner, collecting data from the history, physical exam and laboratory to correctly diagnose and mange the patient?
Patient Management- Was timely and proper treatment given? Were appropriate referrals obtained?
Resource Utilization- Did the candidate order the appropriate tests necessary to mange the case, or did he just shotgun? Shot gunning is disapproved and penalized.
Health Care Provided (Outcome)- From the perspective of the patient, and with reference to current medical practice and standards, was the best possible outcome achieved?
Patient Relations- Did the candidate interact well with the patient and/or close family members, allaying their fears, and treating them in a supportive and empathetic manner?
Comprehension of Pathophysiology- Did the candidate understand the scientific basis for his actions or did he simply rely on memorized routine procedures usually followed in such cases?
Clinical Competence (Overall)- All things considered, how well did the candidate handle these types of conditions or problems?