Sample Written History And Physical Examination: Fill & Download for Free

New EMTs are taught to use the following two mnemonics as a starting point in their prehospital assessment, which include the key information healthcare providers need to know.SAMPLE & OPQRST(I)S: Signs and SymptomsA: AllergiesM: MedicationsP: Pertinent Past Medical HistoryL: Last Oral IntakeE: Events Leading to Injury or IllnessO: Onset (what were you doing when it began? was it sudden? were you exerting yourself?)P: Provocation (does anything make it better or worse? e.g. sitting, touching, temperature, etc)Q: Quality (what does it feel like? e.g. sharp, dull, burning, throbbing, etc)R: Radiation (is the issue in one place or does it move to other areas?)S: Severity (how bad is it on a scale of 1 to 10, with 10 being the worst)T: Time (How long has it been going on? has it changed at all? how?)You can also add an "I" for Interventions: what have you done to treat it?If the answers to these questions change, it'll be good to have a baseline to compare it to. For example, if the pain was a 3 out of 10 and changes to a 7, you'll have a record of that trend.The answers to the above, combined with physical examination, vital signs, and follow-up questions related to their complaint, help cover the bases and paint a picture for verbal and written reports to other healthcare providers that will be continuing care (e.g. Doctors & Nurses).

There is a post on quora by respected collegue dr kesha megharaj on how to clear MRCS part B OSCE…and its a very valuable post…infact it was one of the extremely valuable guidance i found for preparing for MRCS part B OSCE exam.Now i would like to share my experience with this exam.Before that i would like to tell a bit how the exam works.You have 18 stations in OSCE circuit and 2 preparation stations( where you will be given a set of notes which you have to evaluate before going to the next station) and 2 rest stations( where you will be just sitting doing nothing).Of these 18 stations8 stations on knowledge3 stations from anatomy( 1 station on head and neck anatomy,1 station on thorax and abdomen antomy,1 station on upper and lower limb anatomy).2 stations on surgical pathology3 stations on critical care.You are required to pass in these 8 stations as a whole(not individual stations) to secure a pass mark in knowledge section of the exam. Each station is of 20 marks .Total mark is 160. The required pass mark is around 107–111.The time for each of the stations is 10 mins( 1 min for reading the task outside the station and 9 mins you face the examiner).10 station on clinical skills4 stations on physical examination( eg hernia examination,CVS examination)2 stations on information giving( eg.breaking bad news to a patient/ telephone conversation with a senior colleague regarding transfer of sick patient)2 stations on information taking( history taking)2 stations on procedures( eg suturing a wound,foleys insertion)The total marks in these 10 stations is 200( 20 mark each). The pass mark is around 127-130.The time for each station is 10 mins( 1 min to read the task outside and 9 mins to face the examiner)knowledge part ( 8 stations)Regarding the knowledge part ( 8 stations)You can pass easily..not a big deal.Few things you need to read up arePassthemrcs online resource is the best resource .Anatomy book of vishy mahadevan …extremely useful book to cover up the whole anatomy part in a short time.Anatomy pictures from macminn atlasDont waste too much time reading unnecessary resources as you may lose useful time.Skills part ( 10 stations )Regarding the skills part ( 10 stations ) only one thing…u need to practice and practice….only this thing will help here.Useful resources are1.Passthemrcs best useful resource2.Gikymedic videos from youtube but i preferred the giky medic app which you can download from google play.Now i would tell in detail about each of the skills part stations.4 stations on physical examination- here you have 1 min to read the task…6 mins you only examine the patient …3 mins you face the examiner.Things to do1.read up the task carefully outside the station.2.wash your hands before touching the patient.3.greet the patient by saying your name and identity and ask the patient his name and identity.4.ask him if he has any pain and assure him that you will be gentle.5.expose the patient and kneel down while examining any lower limb pathology.6.ask for a chaperone if it involves exposing the breasts or gentilia of the patient.7.examine the patient without giving him any distress and communicate with the patient throughout your examination by speaking to the patient about what you are going to do in front of the examiner.8.Wash hands ,cover up the patient and thank the patient after examining.9.if you have applied any jelly during examination for eg during doppler examination do clean that up with a gauge/ cotton.10.next turn towards the examiner and summarise your findings confidently and answer the questions the examiner asks.The station does not require you to take a history. So stick to examination strictly .If you are given a critically ill patient for examination eg a patient of peritonitis due to anastomotic leak present the case in CCrISP -ABCDE protocol ( do not go for individual system examination in this cases) and do interpret the vitals chart and drug charts given along with it.2 stations on information giving-You will get1.One station in which you have to face a actor( patient/ patient relative) and counsel him( eg regarding consent for a surgery or breaking bad news).you cant use medical words during this conversation as you are speaking to a non- medical person.2.One station in which you speak on phone to a medical colleague regarding transfer or management of a patient . You can use medical words and present the case in SBAR format.Both these stations will have one preparation station ( 1+9 mins ) for reading the notes and you speak to actor/answer telephone call in next station.Things to doRead the notes carefully at the preparation bay and make your own notes on the pad that is provided.Introduce yourself and also ask for identity of the patient/ relative of patient.Gain insight of what they know.( Eg before asking for consent for surgery ask what they know about the surgery).Speak slowly in clear words and listen carefully to what the patient/ relative tells you. Nod your head indicating that you are listening and dont interrupt the patient while he is speaking.Be empathetic towards patient/ relative for eg say I am sorry if you hear that the patient had lost his parents due to a illness.Confirm what they have understood at the end of discussion and summarise .Thank the patient/ relative.Regarding speaking to a medical colleague on phone present case in ISBAR format( I- introduction,S- situation,B- background,R- recommendation).This station is all about communication and empathy.Speak slowly and clearly so that actor can understand what you say.You will find two examiners in the station where you face the actor…one is a medical examiner who checks your medical knowledge and one is a non-medical examiner who checks your empathy and communication.Maximum indian candidates fail this station so practice very well the scenarios .2 stations on information taking( history taking)- you will face a actor inside the station from whom you are required to take a history and summarise your findings to the examiner.The time duration for each station is 10 mins( 1 min for reading the task+ 6 mins to take detailed history from patient+ 3 mins to summarize your findings to the examiner).Things to doRead task carefully .Sit at same level of patient …if patient is sitting sit in front of patient..if patient is standing stand and offer the patient a seat.Introduce yourself and ask identity of patient.Listen carefully, dont interrupt while patient is speaking and be empathetic .( Eg saying i am sorry to hear if he tells he is very troubled by his illness).Do keep eye contact with patient .You can take notes while talking but inform the patient that while you are taking notes your ears are fully dedicated towards listening to the patient.Thank the patient at the end of history .If possible summarise to the patient the history that he gave and crosscheck important points given in history…it gives good marksAt the end of history takng 6 mins turn towards the examiner after thanking the patient and summarise the history and answer the questions asked.Handwashing not mandatory as you are not touching the patient in any way.You are marked not only on your ability to take a proper history in a sequential manner but also on the empathy, body language,eye contact,listening ability. So do practice and practice and do proper time management.Here also you will face two examiners one is a medical examiner who checks your medical knowledge and one is a non-medical examiner who checks your empathy and communication.2 stations on procedure skills- total 10 mins…1 min for reading the task+ 6 mins to complete the task( eg suturing / abscess drainage) + 3 mins to answer the questions.Things to do1. Read task carefully2. Check patient identity and check wrist band for any allergy ( eg lignocaine allergy)3. Introduce yourself first.4. Explain procedure to patient and gain consent.5.wash hands and check written consent6.follow WHO check list and follow sterile precautions.7. Calculate dosage of LA from body weight of patient8.check for effect of LA by pinching with forceps before putting the incision.9. Discard sharps and gloves and drapes accordingly.10. Give patient proper advice on antibiotics and analgesics.11.offer to put down notes of procedure after the task.12.offer to label and fill forms for any sample collected eg labelling of pus culture swab13. Thank patient at end of procedure and wash hands.Patient may ask you some questions eg . when to remove sutures….these are questions that carry marks so do answer them carefully .I have put the exam format in the best possible way.MY EXPERIENCEI passed my exam from RCS Edinburgh in chennai,2019. I had given the exam earlier in march 2019 in delhi but failed by 3 marks in skills section.So in my second attempt i practiced the skills part throughly and made it.Exam preparation time is 4–6 months of dedicated study everyday for 4-6 hrs.Reading theory only doesnt help ..rather practicing helps.Courses i attendedRCS Edinburgh MRCS OSCE course Delhi December 2018RCS England MRCS OSCE course Hyderabad jan 2019KAUVERY MRCS OSCE course Chennai,2019RCS England MRCS OSCE course delhi july 2019.The best was KAUVERY MRCS course as it was a 3 day extensive course focussed on mistakes Indian students commonly do and expert guidance of respected Dr ambika maam and other respected faculty.Recently there is also a online course called Bootcamp which is also very useful.( This is what my friends who passed the exam told me but i myself have not done this course).Easy exam to pass.Choice of centre doesnt matter as its intercollegiate MRCS exam and all exams are of same standard although some may say that some centres have more passing rates. In my opinion if you are well prepared centre choice doesnt matter.Also i am a orthopaedic surgeon…and although this exam is a general surgery exam …orthopaedic surgeons can pass if they put some dedicated effort.All the best to all preparing for this exam .Thank you.

Not at all.I matched to my first choice which was Plastic Surgery at Stanford. Then when I switched from Plastics to Radiology after 2 years in surgery, I matched to my first choice again.You are constantly being evaluated and the interns, residents, and staff physicians on the specialty service turn in written evaluations on the med students who are doing rotations through their specialty.You are judged on whether you know your patients, their labs, their history and their disease. So you study the patient charts. I kept 3X5 on each one of my patients.The interns do the “work ups” taking history and doing physicals and writing orders. But the med students also take history and do physicals so the patients on a teaching service in a teaching hospital get questioned and examined by multiple people - interns, residents and med students. That is what the patients “sign up” for when they are admitted to the Stanford University Hospital and Medical Center.The med student is part of the team that takes care of the patient, and the med student is evaluated and questioned by the intern and residents. Do you know the results of the latest lab tests. What was abnormal? How can we correct that? What are the disadvantages and advantages of each treatment for this patient. Of the possible treatments, what is the best for this patient?“Crap” flows downhill. The resident gives orders to the intern and the intern gives orders to the med student. So med students do a lot of the “scut work”. In the days before electronic medicine, we went to the radiology dept and got the latest X-rays so they could be reviewed. We took samples to the lab. We got lab results. We did dressing changes. We held the retractors during surgery. You name it and we did it. We went to the medical library and read the latest journal articles. The list goes on and on.If you did a good job as a med student, you were taken as an intern in the specialty you wanted.