Simulated Office Orals

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CFPC has some practice SOOs. "Self-learning" is also there. CPFC is cracking down on sharing of copyrighted questions. Collaborate to create open-access SOO repository, with UWO and CFPC blessing.

tanyathornton@hotmail.com MScCl, presented to us re: how to succeed at SOOs.

 

 

Introduction

SOOs evaluate the patient-centred clinical method first, then to diagnose and manage problems.

The two problems are usually related in some way; getting the context is important.

Your ability to deal with patients: establish effective relationships and understand the patient's experience.

Getting the right diagnosis is important, though plays a minor role in scoring.

Five stations: 15 min/station, 2 problems/station.

Patient = examiner

No physical exam

Failure is >2SD below mean.

Involve the patient: FIFE

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Advice and Strategies

Practice extensively.

Bring family/friends to return.

Prepare te FIFE questions.

Don't forget family history.

pauses are not a problem as you gather your thoughts. If you forget your train of thought, have a standard question to fill the space - "do you have any questions so far?"

or, I'm going to ask you a few further questions. PMHx, FHx, DADS, etc

 

Timing

Examiner will provide a prompt at the five minute mark if you have not identified the second problem. You can explore the first issue and simply wait for the patient to throw out the second.

 

First 12 minutes:

Last 3 minutes:

 

Examiner perspective

Do what you need to be liked:

Explicitly FIFE each problems

 

Structured vs Unstructured

Practice template

PQRST x2

FIFE x2

FHx

PMHx, SHx

DADS: drugs, allergies, drinking, smoking

social

finances

childhood

 

 

 

 

Conclusion and Wrap-Up

Time your sessions. Wrap up at the three minute mark. Context integration statement: provide a synthesis of all the material. summary statement, context integration.

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Scoring

Score is increased by encouraging discussion, providing patient with opportunities to ask questions, encouraging feedback, seeking clarification and consensus, and addressing disagreements.

11 categories, each out of 3:

 

  • problem
  • context
  • management
  • process and organization
 

HPI

Illness Experience

superior certificant

covers points 1,2,3, and 4.

 

Actively explores the illness experience and arrives at in-depth understanding, through verbal and non-verbal communication. This includes both effective questioning and active listening.

certificant

 

covers points 1,2,and 3.

 

Inquires about the illness experience to arrive at a satisfactory understanding.

non-certificant

does not cover 1,2, and 3.

 

Demonstrates only minimal interes in the illness experience and so gains little understanding of it.

Little acknowledgement of patient's verbal and non-verbal cues.

How well do you understand this person?

Social and developmental history: relationships, finances, work, upbringing (at times)

 

history

ability to integrate issues

superior certificant

covers points 1,2,3, and 4.

 

demonstrates initial synthesis of contextual factors, and an understanding of their impact on their illness experience. Empathically reflects observations and insights back to patient.

certificant

 

covers points 1,2,and 3.

 

demonstrates recognition of the impact of the contextual factors on the illness experience.

non-certificant

does not cover 1,2, and 3.

 

demonstrates minimal interest in impact of contextual factors on the illness experience, or cuts the patient off.

 

plan

finding common ground

superior certificant

covers points 1,2,3, and 4.

 

Actively inquires about the patient's ideas and wishes for management. Purposefully involves the patient in the development of a plan and seeks her feedback about it. Encourages the patient's full participation in decision-making.

certificant

 

covers points 1,2,and 3.

 

Involves the patient in the development of a plan. Demonstrates flexibility.

non-certificant

does not cover 1,2, and 3.

 

Does not involve the patient in the development of a plan.

 

Entire encounter should have sense of structure and timing.

  • Good direction, with sense of order and structure
  • conversational, rather than interrogation
  • flexibility and good integration of all interview components; should not be piecemeal or choppy
  • appropriate prioritization, with efficient and effective use of time for various interview components

superior certificant

Demonstrates advanced ability in conducting an integrated interview, with clear evidence of a beginning, middle, and an end. Promotes conversation and discussion by remaining flexible and by keeping interview flowing and balanced. Very efficient use of time, with effective prioritization.

certificant

 

Average ability in conducting an integrated interview. Has a good sense of order, conversation, and flexibility. Uses time efficiently.

non-certificant

Demonstrates limited or insufficient ability to conduct an integrated interview. Frequently lacks direction or structure. Man be inflexible/overly rigid, with interrogative tone. TIme inefficient.

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Resources and References

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