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How to do well on the EOF CSE (End of Foundations Clinical Skills Exam)
Preparation
o Review Bates and your physical examination handouts from BAD (complete head-to-toe and organ
system exams).
o Remember that you will be rated on doing a comprehensive history and physical exam accurately and
interacting appropriately with your patients. Be as thorough as possible-if you don’t ask a question or
perform an exam, we cannot judge whether or not you can do that skill.
General
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Greet the patient and state your full name and role (2nd year medical student or student doctor).
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Elicit or confirm the patient's name and age.
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Address the patient formally (Mr., Mrs. Ms., etc.) or ask how the patient would like to be addressed.
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Always stay in your role as a medical student and allow the actor to stay in his/her role as your
patient. Don’t say anything to them that you would not say to your “real” patients. Do not talk to
the camera or explain other than what you would naturally do with patients. The more you are able
to interact with the patients as “real patients” the more you will get out of the experience and the
better you will do.
History & Physical Exam
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Develop the chief complaint – ask all of the LOCATES questions and use your differential to guide
you.
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Begin by using open-ended questions (plural) and progress as needed to more directed questions.
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Ask about past history, family history, social history, medication history, allergies & ROS etc.
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Perform a complete (comprehensive) physical examination.
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Do a comprehensive physical examination based on the patient's complaint, symptoms, and history.
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Demonstrate good technique – standardized patients may have real findings related to or
incidental to their current complaint.
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“Foam in, Foam out” or wash hands at any point prior to the physical exam.
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Keep the patient informed of what you are doing as you examine him/her.
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Use the examination table extension when the patient reclines.
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If you ask a patient to get off the examination table, offer to assist him or her.
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Always use the patient gown and sheet appropriately to maintain patient modesty and comfort, but
never examine through the gown or clothing.
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To auscultate or palpate the heart (for example of the PMI) or examine a female patient’s lungs, you
should move/lift the bra (or ask the patient to do so) to allow palpation or auscultation. Do not
remove a patient’s bra.
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To examine the abdomen the entire examination area must be exposed from the lower edge of the ribs
to the iliac crests
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Consider all parts of the encounter to be a part of the exam (for example, bruises, scars, anything out
of the ordinary, etc.).
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Do not perform corneal reflexes, gag reflex, sternal rubs, breast, pelvic, rectal or male GU exams.
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If inguinal nodes or femoral pulses are relevant, it is okay to perform these exams.
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Do not use sharp objects to repeatedly test sensation on the same area. Test - and if the patient cannot
tell whether it is sharp or dull accept that - then move on to another area.
Communication
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Make eye contact.
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Ask clear questions and avoid or explain all medical terms.
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Be direct and honest, but also be sensitive. Acknowledge the patient's concerns or worries.
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If you don't know the answer to an SP's question, say so.
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Don't give false reassurance or a premature diagnosis.
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Wrap-up/Discussion
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Note that there will be a time warning indicating that you have five minutes remaining in the
encounter.
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Use the remaining time to complete the most important portions of the exam that you have not done
yet.
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Tell the patient the results of your examination. For example, “I did not find anything abnormal on
your physical exam.”
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Ask for and answer any additional questions.
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Tell the patient you are finished with your exam and thank him/her for his/her time and say goodbye.
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