For this exam, you need to be able to evaluate completely a patient, offer counsel, and write an organized patient note. You won't have much time to do it so you must practice until you can complete all objectives on time; and to do so, an organized approach is recommended. The following is an example of how to perform during these exam, but you may make your own approach with which you feel more comfortable.

    1. Doorway.

    a. Do not start until it is indicated

    b. Read the chart

    c.  Make a differential diagnosis from the chief complain

    d.  Knock the door and enter the room

    2. Introduction

    a.  Respectfully salute the patient: "Hello Mr. Doe, I'm Doctor Smith, nice to meet you"

    b. Always smile, keep eye contact, be compassionate, and see if the patient is comfortable

    3.  History of Present Illness

    a.  Start questionnaire with an open ended question

    b. Make a complete description of the chief complain

    c.  Make short questions using layman language

    4.  Past Medical History

    a.  Ask about all previous medical conditions related or not to the chief complain

    b.  Ask for allergies and current medications

    c.  Evaluate social, sexual, and familiar history. If patient is a woman, as for menstrual history

    5. Review of Systems

    a.  Evaluate only the systems that are most probably affected suggested by the chief complain

    b.  Ask short yes/no questions regarding signs and symptoms

    6. Physical Examination

    a.  Do it as they were real patients

    b.  You may ask questions during examination

    c.  Perform a focalized examination

    d.  Be gentle, respectful, and compassionate

    e.  Never try to evaluate for corneal reflex, or perform a rectal, pelvic, genital, or breast examination. Mention the need for such procedures and write it on the patient note

    f.  Consider the vital signs from the chart as accurate

    g.  Perform an ophtalmoscopic evaluation if the patient presents with diabetes, hypertension or ocular complains

    h.  Properly expose the patient, and don't examine over the gown

    i.  Never repeat painful procedures

    7.  Closure

    a.  Briefly recapitulate the information

    b.  Ask if there is anything else that the patient might want to say, or if there is any concern about the condition

    c.  Offer counseling if required

    d.  Politely farewell the patient and leave the room

    8.  Patient Note

    a.  Use the SOAP organization to describe the patient's condition

    b.  List the differential diagnosis in order of probability

    c.  Only order diagnostic procedures, never prescribe treatments or consultations.

In the USMLE CD you will find information about the structure of the exam and an example of a patient note for you to practice. One of the most efficient ways to practice for this exam is to have someone who plays the role of a patient, and help you to complete all procedures on time.

There are cases in which the SP will act distressed and angry, and even might ask you challenging questions. In such cases, always remember to remain calmed, and answer only the truth in a polite and professional way.