SP Encounter/Practical/NBME Info

SP Encounter

During the final week of the IM clerkship, you will be assigned a Standardized Patient session. 

The session is run very similar to a Step 2 CS encounter.

• SP encounter (15 mins) - assessed by a checklist completed by the SP after you finish the encounter
  • The encounter involves a patient presenting with a straightforward IM problem. 
  • You are to perform a focused interview and focused physical exam of the patient.
• Post-encounter note (15 mins) on SP Center software
  • This involves documenting your SP encounter
  • And generating a prioritized differential diagnosis list
• Post-encounter clinical assessment via Canvas (15 mins) which focuses on clinical reasoning and a plan of care
• The grade for the SP encounter is determined by:
  • Checklist completed by the SP
  • Your Post-encounter note
  • Post-encounter clinical assessment
  • Review of your SP video by clerkship leadership

Practical Exam

This will take place the last week of the clerkship. It is in 2 portions:

1. Chest Radiograph & EKG Portion
   • 15 questions in multiple choice question format
   • You will complete this online via a Canvas quiz
   • For additional radiology review, visit this website: UVa Chest Radiograph module Links to an external site.
     
     
2. Clinical Reasoning Portion (short answer)

For the clinical reasoning portion of the practical exam, students should prepare by developing or borrowing an approach to each of the following chief complaints. Many approaches will be introduced during the clerkship through mnemonics or advanced organizers. However, some will not have approaches introduced and it is your responsibility to develop your own. You are encouraged to develop your own approach to the common complaints that we do discuss. Do not feel obligated to use our approaches. The most important thing is that you have an approach to guide your thinking and clinical reasoning and provide a good rationale for what you plan to do. A good approach should do the following:

1. Ensure that you consider the most likely/common diagnoses in the “long list” you develop using your approach and then develop a shorter prioritized list given patient information
2. Ensure that you do not include a large number of unusual or rare diagnoses in your approach.
3. Ensure that you include a full explanation of your process, which may include any calculations you choose to perform to substantiate your clinical reasoning

You are encouraged to develop your own approaches and share with your classmates!!!

General format (2-3 cases):

1. Generate a “long list” based on an approach to a chief complaint, followed by a “smart list” in which diagnoses are prioritized based upon additional information from the HPI
2. You will then be given the rest of the history and physical exam and asked what laboratory studies and imaging studies you would like to order.
3. Finally, you will be given some and required to make a diagnosis and explain your reasoning in a brief paragraph.
4. In some cases, you may be given test results to decipher and interpret and provide appropriate justification for the diagnosis
5. Your grade will be based upon your ability to generate an appropriate differential diagnosis, order and/or interpret key tests, make the correct diagnosis, and provide a plan of care.

NBME IM Shelf Exam

This will take place on the last Friday of the clerkship.

This exam is comprised of approximately 110 multiple-choice questions made by the NBME (National Board of Medical Examiners). To pass the clerkship you MUST score above the 5th percentile. Scoring below this percentile will result in a condition grade for the clerkship and you will have to retake the exam. The NBME Clinical Science Medicine content outline can be found here: NBME-Medicine-Shelf (Links to an external site.)