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Integrated Curriculum Evaluation Exercise. Approach to Interview and PE Skills. Anita C. Mercado, MD ICEE Director. History of Present Illness(HPI). Appropriate Move from open to directed questions “What brings you in today?” Inappropriate Leading: “It’s not a sharp pain, is it?” - PowerPoint PPT Presentation
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Integrated Curriculum Evaluation Exercise
Approach to Interview and PE Skills
Anita C. Mercado, MDICEE Director
2 of 14Integrated Medical Curriculum - ICEE
Appropriate
o Move from open to directed questionso“What brings you in today?”
Inappropriate
o Leading: “It’s not a sharp pain, is it?”o Multiple choice: Is your pain sharp, dull or
aching?
History of Present Illness(HPI)
3 of 14Integrated Medical Curriculum - ICEE
Appropriate
o Clarify answers when neededo Ask questions in sufficient detail
Inappropriate
o “I get the pain when I walk” (how far/fast)o “I’m a social drinker.” (quantify amount)o “I eat a balanced diet.” (explore details)
HPI
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Appropriate
o Relevant positive and pertinent negative itemso ASCVD*: Presence or absence of risk factors
Inappropriate
o ASCVD: Questions not relevant to chief complaint
Interview: PMH, FMH, SH, ROS
*ASCVD- atherosclerotic cardiovascular disease
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Appropriate
o Introduce sensitive subjects appropriatelyoSocial history: “I need to ask you some
personal questions. Is that ok with you?
Inappropriate
o Sexual or drug use history without introduction
Interview: PMH, SH, ROS
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Appropriate
o Place patient in correct positionoExamine the patient from the right side- if
possibleInappropriate
o Examine patient over their gownoHeart exam in sitting position onlyo Fail to drape properlyo Fail to raise leg support
Physical Exam: Position
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Appropriate
o ASCVD: Heart and vascular exams
Inappropriate
o HTN: omit fundoscopic examo Bleeding: omit conjunctiva color/palloro Weight loss: omit thyroid exam
Physical Exam: Relevance
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Appropriate Inappropriate
Physical Exam: Common Mistakes
Ensure appropriate distance from the patient.
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Appropriate Inappropriate
Physical Exam: Common Mistakes
Ensure proper technique when using oto- / ophthalmoscope.
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Appropriate Inappropriate
Physical Exam: Common Mistakes
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Appropriate
o Warn before painful/surprising maneuvers
Inappropriate
o Abrupt PE maneuverso Palpate thyroid gland from behind without
warning
Physical Exam: Patient Comfort
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Poor IntroductionPoor eye contact/No fluidityDisorganized data gatheringPremature closurePremature counselingLecture counselingIgnoring patient concernsInterrupting patientPoor closureIncomplete interview
Interview Challenges
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Questions about the ICEEPlease read ICEE orientation content or
contactAnita C. Mercado, [email protected]
