Fever

Guest hosts: Dr. Sonali Srivastava, Dr. Mark Karanofksy — Family physician at Jewish General Hospital (McGill University training site)

This week, we have a special episode for you! A special thank you to guest hosts Dr. Srivastava and Karanofksy, who chat about Simulated Office Orals (SOOs), a core part of the CCFP examination. Bullet points are included below:

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How do you think residents should prepare for the SOO? What specifically can they do to practice?

• Practice with staff, and practice within a study group — each prepare a different case and practice with each other.
• Be careful not to read all the cases beforehand.

How many SOO's do you think they should do before the actual exam?

• No real number, until you are comfortable.
• Once you master the process of the exam, practice only if you need more confidence.

How much before the exam should they begin practicing?

• It is hard to do an interview with two problems and a social context in R1. Usually we do 1-2 sessions in R1.
• In R2 we do 4 sessions through the residency programme, but then the residents will do a few on the side with each other. A few residents seek out staff to do other SOOs with them in the last few months. I wouldn't worry or spend too much time until 3-4 months into R2. Before then you're likely not ready.

What are the common mistakes people make?

• Cheating on the review of systems.
• Time management.
• Not listening to the answers the patient gives.
• Not listening for cues.
• Not asking questions for all reasonable differential diagnoses (you'll never know what counts for marks and what doesn't).
• Forget to ask for old records.
• Forget to say you would perform physical exam.
• Forget to FIFE: but don't do it obviously / on auto-pilot!
• Not telling the patient what you think the diagnosis / differential is.
• Missing the context integration statement.

Where do people often lose marks?

• All over the place!
• Usually I have seen candidates miss on the differential, review of systems, premature closure, and forgetting to ask about the social context.

If someone gets stuck mid-SOO, what should they do?

• Summarize! "Do I understand you correctly?"

In your experience, what makes someone really great at doing the SOOs?

• Smooth, patient-centred interviewing; not "machine gunning" yes/no questions, calm approach, interested in making the patient better and negotiating a plan – not dictating one.

Do you remember any candidates that stood out for either being really great or losing steam? What did they do to get themselves in that position?

• Don't challenge the examiner or question the ethics of the exam!
• Don't try to get the examiner to tell you the second problem directly.
• Don't listen to the answers then just move on. Don't ask questions just to ask, the responses should be heard and addressed if needed.
• Abrupt, arrogant, or condescending approach does not go over well in this exam.

Let's say it all goes wrong during the SOOs and the resident feels the actor was not being true to their part, what systems are in place for reporting this?

• Forget about it and move on to the next one. You'll have time after the last case is done to think about it.
• Address your concerns to the staff on site – there is a site coordinator. Also write it in your feedback after the exam. Speak to the on-site staff they will help direct you if you feel there was an issue.
• Don't forget, other candidates may get different information based on the questions they ask. Examiners don't volunteer information at times that easily if it says in the script to only answer if candidate asks specifically. You may not get information because you didn't ask the right question.

Any words of wisdom would you like to impart?

• 15 minutes: 2 problems, 1 social context. 1 context integration statement, and manage both. Check with the patient: make sure they agree with each plan.
• Don't leave the room early. You are allowed to, but don't. Ask more questions.
• Don't cheat on the review of systems or the differential diagnoses questions.
• With the three-minutes-left prompt, say something like "So I see you have problem A and also Problem B all in the social context C. That must be difficult and I want to help you through it".
• In management, remember to offer pharma and non-pharma options for treatment if applicable and to involve a support network in plan.

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This week's links:

• Sonali's Approach to the SOO (JPG, 480KB)