HISTORY TAKING
1.) Whatever mnemonic you were using for HPI, the system uses OLDCARTS. When I switched to that, I
started getting better scores.
a. Onset
b. Location/radiation
c. Duration
d. Character
e. Aggravati
...
HISTORY TAKING
1.) Whatever mnemonic you were using for HPI, the system uses OLDCARTS. When I switched to that, I
started getting better scores.
a. Onset
b. Location/radiation
c. Duration
d. Character
e. Aggravating factors
f. Relieving factors
g. Timing
h. Severity
2.) The fewer questions you ask in HPI the better. It scores your "efficiency" as a sort of percentage of how
many "correct" questions you're getting out of your 100 max. So if you focus on sticking more to just their
OLD CARTS script, it seems to give you a better score.
3.) Every HPI is supposed to start with:
a. "How can I help you today," and then
b. "Any other symptoms or concerns." Those two specifically are what it seems to want.
4.) PMH - The absolute must asks for every patient:
a. Allergies
b. Prescription medications
c. OTC/herbal medications
d. immunizations (usually it wants you to ask about the flu shot too, but not always)
5.) It wants you to go through everything in ROS you haven't touched on yet. If it gives an ambiguous answer
go back up and ask each individual question the patient wasn't clear on. Even if their complaint was a
cough, I would recommend asking about urinary symptoms. The system doesn't like abbreviated ROS's.
PHYSICAL EXAM
1.) Your "Key findings" list includes the physical exam, and when you submit the physical exam portion it
automatically submits the "key findings" list too, so make sure you've added everything you want before
clicking submit.
2.) You don't get docked for completing extra portions of the physical exam!! (With the exception of trying to
assess fetal heart rate in a male or something obviously wrong like that) So just perform everything. Just.
Do. Everything. It's a guaranteed 100% in that section.
a. EDIT: The gross pain stimulus is also considered inappropriate and you may get dinged for it.
DIFFERENTIAL AND DIAGNOSIS
1.) From what I can tell the differential list doesn't matter as much. The correct diagnosis, along with taking a
solid history are where the majority of the points are in the system (that's also if you're doing a complete PE
to ensure a 100 in that category). I personally recommend using their drop-down located to the right of the
magnifying glass. Why try to come up with ideas from scratch if they're laid out by system for you already?
2.) Do the assessment quizzes FIRST.
a. They will often give you a big clue as to what the diagnosis actually is. If your patient comes in with a
cough and you're between flu and mono and the assessment quiz is asking you about what type of
test is used to diagnose the flu......Guess what. They have the flu.
ORDERING AND INTERPRETATION OF TESTS
1.) To choose what tests to order you have to add the test under each possible diagnosis. Super annoying. So
you can't just order one CXR, you're going to have to select it three times each under pneumonia, rib
fracture, and pleural effusion for example.
2.) I again recommend using their drop-down here instead of trying to search for tests by typing it in the search
bar.
3.) LFTs are their own separate order, even if you already ordered a CMP. The system won't give you credit for
it unless you order them separately.
4.) The system will interpret the tests for you. Don't get stuck wondering how on earth you're supposed to be
able to interupt ECHO imaging like I did. Above the picture of the test results there is an interpretation option
that looks like a clipboard that will tell exactly what that EKG or ECHO or whatever else means in detail.
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