I signed a form swearing that I will not reveal details about my exam, and so I won't. Please forgive the generalities. I must keep the exam contents confidential for future testing.
You're not allowed to use any notes for these exams. You go in with your bag of tools (BP, steth, otoscope, etc), a piece of paper and a pen. I went in feeling pretty strong about the patient interview, and the process choosing a differential and diagnosis. I am weakest in the physical exams. I haven't done them much and I haven't seen many abnormals. I am beginning to get familiar with the normals, but I am far from proficient with the tools.
The patient that I got is a student at my school. I have had some prior interactions with her. She is cool and distant, and barely responds when I speak to her. During the exam her affect was completely flat, and she did not attempt to act out the case. She was a 30-something answering as if she were a 60-something with an assortment of health woes.
The doctor grading me is a very pleasant man. I was grateful to have him. He did as he said he would, remaining quiet and still while I conducted my patient interview and exams. He was generous with the scoring, considering what happened.
My interview went well, though it wasn't until the very end that I remembered to ask about smoking and drinking. The feedback I got was that I should have spent more time on the history of present illness (HPI). I felt that I continued each line of questioning until I got to a dead end, and then tried another. In hindsight I think I felt this way because of the way my supposed patient presented. If she had been a real sick person, it would have been easier to have a conversation with her about it. My supposed patient answered with monosyllables and could not be enticed to be chatty about her situation. An intentionally restrained fake patient makes it much more difficult to have a decent patient interview. Still, I asked 100% of the questions I was required to ask, and a few more that I thought were important given my differential.
My physical exams went less well. I should have simply made a list of exams to do as I went through the interview process, but I did not. I became scrambled in the process, forgetting two key exams. The results of the exams were confounding as well, causing me to shift my differential and diagnosis. My original differential and diagnosis (based on the interview only) had been more correct. The new version, after confounding by the results of my exams, was shaky, uncertain, and wrong.
I thought I had probably failed. I was grateful to find today that I do not need to take the exam again.
There are two more exams like this. Passing this exam qualifies me to be a secondary in clinic. The next exam allows me to be a primary. The third is the clinic exit exam, which is a prerequisite for graduation. There are a few people who never pass some of these exams. I know of one in particular who is a wonderful caregiver who never passed the exam that I just passed. I'm not sure how many times you can retake it, but at some point you're simply out of the program. I am grateful to have passed on the first go.