ICE:我个人这个得分比较低,而且我认为这个是CS改革致力于强化的一个部分。所以最近ICE的及格分数线一直在提高,考察模式也不断有变化。以前大家给予的重视程度不够,不过最近有不少人在这个环节上Fail掉后大家都慢慢的开始重视这部分了。首先,我们应该熟悉ICE是如何打分的。ICE现在包括两个部分:1.SP给你的查体的分数;2.阅卷大夫给你的Patient Note的分数。如果只看这两条的话,大体上可以想出一些比较极端的得分方式。比如问诊的时候很有侧重性,查体focused但是很全面,最后Patient note的时候再写得比较"丰满"。由于阅卷的大夫并不能看见你和SP的情况,他给你的评分只是看你Patient note的整体感觉,所以问SP的时候并不需要"面面俱到",如果感觉时间不够的话只要最后问一些开放性的问题,比如Before we move on, are there any other concerns (discomfort) you would like to tell me about?就可以。Patient note我需要强调一点的话就是Diagnosis一定要尽可能的正确,Differential一定要尽可能的合理。如果粗略一看的话,这两个都准确无误的话分数肯定不会低的。我从自己的成绩上分析,如果没有那么多wrong diagnosis的话可能就不会borderline,这也是我重视不足的导致的后果。
关于ICE的准备方法,我觉得大体可以分为6类Case:1.Normal;2.Checkup;3.Psychiatry;4.Child;5.Phone;6.Abuse。如果在细分的话每一个的准备方式就都不太一样,这里就不详述了。如果有能力的话,每一个Diagnosis都能形成一套自己的问法的话是最好不过的。一定要注意这几个的问法不是很一样,至少这六类都要分别准备足够多的问题可以支持12分钟+。我个人觉得问题可以参考FA的大Case,但是不要求那么高。ICE里面的难点主要是Associated symptoms,这个如果可以按照diagnosis准备固然是最好的,如果没有经历的话按照Review of system也是很好的。最后这个最好可以请教ICE的大牛来讲解一下怎么写Patient Note,因为个人分数不高就不在这献丑了。
(Read the door information. Take 30-45 sec to think over—make differential diagnosis)
(Knock on door. Take a deep breath, smile and enter)
Good morning/afternoon
Mr./Ms. XXXX?
I am Dr. YYYY, your physician today.
Can I make you more comfortable?
Here is a drape. (Unfold and offer the drape) (目测最近的考场SP都已经自带drape了,那样的情况下就可以忽略此条)
Mind if I take a seat? (Sit down)
Mr./Ms. XXXX, what brings you to our clinic today?
I am very sorry to hear that, you must be going through a lot of difficulties. Could you tell me more about this ZZZZ you’ve been having?
I see, please go on.
So you say you have had ZZZZ for…
Do you also have OTHER ASSOCIATED ...?
How is this problem affecting your life?
Now I would like to ask some questions about your past medical history. Before we move on, are there any other concerns you would like to tell me about?
Now I am going to ask some personal questions, please bear in mind that our conversation will be kept confidential.
(Consult when SP gives you the sign)
Being a concerned physician, I strongly recommend that you …
Closure:
I have taken a brief history and done some physical examination Please allow me to give you a summary.
Let me tell you what I am thinking.
I seems like your problem can be caused by AAAA, although they can also be caused by BBBB and CCCC.
How much do you know about AAAA? (如果比较常见病或者慢性病的话)
We are not sure at the moment, let me order some tests. I would like to take a picture of your DDDD. And I would also like to draw some blood to see if there is EEEE going on. Do you have any questions? Do you have any further concerns?
Please feel free to call me if you have any other concerns, other than that, I will call you when the results are back. In the meantime, is there anybody who can help you with your condition? If not, please allow me to contact a social worker to assist you.