Over my years serving as a mock SOO examiner for residents and practicing physicians, I've seen several candidates who were excellent - and others who didn't quite get it.
Here are a few of my notes to help your CCFP exam preparation: learn from the best candidates I’ve seen - and also from the mistakes of others.
Ask yourself these 3 things:
1) Are you treating the SOO exam as if it were an OSCE?
Remember, a SOO examiner’s script is often 25+ pages long. Though rattling off dozens of questions per minute may serve you well on an OSCE, candidates who asked me rapid-fire questions missed a key point: the “illness experience” is absolutely foundational to every single SOO station. Rapid-fire questions don’t give my character the chance to share my story of my illness experience which is the whole point of this exam.
Run through a mnemonic like a robot. “Where does it hurt? Does it radiate? What aggravates it? What alleviates it? Do you have fever? Night sweats? Weight loss?”
Try questions like, “So what were you doing when the pain started? And then what? What else did you notice?” Also make sure you hit all the red flags (these are popular on the old SOO exams on the CCFP’s website), but also ask broad questions about the illness experience to get the same information in a narrative fashion. For example, “Wow, that sounds awful! Did you notice anything concerning - say, fever or weight loss?”
2) Are your eyes always on your patient?
Even though you may ask all the right questions, if you keep your eyes only on your paper, in my experience you could still lose points that show up on SOO exam answer checklists for “interview process and organization.” Focus first on listening, second on asking the useful questions, and third on your management plan. Other things, like looking at your watch and writing down information, should come last.
Look at your paper more than you look at the examiner. The points are coming from your examiner, not your notepad.
Ask yourself, what am I gaining by writing during the SOO? Is it actually helping me? Try a practice SOO with and without writing anything down, then ask your mock examiner, ‘Which time did I perform better? Which time did I connect with you better?”
3) Are you asking for more information after the “you have 3 minutes left” warning?
In the instructions to the SOO examiners, examiners are instructed to not provide any information after the three minute warning.
Use the 3 minute warning to begin involving the patient in the development of a detailed management plan using a tool like the 3-MINUTE MNEMONIC (NOPQRST) developed by The Review Course.
Don't waste your time asking for more information.
Remember you MUST practice the SOOs to be successful. So grab a colleague, partner, or R1 near you and ask when you can buy them a coffee and run some SOOs to try these techniques.
For those of you writing this weekend, best of luck – at this stage you are fine-tuning your SOO performance and these tips will give you an edge!
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