alex russo

COGNITIVE EXAM IN CASC

6 posts in this topic

is a station that has the highest percentage of subjective/examiner bias

so chances of failing it very very high

i got it all my three attemps

didnt do anything different in all attemps

passed the third time

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What did you do to pass

I mean I did MMSE and frontal lobe then failed

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i did exactly what u did three times

passed 3rd time

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I had this in my exam x years ago and approached it initially by doing the MMSE but it became apparent about halfway through that there were frontal lobe symptoms (I think the patient was perseverating and maybe behaving oddly) so I switched to some frontal lobe tests finishing with "name as many animals in a minute". I reflected afterwards that the examiner was looking for a flexible approach and for the candidate to pay attention to subtle clues played out by the actor whilst demonstrating knowledge of a variety of cognitive tests. I've reiterated that to trainees many times and emphasised the need to stray away from a checklist approach. I've seen some candidates manage to fit in the MMSE and most of an FAB into 7 minutes which contributed to them coming across as too robotic and not empathic.

My advice would be to go into the station armed with a couple of tests or questions designed to target specific lobes that you are familiar with from clinical practice. Start with the MMSE if you must (this is temporal - parietal specific) but don't rush it in case you miss out on the inevitable clues that should lead you to explore in different directions. You need to demonstrate to the examiner that you have a broad understanding of how to test cognitive deficits and are listening to the patient rather than just being well rehearsed in conducting particular tests

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My approach is building the scene first, having a general conversation and try to elicit their orientation to time and place (one of the domains in the exam mark sheet, and it makes sense to check that first). Then explain that you're going to run a few memory test but you will explain yourself as you go along, may it be frontal, parietal/temporal etc.

I agree the actual test bit, everyone would be doing the same thing, but it's the setup that will differentiate.
If you're doing a full MMSE, do it as though you're tracking the score, so it looks like you know what you're doing. 

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