ECFMG Clinical Skills & Competency Assessment 3 — Questions and Answers
Question 1: Which of the following is the most effective opening statement when beginning an ECFMG standardized patient encounter?
- Hello, I am going to examine you today.
- Hi, my name is Dr. Smith. What brings you in today? (Correct answer)
- I need to take your history and do a physical.
- Please tell me your symptoms so I can diagnose you.
Correct answer: Hi, my name is Dr. Smith. What brings you in today?
Introducing yourself by name and opening with an open-ended question establishes rapport and invites patient narrative.
Question 2: When a standardized patient begins crying during a history-taking encounter, the most appropriate response is to:
- Continue asking questions to stay on schedule
- Offer a tissue, pause, and acknowledge the patient's emotion (Correct answer)
- Immediately request a nurse to assist the patient
- Move directly to the physical examination
Correct answer: Offer a tissue, pause, and acknowledge the patient's emotion
Acknowledging emotional distress with empathy and a brief pause is a core CIS competency that demonstrates patient-centered care.
Question 3: Which mnemonic is most commonly used to assess pain in ECFMG clinical encounters?
- FAST
- OLDCARTS (Correct answer)
- SAMPLE
- ABCDE
Correct answer: OLDCARTS
OLDCARTS (Onset, Location, Duration, Character, Alleviating factors, Radiation, Timing, Severity) is the standard pain history framework used in CS encounters.
Question 4: During a clinical skills encounter, an IME asks about family history. The standardized patient states 'my father died of a heart attack at 55.' The best follow-up question is:
- How old are you now?
- Were there any other family members with heart disease? (Correct answer)
- Did your father smoke?
- Do you have any siblings?
Correct answer: Were there any other family members with heart disease?
Exploring first-degree relatives and the pattern of cardiac disease helps assess familial cardiovascular risk, which is directly clinically relevant.
Question 5: The Integrated Clinical Encounter (ICE) score in CS exams assesses which two components?
- Communication skills and English proficiency
- Data gathering and patient note quality (Correct answer)
- Physical exam technique and differential accuracy
- History taking and counseling effectiveness
Correct answer: Data gathering and patient note quality
ICE evaluates the quality of data gathering (history and physical) and the written patient note, scored by trained physician raters.
Question 6: When examining the abdomen of a standardized patient, which sequence should be followed?
- Inspection, palpation, percussion, auscultation
- Auscultation, inspection, percussion, palpation
- Inspection, auscultation, percussion, palpation (Correct answer)
- Palpation, percussion, auscultation, inspection
Correct answer: Inspection, auscultation, percussion, palpation
Abdominal examination follows inspection, auscultation, percussion, palpation — auscultation before palpation avoids altering bowel sounds.
Question 7: A foreign medical graduate is informed their ECFMG CS score failed the Spoken English Proficiency (SEP) subcomponent. This most directly indicates a deficiency in:
- Grammar accuracy in written notes
- Comprehensibility of spoken English during the patient encounter (Correct answer)
- Medical terminology knowledge
- Reading comprehension of clinical vignettes
Correct answer: Comprehensibility of spoken English during the patient encounter
SEP measures whether the candidate's spoken English is understandable to patients, rated by the standardized patient during the encounter.
