United States Medical Licensing Examination (USMLE) Medical Ethics, Communication, and Clinical Skills Flashcards

24 sample cards from the Medical Ethics, Communication, and Clinical Skills deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What are best practices for working with a medical interpreter?

   Use a trained professional (not family/children), speak directly to the patient in the first person, use short sentences, allow time for interpretation, and confirm understanding. Avoid jargon and 'ad hoc' interpreters when possible.

2. What is cultural humility and how does it differ from cultural competence?

   Cultural humility is a lifelong, self-reflective stance of recognizing one's own biases and learning from each patient as the expert on their own culture; cultural competence implies a fixed mastery of cultural knowledge. Humility emphasizes openness over assumptions/stereotypes.

3. What is the LEARN model for cross-cultural clinical encounters?

   Listen to the patient's perspective, Explain your own view, Acknowledge differences and similarities, Recommend a plan, and Negotiate agreement.

4. What are the four classic components of the physical examination, in order?

   Inspection, Palpation, Percussion, and Auscultation. Exception: the abdomen is examined Inspection, Auscultation, Percussion, then Palpation (to avoid altering bowel sounds).

5. Why is the abdominal exam sequence changed to auscultate before palpating?

   Palpation and percussion can stimulate or alter bowel motility and bowel sounds; auscultating first yields an accurate assessment of bowel sounds.

6. What is clinical reasoning, and what are its two main cognitive modes?

   The process of gathering and synthesizing data to reach a diagnosis and management plan. The two modes are System 1 (fast, intuitive, pattern recognition) and System 2 (slow, analytic, hypothesis-driven).

7. What is a differential diagnosis and how should it be prioritized?

   A ranked list of possible diagnoses explaining the patient's findings, ordered by likelihood (most probable), urgency/severity ('can't-miss' or life-threatening conditions), and treatability.

8. Define anchoring bias and confirmation bias in clinical reasoning.

   Anchoring: fixating on the initial diagnosis/impression and failing to adjust with new data. Confirmation bias: seeking or favoring evidence that supports the working diagnosis while discounting contradictory data.

9. What are sensitivity and specificity, and how are SnNout/SpPin used?

   Sensitivity = true positives / all diseased; Specificity = true negatives / all non-diseased. SnNout: a highly Sensitive test, when Negative, rules out disease. SpPin: a highly Specific test, when Positive, rules in disease.

10. How are positive and negative predictive values affected by disease prevalence?

    PPV rises and NPV falls as prevalence increases (and vice versa). Unlike sensitivity/specificity (test-intrinsic), predictive values depend on the pretest probability/prevalence in the population.

11. What are likelihood ratios and how do they affect post-test probability?

    LR+ = sensitivity/(1−specificity); LR− = (1−sensitivity)/specificity. LR+ >10 and LR− <0.1 cause large, often conclusive shifts in probability; an LR of 1 means the test does not change the pretest probability.

12. What is the difference between a screening test and a confirmatory (diagnostic) test?

    A screening test should be highly sensitive to detect disease in asymptomatic populations (minimize false negatives); a confirmatory test should be highly specific to confirm true positives and minimize false positives.

13. What is overtesting/low-value care, and what initiative addresses it?

    Ordering tests unlikely to change management, risking false positives, cost, and harm from incidental findings. The 'Choosing Wisely' campaign promotes avoiding unnecessary tests and procedures.

14. What is the SOAP format for clinical documentation?

    Subjective (patient's reported symptoms/history), Objective (exam findings, vitals, labs), Assessment (diagnosis/differential), and Plan (treatment, tests, follow-up).

15. What are key medicolegal principles of good documentation?

    Document accurately, timely, and legibly; never alter or backdate records (addenda only, with date/time); 'if it wasn't documented, it wasn't done'; avoid copy-paste/note bloat and ensure each entry reflects the actual encounter.

16. What is the difference between an adverse event, a near miss, and a medical error?

    Adverse event: harm caused by medical care rather than the disease. Near miss: an error that was caught before reaching the patient (no harm). Medical error: a preventable act of commission or omission that may or may not cause harm.

17. What is the ethical standard for disclosing a medical error to a patient?

    Errors that affect the patient should be disclosed honestly and promptly, with an explanation, an apology, and a plan to prevent recurrence—regardless of liability concerns; honesty/transparency is required.

18. What is a 'just culture' in patient safety?

    An approach that distinguishes blameless human error and system failures (which should be reported and analyzed without punishment) from reckless behavior (which warrants accountability), encouraging error reporting to improve systems.

19. What is root cause analysis (RCA) and when is it used?

    A structured, retrospective team-based investigation performed after a serious adverse event/sentinel event to identify underlying system causes (not individual blame) and implement corrective actions.

20. Name the PDSA cycle and the model for improvement's three core questions.

    PDSA = Plan-Do-Study-Act, an iterative QI cycle. The three questions: What are we trying to accomplish? How will we know a change is an improvement? What changes can we make that will result in improvement?

21. Distinguish quality improvement from research.

    QI aims to improve local processes/outcomes using rapid iterative cycles (e.g., PDSA) and generally does not require IRB approval; research aims to generate generalizable new knowledge with a fixed protocol and requires IRB oversight and informed consent.

22. What are the six aims of high-quality health care per the Institute of Medicine (STEEEP)?

    Safe, Timely, Effective, Efficient, Equitable, and Patient-centered.

23. What is the SBAR tool and why is it used in care transitions/handoffs?

    SBAR = Situation, Background, Assessment, Recommendation. It is a structured communication format that standardizes handoffs and clinician-to-clinician communication, reducing errors during transitions of care.

24. What is medication reconciliation and when is it most critical?

    Comparing a patient's current medication list against new orders to resolve discrepancies (duplications, omissions, interactions). It is most critical at care transitions—admission, transfer, and discharge—where errors commonly occur.

What this deck covers

Medical Ethics, Communication, and Clinical Skills flashcards FAQ