If you’re preparing for your pediatric clinical rotation, you may be wondering how to score high on the pediatric COMAT. The pediatric COMAT is the exam at the end of the rotation that covers everything clinical that you need to know. The COMAT is the M.D. equivalent to a shelf exam, and tests your competency in that rotation.
I recently took the pediatric COMAT, and it was my first COMAT exam. I finished in about 1hr 45 mins, and scored a 113. For more context, I talked about the scoring in my last post about how to get a good rating in your pediatric clerkship. In this post, I will actually share the steps I took to score so well.
This test was a big milestone for me because I normally don’t receive honors on exams. I did improve in my second year, and started to score higher, but I only received honors in a couple of courses. So when I received my score in this clerkship, it was a pleasant surprise. And I promise it wasn’t a fluke! I worked really hard to make sure I went in there knowing the information. So, here are my top 6 tips for how to score high on the pediatric COMAT.
Find a Good Resource for the Pediatric COMAT
The first step in how to score high on the pediatric COMAT is to find a good study resource. The third-year is different in the sense that you have to become your own self-driven learner. No one is preparing lectures and powerpoints for you. Therefore, you have to go out and find your own resources to study.
My course director did require us to read something, and highly recommended the textbook Nelson Essentials for Pediatrics. I was probably one of a couple of my classmates who read the textbook instead of finding an abbreviated resource. Do whatever works best for you. I like more context, which is why I opted for the book. Plus, I didn’t think the book was that challenging to read.
Other resources include First Aid for Pediatrics, Case Files, OnlineMedEd Whiteboard Notes, and the Board Review Series (BRS) for pediatrics. Find a source that you enjoy and read it cover to cover. You are going to want this baseline information, not only for the exam, but also to help you excel in your pediatric clerkship.
Talk to Your Preceptor About Content on the Pediatric COMAT
The second tip for how to score high on the pediatric COMAT is to talk with your preceptor, who more than likely, is a pediatrician. That means they have taken many exams over the same content that you are. They are going to be an invaluable resource because they can give you a heads up about the nuances of the exam.
Not only can preceptors give you great information about the content on your pediatric COMAT, but they can also compare and contrast that information with what is clinically relevant. This can be confusing because you may be sitting in the test, unable to remember if they told you that was “by the book” or “in-practice” (like I was). But if you can keep them straight, then you receive clinical pearls as well as extra help on the exam.
Drill Age-Related Prevalence for the Pediatric COMAT
The thing that differentiates pediatrics from every other field is the emphasis on age. Sometimes there are distinguishing features in adult medicine based on age. But, overwhelmingly, in pediatrics, everything is based on age. Therefore, if you want to know how to score high on the pediatric COMAT, then it’s essential that you drill age-related prevalence for various diseases and conditions.
The pediatric COMAT is so nit-picky about age, that even the etiology of certain illnesses comes down to how old the child is. This is true for cases of sepsis, meningitis, ear infections, sore throat, and certain rashes.
Additionally, delays in fine motor, gross motor, socioemotional skills, and language are age-dependent. They may give you a question in which they describe a child and their behaviors, and ask you to identify if there are any delays present, and if so, in which domain? Therefore, it’s crucial to at least know the gist of developmental milestones in each of the age group so you can scoop up these easy points. Here is an organizational aid that can help you learn the development milestones. Also, remember, development is a range, so as long as they are within a couple of months, then there is nothing about which to be concerned.
Focus on Overall Diagnosis on the Pediatric COMAT
The main difference I have noticed between Step 1/COMLEX 1 and the questions for the COMAT exams is that in the first exam, they will give you pretty much everything you need to come up with a diagnosis; no less, no more. On the COMAT exams, though, they give you about 75% of a diagnosis, with a sprinkle of another diagnosis for a little razzle, dazzle.
If you want to learn how to score high on the pediatric COMAT, then you have to learn how to block out that access and focus on the overall diagnosis. There may be some other symptoms with which the patient presents. But you have to ignore them, and ask yourself, “What is the most likely diagnosis?” or “Which diagnosis fits most of the presenting symptoms.”
It’s going to be messy, and not tied up neat with a bow. But, that’s exactly how patients are. Most of them don’t come textbook, and if they do then you might have to worry about certain possibilities like malingering.
Be Okay with Choosing “Do Nothing” on the Pediatric COMAT
The other potentially frustrating part about the pediatric COMAT is that reassurance is the answer many times. As a medical student, that answer choice is intimidating. It’s like, “Do nothing? Are you sure?” But so many pediatric cases are benign, that extra testing, poking, and prodding will only do them more harm.
What are the telltale signs that the patient can be sent home?
- They are active. Really sick kids do not want to do anything other than lie there. But kids with viral illnesses, which often do not have a treatment other than supportive care, are friendly, playful and interactive.
- They are not in immediate danger. If you suspect the presentation to be abuse, then definitely don’t send them home without further assessment. Also, if the child was in a recent life-threatening accident (i.e. drowning) then you will want to keep them for observation of delayed sequelae.
- They have a virus. This is sort of redundant, but viral illnesses, for the most part, are treated with supportive care. Therefore, runny nose and a cough that is indicative of a viral illness will mostly be treated with reassurance. Suspect a bacterial infection if they have a really high fever (and you’ve ruled out the exanthems), continue to get worse, have a prolonged illness (>10-14 days), or there is an indication of a systemic infection.
The other important symptom to monitor is a fever. If a fever is accompanied by common cold symptoms, then it’s most likely a common cold. However, if they have a fever, but show no signs of being ill, then you must run a urinalysis and rule out a urinary tract infection.
Key Takeaways
Things present differently in children than they do in adults. Make sure to know this difference, and how symptoms and conditions change with age. If you have any special tips or resources, please leave them in the comments! Customize these tips to yourself, and you will have no trouble figuring out how to score high on the pediatric COMAT.
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