COPR EMR common mistakes
COPR EMR · Understand the traps and how to avoid them.
Treating the primary survey as a checklist to recite rather than a set of decisions: the candidate names each step in order but does not act on abnormal findings, such as continuing to the secondary survey while the airway is still partially obstructed or the patient is in severe respiratory distress.
Candidates memorise the ABC sequence as a script for the scenario and rehearse it aloud, so the sequence becomes the goal. Under stress, reciting the next step feels safer than pausing to intervene, and candidates fear losing marks for 'skipping' a step.
What to do instead
Practise the primary survey as a decision tree: after each step, state the finding, then state the action or the reason for no action before moving on. In practice scenarios, have a partner deliberately insert an abnormal finding early and require the candidate to stop and manage it before proceeding. Mark yourself only on whether the correct intervention followed the finding, not on whether you completed the list.
Applying a treatment that does not match the patient's actual presentation because the candidate pattern-matched a single cue: for example, starting positive-pressure ventilation on a patient with adequate spontaneous breathing who is merely anxious, or withholding oxygen from a hypoxic patient because 'oxygen can be harmful' was remembered out of context.
Exam scenarios often contain one salient cue (a number, a word like 'wheezing') and candidates jump to the associated intervention without weighing the rest of the findings. Isolated facts learned without clinical context are easily misapplied.
What to do instead
Before each intervention, verbalise the indication, the target, and the reassessment plan. Study each intervention with its contraindications attached rather than as a standalone action. In practice, cover the vital signs, describe only the presentation, and justify the intervention from the full picture.
Missing or mis-timing the reassessment: the candidate completes the initial assessment and then never repeats vital signs, or repeats them at arbitrary intervals unrelated to the patient's condition or the intervention just performed.
Reassessment is quiet, repetitive work with no dramatic action, so it is the first thing dropped when the candidate is concentrating on a procedure or on finishing the scenario. Candidates also do not know the expected intervals and so avoid committing to any.
What to do instead
Attach reassessment to every intervention as an automatic paired action: after any drug, splint, oxygen change, or position change, state that you are reassessing the relevant findings. Learn the standard intervals for stable versus unstable patients and state the interval and its rationale aloud in practice.
Performing a physical examination that is either indiscriminate or incomplete: palpating and auscultating everything on every patient regardless of the complaint, or omitting the focused examination of the injured or symptomatic area entirely and relying on the patient's report of where it hurts.
Candidates learn examination techniques as a fixed routine and are reluctant to omit any of them, while under time pressure they skip the focused examination because they assume the chief complaint already localises the problem. Neither approach reflects how findings should direct the examination.
What to do instead
Practise a complaint-based examination: for each common presentation, list the specific findings you must seek and the negatives that matter. In scenarios, state why you are examining a region and what finding would change your plan. Time yourself so that a focused examination becomes faster than a full one.
Recording vital signs without interpreting them: the candidate writes down a respiratory rate, blood pressure, and oxygen saturation, then reports them as 'normal' or says nothing about them, even when the values are clearly outside expected ranges for the patient's age.
Vital signs are taught as data-collection tasks, and candidates practise obtaining numbers rather than judging them. Age-specific normal ranges are learned once and not revisited, so abnormal values are not recognised as abnormal.
What to do instead
For every set of vital signs, state an interpretation in one sentence: within normal limits for age, or abnormal with the direction and likely significance. Memorise paediatric and adult ranges by drilling values until you can classify them instantly. In practice, have a partner read out random values and require an interpretation for each.
Taking a history that follows the question list rigidly and ignores the patient's answers: the candidate asks every question in the same order regardless of the response, fails to follow up on a significant answer such as chest pain radiating to the arm or a recent fainting episode, and misses the relevant medication or allergy history.
History-taking is rehearsed as a script, and candidates worry that departing from it will lose marks. Following up requires recognising significance in real time, which is a separate skill that is rarely practised.
What to do instead
Practise histories where the partner gives one deliberately significant answer and the candidate must pursue it with at least two follow-up questions before continuing. Learn the purpose of each history component so that you can reorder or compress it. Always close the history with allergies, medications, and past medical history, stated explicitly.
Communicating with the patient as an audience rather than a participant: discussing findings, dosages, or likely diagnoses with a partner in front of the patient, issuing commands without explanation, or failing to obtain consent before a procedure.
Candidates focus on demonstrating knowledge to the examiner and treat the patient as a prop. Under performance pressure, the urge to show what you know overrides the professional obligation to include the patient.
What to do instead
Rehearse scenarios with a live partner who is instructed to object if they are not told what is happening or if consent is not sought. Adopt a fixed habit: before every procedure, state what you are doing, why, and ask permission. Keep clinical discussion with your partner brief, quiet, and away from the patient's hearing.
Failing to establish or use a clear chain of command in a team scenario: the candidate either attempts every task personally while directing no one, or assigns tasks without confirming roles, so two responders perform the same intervention while a critical one is missed.
Candidates equate competence with personally performing skills and feel that delegating is passing off work. Team scenarios are also rarely practised, so role clarity and closed-loop communication are unfamiliar.
What to do instead
In every team practice, begin by naming roles aloud and end each instruction with a confirmation from the person assigned. Practise giving an instruction, receiving a confirmation, and requiring a report back on completion. Deliberately take the team-leader role in some scenarios and the hands-on role in others.
Making the transport decision late or by default: the candidate continues scene assessment and treatment until the scenario ends without ever stating a transport priority, destination, or mode, or states 'load and go' without justifying it from the findings.
Scenarios reward visible clinical action, so transport planning feels like an administrative afterthought. Candidates also lack a clear framework for deciding urgency and therefore avoid committing to a decision.
What to do instead
Set a provisional transport decision after the primary survey and revise it after reassessment, stating it aloud each time. Learn the findings that mandate immediate transport and practise justifying a priority level in one sentence from the patient's presentation. Treat an unstated transport plan as an incomplete scenario in your own practice.
Documenting and reporting from memory after the fact, producing a record that omits reassessments, times, and refused interventions, or a handover that delivers a narrative of everything that happened rather than the findings the receiving clinician needs.
Documentation is completed at the end when the candidate is tired and the scenario is 'over', so recall is selective and biased toward actions taken rather than findings observed. Handover is practised less than treatment, and candidates default to chronological storytelling.
What to do instead
Record times and findings as they occur, using a fixed structure, and treat the record as part of the scenario rather than an epilogue. Rehearse handover with a standard format covering the patient's identity, presenting problem, relevant findings and trends, interventions with response, and your concerns. Deliver it in under a minute to a partner who then repeats back what they understood.