Clinical Examination Spec Booklet

TABLE OF CONTENTSC L I N I C A L E X A M I N AT I O N S P E C I F I C AT I O N S A u s t r a l i a n M e d i c a l C o u n c i l “The purpose of the Australian Medical Council is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian Community.” TABLE OF CONTENTS The Australian Medical Council is an independent national standards body for medical education and training. "The purpose of the AMC is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community." © April 2010 Edition 8 First Printing ABN ISSN 97 131 796 980 1325-426X Copyright for this publication rests with the Australian Medical Council Limited Australian Medical Council Limited PO Box 4810 KINGSTON ACT 2604 Website: Telephone: Facsimile: Email: http://www.amc.org.au 02 6270 7878 02 6270 9799 [email protected] TABLE OF CONTENTS IMPORTANT NOTICE TO CANDIDATES FOR THE AUSTRALIAN MEDICAL COUNCIL (AMC) CLINICAL EXAMINATION CLINICAL EXAMINATION FORMAT In July 2001, the AMC implemented changes to the clinical examination that were designed to: • • • streamline the format and operation of the AMC examination bring the AMC examination into line with current assessment practices in Australia and overseas make more effective use of clinical resources and, as a result, accommodate larger numbers of candidates in a timelier manner. An important feature of the new clinical examination was the introduction of a structured, multistation clinical examination format to replace the previous short case clinical examination in Medicine and Surgery. As part of the on-going review of its examinations, the AMC decided to further streamline the clinical examination by collapsing the current Stage 1 and Stage 2 components into a single, multi-station clinical examination format.The changes to the clinical examination are detailed in this booklet and were effective from 1 January 2004. STATEMENT ON PRIVACY The AMC is required to observe the provisions of the Privacy Amendment (Private Sector) Act 2000, (effective from 21 December 2001) and sets out the requirements for the collection and use of personal information collected before and after that date. Each of the Application Forms required by the AMC includes a statement relating to the AMC’s privacy procedures. Each must be signed by the applicant to give formal consent for the AMC to collect and hold personal information. If this consent is not provided, the AMC will not be able to process the application. TABLE OF CONTENTS TABLE OF CONTENTS GUIDELINES AND SPECIFICATIONS 1 INTRODUCTION 1 ASSESSMENT AIMS AND OBJECTIVES 1 STRUCTURE OF THE AMC EXAMINATION 1 STANDARD OF THE AMC EXAMINATIONS 2 APPEALS PROCEDURE 2 THE CLINICAL EXAMINATION 3 REQUIREMENTS FOR THE CLINICAL EXAMINATION 3 OBJECTIVE OF THE CLINICAL EXAMINATION 3 STANDARD OF PERFORMANCE 3 FORMAT OF THE CLINICAL EXAMINATION 3 GENERAL FORMAT 3 ARRANGEMENT FOR THE CLINICAL EXAMINATION 4 SCHEDULING PROCESS FOR THE CLINICAL EXAMINATION 4 VENUE AND WAITING TIMES 5 EXAMINATION FEES 5 STRUCTURED CLINICAL EXAMINATION 6 ASSESSMENT OBJECTIVES FOR THE CLINICAL EXAMINATION 7 TOPICS COVERED IN THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION 8 PASS/FAIL RETEST (ADDITIONAL PASS/FAIL ASSESSMENT FOR MARGINAL PERFORMANCE) 9 CRITICAL ERRORS IN MEDICAL CARE 10 EXAMPLES OF CLINICAL ERRORS IN MEDICAL CARE 10 SCORING IN THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION 12 DETERMINATION OF RESULTS 12 ADMINISTRATION ARRANGEMENTS AT THE EXAMINATION CENTRE 14 PREPARATION FOR THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION 15 REVIEW OF CLINICAL SKILLS 15 CONDUCT OF CANDIDATES PRESENTING FOR EXAMINATION 15 DOCTOR-PATIENT RELATIONSHIP IN AUSTRALIA 16 GENERAL PREPARATION FOR THE CLINICAL EXAMINATION 16 CLINICAL EXAMINATION VIDEO 17 FORMAL NOTIFICATION OF CLINICAL EXAMINATION RESULTS AND FEEDBACK 18 AMC CERTIFICATE 18 REQUEST FOR DUPLICATE COPIES OF AMC RESULTS 18 GENERAL INFORMATION 19 CHANGE OF ADDRESS 19 REQUEST FOR CONFIRMATION OF DATE OF PRELIMINARY APPLICATION WITH THE AMC – Section 19 AB of the Health Insurance Act 19 FURTHER INFORMATION 19 TABLE OF CONTENTS TABLE OF CONTENTS APPENDIX A APPENDIX B APPENDIX C ATTRIBUTES OF MEDICAL GRADUATES ESSENTIAL READING APPENDICES SUMMARY OF THE FORMAT OF THE AMC CLINICAL EXAMINATION GENERAL INFORMATION FOR THE STRUCTURED CLINICAL ASSESSMENT AND GENERAL INFORMATION FOR THE RE-TEST EXAMINATION SAMPLE STATION — MEDICAL AND MARKSHEET SAMPLE STATION — OBSTETRICS AND GYNAECOLOGY AND MARKSHEET SAMPLE STATION — PAEDIATRICS AND MARKSHEET PERFORMANCE FEEDBACK ADDITIONAL PERFORMANCE FEEDBACK SHEET (ASSESSMENT DOMAINS) APPENDIX D APPENDIX E APPENDIX F APPENDIX G APPENDIX H APPENDIX I . The MCQ examination focuses on basic and applied medical knowledge across a wide range of topics and disciplines. diagnosis. investigation. duration of one to two hours. for registration purposes. clinical competency and performance.TABLE OF CONTENTS These guidelines and specification have been prepared to assist candidates for the Australian Medical Council (AMC) examination. of three to four hours duration. The clinical examination also assesses the candidate’s capacity to take a history. skills and attitudes required to satisfy the requirements of the examination the areas and topics covered in the examination the format of the clinical examination preparing for the AMC examination suggested reading lists for the examination. and each containing 125 questions. ASSESSMENT AIMS AND OBJECTIVES The AMC examination is designed to assess. Both MCQ and clinical assessments are multidisciplinary and integrated. clinical examination. will be administered if required. STRUCTURE OF THE AMC EXAMINATION The AMC examination consists of two parts: • The examination is designed as a comprehensive test of medical knowledge. each of three hours duration. a clinical examination.A Re-test examination. • an MCQ examination to test medical knowledge. therapy and management. judgment and reasoning in distinguishing between the correct diagnosis and plausible alternatives. formulate diagnostic and management plans.They contain information about: • • • • • • the format and content of the AMC examination levels of clinical knowledge. involving understanding of disease process. and communicate with patients. as well as on the candidate’s ability to exercise discrimination. their families and other health workers. conduct a physical examination. containing two parts administered on one day. testing clinical and communication skills. the medical knowledge and clinical skills of overseas trained doctors whose basic medical qualifications are not recognised by State and Territory Medical Boards. Clinical Supplement Page 1 . in two parts. which will be administered on a single afternoon or morning. Commencing in 2005 the AMC MCQ examination is a computer-administered examination. INTRODUCTION GUIDELINES AND SPECIFICATIONS Candidates should study these guidelines in conjunction with the current edition AMC publication Information Booklet for Candidates (Application Procedures and Requirements for the AMC Examination) which sets out the formal procedures for the AMC examination. APPEALS PROCEDURE The AMC has established procedures for candidates to appeal a decision of the Board of Examiners on matters covered by the Guidelines Relating to Appeals against the Procedures of a Clinical Examination. The goals and objectives forming the basis of medical education in Australia. objectives relating to attitudes as they affect professional behaviour. Guidelines and application forms are available on request from the AMC Secretariat.TABLE OF CONTENTS STANDARD OF THE AMC EXAMINATIONS The standard of the AMC examinations is formally defined as the level of attainment of medical knowledge. whereas the AMC assessment is conducted through a Multiple Choice Question (MCQ) examination and a Clinical Examination. as determined by the AMC for the accreditation of Medical Schools. are expressed in terms of: • • • objectives relating to knowledge and understanding objectives relating to skills and performance The objectives (Attributes of Medical Graduates) are listed in APPENDIX A. In undergraduate courses these are assessed over several years in a variety of ways. Page 2 Clinical Supplement . clinical skills and attitudes which is required of newly qualified graduates of Australian Medical Schools who are about to commence intern training. the mechanisms and actions of. as well as proficiency in clinical skills. clinical features. conduct a physical examination and. secondly. to be familiar with the concepts of disease processes as they apply to the more common and important diseases in the Australian community and. engage in a reasonable discussion of the diagnosis and management. The general objective of the AMC clinical examination is to evaluate the clinical competence and performance of the candidate in terms of his or her medical knowledge. and how these produce deviation from normal.and post-mortem) appearances pertinent to these important diseases FORMAT OF THE CLINICAL EXAMINATION GENERAL FORMAT • to be familiar with the indication for. clinical skills and professional attitudes for the safe and effective clinical practice of medicine in the Australian community. STANDARD OF PERFORMANCE REQUIRED The clinical examination requires the candidate to demonstrate — to the satisfaction of the examiners. to have some awareness of other diseases in the Australian community to be able to discuss the mechanisms of production of symptoms. It also focuses on the candidate’s ability to communicate effectively with patients. and the adverse affects of. at the level of the graduating final year medical student about to commence the preregistration intern year — an understanding of the basic concepts of disease processes across a broad range of clinical disciplines. signs. The clinical examination includes an assessment of a candidate’s ability to take a history. Clinical Supplement Page 3 . the major therapeutic agents. by integration of the information obtained. morphological changes and the pathological (pre. The candidate is required: • • • firstly.TABLE OF CONTENTS REQUIREMENTS FOR THE CLINICAL EXAMINATION OBJECTIVE OF THE CLINICAL EXAMINATION THE CLINICAL EXAMINATION Candidates are required to meet the pass standard in the MCQ examination before being eligible to proceed to the clinical examination. A summary of the clinical examination is set out in APPENDIX B. From January 2004. both in the eliciting of symptoms and in counselling on health care. the clinical examination will consist of – A multi-station structure assessment of clinical skills. Candidates should refer to the Form C-2. The AMC is aware that this scheduling of clinical examinations may create difficulties for some candidates due to religious convictions. due to limitations on the availability of suitable clinical examination venues.au). where the number of applications for clinical examination places in a specific examination Series exceeds the availability of examination places.Therefore.The specified periods for clinical examinations are provisional. candidates who have been scheduled for a clinical examination may not lodge an application for another Series before they have received the results of the scheduled examination. although it will endeavour to do so wherever possible.org. scheduling will be on a priority basis. approximately 10 days after the closing date for the Series for which they applied.Adelaide and Brisbane. Please Note: The AMC cannot guarantee to place an applicant in his/her preferred centre. The scheduling of candidates into a particular centre is done immediately after the closing date of each Series. Candidates will be notified if they have been successful in gaining a clinical position. applicants seeking special consideration in scheduling will required to submit documentary evidence in support of their case for special scheduling. where it does not disadvantage other candidates. as final dates and centres for examinations are subject to negotiation with participating venues. Melbourne. please contact the AMC. examinations are also held in other cities within Australia. As alternative venues are very limited. Candidates may only apply for one Series of examination at a time. Clinical Supplement .TABLE OF CONTENTS ARRANGEMENTS FOR CLINICAL EXAMINATION The AMC has grouped the clinical examination into four separate Series per year. AMC Clinical examinations are conducted on specified Saturdays throughout the year. along the following lines: • • • • • Page 4 first attempt candidates will have priority over repeat attempt candidates the scheduling of first attempt clinical candidates will take into consideration the time since they sat and qualified at the MCQ examination candidates will be ranked in merit order based on their overall score in the MCQ examination candidates with fewer repeat attempts will have priority over candidates with a higher number of repeat attempts the AMC will give special consideration to candidates in exceptional circumstances.You can also print a copy of the Form C-2 from the AMC website (www. SCHEDULING PROCESS FOR THE CLINICAL EXAMINATION For an application form to sit the clinical examination (Form C-2). Candidates should note that.amc. Occasionally. with specified examination periods and defined closing dates. Examinations are held in Sydney. Candidates who believe that they fall into this category should contact the clinical examinations section of the AMC concerning alternative arrangements for scheduling of clinical examinations in such cases. which specifies which centres are available in any given Series. Candidates are sent exact venue details showing report times and locations approximately three weeks prior to their examination. Due to the structure of the examination.org. the AMC is obliged to increase a number of fees and charges associated with the AMC Examination and other assessment pathways effective for examination and assessments conducted after 1 July 2010. under the direction of the administrative staff. The fees for the AMC examination are reviewed from time to time and are subject to variation.au). In order to accommodate increased costs associated with the scheduling and delivery of examinations. Candidates must arrive promptly and report to the administrative staff in attendance. Clinical Supplement Page 5 . A schedule of the fees.au). Candidates complete the examination within three to four hours. which were last changed in 2005/06. Candidates who withdraw after accepting a clinical place will incur a withdrawal fee. Payment of the examination fee will confirm the placement in the relevant clinical examination session.TABLE OF CONTENTS The aim of this approach is to ensure that all candidates have an opportunity to complete the clinical examination as quickly as possible.amc.org. For more information please see the AMC website.The fees are not to be forwarded with the Form C-2. the candidate will not be permitted to sit for the examination. and withdrawal fees. VENUE AND WAITING TIMES Candidates are scheduled for a single morning or afternoon examination. currently applying to the examination are available on the AMC website (www. If the examination fee is not paid by the due date. Candidates will be required to wait at the venue of each examination at the direction of the administrative staff in attendance.amc. the amount of which will depend on the date of the withdrawal. candidates arriving late will be excluded from commencing the examination. EXAMINATION FEES The examination fees for the clinical examination (based on current examination costs) are shown on the AMC website (www. There will not be a separate fee for the AMC certificate. The examination fees for the clinical examinations are payable when a candidate has been scheduled for the relevant examination session. until the examination session concludes. Once candidates have reported they will be required to remain. The Australian Medical Council has reviewed its schedule of examination and assessment fees and charges. One examiner will be involved in each observed station. Rest stations will not be scored. the AMC clinical examination will be an integrated multidisciplinary structured clinical assessment consisting of a 16 component multi-station assessment. counselling/patient education Examples of material that could be included in the stations are: physical examination of a patient with symptoms of suspected intermittent claudication [physical examination station] interpretation of a clinical chemistry result [investigation station] physical examination of a patient with suspected thyrotoxicosis [physical examination station] counselling of an asthmatic patient on the use of an inhaler [patient education station] Clinical Supplement . Scoring will be structured. of which 16 will be marked. standardised patients or examiners as role-playing patients. prescription pads. or linked. Candidates will rotate through a series of 20 stations. or video presentations. including three Obstetric/Gynaecology stations and three Paediatric stations. or linked. stations. and will undertake a variety of clinical tasks. Candidates are scheduled for the structured clinical assessment examination in a single morning or afternoon and will be required to wait at the venue of the examination at the direction of the administrative staff in attendance. but will provide candidates with an opportunity to have a break between the score stations. Surgery. General Practice and Psychiatry.All candidates in a clinical examination session will be assessed against the same stations. Each station will be of 10 minutes duration (eight minutes for the actual assessment and two minutes for change over and reading of the written information for the next session).The station may include observed and non-observed. with individual aspects of each station specified under the following broad headings: • • • • • • • • • • • Page 6 history physical examination investigations diagnosis/differential diagnosis therapeutics/management clinical procedures. e. Models and other relevant equipment may also be used in the examination.There are four rest stations in addition to the 16 marked stations. Stations may utilise actual patients.TABLE OF CONTENTS STRUCTURED CLINICAL ASSESSMENT From 1 January 2004. Gynaecology. A Re-test (Additional Pass/Fail Assessment) for candidates with marginal performance will be held within the next Series of examinations. stations. including the non-observed. and all 16 stations will be scored. Stations will assess clinical skills in Medicine. Obstetrics. Paediatrics.g. The structured clinical assessments will make use of examiners from all disciplines. completeness and orderliness in eliciting the signs the interpretation of the signs and investigations in the determination of diagnosis and management appropriateness of management of the patient and of additional investigations. ability to take a focussed history. General information to be followed by candidates is given to candidates when they accept their clinical examination place. physical examination technique and communication skills the candidate’s skills. Clinical Supplement Page 7 . ASSESSMENT OBJECTIVE FOR THE CLINICAL EXAMINATION The focus of the examination/assessment will be: • • • • the candidate’s approach to the patient. It is also shown at APPENDIX D.TABLE OF CONTENTS • • • • • • • • counselling of a patient with obesity [counselling station] administration of an insulin injection [procedure station] physical examination of a patient with symptoms of shortness of breath [physical education station] physical examination of a patient with ascites [physical examination station] advice to a patient on anticoagulant therapy [therapeutic station] diagnosis of a common benign skin lesion [diagnosis station] counselling a patient in regard to the benefits and risks of hormone replacement therapy [counselling station] counselling a parent concerning childhood immunisation [counselling station]. anorexia. in the post menopausal era cervical smear — implications of result pelvis pain — causes and management contraception — sterilisation. sexual counselling general approach to gynaecological malignancy menopausal care general approach to infertility evaluation and care general approach to urinary incontinence others — vaginal discharge.The following list is provided as a guild only.TABLE OF CONTENTS TOPICS COVERED INTHE STRUCTURED CLINICAL ASSESSMENT EXAMINATION The examination will include the more common and/or important diseases in the Australian community. nose and throat disorders breast and endocrine disorders ophthalmology lesions of the skin and subcutaneous tissue antenatal care intra-partum care post-partum care • Gynaecology: the newborn baby abnormal bleeding — as a child. pregnancy termination. premenstrual syndrome dietary and nutritional problems iron deficiency. and is not exhaustive: • • • • • • • • • • cardiovascular system and disorders respiratory system renal system blood (including oncology) endocrine system • • • • • • • • • thoracic disorders nervous system gastrointestinal system skin (dermatology) musculoskeletal system (rheumatology) orthopaedic disorders urological disorders Obstetrics: abdominal and gastrointestinal diseases with infection head. ear. adult. neck. sexually transmitted diseases. obesity Page 8 Clinical Supplement . APPENDIX F is a sample of an Obstetric & Gynaecology case.The candidates’ listing will be shown by AMC candidate reference number only. PASS/FAIL RE-TEST (Additional Pass/Fail Assessment for Marginal Performance) The Re-test will involve eight marked stations. advice in regard to a psychological treatment.amc. in compliance with Commonwealth Privacy Legislation. usually within two weeks of the examination. then the overall result will be confirmed as a FAIL.au/results. a pass must be obtained in at least six of the eight stations. and therefore the whole structure clinical assessment examination. bowel obstruction. Candidates will be advised of relevant dates and times by the AMC examination secretariat. Formal examination results will be posted to all candidates. and APPENDIX G is a sample of a Paediatric case. each of eight minutes duration (an additional two minutes are given for change over from room to room and to read the written information outside the next station). A listing of candidates’ results will be available on the AMC website (www. gastroenteritis vaccinations asthma behavioural problems • Psychiatry: infectious diseases mental status assessment advice in regard to psychotropic medication history taking — of a person with anxiety disorder APPENDIX E is a sample of a physical examination station showing details of information given to candidates and the key assessment objectives that the examiners will assess. The Pass/Fail Re-test examination will usually be held within the next Series of examination. Candidates with borderline or Marginal Performances will have an opportunity to validate their result as a Pass or Fail in the form of a Re-test examination of clinical skills. including one Obstetric and Gynaecology station and one Paediatric station.asp) from 9am (AEST) on the Thursday following the examination and remain for a period of four weeks. Candidates should ensure that their current address is registered with AMC Secretariat.TABLE OF CONTENTS • Paediatrics: neonatal problems — feeding difficulties. Clinical Supplement Page 9 . To Pass the Re-test examination.org. If a candidate is required to present for the Re-test examination and does not present. When. Inadequate or incorrect reasoning in considering the history. the following could apply — OR • • the obtaining of two or more UNSATISFACTORY — FAIL assessment in two or more areas the obtaining of one VERY UNSATISFACTORY — FAIL assessment. etc. In general.This would usually mean the candidate made a critical error. after a wrist laceration OR moved unconscious patient inappropriately. the mark awarded in the particular section of the mark sheet should be VERY UNSATISFACTORY – FAIL. where a critical error has been made by a candidate. during a clinical examination of assessing the competence of an individual candidate. • This could be for any of the following reasons — FAILURE TO MAKE THE CORRECT DIAGNOSIS. risking further injury. An unsatisfactory — fail performance only in an assessment area which is not identified as a key issue is unlikely to result in the candidate failing the station. OR finding incorrect important physical signs inappropriate investigations being arranged. he/she will not pass the particular station in the structured clinical assessment examination. for a candidate to fail a particular station. a critical error by the candidate has been identified. the diagnosis being made much later than ideal. It is therefore essential for critical errors to be kept to an absolute minimum. despite the fact all the data were readily available to indicate which history areas needed to be explored — failure to ask about the possible use of hormone replacement therapy or when the last Pap test was performed in a patient with post-menopause bleeding. • • inadequate examination being performed — only assessed nerve damage. Errors are only considered critical when that is what they are. In general. or complication occurring which would otherwise have been unlikely. and not tendon damage. • Page 10 Clinical Supplement . irrespective of their performance in the remainder of that station. or failure to request the investigation needed to make the correct diagnosis — failure to advise colonoscopy for a patient with bleeding per rectum OR ordering invasive. The examiner at each station has therefore been advised that. wrong treatment being given. and is NOT exhaustive — 1. complex or expensive investigations which were clearly not necessary. not just where performance of the candidate is not up to the expected standard. preferably zero. examination and/or examination results. these can result in the wrong diagnosis being made.TABLE OF CONTENTS CRITICAL ERRORS IN MEDICAL CARE Where critical errors are made by a medical practitioner. the examiner needs to assess the severity of the error and award a mark to the candidate which takes the performance of the critical error into account. OR AN INAPPROPRIATE DELAY IN MAKING THE CORRECT DIAGNOSIS inadequate history being taken from the patient. EXAMPLE OF CRITICAL ERRORS IN MEDICAL CARE The list below is a guide only. TABLE OF CONTENTS 2. if this is the case the provision of grossly wrong information to the patient concerning the likely diagnosis. • • • • • 3. and must involve a drug which is well known and where the effect of under. • • • 4. management.or over-dosing is well known failure to recognise interaction between two drugs prescribed simultaneously failure to check that the patient is not allergic to the drug proposed. etc. Knowledge of any likely cross-sensitivity could be important failure to recognise the need for assessments for adverse effects – failure to perform a Full Blood Examination if the patient is being given cytotoxic drugs OR failure to measure serum gentamicin levels when appropriate failure to recognise that certain drugs should not be administered in pregnancy.The mistake made must be potentially harmful to the patient. etc. except in the life threatening circumstances performance of a sterilisation procedure in a mentally handicapped individual without the permission of a Court of Law or Guardianship Board. failure to provide appropriate information to the patient to enable informed consent to be given by the patient for a particular investigation. medical treatment. surgical procedure. failure to correctly advise a patient concerning the use of a medical device — appropriate use of a blood glucose measuring device. prognosis. Page 11 Clinical Supplement . INAPPROPRIATE PRESCRIBING This could be for any of the following reasons — wrong drug or other treatment given. failure to admit a patient to hospital when clearly indicated. not just less appropriate than a variety of options wrong dose. BREACH OF ETHICAL BEHAVIOUR This could be for any of the following reasons — communication with an organisation or person without the consent of the patient performance of an operative procedure or the administration of potentially harmful drugs without the consent of the patient. frequency or wrong route of drug treatment. • • • • • • This could be for any of the following reasons — FAILURE TO COMMUNICATE APPROPRIATELY WITH THE PATIENT CONCERNING HIS/HER CONDITION failure to advise the patient of a probable good prognosis for treatment of the condition or malignancy. etc. or a Ventolin inhaler.The drug selection is completely inappropriate. DETERMINATION OF RESULTS Performance Requirements The overall result for each of the 16 marked stations will be recorded as a Pass or Fail only. Page 12 Clinical Supplement . some minor omissions or inaccuracies (pass) Demonstrated significant errors of omission or significant flaws of procedure (fail) Serious omissions or errors. irrespective of the total number of stations passed OR A candidate who obtains a Marginal Performance grade will be eligible to present for a Pass/Fail Re-test to confirm their result as a pass or fail. Very Satisfactory Satisfactory Unsatisfactory Very Unsatisfactory Covered all essential aspects competently — minimal errors or omissions (pass) Major elements covered. Each station will have the appropriate importance of individual domains indicated. inadequate explanations. irrespective of the total number of stations passed. as follows: • Clear Pass = a pass score in 12 or more of the 16 stations including: at least one Paediatric station as a Pass at least one Obstetric/Gynaecological station scored as a Pass AND • • Marginal Performance = Clear Fail = a pass score in 10 or 11 of the 16 stations a pass score in nine or less of the 16 stations OR fails in all three Obstetric/Gynaecological stations. critical errors (fail). incorrect diagnosis. fails in all three Paediatric stations.TABLE OF CONTENTS SCORING IN THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION GRADE LEVEL OF PERFORMANCE The following scoring system is used for individual domains under each station in the clinical examination. failure to respond to prompts. dangerous or life threatening practice. Candidates will be globally graded as Clear Pass/Marginal Performance/Clear Fail. A candidate who obtains a Clear Fail at the main examination or the Re-test will be required to re-sit the clinical examination.TABLE OF CONTENTS Candidates will be globally graded as Clear Pass/Clear Fail in the Re-test. as follows: • • Clear Pass = Clear Fail = a pass score in at least six of the eight stations a pass score in five or less of the eight stations.A sample is shown in APPENDIX I. Each candidate will receive a computer generated transcript of their results and feedback on their performance in the clinical examination.A sample is shown in APPENDIX H. Clinical Supplement Page 13 . Unsuccessful candidates also receive a more detailed breakdown of their performance against the assessment domains. to assist with revision for future attempts. This should not be taken as a negative performance. textbooks. including mobile telephones. No questions regarding the examination are permitted. this does not mean that they have done well or failed. Page 14 Clinical Supplement . It merely means the task has been completed ahead of the allotted eight minutes.TABLE OF CONTENTS ADMINISTRATION ARRANGEMENTS AT THE EXAMINATION CENTRE On entering the examination venue. candidates will be given a pouch containing a coloured card signifying which group you are in. on their skin. Stations may utilise actual patients. etc. Two minutes are given for the changeover from room to room and to read the information outside each room at the next station. standardised patients or examiners role playing as patients. which will be supervised by examination marshals. candidates will only be permitted to take into the examination area a stethoscope and a tendon hammer. Basic equipment for each station will be provided. Each station will last eight minutes. handbags. due to the eight minute examination time period. When the final bell sounds. at the direction of the examination marshal. And so on. If candidates finish a station early. they will be required to stand on the red cross outside the room just completed. all candidates will have completed all the assessed stations and will be guided out of the examination area. paper or other material are allowed into the examination area.This is to ensure that all candidates have the full eight minutes to complete the task of the station.Therefore. and therefore need to wash their hands as appropriate after physical examination. with one examiner assessing each candidate’s performance. and which station you will be starting the examination on. the examiner may interrupt and indicate or request the candidate to move on with the next step. Physical examination — in some stations. Candidates are not permitted to write any prompting material. for example. to their next station and read the information outside their second station. Candidates will be taken into the examination area and asked to stand on the red cross on the floor outing their starting station. If candidates complete a station either early or on time.The second bell heard will commence the examination and candidates will then proceed into the appropriate examination room.Therefore. Candidates may finish at a rest station and will be required to wait until the final bell sounds before being allowed to leave the examination area. there is not enough time to do a full physical examination. Drinking water is provided at each rest station and there will be access to toilets. Candidates DO NOT need to interact with this second person. No books. however. will be starting at a REST STATION (this will be shown on the coloured starting card) — and will be required to stay in the rest station for the first ten minutes. Candidates will then move. Mobile telephones must be switched off and left in the candidate’s bag at the allocated baggage area. Candidates should regard and treat every patient as they would in a real setting. Some candidates. The first bell heard will commence the two minute reading time outside the candidate’s first station.The third bell heard will be after eight minutes of assessment and will conclude the first station. Candidates must keep quiet whilst in the rest stations. There may be a second person in a station who will be monitoring the station. until moved to their next station by the examination marshal. general practice or other specialties. employees or agents of the AMC.amc. may forfeit their eligibility to sit future AMC examinations. surgery. interpret these to arrive at an accurate diagnosis. Some candidates overlook the importance of the feedback on the MCQ examination when preparing for the clinical examination. The AMC examiners consider that candidates who are able to maintain continuing contact with the practice of clinical medicine in a teaching hospital situation can significantly improve their chances of success in the AMC examination. The AMC clinical examination is NOT set at postgraduate level in internal medicine.org.asp) from 9am (AEST) on the Thursday following the examination and remain for a period of four weeks.TABLE OF CONTENTS Any candidate found recording any information during the examination or attempting to circumvent the examination procedures will not be permitted to continue with the examination and may forfeit his or her eligibility to proceed with the AMC examination process. Experience suggests that a review of journals which contain articles dealing with common clinical conditions in the Australian community will be more effective in preparing for the clinical examination than spending too much time with reference books. Listings of candidates’ results will be available on the AMC website (www. in compliance with Commonwealth Privacy Legislation. correspondence and in personal contact with examiners. whose conduct is disruptive or is considered by the AMC to have been outside the bounds of reasonable and decent behaviour.A list of useful journals (essential reading) is set out in APPENDIX C. Formal examination results will be posted to all candidates.The examination format and standards are geared to these aspects as required of Australian medical graduates. Reviews of the performance of candidates in the clinical examination show that there is a strong correlation between performance in the MCQ and the clinical examination. Candidates are expected to conduct themselves courteously in examinations. Clinical Supplement Page 15 .The candidates’ listing will be shown by AMC candidate reference number only.au/results. AMC clinical examiners recommend that candidates undertake a comprehensive review of clinical skills and differential diagnosis. and to communicate with the patient or carer. CONDUCT OF CANDIDATES PRESENTING FOR EXAMINATION Particular attention in the clinical examination needs to be paid to reviewing basic clinical skills. competence and safety to a standard comparable to that expected of an Australian medical graduate and to practising consultations skills and communication in everyday English.The clinical examination is designed to evaluate the candidate’s ability to identify physical signs and symptoms. briefly discuss the appropriate management of the patient and the condition. It is in the candidates’ best interest to identify their clinical strengths and weaknesses and to focus their efforts to overcome any basic clinical deficiencies. usually within two weeks of the examination. Candidates who fail component subjects in the clinical examination are often found to have performed poorly (less than 50% correct) in the same subject in the MCQ. Candidates should ensure that their current address is registered with the AMC Secretariat. REVIEW OF CLINICAL SKILLS PREPARATION FORTHE STRUCTURED CLINICAL ASSESSMENT EXAMINATION The objective of the clinical examination is to assess clinical skills and safety.A candidate. Candidates are advised that NO mobile telephones. Failure to do so will constitute a breach of examination procedures and may result in action being taken against the candidate concerned.TABLE OF CONTENTS All candidates must comply with instructions of clinical examination supervisors during examinations.The candidate is expected to be able to take a focussed history and perform a concise but complete physical assessment based on the patient’s presenting problem. GENERAL PREPARATION FOR THE CLINICAL EXAMINATION • A doctor who crosses professional boundaries will be guilty of professional misconduct and will be sanctioned under the relevant State/Territory Legislation. Candidates in clinical examinations are expected to observe the confidentiality of patients who participate in the examination and should not discuss the personal details of medical history of patients outside the examination. Candidates’ family/friends accompanying them to an examination centre will NOT be allowed into the examination area and are reminded that the use of mobile phones is NOT permitted. Mobile telephones must be switched off and left in the candidates’ bag at the allocated baggage area. and disciplinary action may be taken. Any candidate found contravening this regulation will be reported to the Board of Examiners for possible disciplinary action. A candidate who attempts to circumvent the examination procedures may forfeit his/her eligibility to proceed with the examination. Candidates do not get ‘extra points’ because they can recite detailed material from a text book on a particular clinical condition get a good night’s rest before presenting for the examination. The following points are suggested to assist candidates in planning for and sitting the clinical examination: • • Page 16 undertake a comprehensive review of clinical skills leading up to your scheduled clinical examination. Use clinically oriented texts but avoid heavy study of reference books. receiving or recording information during the examinations will not be permitted to continue in the examination and may forfeit their eligibility to sit future AMC examinations. recording devices or textbooks are to be taken into the clinical examination. Candidates found to be giving.The State and Territory Medical Boards have codes of practice on this matter. THE DOCTOR-PATIENT RELATIONSHIP IN AUSTRALIA Professional boundaries are crossed when any interaction of a sexual nature occurs between a doctor and the patient or an immediate family member of the patient. The clinical examination is not designed to re-test knowledge alone. Avoid the use of stimulants read your venue notice carefully and note the times and locations of your examination Clinical Supplement . No books or papers may be used in the examination. The AMC will investigate thoroughly a complaint or adverse report concerning any candidate sitting an AMC examination. Action may be taken against any candidate found to be selling or offering for sale examination papers or questions purporting to be AMC examination papers or questions. The patients in the examination have a right to receive the same care exercise care with both the technique and the accuracy of the physical examination of the clinical cases.These factors should be paramount in any discussion concerning the management of the patient or the relevant condition in both the clinical cases and any viva section of the clinical examination.The videotape/DVD takes the candidate through the new clinical examination and complements the AMC Examination Specification Booklet (www. in some cases.As a medical practitioner . Many candidates who fail the examination do so because they do not recognise the clinical safety aspect of patient management or prescribe a clinically inappropriate treatment. you already have a duty of care to your patients. Failure to identify the physical signs present leads to failure in determining the diagnosis and consequently failure in identifying the appropriate management • • avoid discussing patients with other candidates at the clinical examination centre.TABLE OF CONTENTS • • • • ensure that you arrive on time for each clinical examination session and give yourself time to settle down before your examination commences listen carefully to the examiners’ introductory statements. alternative conditions are examined in patients with multiple clinical signs.The examiners will take note of the manner in which a candidate addresses and deals with the patient.amc. has produced videotape and DVD of the Structured Clinical Assessment — A guide to preparing for the AMC Clinical Examination. you should ask for clarification of the particular matter. Patients are rotated and.Any candidate who attempts to formulate a diagnosis or management on the basis of information provided by other candidates. in association with the Education Resource Centre of the Royal Children’s Hospital.au). The AMC.org. without having examined the patient. Order forms for the video/DVD are available through the AMC Secretariat and the AMC website Clinical Supplement Page 17 . or for the question to be repeated • candidates often appear to overlook the fact that there may be role playing examiners or real patients in the clinical examination. and read carefully any preliminary data given to you if you are uncertain about any instruction or question from the examiners during your clinical examination. is likely to fail on the grounds of clinical safety CLINICAL EXAMINATION VIDEO/DVD the final consideration in determining the result in the clinical examination is the safety and appropriateness of the assessment and/or treatment of the patient. TABLE OF CONTENTS FORMAL NOTIFICATION OF CLINICAL EXAMINATION RESULTS AND FEEDBACK Formal examination results will be posted to all candidates. REQUEST FOR DUPLICATE COPIES OF AMC RESULTS For reasons of privacy. Clinical examination) of the AMC examination and when International Credentials Service of the Educational Commission for Foreign Medical Graduates of the United States (ECFMG) verification of medical qualifications has been confirmed.au/results. Each candidate will receive a computer generated transcript of their results and feedback on their performance in the clinical examination. It may take up to ten working days before duplicate copies of results are received. However. the AMC will not send copies of candidate’s official examination results to anyone but the candidate. candidates will be issued with an AMC Certificate. usually within two weeks of the examination.The candidates’ listing will be shown by AMC reference number only. MCQ examination. which should be filled in and returned to the AMC.e. with the appropriate fee. in compliance with Commonwealth Privacy Legislation. AMC CERTIFICATE PLEASE NOTE: under no circumstances will final results be given over the telephone Candidates who pass all sections (i.amc.asp) from 9am (AEST) on the Thursday following the examination and remain for a period of four weeks.org. the AMC will issue candidates with an application form.A sample is shown at APPENDIX I. It should be noted that the AMC Certificate is only issued in Australia and cannot be re-issued once collected. to assist with revision for future attempts. Candidates should ensure that their current address is registered with the AMC Secretariat. A listing of candidates’ results will be available on the AMC website (www. Page 18 Clinical Supplement . A candidate’s Certificate will be sent to the Medical Board in the State where the candidate resides approximately six to eight weeks after completion of the clinical examination.A sample is shown at APPENDIX H. upon request for duplicate copies of the results. Unsuccessful candidates also receive a computer generated breakdown of their performance against the assessment domains. org. Under the Commonwealth Privacy Amendment (Private Sector) Act 2000.amc.org. which will take approximately 10 working days.au Page 19 . If a candidate is in doubt about any aspect of the AMC examination.The form is also available on the AMC website (www.au http://www.au). he/she should contact the AMC Secretariat: Australian Medical Council PO BOX 4810 KINGSTON ACT AUSTRALIA Clinical Supplement 2604 Telephone: Facsimile: Email: Website: 02 6270 7878 02 6270 9799 clinical@amc. FURTHER INFORMATION Candidates are advised to carefully study the current edition AMC publication Information booklet for Candidates (Application and Procedures and Requirements for the AMC Examination) concerning examination procedures and requirements. rule or eligibility changes.amc.The Change of Address form is also available on the AMC website (www. This will ensure that contact can be made quickly with candidates as the occasion arises to notify examination venue changes.org. the AMC is unable to accept changes of address or other candidate details taken over the telephone or submitted by email. When advising of a change of address in writing. Please complete and return the form to the AMC to enable the Secretariat to process the request. please include the following details: candidate number full name previous address new address candidate signature date of birth GENERAL INFORMATION • • • • • • Under the provisions of the Commonwealth privacy Amendment (Private Sector) Act 2000 (effective from 21 December 2001). or to confirm information provided by the candidate on his or her application forms. WITH THE AMC Section 19 AB of the Health Insurance Act REQUEST FOR CONFIRMATION OF DATE OF PRELIMINARY APPLICATION Please obtain a copy of the form Request for Confirmation of Date of Preliminary Application from the Secretariat if you require confirmation in writing of the date your preliminary application was received by the AMC to enable you to apply for an exemption from the Moratorium on the Medicare Provider Number with the Commonwealth Department of Health and Ageing.amc. Please advise of any changes using the Change of Address form which can be obtained by contacting the AMC Secretariat. the AMC is not able to send these details to anyone but the candidate.org. Further information regarding the Moratorium can be obtained from the Workforce and Quality Branch of the Department of Health and Ageing by contacting them on 02 6289 5903.TABLE OF CONTENTS CHANGE OF ADDRESS It is important that candidates advise the AMC Secretariat promptly of each change of address and/or telephone number.au). TABLE OF CONTENTS Page 20 Clinical Supplement . 7.A more detailed knowledge is required of those conditions that require urgent assessment and treatment. disease prevention and screening. and the interactions between body and mind. Normal pregnancy and childbirth. the principles of antenatal and postnatal care. and that they have an appropriate foundation for further training in any branch of medicine and for lifelong learning. 3. 9. rehabilitation. KNOWLEDGE AND UNDERSTANDING ATTRIBUTES OF MEDICAL GRADUATES APPENDIX A Scientific method relevant to biological. the principles of efficient and equitable allocation and use of finite resources. 11. adults and the aged. Common diagnosis procedures. 8. Included below is the list of knowledge and understanding. Graduates completing basic medical education should have knowledge and understanding of: 1. The principles of health education. and prognosis of common mental and physical ailments in children. behavioural and social sciences at a level adequate to provide a rational basis for present medical practice. adolescents. 4. function and development of the human body and mind at all stages of life. The normal structure. natural history. the more common obstetrical emergencies. the psychological well-being of patients and their families.TABLE OF CONTENTS The goal of medical education is to develop junior doctors who possess attributes that will ensure they are initially competent to practice safely and effectively as interns in Australia or New Zealand. The principles of amelioration of suffering and disability. The principle of ethics related to health care and the legal responsibilities of the medical profession. Attributes should be developed to an appropriate level for the graduates’ stage of training. The aetiology. 5. 10. their uses and limitations. and the care of dying. nutritional and psychological therapies. Factors affecting human relationships. skills and attributes required of graduates completing basic medical education that is included in the AMC’s Assessment and Accreditation of Medical Schools: Standards and Procedures. pathology. and to acquire and incorporate the advances in knowledge that will occur over their working life. and the interactions between humans and their social and physical environment. 2. symptoms and signs. the factors that may disturb these. Clinical Supplement Page A1 . physical. and medical aspects of family planning. Systems of provision of health care including their advantages and limitations. 6. Management of common conditions including pharmacological. 20. 18. and to use libraries and other information resources to pursue independent inquiry relating to medical problems. 19. The ability to select the most appropriate and cost effective diagnostic procedures. The ability to counsel patients sensitively and effectively and to provide information in a manner that ensures patients and families can be fully informed when consenting to any procedure. The ability to recognise serious illness and to perform common emergency and lifesaving procedures such as caring for unconscious patient and cardiopulmonary resuscitation. and to plan management in concert with the patient. The ability to interpret common diagnosis procedures. considerately and sensitively with patients and their families. accurate. 17. The ability to interpret and integrate the history and physical examination findings to arrive at an appropriate diagnosis or different diagnosis. other health professionals and the general public. The ability to choose from the repertoire of clinical skills. 16. 23. 15. Page A2 Clinical Supplement . The ability to perform an accurate physical and mental state examination. 21. The ability to take a tactful. nurses. 22. The ability to interpret medical evidence in a critical and scientific manner. The ability to communicate clearly.TABLE OF CONTENTS SKILLS Graduates completing basic medical education should have developed the following skills: 13. doctors. organised and problem-focused medical history 14. The ability to formulate a management plan. The ability to use information technology appropriately as an essential resource for modern medical practice. those that are appropriate and practical to apply in a given situation. 12. Recognition that the doctor should have the necessary professional support. 31. An appreciation of the system approach to health care safety. A desire to achieve the optimal patient care for the least cost. A realisation that one’s personal or religious beliefs should not prevent the provision of adequate and appropriate information to the patient and/or the patient’s family. An awareness of the need to communicate with patients and their families. 30. 28. with an awareness of the need for cost-effectiveness to allow maximum benefit from the available resources. including respect of sexual boundaries. including an appreciation of the diversity of human background and cultural values. 26. and the need to adopt and practice health care that maximises patient safety. Respect for every human being. 24. including a primary care physician. or the provision of appropriate management including referral to another practitioner. Clinical Supplement Page A3 . 27. A realisation that it is not always in the interests of patients or their families to do everything that is technically possible to make a precise diagnosis or to attempt to modify the course of an illness. including the allocation of scarce resources. 33. An appreciation of the responsibility to maintain standards of medical practice at the highest level throughout a professional career. 37. An appreciation of the complexity of ethical issues related to human life and death. A commitment to ease pain and suffering. An appreciation of the need to recognise when a clinical problem exceeds their capacity to deal with it safely and efficiently and of the need to refer the patient for help from others when this occurs. students should demonstrate the following professional attitudes that are fundamental to medical practice: 25.TABLE OF CONTENTS ATTITUDES AS THEY AFFECT PROFESSIONAL BEHAVIOUR At the end of basic medical education. 34. Recognition that the doctor’s primary professional responsibilities are the health interests of the patient and the community. and to involve them fully in planning management. Respect for community values. 35. 36. A willingness to work effectively in a team with other health care professionals. to ensure his or her own well-being. 32. An appreciation of the responsibility to contribute towards the generation of knowledge and the professional education of junior colleagues. 29. 38. TABLE OF CONTENTS Page A4 Clinical Supplement . and may be linked to other stations 8 minutes per station plus 2 minutes changeover and Examiner’s marking One Examiner per observed station 16 Stations marked STRUCTURED CLINICAL ASSESSMENT EXAMPLE ONLY TOTAL 20 STATIONS 1 2 (Paeds) Rest Station 3 4 (O or G) 5 6 Rest Station 7 8 (Paeds) 9 (O or G) 10 Rest Station 11 12 13 (Paeds) 14 Rest Station 15 16 (O or G) CLEAR PASS Pass scores in 12 or more Stations including at least one Pass in O/G and at least one Pass in Paeds Qualifies for AMC Certificate MARGINAL PERFORMANCE Pass scores in 10 or 11 Stations CLEAR FAIL Pass scores in nine or less Stations or fails in all three O/G or fails in all three Paeds Repeats Structured Clinical Assessment Proceeds to Additional Assessment Re-test (Additional Assessment) — Held in conjunction with the next series of examinations) 10 Station Structured Clinical Assessment (8 Scored + 2 Rest Stations) Candidates assessed on basis of 8 additional (new content) stations (including one Obstetric or Gynaecology case and one Paediatric case) CLEAR PASS Pass scores in at least six of the eight stations CLEAR FAIL Pass scores in five or less of the eight stations Repeats Structured Clinical Assessment Clinical Supplement Qualifies for AMC Certificate Page B1 .TABLE OF CONTENTS APPENDIX B SUMMARY OF THE FORMAT OF THE AMC CLINICAL EXAMINATION 20 Station Structured Clinical Assessment (16 Scored + 4 Rest Stations) Includes 3 Obstetric/Gynaecology & 3 Paediatric Stations Some Stations may be unobserved. TABLE OF CONTENTS Page B2 Clinical Supplement . This book is essential reading for those intending to sit the AMC examination.elsevier.TABLE OF CONTENTS AMC Annotated Multiple Choice Questions ESSENTIAL READING APPENDIX C Distributions: The AMC publication Anthology of Medical Conditions has been produced not only to assist overseas trained doctors to prepare for the AMC examinations but also as an essential tool for clinical practice.These questions have been used in previous AMC examinations and will provide candidates with comprehensive guide to the format. MEDICINE Devitt P. There are many medical textbooks available and most of them are of high standard.The publication is enhanced throughout with medical illustrations. The Anthology of Medical Conditions can be ordered from the AMC secretariat — via the AMC website for an electronic order or downloading of a hard-copy order form. Davidson’s Principles and Practice of Medicine. SUGGESTED TEXTBOOKS The publication is recommended for use in preparing for the AMC multiple choice question (MCQ) and clinical examinations. Mitchell J and Hamilton-Craig C. Barker J.au/healthprof/ Clinical Supplement Page C1 . It is essential for all doctors to be familiar with the laws of the society in which they practice medicine and the ethics that underpin medical practice.harcourt. scope and standard of the AMC MCQ examination. Blackwell Publishing Asia 550 Swanston Street CARLTON VIC 3053 AUSTRALIA AMC Anthology of Medical Conditions The AMC has prepared a selection of over 600 MCQ Questions from its MCQ Question Bank with commentaries and explanations of each question.They range from quite short texts.The book Annotated Multiple Choice Questions details are as follows: AMC examinations are set on the latest editions of the recommended textbooks. to long and comprehensive treatises which most people use as reference books. Churchill Livingston.com. 18th edn.The publication lists over 130 Clinical Presentations of clinical conditions and classifies them to assist in a problem-solving approach to diagnosis and management. http://www.The Anthology of Medical Conditions contains a separate section dealing with these important issues. Material contained in previous editions of the recommended textbooks. 2003.au Edwards C and Bouchier IA (eds). It is up to the AMC candidate to obtain the latest information. which cover essential knowledge. or other unspecified textbooks. Edinburgh.The AMC has drawn up the following list. Ethical and Organisational Aspects of the Practice of Medicine (LEO). 1999. ISBN 0443073236. Livingstone. ISBN 0443059446 http://www. An order form is enclosed with this book. may not be correct and will not be used to determine the result of AMC examinations.com. entitled Legal. 2nd edn. Clinical Problems in General Medicine. as a guide to some useful texts. It is also important to understand the organisational aspects of medicine in the Australian context.They are not intended as prescribed reading. S. 3rd edn. New York. 2001. Edinburgh. Sydney. ISBN 086793431X http://www. ISBN 044305603X. MacLennan & Petty. Melbourne.com National Health and Medical Research Council (NHMRC). 1999. Morris PJ. 2002. Harrison’s Principles of Internal Medicine. Paperback. Churchill Livingstone. http://www.TABLE OF CONTENTS Braunwald.us. Oxford University Press.com Hunt PS.oupusa.blaksci.au Talley NJ.Tjandra JJ. ISBN 044307139X http://www. Melbourne.edu. 4th edn. Oxford Textbook of Surgery. 4th edn. Smallwood R. ISBN 0192629220 (set of 3).co.ranzcr. Imaging Guidelines. http://www. 8th edn. ISBN 0867930233. Churchill Livingstone. ISBN 019228844 (three volume set). 1994. Clinical Skills:The Medical interview. Firth JD.htm Page C2 Clinical Supplement . Blackwell Science Asia. Essential Paediatrics.Waxman BP. The Australian Immunisation Handbook. Roberton DM. http://www. ISBN 0522844677 (paperback).org/medical SURGERY Cluine GJA. ISBN 0642822042 http://immunise.mcgraw-hill. Butterworths.com. Melbourne. 2003.org/medical PAEDIATRICS Williamson R. Churchill Livingstone.au Warrell DA. 4th Edn. Oxford University Press.us. http://www.unimelb.J.bookstore. 2006. 6th edn. Churchill Livingstone.mnemosyne. http://www.au/handbook. http://www.Wood WC. 2001. http://www. ISBN 0070072744 (hardcover).us.htm Forrest AP. ISBN 0443059586 http://www.htm Cluine GJA. Textbook of Surgery. MCQ’s and Short Answer Questions for Surgery. Blackwell Science Asia. http://www. Clinical Examination:A Systematic Guide of Physical Diagnosis.com Hull D. 1998.com Larkins R. 2nd edn. Melbourne 2004.blaksci.).edu. 2001. MacLeod IB. ISBN 0959285415.uk/australi/books. 7th edn.health. ISBN 0443048606. O’Conner S.co.elsevierhealth. Edinburgh.Vic. 2001. Carter DC. Cox TM.Thomas R. 1991. Johnson D.elsevierhealth. Practical Paediatrics. 16th edn.mup. Principles and Practice of Surgery – A Surgical Supplement to Davidson’s Principles and Practice of Medicine.uk/australi/books.htm Royal Children’s Hospital (Melbourne.This publication is out of print and only available second hand.mnemosyne. Ross H. Melbourne. Sydney. 2 volume set). ISBN 0079136869 (hardcover. 4th edn. ISBN 0867930101. 1995.elsevierhealth. Scott: An Aid to Clinical Surgery. New York. 5th edn. Blackwell Science Asia. McGraw-Hill. Physical Examination and Assessment of the Patient’s Problems. Paediatrics Handbook.maclennanpetty. http://www.The Royal Australian and New Zealand College of Radiologists.com Robinson MJ. Marshall VC.us. New York. Melbourne University Press. Melbourne.Australian Government Printing Service 2003.Tjandra JJ.elsevierhealth. Edinburgh. Clinical Problems in General Surgery.blacksci. 2nd edn. ISBN 0071402357 (CD-ROM) http://www. Benze EJ Jr (eds) Oxford Textbook of Medicine. ISBN 0409492132.uk/australi/books.oup-usa. E. Scott PR.gov. ISBN 0864331444.co.au Lau L. 1999. 2001. Obstetrics and the Newborn – An Illustrated Text. http://www.au MIMS Australia.au/products/kro_druginfo.bookstore.Wood C.au Therapeutic Guidelines:Analgesic Version 4.The Royal College of Pathologists of Australasia. ISBN 0729512118. 2002 Therapeutic Guidelines: Neurology Version 2.hcn. 2004 Therapeutic Guidelines: Endocrinology Version 3.us. 2003 Therapeutic Guidelines: Cardiovascular Version 4. ISBN 0890420246 (hardback) http://www.org GENERAL PRACTICE MISCELLANEOUS Murtagh J. 2002. Illustrated Textbook of Gynaecology. 2003 Therapeutic Guidelines: Respiratory Version 2.Andearsen N. St Leonards. ISBN 0646409646. 2000 Note:Available in print individually or as complete set in the form of an electronic subscription (i. Lopez-Ibor JJ.com.American Psychiatric Association. ISBN 0192629700 (paperback) http://mnemosyne. 4th edn.TABLE OF CONTENTS OBSTETRICS & GYNAECOLOGY Beischer NA.elsevierhealth. ISSN 0725-4709 (MIMS Australia Annual). Mackay EV. 2002 Therapeutic Guidelines: Palliative Care Version 1. CD-ROM or MIMS on PDA (Personal digital assistant). Oxford University Press.rcpa. Sydney 1998.oup-usa.TG complete).mcgraw-hill.mosby. 2nd edn.Washington DC. Subscriptions: ISSN 10355723 (MIMS Australia Bi-monthly).us.psych. 4th edn text revision. The Oxford Textbook of Psychiatry. MediMedia Australia Pty Limited.com. 2nd edn.Vic. ISBN 0074704362 Soft cover edition 1999.com PSYCHIATRY Mackay EV. Pepperell R. 2nd edition.elsevierhealth. Fundamentals of Obstetrics and Gynaecology. McGraw Hill Australia 1998. DSM-IV-TR: Diagnostic and Statistical Manual of Metal Disorders.edu.tg. NSW. ISBN 0890420254 (paperback).au Clinical Supplement Australian Medical Handbook.org/medical American Psychiatric Association. ISBN 0959335528.e. http://www. 3rd edn. Manual of Use and Interpretation of Pathology Tests. 2001 Therapeutic Guidelines: Psychotropic Version 5.WB Saunders. 3rd edn.com Llewellyn-Jones D.com. 3rd edn. North Melbourne. http://www. http://www. 2003 ISBN 0957852126. Online version available via Health Communication Network. General Practice. 2004 Therapeutic Guidelines: Gastrointestinal Version 3. Beischer NA.mims. Mosby.ABNRID 000012656851 (eMIMS. 2000. Hardcover. London 2004. 8th edn ISBN 0723433291 http://www.html Page C3 . 2003 Therapeutic Guidelines: Dermatology Version 2. ISBN 0074707191 http://www. 2002 Therapeutic Guidelines:Antibiotic Version 12.com Gelder M. 1997.com Therapeutic Guidelines from Therapeutic Guidelines Limited. Sydney 1992.WB Saunderers.This edition available on CD-ROM or online only http://www. ISBN 0702021237. http://www. com).com).racgp.ctonline.au/publications). Current Therapeutics (http://www.au). British Medical Journal (www.thelancet.TABLE OF CONTENTS In addition to major texts.mja. Lancet (www. Medical Journal of Australia (www. annotations and review articles. New England Journal of Medicine (http://www.org).au).The following journals are suggested as source material: Australian Family Physician (www.com. using editorials. journals should be read selectively.australianprescriber.co.org. British Journal of Hospital Medicine http://www. JOURNALS Page C4 Clinical Supplement .com).com. Australian Prescriber (www.bmj.hospitalmedicine.nejm.uk).content. Candidates should regard the standardised patients or role-playing examiners as patients and treat them as they would treat real patients. Stations may utilise actual patients. Candidates should regard the standardised patients or role-playing examiners as patients and treat them as they would treat real patients. Each candidate will be allocated one of the stations to start the examination. appropriately aged individuals are used for these tasks. Clinical Supplement LATE ARRIVAL — Candidates who do not attend before the time indicated will be excluded from commencing the examination. unless the candidate’s next station is a rest station.There will be registered nurses available to assist the real patients if required.There will be registered nurses available to assist the real patients if required. the candidate is given written information concerning the next station to read.Where possible. when the station will end. During this 2 minute change over time. Each candidate will be allocated one of the stations to start the examination. There will be 8 marked stations (some unobserved and may be linked to subsequent stations. During this 2 minute change over time. GENERAL INFORMATION FOR THE RE-TEST EXAMINATION LATE ARRIVAL — Candidates who do not attend before the time indicated will be excluded from commencing the examination. Page D1 .TABLE OF CONTENTS • • GENERAL INFORMATION FOR THE STRUCTURED CLINICAL ASSESSMENT APPENDIX D There will be 16 marked stations (some unobserved and may be linked to subsequent stations. plus 2 rest stations) • • Each station will be of 10 minutes duration (8 minutes for the actual assessment and 2 minutes for change over). standardised patients or examiners role-playing patients. Stations may utilise actual patients.however white coats are not required. unless the candidate’s next station is a rest station. • • • • • • The dress standards are as for clinical work — however white coats are not required. An alarm will sound at 8 minutes. Most equipment will be provided: candidates will only be allowed to take into the examination their own stethoscope and hammer. plus 4 rest stations) • • Each station will be of 10 minutes duration (8 minutes for the actual assessment and 2 minutes for change over). Candidates will be required to move to the next station when the alarm sounds at the direction of the examination marshal. appropriately aged individuals are used for these tasks. Candidates will be required to move to the next station when the alarm sounds at the direction of the examination marshal. the candidate is given written information concerning the next station to read. • • • • The dress standards are as for clinical work .Where possible. standardised patients or examiners role-playing patients. Most equipment will be provided: candidates will only be allowed to take into the examination their own stethoscope and hammer. An alarm will sound at 8 minutes. when the station will end. TABLE OF CONTENTS Page D2 Clinical Supplement . Key Issues • Performance of an adequate respiratory examination. clubbing. Ability to formulate an appropriate probability diagnosis. Never admitted to hospital before.rate. allergies. • Accurate and complete interpretation of the physical signs. He/she will be asked to sit on an examination couch and will need to be willing and able to be subjected to repeated respiratory examinations by sequential candidates. pattern) trachea and apex beat chest expansion (including upper lobes) chest percussion (all areas) auscultation (all areas. flap. Examiner’s Instructions The aims of this station are to assess: i) ii) Proficiency in performing a respiratory examination including looking for evidence of RV failure. pulse. occupational and social history (dust exposure — nil. flow rate to be measured. on Ventolin puffer twice daily. resp. Ability to detect and describe the key findings (examiner to check): — — — — — — — — iii) peripheral signs – hands. such as asthma — yes for 20 years. EXAMINERS ARE TO ENCOURAGE EACH CANDIDATE TO WASH THEIR HANDS AFTER EXAMINING THE PATIENT OR PRIOR TO LEAVING THE ROOM AT THE 8 MINUTES BELL.TABLE OF CONTENTS APPENDIX E STRUCTURED CLINICAL ASSESSMENT STATION Information Sheet for Candidates This patient is a 60-year old patient who presents to his/her General Practitioner because of increasing shortness of breath over a period of some 12 months. over-distended chest). YOUR TASK IS TO — • • • • perform a respiratory examination summarise your findings formulate a provisional diagnosis give a commentary outlining what you are doing as you proceed. peak exp. Key aspects of past history to be given if asked. YOU WILL NOT NEED TO TAKE A DETAILED HISTORY. summarising the normal and abnormal findings. smoking — 20 per day). JVP chest inspection (shape. including resonance) check pulmonary hypertension bedside pulmonary function tests (check X-ray to be arranged. cyanosis (central). bronchitis — occasional. but can ask appropriate focused questions. sputum – culture). Clinical Supplement Page E1 . Role Player/ Standardised Patient Sheets The patient will be required to undress down to underwear and put on a hospital gown. poor rapport . Needed excessive prompting.poor listening skills understands (no jargon) .causes harm to the patient .empathy.does not address patient’s ques.significant omissions . Did the candidate identify the physical findings accurately as per examiners’ instructions? TABLE OF CONTENTS Key Issue Diagnosis/Differential Diagnosis Did the candidate formulate and describe an appropriate diagnosis/differential diagnosis? Key Issue Covered all essential Commentary to Examiner aspects competently — Did the candidate describe the find. Little evidence of clinical reasoning skills.causes unnecessary discomfort . Choice of investigations inappropriate and with poor perspective. Choice of investigations optimal and with good perspective. but still reasonable. Clinical Supplement Choice of Investigations Did the candidate make an appropriate choice of investigations as per examiners’ instructions? Overall rating for this candidate for this station Covered all essential asSome errors in choice and pects competently — priority of investigations minimal errors or omissions. CRITICAL ERROR Examiner to tick ONE box in each ROW — NO OTHER WRITTEN COMMENTS ON THIS MARKSHEET Candidate’s ID card sighted Very Satisfactory — PASS Satisfactory — PASS Unsatisfactory — FAIL Very Unsatisfactory — FAIL Approach to patient Covered all essential Candidate displays one or Candidate displays one or Sound. hesitancy leading to inadequacy. Scatter gun approach with little apparent perspective CRITICAL ERROR .poor technique Serious errors or omissions in technique CRITICAL ERROR Serious errors or omissions in findings. Minor errors in formulation. Diagnosis and differential diagnosis appropriate to case even if not completely accurate. fails to put patient at ease the consultation.Condition: Emphysema (chronic) Page E2 Minor technical faults but examination completed reasonably. Wrong interpretations of findings. Significant errors in explanations of findings.minimal errors or omissions.obtains verbal consent to proceed but not serious harm to the CRITICAL ERROR as examiners instructions? patient. opings with an appropriate commentary timal commentary.inability to establish approthe patient. communicated . Logical. not interfering with overall adequacy of commentary. Diagnosis inappropriate to the case.poor communication skills. consideration aspects competently.checks for patient understanding the explanation of the procedure tions or concerns appropriately . One or more significant errors in findings. Some loss of using language that the patient priate rapport and communication rapport or empathy at points in . Minor errors in formulation. comfort.explanation of examination . PASS FAIL Diagnosis not given. well organised. this box must be marked.sions. more of the following: more of the following: essential information to . Clinical reasoning and diagnostic skills markedly deficient.significant errors of technique . If wrong diagnosis would result in harm to patient. Key Issue Covered all the essential Technique of examination. oraspects competently — ganisation and sequence minimal errors or omisDid the candidate carry out an appro. . Candidate displays one or more of the following: . Minor omissions or errors in explanations of findings. Needed constant prompting. Unclear and poorly organised. as per examiners instructions? CRITICAL ERROR Serious errors or omissions in presentation.answers patient’s questions . Very poor organisation.causes no discomfort to the patient interfering with some aspects of . priate focused and relevant examination as per examiners instructions? Key Issue Identified most or all Accuracy of Examination findings accurately. little evidence of logical structure. reported findings not consistent with physical signs. Covered all essential aspects competently — minimal or no errors or omissions. clear. CRITICAL ERROR Serious errors or omissions in choice of investigations. Serious omissions/errors in interpretation of findings. Minor errors in findings. Page F1 • Clinical Supplement .The patient has the option as to whether to terminate the pregnancy forthwith. which has revealed an anencephalic fetus. YOUR TASK IS TO — • • Take any further relevant history. and cervical damage resulting in subsequent cervical incompetence may result when the procedure is done after 16 weeks of gestation. otherwise labour post term is common. followed by virginal delivery of the fetus. Termination of the pregnancy could be performed by using prostaglandins. • Advise patient. religious or other reasons. likely response to treatment or prognosis). This is a developmental defect of the brain which has occurred somewhere between 5 and 8 weeks of gestation. or continue until labour occurs.As the patient has indicted she would not wish to continue with the pregnancy because of the abnormality present. and this had shown elevated levels of alpha fetoprotein. Examiner’s Instructions Diagnosis — Fetal anencephaly. Examination Findings Uterus 1 cm below umbilicus. referral to a person who could follow this through must be arranged. Blood pressure 120/80. It is quite a difficult procedure except in expert hands. or not prepared to do the termination procedure for ethical.TABLE OF CONTENTS Information Sheet for Candidates STRUCTURED CLINICAL ASSESSMENT STATION APPENDIX F This patient is a 25 year old primigravida has just had an ultrasound scan perform at 18 weeks of gestation. in lay terms. Pulse 80. Ask the examiner about appropriate findings likely to be evident on general and/or gynaecological/obstetric examination and appropriate investigation results.The condition is uniformly fatal soon after birth. Speculum and PV examination not done. Investigation Results Advice to Patient • • None done.This latter procedure has the advantage of being performed under general anaesthetic with the procedure being over when the patient wakes up. The information concerning anencephaly above should be given. Prostaglandin termination may take several hours or even days and requires uterine contractions similar to those experienced in labour. or by the surgical procedure of dilatation and evacuation. If hydramnios occurs the labour is likely to be premature. There is also a possible need for curettage to remove any retained placental fragments. these matters must be discussed. of the diagnosis and subsequent management (and. except MSS and ultrasound as indicted in the instructions to the candidate. if appropriate. If the candidate is not prepared to discuss these matters.A maternal serum screening (MSS) was done at 16 weeks. • No family history of neural tube defect in pregnancy. the overall mark for this case would normally be a FAIL. Role Player / Standardised Patient Sheets The candidate will generally be expected to take an appropriate history from you in order to manage the case. and maternal serum alpha fetoprotein assessment at about 15 weeks of gestation. Key Issues If the candidate obtains a VERY UNSATISFACTORY mark in any of the “KEY” category areas. and any other relevant history which might be appropriate. is also useful as a screening test. or spina bifida. indirect Coomb’s test negative. The critical errors box on the mark sheet should be marked if a critical error is made. Some could be used to clarify points raised by the candidate. • Ultrasound examination in a subsequent pregnancy is imperative. Failure to determine the preferences of the mother in respect to termination of pregnancy or not. • Postmortem examination of the fetus should be advised to check that no other abnormality is present which might influence the advice given to them concerning the success or otherwise of any subsequent pregnancy. or “I don’t know”.TABLE OF CONTENTS If the patient had not requested termination of the pregnancy the potential problems of premature labour and increased risk of placental abruption should polyhydramnios occur. • Would not wish to continue with the pregnancy if this was feasible. or for which an answer is not included in the list below. OR postmaturity and increase risk of shoulder dystocia if polyhydramnios does not occur would have needed to be discussed. Lists of Answers relevant to this specific case • Did not take any folic acid in early pregnancy. The list of responses below is likely to cover most of the questions you will be asked as they are likely to be relevant to the case presented. It is important that information which is not specifically requested by the candidate is not offered. None of these may be required if the candidate covers most or all of the points proposed in the’ Advice for Patients’ section. or to introduce topics not considered by the candidate – • • • What is wrong with my baby? Can I have the pregnancy terminated? Is this problem likely to occur again? Page F2 Clinical Supplement . as patients are not meant to give hints to the doctor! If you are asked something which is clearly irrelevant. is somewhere between 2% and 5%. List of prompts for the Role Player A list of prompts is provided for the role player. • The risk of recurrence of a neural tube defect such as anencephaly. It would be rare for a candidate to pass the station where a critical error has been made. • Blood group O positive. Folic acid administration (in a dosage of 5mg per day) should be commenced prior to conception. • No asthma or other contraindication to prostaglandin therapy. • Failure to counsel the patient appropriately concerning management in a subsequent pregnancy. CRITICAL ERRORS — • • Failure to recognise that this is a lethal abnormality to the baby. answer – “no”. and continued until about 12 weeks of gestation. as this has been shown to reduce the risk of a subsequent neural tube defect.This will be an assessment of your presenting symptom(s). or obtains 2 UNSATISFACTORY marks in “KEY” areas. Optimal management plan. communicated Candidate displays one or Candidate displays one or Approach to patient essential information to more of the following: more of the following: .answers patient’s questions but not serious harm to the .minimal errors or omistory.. TABLE OF CONTENTS Examiner to tick ONE box in each ROW — NO OTHER WRITTEN COMMENTS ON THIS MARKSHEET Candidate’s ID card sighted Very Satisfactory — PASS Very Unsatisfactory — FAIL Satisfactory — PASS Unsatisfactory — FAIL Covered all essential Sound.quate communication of knowltion.candidate displays very inadetion of knowledge of the condi.empathy. making it diffiately focused medical history as sions.poor rapport .causes harm to the patient . edge of the condition. quate history. consideration aspects competently.poor listening skills rapport and communication using language that the patient sultation. initial management plan.causes unnecessary discomfort .causes no discomfort to the patient the explanation of the procedure tions or concerns appropriately . CRITICAL ERROR Key Issue Covered all essential asMinor errors but did not inSignificant errors which Serious errors or omisInitial Management Plan pects competently — miniterfere with an adequate did interfere with an adesions.checks for patient understanding . tory. the patient.explanation of examination or empathy at points in the con.obtains verbal consent to proceed CRITICAL ERROR patient. Inappropriate manDid the candidate formulate and mal errors or omissions. poorly History aspects competently — fering with adequate hisleading to inadequate hisorganised. Totally inadeDid the candidate take an appropri.Condition: Fetal Neural tube defect Clinical Supplement Information given to patient was appropriate. cult if not impossible to define the per examiners instructions? correct diagnosis etc. structions? CRITICAL ERROR Correct information proInadequate information provided but inadequately exvided and inadequate explained. The candidate planation given. management proposed is potenagement plan as per examiners intially harmful to the patient. CRITICAL ERROR Key Issue Covered all essential asPatient Counselling/Education pects competently — miniDid the candidate give appropriate mal errors or omissions. fails to put patient at ease understands (no jargon) interfering with some aspects of .inability to establish appropriate . counselling to the patient/relative as per examiners instructions? Overall rating for this candidate for this station PASS FAIL Page F3 .does not address patient’s ques. .poor communication skills. The displays inadequate communica. comfort. quate management plan. agement and/or describe an appropriate initial man. Adequately explained. Some loss of rapport . as examiners instructions? Key Issue Covered all the essential Minor omissions not interSignificant omissions Serious omissions. TABLE OF CONTENTS Page F4 Clinical Supplement . the candidate should indicate to you that he would: check the boy’s urine by Multistix testing +/. an 8-year-old boy is brought to see you because of a bedwetting problem. which occurs nightly. His parents were exasperated initially by the wetting. Johnny is doing well at school and has lots of good friends. Reassurance that there is no organic pathology present. This should include — • • • Empathy with the exasperating nature of the condition particularly with the excessive washing of bedclothes and pyjamas but enthusiasm for the interest the parents are showing in trying to help Johnny.TABLE OF CONTENTS APPENDIX G STRUCTURED CLINICAL ASSESSMENT STATION Information Sheet for Candidates Johnny.a urine m/c/s. but now accept that it is involuntary and both parents are keen to assist in any way possible to help him. Renal ultrasound may be suggested but is probably unnecessary unless there is a great deal of parental anxiety — Enquire of the child’s growth percentiles — Ensure his blood pressure is normal Having excluded any organic pathology and having ensured that there are no serious emotional reasons to account for the symptom. if the parents are keen to try this they should feel free to do so as it occasionally does help some children. The parents are happily married and under no major stresses.These are important points the candidate should appreciate. • is happy at home and does well at school. Johnny has – • been fully continent by day since he was 3 years old. Advise that even though lifting and restriction of fluids have not been shown to be effective generally. YOUR TASK IS TO — • Advise Johnny’s PARENT how you will further assess and manage his condition. He is well otherwise. Examiner’s Instructions This scenario describes an eight year old boy with persistent primary bedwetting from 3 years of age. Before embarking on a plan of action. and his parents are willing to help him achieve this.There is a younger sibling aged 4 years who has been dry day and night since age 2 ½ years old. the candidate should outline his ongoing plan of management. His height and weight are on the 50th percentile. The candidate should enquire about family history and one parent was a bed wetter until age 9 years. Page G1 — — Clinical Supplement . Amitriptyline (Tryptanol®) was tried about two years previously to no avail. • previously been treated unsuccessfully with nightly Amitriptyline (Tryptanol®). has no day time wetting or any other symptoms to suggest a pathological cause for his wetting. The boy himself is very keen to be dry. • Support and encourage child and parent by regular frequent review to enthuse on even minor successes as a means of encouraging the boy. His father wet the bed until age 9 years. e. You were initially exasperated by the wetting but now have been accepting that the wetting is involuntary. The tablets that were tried 2 years ago made no difference to the wetting. Clinical Supplement . Johnny’s general health is excellent. • Discuss the success rate is much higher if the child himself is motivated to become dry as Johnny is. it could be performed if there is excessive parental anxiety. • Explain how to obtain the alarm. Key Issues • Candidates should ensure that there is no possibility of organic pathology.TABLE OF CONTENTS Outline the plan of management including how the alarm works as a conditioning response to release of urine. You. his parents are happily married and have no major stresses in your lives. Role Player/Standardised Patient Sheets • • • • • • • • • • • Page G2 You are the parent of Johnny who has a problem with bedwetting nightly since the age of 3 years. Advice re plan of action should be logical and clear.While Ultrasound of the urinary tracts is probably unnecessary. He appears to be growing normally and is on his middle line of his graph for height and weight. empathic and supportive to both child and parent. Candidates should be encouraging. He has lots of good friends. He has always been dry during the day and never had any incontinence. He has never has a urinary tract infection. Johnny is going very well at school and enjoys his teacher. it can be a dangerous drug in overdose and is rarely used now.This is determined by the history and by arranging simple urine testing. Candidates should enquire re a family history as this is an important piece of history. buying or through some Community Health Centres or Children’s hospitals. Johnny approached you because he is embarrassed and you and your spouse are very keen to help him control his wetting. • Advise that even with the alarm it may be some weeks before success is achieved and the alarm should be persisted with for up to 3 months.g. • Advise that the success rate with Amitriptyline (Tryptanol®) is low. through pharmacies (hiring). and he has had no major illnesses..You have not punished Johnny despite your exasperation. Explain the safety of this substance if used only as directed. • Discuss a recording star chart and reward system. • Explain a plan of action for the use of DDAPV by nasal spray for school camps and sleepovers when it is important to remain dry and avoid any embarrassment. CRITICAL ERRORS There are few in this scenario but a candidate should be marked down if he indicated that there is an organic cause for wetting and wants to put the child through unnecessary invasive investigations. A review appointment should be made 2 to 3 weeks after the alarm has started to review the progress. Johnny has a 4 year old younger sister who has been dry day and night since the age of two and a half. TABLE OF CONTENTS Questions you might ask or statements you could make — • • • • • Is there something wrong with his kidneys or bladder? Does he need any investigations? Some friends told us we should restrict his fluids after dinner at night and should lift him when we go to bed.What do you think? What about when he is asked to sleep over at a friend’s place – so far we haven’t let him do this. Is there anything we can do for that? How does this alarm work if he has already passed urine and wet his bed before it goes off? Clinical Supplement Page G3 . Information given to patient was appropriate. Key Issue Diagnosis/Differential Diagnosis Did the candidate formulate and describe an appropriate diagnosis/differential diagnosis? Minor errors but did not interfere with an adequate initial management plan. essential information to more of the following: more of the following: the patient. Scatter gun approach with little apparent perspective CRITICAL ERROR Diagnosis not given. Very poor organisation.does not address patient’s quesnation of the procedure tions or concerns appropriately . . The candidate nation given. The candidate displays inadequate communica.causes no discomfort to the patient . Covered all essential aspects competently — minimal or no errors or omissions. Examiner to tick ONE box in each ROW — NO OTHER WRITTEN COMMENTS ON THIS MARKSHEET Very Satisfactory — PASS Satisfactory — PASS Unsatisfactory — FAIL Very Unsatisfactory — FAIL Covered all essential Sound. Diagnosis and differential diagnosis appropriate to case even if not completely accurate.nication of knowledge of the contion.inability to establish approrapport or empathy at points in .. Optimal management plan.obtains verbal consent to proceed as examiners instructions? Key Issue History Did the candidate take an appropriately focused medical history as per examiners instructions? Choice of investigations inappropriate and with poor perspective.answers patient’s questions . this box must be marked. Covered all essential asSome errors in choice and pects competently — priority of investigations minimal errors or omisbut still reasonable.poor communication skills.Condition: Bed Wetting Page G4 Minor omissions not interfering with adequate history.poor listening skills priate rapport and communication the consultation.explanation of examination using language that the patient understands (no jargon) . poorly organised. interfer. Key Issue Initial Management Plan Did the candidate formulate and describe an appropriate initial management plan as per examiners instructions? Key Issue Patient Counselling/Education Did the candidate give appropriate counselling to the patient/relative as per examiners instructions? Covered all essential aspects competently — minimal errors or omissions. CRITICAL ERROR Serious omissions.causes unnecessary discomfort . sions.fails to put patient at ease ing with some aspects of the expla. CRITICAL ERROR Covered all the essential aspects competently — minimal errors or omissions. comfort. Totally inadequate history. Adequately explained. Significant errors which did interfere with an adequate management plan.poor rapport . communicated Candidate displays one or Candidate displays one or aspects competently. CRITICAL ERROR TABLE OF CONTENTS Covered all essential aspects competently — minimal errors or omissions. Serious errors or omissions in choice of investigations. CRITICAL ERROR . making it difficult if not impossible to define the correct diagnosis etc.empathy. Clinical Supplement Overall rating for this candidate for this station PASS FAIL Serious errors or omissions. Serious omissions/errors in interpretation of findings. Choice of investigations optimal and with good perspective. dition. consideration . CRITICAL ERROR Correct information proInadequate information provided but inadequately exvided and inadequate explaplained.causes harm to the patient but not serious harm to the patient. Choice of Investigations Did the candidate make an appropriate choice of investigations as per examiners’ instructions? Minor omissions or errors in explanations of findings.checks for patient understanding . clear. Inappropriate management and/or management proposed is potentially harmful to the patient. Unclear and poorly organised. If wrong diagnosis would result in harm to patient. Diagnosis inappropriate to the case. Logical. Significant omissions leading to inadequate history. Candidate’s ID card sighted Approach to patient/relative . Clinical reasoning and diagnostic skills markedly deficient. well organised. Little evidence of clinical reasoning skills. Significant errors in explanations of findings.displays very inadequate commution of knowledge of the condi. Wrong interpretations of findings. Some loss of . OR • • Fails in all three Paediatric Stations.: STRUCTURED CLINICAL ASSESSMENT EXAMINATION — PERFORMANCE FEEDBACK XXX – XXX XXXXXXX APPENDIX H Score obtained ( /16 Stations) Paediatric Stations: Obstetrics and Gynaecological Stations: XX/16 Candidate Name: XXXXXXXX X/3 X/3 Overall Grade: XXXX Stations Passed Intermittent claudication Asthma Thyrotoxicosis Symptoms of shortness of breath Insulin injection Ascites Anticoagulant therapy Benign skin lesion Hormone replacement therapy Childhood immunisation Ectopic pregnancy Stations Failed Interpretation of clinical chemistry result Obesity Contraception Recognition of Bronchiolitis Childhood breath holding attack Performance Requirements • Clear Pass = a pass score in 12 or more of the 16 scored stations including: at least one Obstetric/Gynaecological Station scored as a Pass. Please retain this result sheet for your records (An administration fee is incurred for the issue of duplicates of previously issued results. Clinical Supplement Page H1 . irrespective of the total number of stations passed. AND at least one Paediatric Station scored as a pass.TABLE OF CONTENTS Examination Session: Candidate Ref No. Marginal Performance = A pass score in 10 or 11 of the 16 stations Clear Fail = a pass score in 9 or less of the 16 stations. OR Fails in all three Obstetric/Gynaecology Stations. irrespective of the total number of stations passed. TABLE OF CONTENTS Page H2 Clinical Supplement . Little evidence of clinical reasoning skills.empathy. these areas.priately comfort but not serious .answers patient’s questions . [4] .causes no discomfort to the patient . Maximum possible number with this 2 2 1 assessment domain. communicated es.poor communication ate rapport and communication in the consultation. One or more significant Did the candidate identify the accurately. physical findings accurately as per examiners’ instructions? Maximum possible number with this assessment domain Answers to questions Answers to questions asked? [1] Maximum possible number with this assessment domain [1] 1 0 Covered all aspects compe.causes unnecessary dis. Serious errors or omissions in findings.. comfort.inability to establish appropri.poor listening skills port or empathy at points . poor perspective tigations optimal and with good perspective. in answers given. Scatter gun approach with little apparent perspective 0 APPENDIX I Page I1 Covered all essential aspects Some errors in choice and Choice of investigations competently — minimal errors priority of investigations inappropriate and with or omissions.including Retest stations in which this Performance as scored by the examiners domain was assessed) A.poor rapport .. Choice of inves.obtains verbal consent as per examiners instructions Maximum possible number with this assessment domain [9] Choice of investigations Did the candidate make an appropriate choice of investigations as per examiners instructions? 0 0 Significant errors in the Serious errors or omissions answers to questions. 1 1 0 0 Covered all essential aspects Sound. errors in findings.fails to put the patient at ease skills. . ASSESSMENT DOMAINS WITH SATISFACTORY PERFORMANCE **More than 2/3rds satisfactory** Accuracy of Examination Identified most or all findings Minor errors in findings. No. or comInadequate plete unfamiliarity with the knowledge/expertise in subjects asked.Candidate displays one or Candidate displays one or competently.: XXXXXXXXXX Examination Session: XXXX ASSESSMENT DOMAINS (Numbers in brackets indicate the number of stations. harm to the patient.but still reasonable. Some loss of rap.does not address the patient’s planation of the procedure questions and concerns appro.causes harm to the patient.Clinical Supplement Candidate Name: XXXXXXXXXXXXXX Very Satisfactory Satisfactory Unsatisfactory Very Unsatisfactory AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref.Minor errors in answer to tently. TABLE OF CONTENTS Approach to patient/relative . sions. sential information to the more of the following: more of the following: patient. minimal errors or omis. interfering with some aspects of the ex. reported findings not consistent with physical signs.checks for patient understanding .questions.explanation of examination using language that the patient understands (no jargon) . 1 8 0 0 Serious errors or omissions in choice of investigations. consideration . diagnostic/ therapeutic plan inappropriate. as per examiners instructions? 1 8 Reasonably organised approach. Totally inadequate history.: XXXXXXXXXX Examination Session: XXXX Covered all essential aspects Minor errors not interfering Significant omissions History leading to inadequate Did the candidate take an appro. making it difficult if not impossible to define the correct diagnosis etc. poorly organised. 0 TABLE OF CONTENTS Clinical Supplement . Diagnostic/ therapeutic plan inadequate and/or potentially seriously harmful or even lethal. priately focused medical history or omissions. history. No. Maximum possible number with [10] this assessment domain Interpretation of investigation Well organised.competently — minimal errors with adequate history. 0 Serious omissions.proach optimal diagnostic/ vestigations appropriately in formu. diagnostic/ therapeutic plan appropriate despite some errors. logical apDid the candidate interpret the in.Page I2 Candidate Name: XXXXXXXXXXXXXX AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref. lating diagnostic/therapeutic plan as per examiners instructions? 0 4 Maximum possible number with this assessment domain [4] 1 Poor interpretation of investigations. 0 Little or no evidence of logical structure.therapeutic plan. but not potentially seriously harmful. Clinical Supplement Candidate Name: XXXXXXXXXXXXXX Very Satisfactory Satisfactory Unsatisfactory AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref. No. examination as per examiners in. ised. 0 1 Significant errors in use or Serious errors or omissions selection of equipment completely unfamiliar with which interfered with an equipment.significant omissions sonably. Maximum possible number with [6] this assessment domain 3 0 1 3 Explanation of procedure Clear.on ability in explanation: conExplanation of procedure and im. testing of equipment and material for this procedure as per examiners instructions? Maximum possible number with this assessment domain [2] Page I3 . or. plained. confusing patient. 0 1 0 1 Maximum possible number with this assessment domain [1] 0 2 Familiarity with test equipment Covered all essential aspects Minor error in use or selecDid the candidate demonstrate ap. Did the candidate carry out an .poor technique. resulting in an inadequate assessment adequate assessment being being obtained. optimally extion overall satisfactory. well organised. planation.: XXXXXXXXXX Examination Session: XXXX Very Unsatisfactory ASSESSMENT DOMAINS TABLE OF CONTENTS (Numbers in brackets indicate the number of stations. fuses and distresses patient. selection and or omissions.including Retest stations in which this Performance as scored by the examiners domain was assessed) C. free Some defects but explana.from jargon.Significant defects in ex. propriate familiarity. poorly organ.Covered all essential aspects Minor technical faults but Candidate displays one Serious errors or omissions ganisation and sequence. ASSESSMENT DOMAINS WITH UNSATISFACTORY PERFORMANCE (Needs significant revision to achieve pass standard overall) * *Less than 1/2 Pass/Satisfactory Technique of examination.Little evidence of organisation. competently — minimal errors examination completed rea.competently — minimal errors tion of equipment. used jargon. obtained.significant errors/techstructions? nique . plications of patient/relative. appropriate focused and relevant or omissions.or more of the following: in technique. No. mentary. Needed excessive prompting. optimal comadequacy of commentary. 0 Commentary to Examiner Did the candidate describe the findings with an appropriate commentary as per examiners instructions? Maximum possible number with this assessment domain Covered all essential aspects Minor error in formulations. little evidence of the logical structure. leading to inadequacy. [1] 0 1 0 TABLE OF CONTENTS Clinical Supplement .Candidate Name: XXXXXXXXXXXXXX AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref.: XXXXXXXXXX Examination Session: XXXX Page I4 Serious errors or omissions in the presentation. Significant errors in forcompetently — minimal errors not interfering with overall mulations. hesitancy or omissions. Needed constant prompting. plained. to the patient Maximum possible number with [10] this assessment domain 2 2 3 3 Patient counselling/education Covered all aspects compe. plan.was appropriate. [9] 2 5 2 0 Page I5 .Diagnosis not given. displays inadequate com. tions of findings.) wrong dose or at seriously Maximum possible number with this wrong frequency. The candidate ate counselling to the patient/rel. ised. Diagnosis nation of findings. which Serious errors or omissions. assessment domain [7] 1 2 3 0 Performance of procedure Well organised.vided and inadequate explanaDid the candidate give appropri.sions.: XXXXXXXXXX Examination Session: XXXX ASSESSMENT DOMAINS Very Satisfactory Satisfactory Unsatisfactory Very Unsatisfactory (Numbers in brackets indicate the number of stations.Significant errors in expla.Inappropriate management describe an appropriate initial and/or management protial management plan.errors or omissions.Inadequate information provided but inadequately ex. Clinical reasonclear. Very poor performance. dure. Wrong omissions or errors in interpretadescribe an appropriate diagno. Did the candidate formulate and competently — minimal errors terfere with an adequate ini. For script writing. The candidate tion given. If wrong diagnosis would result in serious harm to Maximum possible number with this patient. Adequately explained. appropriate level of performance in mance. appropriate to the case even if interpretations of findings. Serious Did the candidate formulate and competently — minimal or no planation of findings. Or inadequate or Unable to complete proceformance.tently.markedly deficient. Logical. No. ganisation. Very poor orate to case.ing and diagnostic skills sis/differential diagnosis? not completely accurate. Unclear and poorly organ.displays very inadequate comative as examiners instructions munication of knowledge munication of knowledge of the Maximum possible number with this of the condition. including Retest stations in which this domain was Performance as scored by the examiners assessed) AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Clinical Supplement TABLE OF CONTENTS B. well organised.Causes unnecessary dis. wrote as per examiners instructions in ing task (if asked to write a wrong drug or in a seriously written form? script etc. logical apReasonably organised ap.Significant errors. ASSESSMENT DOMAINS WITH MARGINAL PERFORMANCE (Needs attention to achieve pass standard overall) **1/2–2/3rds satisfactory Initial management plan Covered all essential aspects Minor errors but did not in.or omissions.Information given to patient Correct information pro.did interfere with an ad. assessment domain. minimal errors or omis.Poor performance. assessment domain [2] 1 0 1 0 Diagnosis/Differential diagnosis. condition. Covered all essential aspects Minor omissions or errors in ex.Causes discomfort or harm. equate management management plan as per examin. Did the candidate demonstrate an proach and optimal perforproach and reasonable per.technique. comfort. Diagnosis inappropri. Optimal maners instructions? posed is potentially harmful agement plan.Candidate Name: XXXXXXXXXXXXXX Candidate Ref. No significant undertaking the procedure or task incorrect script writing mistakes in completing writ. TABLE OF CONTENTS . TABLE OF CONTENTS .