2018 RACP Divisional Clinical Examination Australia

Transcription

1 2018 RACP Divisional Clinical Examination Australia Instructions to Candidates 2018 RACP Divisional Clinical Examination - Instructions to Candidates 1

2 Table of Contents h 2018 Examination Details... 3 Key Dates...3 Locations...3 Fees...3 The Application Process Invitation to Apply Eligibility Examination Attempts Invitation s Application Period Application Confirmation Allocation Withdrawal of Application Special Consideration Grounds for Special Consideration How to Apply for Special Consideration...6 Preparing for the Examination Format and Content of the Examination Overview Long Case Assessment Short Case Assessment Examiners Examiner Review of Patients Number of Examiners Conduct of the Clinical Examination Quality and Safety Standards Case Selection Adolescent Patients Examination Preparation Pre-Examination Contact at Examination Sites...9 On Examination Day Examination Timetable Items to Bring Examination Assistants After the Examination Standard Required Marking Pass Mark Results Candidate Feedback Appendix A Criteria for Assessment of Performance in the Long Case Appendix B Criteria for Assessment of Performance in the Short Case Appendix C Summary of Possible Special Consideration Outcomes RACP Divisional Clinical Examination Instructions to Candidates 2

3 2018 Examination Details Key Dates Clinical Examination Dates Results Release (via ) Paediatrics & Child Health Friday, 18 May Sunday, 27 May pm AEST, Thursday, 7 June 2018 Adult Medicine Friday, 27 July Sunday, 5 August pm AEST, Thursday, 16 August 2018 Examination Applications Open 9 am AEDT, Wednesday, 14 March 2018 Examination Applications Close 12 midday AEDT, Tuesday, 27 March midday AEST, Tuesday, 3 April 2018 Pre-Examination Special Consideration Requests Close - Provisions for examination day - Allocation requests Post-Examination Special Consideration Requests Close - Technical and procedural issues 12 midday AEST, Friday, 6 April midday AEST, Friday, 1 June midday AEST, Thursday, 7 June midday AEST, Friday, 10 August 2018 Locations Eligibility criteria and application deadlines will be strictly enforced. No late applications will be accepted. The 2018 Clinical Examination will be hosted by approximately 110 hospital sites across Australia. Candidates cannot be examined in hospitals where they have undertaken training rotations, and will normally be required to travel interstate. Fees Amount (AUD) Clinical Examination Fee $2, For more information about paying examination fees, please refer to the Terms and Conditions for RACP fees RACP Divisional Clinical Examination Instructions to Candidates 3

4 The Application Process 1. Invitation to Apply 1.1. Eligibility To be eligible to sit the Clinical Examination as a basic trainee a candidate must: have passed the Written Examination; apply to sit by the due date; have renewed his/her registration as a trainee for 2018; have satisfactorily completed 24 months FTE of certified Basic Training before the beginning of the clinical year in which the exam is held; have completed all necessary training requirements; comply with the limit on the number of examination attempts and other requirements for progression through training, which are detailed in the Progression through Training Policy; be fully current with all RACP training fees. Trainees with outstanding training fees will not be eligible to sit the Clinical Examination unless they have made an application in writing to the Honorary Treasurer requesting special consideration. Overseas Trained Physicians (OTPs) under assessment with the RACP should contact OTP@racp.edu.au concerning their eligibility to apply for the Clinical Examination Examination Attempts Limits on the total training time allowed and the number of examination attempts are specified by the Progression through Training Policy. The revised policy took effect on 1 January Transition arrangements are in place that may be relevant to trainees sitting the Clinical Examination in For more details please see the relevant Basic Training Handbook and the Progression through Training Policy information on the RACP website Invitation s Invitations to apply for the Clinical Examination will be sent out by from 4pm AEDT on Tuesday, 13 March for trainees resitting the Clinical Examination and from 4pm AEDT on Wednesday, 15 March for trainees who sat the Reserve Written Examination on 2 March Trainees should visit my.racp.edu.au and ensure that their contact details, particularly address, are up to date. Trainees who expect to be eligible to sit in 2018 but who have not received an invitation by Wednesday 14 March should check their junk/spam folder, and contact prep_bt@racp.edu as soon as possible RACP Divisional Clinical Examination Instructions to Candidates 4

5 Failure to receive an invitation will not be accepted as a reason for extension to the application period (see below); trainees must contact the RACP in sufficient time to complete an application. 2. Application Period Applications must be submitted via MyRACP by 12 midday AEDT, Tuesday, 27 March 2018 (Paediatrics & Child Health) or 12 midday AEST, Tuesday, 3 April 2018 (Adult Medicine). The application process will only be accessible to eligible trainees. Trainees who believe they are eligible to sit the examination but are unable to commence the application process should contact prep_bt@racp.edu.au as soon as possible. Payment of the examination fee is required before submitting an application. Trainees should contact examinations@racp.edu.au as soon as possible if they experience or anticipate any difficulties with submitting an application. It will not be possible to assist trainees if they have experienced technical issues but did not contact the RACP until after the application deadline. Unfortunately, extensions to the application deadline will not be granted. 3. Application Confirmation A payment receipt will be available in MyRACP once an application is completed. Candidates will also receive a confirmation . Candidates who do not receive a confirmation within an hour of submitting an application should contact examinations@racp.edu.au immediately to confirm that the application has been submitted successfully. 4. Allocation To make specific requests regarding the timing or location of the examination, candidates must submit an application under the Special Consideration for Assessments Policy as early as possible (see Item 6 below). This includes requests such as scheduling considerations for religious reasons or difficulties with long-distance travel due to medical issues, advanced pregnancy or newborn care. Requests to be allocated to a specific venue will not be considered. Requests involving travel difficulties will take into account potential travel distances, modes of travel and airline policies, along with the probability of candidate contact with known patients. Registered candidates will be advised of the date and location of their allocated examination place by by mid-april 2018 (Paediatrics & Child Health) or late June 2018 (Adult Medicine). Candidates who are allocated an examination place at a hospital where they work, have worked in the past, or have undertaken examination preparation should contact examinations@racp.edu.au as soon as possible. 5. Withdrawal of Application Candidates who wish to withdraw from the Clinical Examination should notify the Examinations Unit by examinations@racp.edu.au. Withdrawals are not counted as examination attempts. Candidates may withdraw up until the commencement of the examination. Refunds of application fees will be provided according to the following rules: Date of Withdrawal Paediatrics & Child Health Adult Medicine Refund By 27 March By 3 April (close of applications) (close of applications) 100% of fee 28 March 25 April 4 April 20 June 50% of fee 26 April onwards 21 June onwards No refund available To request a refund outside of these rules on medical or compassionate grounds, candidates must submit an application under the Special Consideration for Assessments Policy (see 'Special Consideration' below) RACP Divisional Clinical Examination Instructions to Candidates 5

6 Candidates who withdraw from the Clinical Examination may re-apply for the Clinical Examination in the following year provided they meet the eligibility criteria. Application fees cannot be rolled over from one year to another. 6. Special Consideration Please note the following relating to examination results: Following the examination, candidates may request only: Special Consideration due to technical or procedural issues during the examination (see below). Marks/results will not be altered. Candidates are unable to request any of the following in relation to their examination mark or result: Appeals Reviews Reconsiderations 6.1. Grounds for Special Consideration The RACP will take the following circumstances into consideration for the Clinical Examination: Circumstances occurring prior to the examination: Permanent and longstanding impairment Temporary impairment medical grounds Non-medical compassionate grounds or serious disruption Essential commitments (religious, cultural, societal or legal obligations). Circumstances occurring after a candidate has commenced the examination: Technical/procedural problems during the assessment. Each of the circumstances above has specific possible outcomes, which are set out in Appendix C: Summary of Possible Special Consideration Outcomes, including details of the supporting documentation required, and the timing of applications. The RACP will not adjust examination marks or examination results due to any of the circumstances above How to Apply for Special Consideration 1. Review the Special Consideration for Assessments Policy. 2. Complete the Special Consideration application form and attach the relevant supporting documents. 3. Submit the application to examinations@racp.edu.au by the relevant due date (see Appendix C). Not sure what the options are? Don t wait for results release! - Check the FAQs - Contact us: examinations@racp.edu.au 2018 RACP Divisional Clinical Examination Instructions to Candidates 6

7 Preparing for the Examination 7. Format and Content of the Examination 7.1. Overview The Clinical Examination consists of two Long Cases and four Short Cases, undertaken in a single day. There are two examination cycles: one morning and one afternoon. In each cycle, each candidate will be examined on one Long Case patient and two Short Case patients. In one cycle, the Long Case will be seen before the Short Cases, while in the other cycle, the Long Case will follow the Short Cases. Candidates will be examined during these two cycles by at least four pairs of Examiners. Each case will be scored independently before a consensus score is determined. The consensus score is the final result in each case Long Case Assessment The purpose of the Long Case is to test clinical examination skills with an emphasis on accuracy of history and findings on examination, attitudes to clinical problems, possible diagnosis, investigations required and their appropriateness, overall interpretation, and approach to management. Examiners will assess whether candidates display the skills listed above to the relevant standard in the time allowed, based on the criteria set out in Appendices A and B. Excessively lengthy case presentations are inadvisable and may be interrupted by an Examiner to prompt the candidate regarding case timing. Candidates will be allotted 60 minutes to take a history, examine, and develop a management plan for the patient. Candidates will then have 10 minutes to prepare their discussion points and move to the Examiners room. Candidates will then spend 25 minutes discussing the patient with their allocated Examiner Team. Candidates are allowed to take some items into the patient's room in order to aid in the physical examination of the patient (see Items to Bring below). However, no printed material (including textbooks, notes, MIMS, or other drug compendia), pro-forma sheets, or electronic devices are permitted. The aim of these restrictions is to make the examination as fair as possible for all candidates. Please note: where relevant, candidates will be given access to medication lists and results of urinalysis/rectal examination Short Case Assessment The purpose of the Short Case is to test clinical examination skills, with emphasis placed on the interaction with the patient and/or family, technique and accuracy of physical examination, ability to elicit physical signs and place appropriate significance upon them. As part of a candidate s assessment of the findings, they may be asked to comment on relevant diagnostic tests (e.g. x- rays, ECGs) and/or nominate appropriate investigations. Each of the Short Case examinations will last for 15 minutes. Before entering the Short Case room, the candidate will be given two minutes to read a written introduction to the Short Case ( stem ), which will be attached to the outside of the Short Case room door. This introduction is written by the Examiners and will contain the patient s name, the relevant body system and sometimes the dominant clinical problem. It will be standardised prior to the candidate s entry and is designed to be accurate, short, and directive. There will be a 10-minute break in between the two Short Cases in each cycle RACP Divisional Clinical Examination Instructions to Candidates 7

8 Candidates are reminded that all patient records, including their own notes about patients, are confidential patient information and confidential examination material. Candidates are not permitted to reproduce or distribute this information at any time or in any way. Following the examination, candidates must ensure that their patient notes are left with the organisers at the examination for destruction. Please refer to the Academic Integrity in Training Policy. 8. Examiners 8.1. Examiner Review of Patients Prior to each cycle of the examination, Examiners will take a history, examine and identify the relevant issues for discussion for each Long Case patient. This is done without the aid of patient notes or prepared histories to enable a more accurate appraisal of the patient's ability to give an appropriate history and of the accuracy of signs. Each Short Case patient is assessed blind by the Examiners Number of Examiners Candidates are examined by a team of Examiners on each Short and Long Case. Each team is made up of at least two Examiners, and each candidate sees at least four different teams of Examiners. Candidates may expect one Examiner to lead in the discussion, usually followed by the second; although variations to this may occur. On occasion, a third Examiner may be present, but will act only as an observer. Only two Examiners will actively examine each candidate and determine their score. 9. Conduct of the Clinical Examination 9.1. Quality and Safety Standards In order to maintain appropriate health and safety standards during the examination, candidates must wash their hands before and after carrying out any physical examination. Alcoholic hand gel may be provided either outside or inside the patient rooms. Many candidates choose to bring their own supply. Using the gel before entering the room can save time during the examination segment. Candidates should advise the Examiners if they have washed their hands prior to entering the room. Clean disposable pins should be used for neurological examinations (for both the Long Cases and the Short Cases). Please ensure that pins are disposed of appropriately Case Selection While a broad range of cases are selected for the examination, it is possible that candidates may be asked to examine similar systems on more than one patient during their examination Adolescent Patients On examination day, candidates should not request that parents/guardians leave the room in order to interview adolescent patients privately. This request is inappropriate during preparation for the examination and is not expected during the Clinical Examination. 10. Examination Preparation Regular clinical activities in candidates hospitals should be the best preparation for the Clinical Examination. In most hospitals, the Director of Physician/Paediatric Education (DPE) and other Fellows will often assist candidates by discussing the Clinical Examination and arranging Long and Short Case practice sessions. The RACP does not endorse any commercial Clinical Examination preparation courses RACP Divisional Clinical Examination Instructions to Candidates 8

9 10.1. Pre-Examination Contact at Examination Sites Some candidates have in the past approached their allocated examination hospital after receipt of their allocation letter, attempting to obtain information regarding the patients selected for the examination, or the types of cases in which a hospital specialises. The following actions may be perceived as attempting to gain an advantage in the examination, and may lead to disqualification from the examination and/or may affect a candidate s progress through training: Any attempt to gain information pertaining to possible cases from staff organising the examination at the allocated hospital; Attendance at practice cases or practice exams at the allocated hospital after notification of allocation; Any attempt to inspect, or to organise to inspect, specific rooms or departments that may be involved in the examination at the allocated hospital; Any attempt to gain knowledge of who the Examiners at the allocated hospital will be; Any attempt to contact potential Examiners to seek guidance on how to improve performance in the examination; Any attempt after the Clinical Examination to contact the Examiners encountered during the Clinical Examination day, apart from through the standard feedback procedures for failed candidates. All enquiries after the examination must be made through the Examinations Unit at the RACP. Please refer to the Academic Integrity in Training Policy RACP Divisional Clinical Examination Instructions to Candidates 9

10 On Examination Day 11. Examination Timetable Candidates are expected to allocate the entire day for the examination. The expected arrival times are listed as follows (times will be confirmed in the Candidate Allocation Letter): Expected Arrival Time Paediatrics & Child Health Adult Medicine 8.45am 8.15am On reporting to the examination site, candidates will be asked to present a current form of photo identification and sign an attendance record. All candidates must bring current identification that clearly shows all of the following: Name (as registered with the RACP) Photograph Signature Examples of acceptable identification include driver s licence and passport. After signing in, candidates will be provided with an individualised sheet of stickers. Each sticker will have the candidate s name, candidate number, allocated hospital name and a barcode. The Examination Assistant (see Examination Assistants below) should carry the sheet of stickers throughout the day and provide two stickers to each team of Examiners the candidate sees, at the beginning of that case. Examination organisers will have additional stickers available if needed. The following table represents the typical examination day schedule. While all hospitals try to adhere to the schedule, individual variation may occur. Morning Afternoon Morning Afternoon Paediatrics & Child Health One Half of Candidates 1 Long Case followed by 2 Short Cases 2 Short Cases followed by 1 Long Case One Half of Candidates 1 Long Case followed by 2 Short Cases 2 Short Cases followed by 1 Long Case 9.25 am to am 2.20 pm to 5.00 pm Adult Medicine 8.55 am to am 1.50 pm to 4.30 pm Other Half of Candidates 2 Short Cases followed by 1 Long Case 1 Long Case followed by 2 Short Cases Other Half of Candidates 2 Short Cases followed by 1 Long Case 1 Long Case followed by 2 Short Cases 9.40 am to pm 2.05 pm to 4.30 pm 9.10 am to am 1.35 pm to 4.00 pm Candidates will have a 10-minute break between their two Short Cases in both the morning and afternoon sessions. Candidates are responsible for providing their own food and beverages on the examination day. It is inappropriate to request that parents/guardians leave the room to interview adolescent patients privately. Candidates should not do so RACP Divisional Clinical Examination Instructions to Candidates 10

11 12. Items to Bring Candidates must bring their own stationery for use during the examination e.g. blank manila folders, blank cards or paper and pens/pencils. Pre-printed/written templates or reminders are not permitted. Candidates will be required to bring their own equipment to the Clinical Examination. The rationale for standardisation of acceptable equipment includes fairness to all candidates and to ensure that, as far as possible, the clinical signs that a candidate elicits will match those obtained by Examiners, who will likewise use standard equipment. Candidates may bring the following approved equipment: 1. Blank paper/cards and pencils/pens 2. Stethoscope (these must not be electronically augmented unless you have obtained specific permission for medical reasons) 3. Standard hand-held ophthalmoscope (not a pan-ophthalmoscope) 4. Red topped hat pin or equivalent for visual field testing 5. Standard auroscope 6. Pocket torch 7. Tape-measure and/or ruler 8. Tendon hammer 9. Single-use spatulas 10. Tuning forks (128 and 256 Hz) 11. Hand-held visual acuity chart(s) 12. Cotton wool 13. Single-use neurological examination pins for testing sensation 14. Pre-printed picture for higher centres testing (*) 15. A blank form for undertaking a screening mini-mental test (*) 16. Props such as a jar, key and shirt-sleeve with button for hand function testing (*) 17. Toys for distraction and testing of development (*) 18. Standard Growth Charts (*) (*) Some items are more relevant to either the Adult Medicine or Paediatrics & Child Health Examination. Candidates are not allowed to bring in references, PDAs, mobile phones, or other data storing/sharing/recording devices, whether written or electronic. Candidates who inadvertently bring any of these items or any other equipment not considered acceptable to the examination, must declare this to the examination organisers, who will take the item(s) for safe keeping until the examination is finished. Any candidate who takes in unauthorised material may be disqualified from the examination. Any candidate found with a recording device, including a mobile phone, will be automatically disqualified. Candidates examination cases may be checked on exam day RACP Divisional Clinical Examination Instructions to Candidates 11

12 13. Examination Assistants Examination Assistants will be present on the day. An assistant will escort candidates between rooms during the examination and supply the candidate identification stickers to each team of Examiners. They will sit in during presentation of both Long and Short Case segments. Assistants should not be asked to be involved in the examination in any way. Candidates who feel that they require assistance in some way should inform the Examiners. Examination Assistants should not communicate with candidates during the period that a candidate is with the Examiners. They are also not able to assist candidates with timekeeping during segments (e.g. giving a five-minute warning). Candidates must not ask them to do so. Candidates must not ask Examination Assistants for feedback on their examination performance, nor ask them for any details about the patients before or after the examination RACP Divisional Clinical Examination Instructions to Candidates 12

13 After the Examination Please note the following relating to examination results: Following the examination, candidates may request only: Special Consideration due to technical or procedural issues during the examination (see below). Marks/results will not be altered. Candidates are unable to request any of the following in relation to their examination mark or result: Appeals Reviews Reconsiderations 14. Standard Required To pass the Clinical Examination, candidates will need to demonstrate the standard required based on defined criteria. The criteria used for assessment of the performance in both the Long and Short Cases can be found in Appendices A and B. The RACP recognises that candidates have their own way of taking a history, performing an examination, and preparing for the Clinical Examination. The appendices are provided to assist candidates with understanding the criteria used by the Examiners in judging their performance, and should not be interpreted as support for a particular method of history-taking and examination. It should also be noted that not all of the assessment domains will be applicable in every case and that domains may be weighted differently in different cases. 15. Marking The Clinical Examination has a total possible score of 210. Examiners will give a consensus mark between 1 and 7 for each Long and Short Case. Positives and negatives are incorporated in the scoring system. The Long Case mark is weighted three times more than the Short Case mark. Each Long Case mark is multiplied by nine and each Short Case mark by three. Each candidate s overall score for the examination will be determined by adding the marks of the individual segments. 16. Pass Mark In order to pass the examination, a candidate must pass at least one Short Case and one Long Case, and obtain an overall score of at least 120 marks out of RACP Divisional Clinical Examination Instructions to Candidates 13

14 17. Results Results released: Paediatrics & Child Health: 3pm AEST Thursday, 7 June 2018 Adult Medicine: 3pm AEST Thursday, 16 August 2018 Contacts*: To check or update details log in to MyRACP If you have not received your results by 8am the following day: o o o Have you checked your junk/spam ? Are you using a computer with a firewall? Still have issues? Request that your notification be resent: examinations@racp.edu.au By phone 1300 MY RACP ( ), (+61) *Please note that the Examinations Unit is unable to discuss examination results with candidates over the phone or via Candidate Feedback Immediately after each case in the Clinical Examination, the Examiners complete feedback sheets, recording each candidate s performance. These are used to provide feedback to candidates. Formal results letters will be sent out to all candidates by within four weeks of the release of results. Candidates who are successful in the examination will receive copies of their feedback sheets with their results letter . Candidates who are unsuccessful in the examination will be invited to meet with a member of the National Examining Panel (NEP) to receive and review their feedback sheets and to discuss their performance. The NEP member will use the information on the feedback sheets and his/her experience with the examination to assist candidates in recognising areas of relative strength or weakness and to advise them on how to improve their performance in a subsequent examination.. Candidates will be provided details of NEP members who may be contacted to provide feedback. It is the candidate s responsibility to arrange this feedback meeting. Candidates should contact their confirmed NEP member shortly after receipt of their letter, as candidate feedback is not retained indefinitely. Candidates are strongly encouraged to invite their DPE and/or supervisor to join them at the feedback meeting. In the interests of patient confidentiality: All specific personal patient information will be removed from feedback sheets, and Case summaries will not be provided to candidates. Candidates should note that feedback sheets are considered confidential examination material and/or confidential patient information. Candidates should not reproduce or distribute such material at any time, in any format, neither should they discuss this information outside of their feedback meeting. All enquiries after the examination must be made through the Examinations Unit. Please refer to the Academic Integrity in Training Policy RACP Divisional Clinical Examination Instructions to Candidates 14

15 Appendix A Criteria for Assessment of Performance in the Long Case Assessment Domains Examination Synthesis and Priorities Impact of Illness on Patient and Family Management Plan History Level of Performance Exceptional Performance Exceptional attention to detail Highly sophisticated interpretation Mature understanding of complex issues Highly mature, systematic, wellstructured completion of complex examination Very sophisticated and intelligent synthesis Mature and competent arrangement of interactive problems Highly sophisticated, well balanced and complete understanding of psychological and social aspects Sophisticated management plan incorporating all therapeutic options Mature anticipation of prognosis Ability to adjust management plan for different outcomes Much Better than Expected Standard Sophisticated interpretation of the history Focuses on key issues Shows maturity in extracting difficult information Actively seeks subtle signs that might enhance diagnosis Superior organisation of difficult examination Identifies all major and minor problems Very careful prioritisation which includes a long term view Recognises social impact of disease Shows mature understanding of subtle, difficult, or intimate aspects of patient s functioning Demonstrates balance when discussing issues and sophisticated use of external social support Superior construction of management plan, including long term impact Highly developed and discriminating use of investigations Mature recognition and interpretation of inconsistent results Better than Expected Standard Emphasis on appropriate details Appreciates subtleties Interprets significant aspects of the history Includes important relative negative signs Appreciates significance of more subtle signs Confidently identifies essential problems Shows maturity in recognising lesser issues Shows persistence in exploring subtle psychological issues, or issues that impact on the patient or family Proposes appropriate management plan with good understanding of social impact lifestyle and psychological aspects of disease Good use of discriminating investigations Accurate interpretation of results Expected Standard Complete and accurate history Minimal need to clarify details Timely and well structured Some interpretation Correctly identifies all important physical signs Identifies all key problems Arranges problems in order of priority Understands patient s physical and psychological functioning in relation to disease Appreciates impact of treatment and prognosis on patient and family Proposes an appropriate management plan for the major issues Provides a sensible, balanced approach to investigations Interprets investigations appropriately Recognises important side effects of proposed treatment Short of Expected Standard Poorly organised Omission of some key issues Need to clarify important details Omission of some important physical signs Problems poorly prioritised Significant problems undervalued Fails to recognise some important aspects of the disease on patient or family Misses some aspect affecting functioning or reaction to illness Lacking confidence and including some errors in arranging a management plan Erratic and non-discriminatory use of investigations Errors in the interpretation of tests Lacking some appreciation of complication of treatment Well Short of Expected Standard Omission of many key points Inaccuracies or lack of detail Repetitive, poorly structured Need to spend substantial time in clarifying details Many significant signs not recognised Poor understanding of significant problems Requires substantial prompting Poor understanding of the impact of disease on patient and family Shows little concern about psychological aspects Inappropriate or poorly directed management plan Poor understanding of useful investigations Inability to interpret investigations Major inability to appreciate side effects of treatment Very Poor Performance No clear structure Focused only on single problem Minimal detail Minimal attention to detail with the examination Most key management issues unidentified No attempt to establish priority Impact of disease not explored at all, or unable to be discussed Poorly directed management plan without regard to major issues Very poor ordering of investigations without regard to expense or potential complications No attempt to interpret investigations No understanding of side effects of treatment 2018 RACP Divisional Clinical Examination Instructions to Candidates 15 Updated: February 2018

16 Appendix B Criteria for Assessment of Performance in the Short Case Assessment Domains Approach to Patient Examination Technique Examination Accuracy Interpretation of Physical Findings Discussion of Investigations Level of Performance Meets expected standard Fluent and accurate and within time Exceptional Performance Makes adjustment to routine when appropriate Correctly identifies all signs found by examiners Establishes a most likely diagnosis on basis of examination and includes discussion of difficult signs Discusses alternatives at consultant equivalent Thorough interpretation of investigations, including integration with physical examination Recognises areas of doubt and discusses at consultant equivalent Much Better than Expected Standard Meets expected standard Fluent and accurate and within time Makes adjustment to routine when appropriate Correctly identifies all essential and desirable signs Establishes a most likely diagnosis on basis of examination, considers all likely alternatives Correctly interprets investigations, integrates with examination findings without prompting, at a mature level Better than Expected Standard Meets expected standard Fluent and accurate and within time Makes adjustment to routine when appropriate Correctly identifies all essential and most desirable signs Identifies most likely diagnosis and provides a reasonable differential diagnosis based on physical findings Correctly interprets all major findings Expected Standard Introduces him/herself to the patient Shows respect for patient as indicated by preservation of patient s modesty, seeking permission for sensitive aspects of examination e.g. groin palpation Recognises and modifies examination when painful Undertakes systematic examination of required area or system, without unnecessary duplication Demonstrates confidence in the examination Completes assigned task in appropriate time Detects all essential signs Reports significant negative findings Does not find major signs that are not present Provides appropriate interpretation of signs Recognises inconsistencies in interpretation and findings Provides sensible priorities in diagnosis Discusses appropriate alternative diagnoses Accurately interprets and recognises major findings in investigations Integrates investigations with examination findings Short of Expected Standard Less than expected standard Unduly rough, clumsy or causes pain without adjustment or apology Expected components not completed May require prompting to proceed with appropriate examination Misses essential signs Fails to look for or mention important negative findings Not confident with a diagnosis List of differential diagnoses poorly developed Unable to consider alternative explanations for findings Does not offer appropriate investigations Misinterprets or is unable to integrate investigations with examination findings Requires more than minor prompting to reconsider options Well Short of Expected Standard Less than expected standard, requiring examiners to intervene Very slow and requires substantial prompting and guidance Misses essential signs Finds abnormalities that are not present Fails to look for important negative findings Unable to suggest a reasonable diagnosis May advance incorrect diagnosis inconsistent with signs Requires substantial prompting Unable to use investigations to assist in diagnosis Inappropriate dependence on investigations Unable to reconsider additional information which may alter diagnosis Very Poor Performance Inappropriate and insensitive approach to patient Slow examination not completed in appropriate time Cannot perform appropriate examination of system Misses all essential signs Finds abnormalities that are not present Fails to look for important negative findings Unable to suggest a reasonable diagnosis Unable to interpret the physical signs elicited Unable to suggest reasonable investigations Misinterprets information provided 2018 RACP Divisional Clinical Examination Instructions to Candidates 16

17 Appendix C Summary of Possible Special Consideration Outcomes Request Timing of application Documentation required Possible outcomes Circumstances occurring prior to commencement of the Examination Provisions on examination day Permanent and longstanding impairment Temporary impairment (medical grounds) Essential commitments (religious, cultural, societal or legal obligations) Withdraw without financial penalty Temporary impairment (medical grounds) Non-medical compassionate grounds or serious disruption Examination allocation Temporary impairment (medical grounds) Non-medical compassionate grounds or serious disruption Essential commitments (religious, cultural, societal or legal obligations) Circumstances occurring during the Examination Significant technical or procedural problems during the assessment. At time of examination application where possible but no later than: Paediatrics & Child Health: 6 April 2018 Adult Medicine: 7 June 2018 With notification/confirmation of withdrawal No later than: Paediatrics & Child Health: 6 April 2018 Adult Medicine: 7 June 2018 Notify the examiners during the exam. Notify the Chief Examiner during the assessment. Notify the Chief Examiner during the assessment and submit no later than: Paediatrics & Child Health: 1 June 2018 Adult Medicine: 10 August 2018 Medical certificate/letter from treating doctor Explanation of religious requirement. T h e RACP may seek advice from religious authorities. Medical certificate/letter from treating doctor Explanation of circumstances Medical certificate/letter from treating doctor Explanation of religious requirement. The RACP may seek advice from religious authorities. Explanation of circumstances supported by documentation from a relevant and recognised official or community leader None. Chief Examiner will report to the Results Committee Detailed description of issue and the impact on performance. Aids during assessment (special equipment, advice to examiners) Permission to carry food/drinks/medication Arrangements to facilitate religious observance. No additional time will be granted Marks will not be altered 100% refund of application fee outside normal refund timeframe Consideration for timing/location of allocation Rescheduling of allocation within exam period Issue resolved on the day and/or compensation in marking where examiners consider it warranted Supplementary exam * Late requests will only be accepted where an impairment/s occurred or became known after the close of application dates. These requests will be considered on a case by case basis. and may not be able to be accommodated 2018 RACP Divisional Clinical Examination Instructions to Candidates 17