LAMPIRAN B PROFESSIONAL III CLINICAL EXAMINATION GUIDELINES (M.D) 1. THE EXAMINATION Each cidate will be examined on a long case a minimum of three short cases on two separate days. If the student had a medical-based long case, he/she will be examined in the surgical-based short cases vice-versa. 2. EXAMINERS 2.1 2.2 Two sets of examiners will examine each cidate. There will be 2 examiners per student for the long case three examiners per student for the short cases - see annexure The examiners will meet on the morning of the first day of the clinical examination to be briefed on the general conduct of the examination the marking system. 3. VENUE 3.1 3.2 Student s Learning & Resource Block (SLRB), School of Medical Sciences (SoMS), Health Campus (HC), Universiti Sains Malaysia (USM) - see annexure The Ward Sister will be informed regarding the examination. ensure that necessary equipment tools are available. She will e.g X-ray illuminations, B.P apparatus, thermometer, etc Adequate number of nursing staff will also be made available. 4. PATIENTS 4.1 4.2 4.3 4.4 Patients will be made available from these clinical disciplines i.e. surgery, O&G, medicine, paediatrics, psychiatry, orthopaedics, ENT ophthalmology, Cases are distributed in the ratio of 2:2:2:2:1:1:1:1. ENT ophthalmology contribute to short cases only. The Heads of Departments, Department Coordinators Clinical Coordinators in charge will ensure that sufficient patients are available each day for the clinical examination. Reserve patients will be made available. A Summary of the patients appearing for the examination will be made available to the examiners during the examination. 1
5. TIME ALLOCATION TO CANDIDATES 5A. Long Case 5.1 5.2 5.3 Cidates are allowed 60 minutes to clerk examine the patient. During this time the cidates are not questioned. The examiners then spend 15 minutes with the cidate for presentation, during which time the cidate may be requested to elicit or clarify his history asked to demonstrate clinical signs. Fifteen (15) minutes are then devoted to discuss (a) differential diagnoses, (b) investigations, (c) treatment, (d) general management of the patient. The cidate may be assessed away from the patient during this time. (Examination rooms will be provided). i.e 1) 2) 3) History Examination Presentation Discussion : : : 60 minutes 15 minutes 15 minutes --------------- 90 minutes --------------- 5B. Short Cases 5.4 5.5 The cidate will sit for the short cases on a different day with a new set of examiners. Each cidate will be given a minimum of three (3) short cases. (Borderline students may be given one extra case). The cidate will be given 5 minutes for examination 5 minutes for presentation & discussion of each case. 5.6 Generally, cidates who have had a surgical-based long case will be examined on medical-based short cases & vice versa. 2
6. GUIDELINES FOR CLINICAL ASSESSMENT 6A. Long Case 6.1 History Assessment should be made in relation to presenting symptoms, history of presenting illness, past history, family & social history. Weightage should be for relevant symptomatology, sequence of the disease process & associated problems rather than to routine questions, Excellent / Good >15 Elicits problem related data, stresses important points, well organised approach. As above but misses a few relevant information. Concentrates on data not relevant to the problem. Misses important information, not well organised Approach not well organised, not problem related, misses many important information 6.2 Examination Assessment should be in relation to correct technique of examination the ability to elicit physical signs. More emphasis on the thoroughness of examination on the system/s involved, depending on each case. Excellent / Good >15 Elicits interprets correctly all signs, good approach, technique organisation As above but misses a few relevant physical signs. Some technical organisational imperfection, misses some important physical signs. Imperfect or unacceptable approach, technique organisation, missed important data, invents signs. 3
6.3 Formulation of Diagnosis Emphasis should be on the ability to arrive at differential diagnoses in relation to the problems identified from the history & examination. Ability to logically deduce the most likely diagnosis. Excellent / Good >15 Makes reasoned deduction from available data, able to give correct provisional differential diagnoses. 6.4 Investigations As above but shows minor faulty deductions, able to give correct provisional but not all relevant differential diagnoses. Makes major faulty deductions from available data (wrong provisional diagnosis, able to give some differential). Does not follow logical approach to deduction from data (haphazard), faulty deduction wrong provisional diagnosis differential). (iii) Ability to request justify the investigations relevant to the problems identified. Emphasis should be on simple investigations rather then sophisticated ones the ability to request investigations in a logical sequence. Cidates should be able to interpret common investigations. e.g : x-ray, E.C.G Investigation. Excellent / Good Plans / requests interprets > 15 investigations appropriate to the problem with attention to specificity, reliability, patient safety, comfort cost. Able to explain reasons for nature of investigation. Misses a few relevant investigations. Misses a few relevant investigations. Some investigations are not appropriate to the problem. Makes inappropriate decision in ordering investigation, misinterprets data. 4
6.5 Patient Management Ability to recommend justify appropriate treatment based on the diagnosis. Emphasis should be on the principles of management rather than detailed management protocols e.g. operative techniques. Excellent / Good 6B. Short Cases >15 Suggest appropriate comprehensive management, exhibits awareness of the role possible complications of the proposed intervention (for example, adverse drug reaction, surgical morbidity). As above, but misses a few relevant points in the management. Misses many important points on principles of management. Suggest inappropriate management; shows lack of awareness of role of proposed interventions their possible complications. Emphasis should be on correct technique of examination the ability to elicit correct physical signs. Discussion on differential diagnoses management. 6C. Note (iii) The guidelines for marking long short cases are attached (Annex A/B). This guideline is flexible. The dispersion of marks may vary with cases. Bear in mind that graduates are expected to be able to work as a safe competent house officer. Each examiner will mark the student performance separately before arriving at a consensus / average mark. 7. Weightage of the different components of the phase III examination is as Annex C. Disediakan oleh Dr Wan Maziah Wan Mohamed Pengerusi Fasa III MD USM Februari 2004 Guidelines MD-F3/komp.nk/ms.1-5 5
Annex C Professional III Examination Format Paper Type No. of Questions/Cases Duration Weightage % Total % T H E O R Y C L I N I C A L S MCQ I 100 2 ½ hrs 25 MCQ II 100 2 ½ hrs 25 MEQ I 5 2 ½ hrs 25 MEQ II 5 2 ½ hrs 25 Long Case 1 1 ½ hrs 50 Osce I 12 Osce II 12 Short Cases Minimum 3 1 hr (5 minutes each station) 1 hr (5 minutes each station) 30 mins (10 mins each case) 10 10 30 100 100 Criteria For Passing / Failing The Professional III Examination Pass Borderline Fail THEORY 50 CLINICAL 50 TOTAL 100% 100% 100% Note : 1. Borderline students will undergo a viva voce to determine whether they pass or fail. 2. Distinction will be awarded to students who obtained a total of 70 marks pass the viva board. 6
Grading System Marks 70 % above A 60-69 % B Grade Pass 50-59 % C below 50% F Fail Fn: Guideline MD/nk 7