Transcript File - GP Teaching Resources

GP Supervisors Education Night
“The fellowship exams info for your GP registrars”
Written by: Dr. Andrew Moreton
Presented by: Dr. Kam Wong
slide 1
• The Royal Australian College of General
Practitioners (RACGP) Fellowship exams consist
of three segments:
•applied knowledge test (AKT)
• key feature problems (KFP)
• objective structured clinical exam (OSCE)
slide 2
slide 3
Segment
Fee
AKT
$1670
KFP
$1670
OSCE
$3315
What’s the exam structure
• Written exam
– Applied Knowledge Test (AKT) - 150 Questions in 4 hrs
– Key Features Problems (KFP) – 26 Questions in 3.5 hrs
slide 4
FAQ re on-line Exam
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No alternative available
Pilot very positive
Back-up connection
Program very robust
Practice exam available:
Once Mozilla Firefox is installed you can access
the online examination practice system by going
to http://practiceexam.racgp.org.au/practice.
slide 5
Written Exam: AKT
* Single-best answer
* Extended matching
slide 6
AKT: Single-best answer
A four year old child is brought to you by the kindergarten teacher.
She states that the child was not well that morning, has vomited
once and has complained of central abdominal pain. She has found
the child's temperature to be 39C.
Your clinical examination is most likely to reveal:
A. numerous pus cells on microscopy of urine
B. inflamed ear drums
C. neck stiffness
D. inflamed tonsils.
E. tenderness localised to the R.I.F.
slide 7
AKT: Extended Matching Questions
Knee pain
A. ACL tear
B. Baker’s cyst
C. Chondromalacia
D. Complex regional pain
syndrome
E. Diabetes mellitus
F. Fibromyalgia
G. Gout
H. Haemophilia
I. Lumbar spinal canal stenosis
J. Osgood schlatters disease
K. Osteoarthritis
L. Rheumatoid arthritis
M. Septic arthritis
N. Tuberculosis
For each of the following patients with knee pain, select the
MOST likely diagnosis
slide 8
AKT: Extended Matching Questions
A 2 y.o. boy presents with recurrent painful
swelling of his right knee. His Mother says
he has previously had similar acute
swellings of his ankles and elbows. She
notes he bruises easily & had prolonged
bleeding after his circumcision.
She believes her father has had similar
troubles as well.
slide 9
AKT: Extended Matching Questions
• A 69 year old man notices his knee gets sore
especially walking down stairs.
slide 10
Written Exam: KFP
slide 11
Key Feature Problems (KFP)
•
•
There are 26 KFP in 3.5 hours
= 8 mins each
•
Two answer formats
–
Write in responses – free text
–
Choice of responses – pick list
slide 12
Key Feature Problems
• Problems should be common conditions or serious
uncommon ones
• Can have 2-3 parts in the question – scenario can
evolve
• Think about the key clinical decision making involved
• Make sure it is from the point of view of a general
practitioner (although can vary the setting – rural)
• May involve Pictures, ECGs, x-rays and/or test results
as part of the question
slide 13
KFP- an example
Mr Paul Young, a 56 y.o. man consults you in the
surgery for pain in his left lower leg which has
been getting progressively worse over the past
2 days. He says his leg is tender below the
knee and swollen around the ankle. He has
not had a similar problem before. His other
leg is fine.
slide 14
KFP- an example
What diagnoses would you consider at this
time? List, in note form only, up to two
diagnoses.
slide 15
KFP- an example
What elements of history would you like to
elicit?
List up to seven (7) of the following items.
slide 16
KFP- an example
1. Activity at onset of symptoms
2. Alcohol intake
3. Allergies
4. Angina pectoris
5. Anti-inflammatory therapy
6. Cigarette smoking
7. Colour of stools
8. Cough
9. Headache
10. Haematemesis
11. Impotence
12. Intermittent claudication
13. Low back pain
14. Nocturia
15. Palpitations
slide 17
16. Paraesthesia
17. Paroxysmal nocturnal dyspnoea
18. Polydipsia
19. Previous back problems
20. Previous knee problems
21. Previous neoplasia
22. Previous urinary tract infection
23. Recent dental procedure
24. Recent immobilisation
25. Recent sore throat
26. Recent surgery
27. Recent work environment
28. Wounds on foot
29. Wounds on hand
KFP Answers – according to the College
Question 1
Deep venous thrombosis must be included in the differential diagnoses (Score 1)
Providing more than two (2) diagnoses, score = 0.
Total score = 1.
Question 2
Any seven (7) of the following items are required:
Activity at onset of symptoms
Cigarette smoking
Previous knee problems
Previous neoplasia
Recent immobilisation
Recent surgery
Recent work environment
Wounds on foot
All score 1. Selecting more than seven (7) items, score = 0.
Total score = 7.
Reference: Dr Andrew Moreton’s slide. There may be changes to the above marking criteria recently.
slide 18
The clinical exam - OSCE
slide 19
OSCE
• May and October
• 17 stations (3 ‘Rests’ 14 cases)
–2
– 12
slide 20
19 minute long cases
8 minute short cases
Components of the Clinical Exam
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Diagnostic interviews
“Management” interviews
Physical Examinations
Viva
+/- Practical Procedure
slide 21
Candidate Instructions
1.
2.
3.
4.
This is an 8 minute station.
Read the following scenario.
Take a focussed history.
Give a brief differential diagnosis to the observing
examiner
5. Request the findings of relevant physical
examination.
6. Request the results of any investigations you think
appropriate.
7. Discuss the diagnosis and management with the
patient.
slide 22
OSCE: Short case
- an example
slide 23
OSCE- an example
Miss Debbie Williams is a 27 y.o. receptionist who has
been coming to this surgery since childhood. She has
enjoyed good health but has attended for her Pap
smears (all normal) and occasional URTI’s. She is not
married and has never been pregnant. Her only past
regular medications have been the OCP. She has no
known allergies and there is no significant family history.
She had her appendix removed at the age of 12.
She rang yesterday for an appointment today.
slide 24
OSCE: long case
- an example
slide 25
CANDIDATE INSTRUCTIONS
1. This is a 19 minute station.
2. This consultation may be conducted as over a number
of sessions.
3. Read the following scenario.
4. Take any additional history you think is appropriate.
5. Request any physical examination findings you require.
6. Give your Differential diagnoses to the observing
examiner.
7. Request the results of any investigations you require.
8.
Outline your management to the observing examiner.
slide 26
OSCE – long case- an example
• Nell Worthington is an 80 y.o. retired librarian.
• She has just moved to your area to be nearer
to her daughter.
• She has provided the following summary
sheet from her previous doctor.
• She called & made a long appointment 2
weeks ago.
slide 27
Nell Worthington – Summary Sheet
• Past medical Hx:
– Hypertension
– Osteoarthritis
– Vaginal hysterectomy for prolapse 1980
• Medication:
– Aldactone 25mg mane
– Ramipril 10mg daily
– Slow K 600mg 2 daily
• Allergies: nil
• Social Hx:
– Widowed 1998
– non-smoker
– 4 grown children
slide 28
SUMMARY
• The RACGP Fellowship exams consist of three segments:
•applied knowledge test (AKT): 150 Questions in 4 hrs
• key feature problems (KFP): 26 Questions in 3.5 hrs
• objective structured clinical exam (OSCE): 12 short
cases (8 minutes each) and 2 long cases (19 minutes each)
slide 29
Thank you for your attention.
slide 30