The comments written by the examiners in regards to this clinical section were clearly a masterpiece of helpful feedback. They were so good that the college reused them, copying the comments almost verbatim in the next three papers.
The Clinical Section: Hot cases
The Clinical Section (hot cases) was conducted at the St George Hospital, and Prince of Wales Hospital, Sydney.
Fourteen out of twenty-two candidates passed this combined section.
Candidates should listen carefully to the introduction given by the examiners and direct their examination accordingly. Patients were usually presented as problem solving exercises. For maximal marks, candidates should demonstrate a systematic approach to examination, clinical signs should be demonstrated, and a reasonable discussion regarding their findings should follow. The twenty minutes available for each case provides ample opportunity to discuss related investigations and plans of management.
Exposing the patients should be limited to those areas that are necessary for that component of the examination, and in keeping with the modesty requirements of the patients. Candidates must show appropriate courtesy and respect to patients.
Cases encountered as hot cases included patients with:
· Cardiogenic shock after cardiac surgery (introduced as “presented with cardiogenic shock. Subsequently suffered a cardiac arrest. After resuscitation he had urgent angiography which showed severe triple vessel disease. Then had urgent coronary artery grafting. This was now 5 days ago. Please can you assess with a particular focus on suitability for weaning.”)
· Oliguria after prolonged abdominal surgery (introduced as “could you please examine, particularly in regards to diagnosis/management of oliguria”)
· Multiple trauma (introduced as problem is increased ICP. Can you please examine patient in relation to increased ICP”)
· Febrile after surgery (introduced as “in ICU after complications post-elective surgery. Febrile overnight; please examine for a cause.”)
· Respiratory failure and AML (introduced as “respiratory failure for 5 days. Please examine for causes and status of respiratory failure”).
· Spinal injury (introduced “prolonged ICU stay after being injured in an accident. Please examine neurological state”)
Comments documented at the time of the clinical examination suggested that common problems encountered related to examination technique (eg. erratic/disorganised), detection and interpretation of clinical signs, and identification of clinically significant issues.