The Clinical Section (hot cases) was conducted at the Alfred Hospital, Melbourne.
Nine out of sixteen candidates passed this combined section (nine out of sixteen passed the hot cases overall, and eleven out of sixteen passed the cold cases overall). 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:
· Difficulty to wean after chest trauma (introduced as “isolated chest trauma. Why difficult to wean?”)
· Extubation after a stroke (introduced as “admitted following a stroke. He was extubated 6 days ago, but required re-intubation within 3 hours. Fasted overnight for consideration of extubation. You are taking over care today. Please examine and determine what problems are and how you want to manage them.”)
· Weaning after cardiac surgery (introduced as “cardiac surgery 12 days ago. Slow to wean and confused post-op. Readmitted after asystolic arrest. You are taking over care. Please examine and determine hat medical issues exist and how you would manage them.”)
· respiratory failure and bone marrow transplant (introduced as “10 days of increasing shortness of breath, 3 months post BMT for AML. Arrived in the unit last night. Please examine respiratory system and suggest a diagnostic and management plan”).
· sepsis (introduced as “presented with respiratory distress and shock 8 days ago after a 3 day prodrome of fever and malaise. Please examine and focus on possible sources for sepsis.”)
· haemodynamically unstable after cardiac surgery (introduced as “post-CABG who is haemodynamically unstable day 1 post-op. Please examine”)
· Intracerebral haemorrhage
· Out-of-hospital cardiac arrest
Comments documented at the time of the clinical examination suggested that common problems encountered related to poor examination technique (eg. erratic/disorganised), detection and interpretation of clinical signs, and identification of clinically significant issues.