The brief examiner's commentary for the clinical section this year was identical to the commentary for the previous year's second paper. This supports the idea that it would be inefficient to write different comments for every paper, as the candidates make exactly the same mistakes every year. A less likely explanation for this duplication is the examiners' complete lack of interest in making any useful comments.
The Clinical Section: Hot cases
The Clinical Section (comprising 2 hot cases) was conducted at the Alfred Hospital, Melbourne.
Sixteen out of twenty-seven candidates passed the combined clinical section (seventeen out of twenty-seven passed the hot cases overall, and nineteen out of twenty-seven 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. Some candidates waste valuable time at the start of the case by spending more than a couple of minutes around the bedside before they actually commence examining the patient. 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:
· Sepsis, psoas abscess
· Multiple trauma after a motor vehicle crash with long bone fractures and a ruptured bladder
· End-stage liver disease, acute renal failure and shock
· Lung abscess and bronchopleural fistula
· Respiratory distress and Guillain-Barre Syndrome
· Faecal peritonitis and multiple organ dysfunction
· Pancreatitis and multiple organ dysfunction
Introductory questions included:
“This man presented with a gastrointestinal bleed. Can you work out why he may be jaundiced?”
“This elderly woman has been in Intensive care with abdominal sepsis. She is becoming difficult to wean off the ventilator. Can you assess her to try and elucidate why she is being difficult to wean?”
“This man has been in Intensive care for 8 weeks with an abdominal problem. Last night he spiked a temperature of 39°C. Can you examine him specifically to work out why he may have done so?”
Comments documented at the time of the clinical examination suggested that common problems encountered related to poor examination technique (eg. slow to actually start examining the patient), and poor discussion.