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C L I N I C A L E X A M I N AT I O N S P E C I F I C AT I O N S

A u s t r a l i a n

M e d i c a l

C o u n c i l

The purpose of the Australian Medical Council is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian Community.

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The Australian Medical Council is an independent national standards body for medical education and training. "The purpose of the AMC is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community."

April 2010 Edition 8 First Printing ABN ISSN 97 131 796 980 1325-426X

Copyright for this publication rests with the Australian Medical Council Limited Australian Medical Council Limited PO Box 4810 KINGSTON ACT 2604 Website: Telephone: Facsimile: Email: http://www.amc.org.au 02 6270 7878 02 6270 9799 amc@amc.org.au

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IMPORTANT NOTICE TO CANDIDATES FOR THE AUSTRALIAN MEDICAL COUNCIL (AMC) CLINICAL EXAMINATION CLINICAL EXAMINATION FORMAT In July 2001, the AMC implemented changes to the clinical examination that were designed to: streamline the format and operation of the AMC examination bring the AMC examination into line with current assessment practices in Australia and overseas make more effective use of clinical resources and, as a result, accommodate larger numbers of candidates in a timelier manner.

An important feature of the new clinical examination was the introduction of a structured, multistation clinical examination format to replace the previous short case clinical examination in Medicine and Surgery. As part of the on-going review of its examinations, the AMC decided to further streamline the clinical examination by collapsing the current Stage 1 and Stage 2 components into a single, multi-station clinical examination format.The changes to the clinical examination are detailed in this booklet and were effective from 1 January 2004.

STATEMENT ON PRIVACY The AMC is required to observe the provisions of the Privacy Amendment (Private Sector) Act 2000, (effective from 21 December 2001) and sets out the requirements for the collection and use of personal information collected before and after that date. Each of the Application Forms required by the AMC includes a statement relating to the AMCs privacy procedures. Each must be signed by the applicant to give formal consent for the AMC to collect and hold personal information. If this consent is not provided, the AMC will not be able to process the application.

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GUIDELINES AND SPECIFICATIONS 1 INTRODUCTION 1 ASSESSMENT AIMS AND OBJECTIVES 1 STRUCTURE OF THE AMC EXAMINATION 1 STANDARD OF THE AMC EXAMINATIONS 2 APPEALS PROCEDURE 2 THE CLINICAL EXAMINATION 3 REQUIREMENTS FOR THE CLINICAL EXAMINATION 3 OBJECTIVE OF THE CLINICAL EXAMINATION 3 STANDARD OF PERFORMANCE 3 FORMAT OF THE CLINICAL EXAMINATION 3 GENERAL FORMAT 3 ARRANGEMENT FOR THE CLINICAL EXAMINATION 4 SCHEDULING PROCESS FOR THE CLINICAL EXAMINATION 4 VENUE AND WAITING TIMES 5 EXAMINATION FEES 5 STRUCTURED CLINICAL EXAMINATION 6 ASSESSMENT OBJECTIVES FOR THE CLINICAL EXAMINATION 7 TOPICS COVERED IN THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION 8 PASS/FAIL RETEST (ADDITIONAL PASS/FAIL ASSESSMENT FOR MARGINAL PERFORMANCE) 9 CRITICAL ERRORS IN MEDICAL CARE 10 EXAMPLES OF CLINICAL ERRORS IN MEDICAL CARE 10 SCORING IN THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION 12 DETERMINATION OF RESULTS 12 ADMINISTRATION ARRANGEMENTS AT THE EXAMINATION CENTRE 14 PREPARATION FOR THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION 15 REVIEW OF CLINICAL SKILLS 15 CONDUCT OF CANDIDATES PRESENTING FOR EXAMINATION 15 DOCTOR-PATIENT RELATIONSHIP IN AUSTRALIA 16 GENERAL PREPARATION FOR THE CLINICAL EXAMINATION 16 CLINICAL EXAMINATION VIDEO 17 FORMAL NOTIFICATION OF CLINICAL EXAMINATION RESULTS AND FEEDBACK 18 AMC CERTIFICATE 18 REQUEST FOR DUPLICATE COPIES OF AMC RESULTS 18 GENERAL INFORMATION 19 CHANGE OF ADDRESS 19 REQUEST FOR CONFIRMATION OF DATE OF PRELIMINARY APPLICATION WITH THE AMC Section 19 AB of the Health Insurance Act 19 FURTHER INFORMATION 19

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APPENDIX A APPENDIX B APPENDIX C

ATTRIBUTES OF MEDICAL GRADUATES ESSENTIAL READING

APPENDICES

SUMMARY OF THE FORMAT OF THE AMC CLINICAL EXAMINATION GENERAL INFORMATION FOR THE STRUCTURED CLINICAL ASSESSMENT AND GENERAL INFORMATION FOR THE RE-TEST EXAMINATION SAMPLE STATION MEDICAL AND MARKSHEET SAMPLE STATION OBSTETRICS AND GYNAECOLOGY AND MARKSHEET SAMPLE STATION PAEDIATRICS AND MARKSHEET PERFORMANCE FEEDBACK ADDITIONAL PERFORMANCE FEEDBACK SHEET (ASSESSMENT DOMAINS)

APPENDIX D APPENDIX E APPENDIX F

APPENDIX G APPENDIX H APPENDIX I

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These guidelines and specification have been prepared to assist candidates for the Australian Medical Council (AMC) examination.They contain information about: the format and content of the AMC examination levels of clinical knowledge, skills and attitudes required to satisfy the requirements of the examination the areas and topics covered in the examination the format of the clinical examination preparing for the AMC examination suggested reading lists for the examination.

INTRODUCTION

GUIDELINES AND SPECIFICATIONS

Candidates should study these guidelines in conjunction with the current edition AMC publication Information Booklet for Candidates (Application Procedures and Requirements for the AMC Examination) which sets out the formal procedures for the AMC examination. ASSESSMENT AIMS AND OBJECTIVES The AMC examination is designed to assess, for registration purposes, the medical knowledge and clinical skills of overseas trained doctors whose basic medical qualifications are not recognised by State and Territory Medical Boards. The MCQ examination focuses on basic and applied medical knowledge across a wide range of topics and disciplines, involving understanding of disease process, clinical examination, diagnosis, investigation, therapy and management, as well as on the candidates ability to exercise discrimination, judgment and reasoning in distinguishing between the correct diagnosis and plausible alternatives. The clinical examination also assesses the candidates capacity to take a history, conduct a physical examination, formulate diagnostic and management plans, and communicate with patients, their families and other health workers. STRUCTURE OF THE AMC EXAMINATION The AMC examination consists of two parts:

The examination is designed as a comprehensive test of medical knowledge, clinical competency and performance. Both MCQ and clinical assessments are multidisciplinary and integrated.

an MCQ examination to test medical knowledge, in two parts, each of three hours duration, and each containing 125 questions. Commencing in 2005 the AMC MCQ examination is a computer-administered examination, containing two parts administered on one day. a clinical examination, testing clinical and communication skills, of three to four hours duration, which will be administered on a single afternoon or morning.A Re-test examination, duration of one to two hours, will be administered if required.

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STANDARD OF THE AMC EXAMINATIONS

The standard of the AMC examinations is formally defined as the level of attainment of medical knowledge, clinical skills and attitudes which is required of newly qualified graduates of Australian Medical Schools who are about to commence intern training. The goals and objectives forming the basis of medical education in Australia, as determined by the AMC for the accreditation of Medical Schools, are expressed in terms of: objectives relating to knowledge and understanding objectives relating to skills and performance

The objectives (Attributes of Medical Graduates) are listed in APPENDIX A. In undergraduate courses these are assessed over several years in a variety of ways, whereas the AMC assessment is conducted through a Multiple Choice Question (MCQ) examination and a Clinical Examination. APPEALS PROCEDURE The AMC has established procedures for candidates to appeal a decision of the Board of Examiners on matters covered by the Guidelines Relating to Appeals against the Procedures of a Clinical Examination. Guidelines and application forms are available on request from the AMC Secretariat.

objectives relating to attitudes as they affect professional behaviour.

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REQUIREMENTS FOR THE CLINICAL EXAMINATION OBJECTIVE OF THE CLINICAL EXAMINATION

THE CLINICAL EXAMINATION

Candidates are required to meet the pass standard in the MCQ examination before being eligible to proceed to the clinical examination. The general objective of the AMC clinical examination is to evaluate the clinical competence and performance of the candidate in terms of his or her medical knowledge, clinical skills and professional attitudes for the safe and effective clinical practice of medicine in the Australian community.

The clinical examination includes an assessment of a candidates ability to take a history, conduct a physical examination and, by integration of the information obtained, engage in a reasonable discussion of the diagnosis and management. It also focuses on the candidates ability to communicate effectively with patients, both in the eliciting of symptoms and in counselling on health care, as well as proficiency in clinical skills. STANDARD OF PERFORMANCE REQUIRED

The clinical examination requires the candidate to demonstrate to the satisfaction of the examiners, at the level of the graduating final year medical student about to commence the preregistration intern year an understanding of the basic concepts of disease processes across a broad range of clinical disciplines, and how these produce deviation from normal. The candidate is required: firstly, to be familiar with the concepts of disease processes as they apply to the more common and important diseases in the Australian community and, secondly, to have some awareness of other diseases in the Australian community to be able to discuss the mechanisms of production of symptoms, signs, clinical features, morphological changes and the pathological (pre- and post-mortem) appearances pertinent to these important diseases

FORMAT OF THE CLINICAL EXAMINATION GENERAL FORMAT

to be familiar with the indication for, the mechanisms and actions of, and the adverse affects of, the major therapeutic agents.

From January 2004, the clinical examination will consist of

A multi-station structure assessment of clinical skills.

A summary of the clinical examination is set out in APPENDIX B.

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ARRANGEMENTS FOR CLINICAL EXAMINATION

The AMC has grouped the clinical examination into four separate Series per year, with specified examination periods and defined closing dates.The specified periods for clinical examinations are provisional, as final dates and centres for examinations are subject to negotiation with participating venues.

Examinations are held in Sydney, Melbourne,Adelaide and Brisbane. Occasionally, examinations are also held in other cities within Australia. Candidates should refer to the Form C-2, which specifies which centres are available in any given Series. AMC Clinical examinations are conducted on specified Saturdays throughout the year, due to limitations on the availability of suitable clinical examination venues. The AMC is aware that this scheduling of clinical examinations may create difficulties for some candidates due to religious convictions. Candidates who believe that they fall into this category should contact the clinical examinations section of the AMC concerning alternative arrangements for scheduling of clinical examinations in such cases. As alternative venues are very limited, applicants seeking special consideration in scheduling will required to submit documentary evidence in support of their case for special scheduling. Candidates may only apply for one Series of examination at a time.Therefore, candidates who have been scheduled for a clinical examination may not lodge an application for another Series before they have received the results of the scheduled examination. SCHEDULING PROCESS FOR THE CLINICAL EXAMINATION

For an application form to sit the clinical examination (Form C-2), please contact the AMC.You can also print a copy of the Form C-2 from the AMC website (www.amc.org.au).

The scheduling of candidates into a particular centre is done immediately after the closing date of each Series. Candidates will be notified if they have been successful in gaining a clinical position, approximately 10 days after the closing date for the Series for which they applied. Please Note: The AMC cannot guarantee to place an applicant in his/her preferred centre, although it will endeavour to do so wherever possible.

Candidates should note that, where the number of applications for clinical examination places in a specific examination Series exceeds the availability of examination places, scheduling will be on a priority basis, along the following lines:
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first attempt candidates will have priority over repeat attempt candidates

the scheduling of first attempt clinical candidates will take into consideration the time since they sat and qualified at the MCQ examination candidates will be ranked in merit order based on their overall score in the MCQ examination candidates with fewer repeat attempts will have priority over candidates with a higher number of repeat attempts the AMC will give special consideration to candidates in exceptional circumstances, where it does not disadvantage other candidates.

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The aim of this approach is to ensure that all candidates have an opportunity to complete the clinical examination as quickly as possible. VENUE AND WAITING TIMES Candidates are scheduled for a single morning or afternoon examination. Candidates complete the examination within three to four hours. Candidates are sent exact venue details showing report times and locations approximately three weeks prior to their examination. Candidates will be required to wait at the venue of each examination at the direction of the administrative staff in attendance. Candidates must arrive promptly and report to the administrative staff in attendance. Once candidates have reported they will be required to remain, under the direction of the administrative staff, until the examination session concludes. Due to the structure of the examination, candidates arriving late will be excluded from commencing the examination. EXAMINATION FEES The examination fees for the clinical examination (based on current examination costs) are shown on the AMC website (www.amc.org.au).The fees are not to be forwarded with the Form C-2. The examination fees for the clinical examinations are payable when a candidate has been scheduled for the relevant examination session. The Australian Medical Council has reviewed its schedule of examination and assessment fees and charges, which were last changed in 2005/06. In order to accommodate increased costs associated with the scheduling and delivery of examinations, the AMC is obliged to increase a number of fees and charges associated with the AMC Examination and other assessment pathways effective for examination and assessments conducted after 1 July 2010. There will not be a separate fee for the AMC certificate. For more information please see the AMC website. Payment of the examination fee will confirm the placement in the relevant clinical examination session. If the examination fee is not paid by the due date, the candidate will not be permitted to sit for the examination. Candidates who withdraw after accepting a clinical place will incur a withdrawal fee, the amount of which will depend on the date of the withdrawal. The fees for the AMC examination are reviewed from time to time and are subject to variation. A schedule of the fees, and withdrawal fees, currently applying to the examination are available on the AMC website (www.amc.org.au).

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STRUCTURED CLINICAL ASSESSMENT

From 1 January 2004, the AMC clinical examination will be an integrated multidisciplinary structured clinical assessment consisting of a 16 component multi-station assessment, including three Obstetric/Gynaecology stations and three Paediatric stations. A Re-test (Additional Pass/Fail Assessment) for candidates with marginal performance will be held within the next Series of examinations. Candidates are scheduled for the structured clinical assessment examination in a single morning or afternoon and will be required to wait at the venue of the examination at the direction of the administrative staff in attendance. Candidates will rotate through a series of 20 stations, of which 16 will be marked, and will undertake a variety of clinical tasks.All candidates in a clinical examination session will be assessed against the same stations. Rest stations will not be scored, but will provide candidates with an opportunity to have a break between the score stations.There are four rest stations in addition to the 16 marked stations. Each station will be of 10 minutes duration (eight minutes for the actual assessment and two minutes for change over and reading of the written information for the next session).The station may include observed and non-observed, or linked, stations. One examiner will be involved in each observed station, and all 16 stations will be scored, including the non-observed, or linked, stations. Stations may utilise actual patients, standardised patients or examiners as role-playing patients, or video presentations. Models and other relevant equipment may also be used in the examination, e.g. prescription pads. Stations will assess clinical skills in Medicine, Surgery, Paediatrics, Obstetrics, Gynaecology, General Practice and Psychiatry. Scoring will be structured, with individual aspects of each station specified under the following broad headings:
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history

physical examination investigations diagnosis/differential diagnosis therapeutics/management clinical procedures. counselling/patient education

Examples of material that could be included in the stations are:

physical examination of a patient with symptoms of suspected intermittent claudication [physical examination station] interpretation of a clinical chemistry result [investigation station] physical examination of a patient with suspected thyrotoxicosis [physical examination station] counselling of an asthmatic patient on the use of an inhaler [patient education station]

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counselling of a patient with obesity [counselling station] administration of an insulin injection [procedure station]

physical examination of a patient with symptoms of shortness of breath [physical education station] physical examination of a patient with ascites [physical examination station] advice to a patient on anticoagulant therapy [therapeutic station] diagnosis of a common benign skin lesion [diagnosis station]

counselling a patient in regard to the benefits and risks of hormone replacement therapy [counselling station] counselling a parent concerning childhood immunisation [counselling station].

The structured clinical assessments will make use of examiners from all disciplines.

General information to be followed by candidates is given to candidates when they accept their clinical examination place. It is also shown at APPENDIX D. ASSESSMENT OBJECTIVE FOR THE CLINICAL EXAMINATION The focus of the examination/assessment will be: the candidates approach to the patient, ability to take a focussed history, physical examination technique and communication skills the candidates skills, completeness and orderliness in eliciting the signs the interpretation of the signs and investigations in the determination of diagnosis and management appropriateness of management of the patient and of additional investigations.

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TOPICS COVERED INTHE STRUCTURED CLINICAL ASSESSMENT EXAMINATION The examination will include the more common and/or important diseases in the Australian community.The following list is provided as a guild only, and is not exhaustive: cardiovascular system and disorders respiratory system renal system blood (including oncology) endocrine system thoracic disorders nervous system gastrointestinal system

skin (dermatology)

musculoskeletal system (rheumatology) orthopaedic disorders urological disorders Obstetrics: abdominal and gastrointestinal

diseases with infection

head, neck, ear, nose and throat disorders

breast and endocrine disorders ophthalmology

lesions of the skin and subcutaneous tissue

antenatal care

intra-partum care post-partum care Gynaecology: the newborn baby abnormal bleeding as a child, adult, in the post menopausal era cervical smear implications of result pelvis pain causes and management

contraception sterilisation, pregnancy termination, sexual counselling

general approach to gynaecological malignancy menopausal care

general approach to infertility evaluation and care general approach to urinary incontinence

others vaginal discharge, sexually transmitted diseases, premenstrual syndrome dietary and nutritional problems iron deficiency, anorexia, obesity
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Paediatrics:

neonatal problems feeding difficulties, bowel obstruction, gastroenteritis vaccinations asthma

behavioural problems Psychiatry: infectious diseases

mental status assessment

advice in regard to psychotropic medication

history taking of a person with anxiety disorder APPENDIX E is a sample of a physical examination station showing details of information given to candidates and the key assessment objectives that the examiners will assess; APPENDIX F is a sample of an Obstetric & Gynaecology case; and APPENDIX G is a sample of a Paediatric case. advice in regard to a psychological treatment.

Candidates with borderline or Marginal Performances will have an opportunity to validate their result as a Pass or Fail in the form of a Re-test examination of clinical skills. The Pass/Fail Re-test examination will usually be held within the next Series of examination. Candidates will be advised of relevant dates and times by the AMC examination secretariat. If a candidate is required to present for the Re-test examination and does not present, then the overall result will be confirmed as a FAIL.

PASS/FAIL RE-TEST (Additional Pass/Fail Assessment for Marginal Performance)

The Re-test will involve eight marked stations, including one Obstetric and Gynaecology station and one Paediatric station, each of eight minutes duration (an additional two minutes are given for change over from room to room and to read the written information outside the next station). To Pass the Re-test examination, and therefore the whole structure clinical assessment examination, a pass must be obtained in at least six of the eight stations. A listing of candidates results will be available on the AMC website (www.amc.org.au/results.asp) from 9am (AEST) on the Thursday following the examination and remain for a period of four weeks.The candidates listing will be shown by AMC candidate reference number only, in compliance with Commonwealth Privacy Legislation. Formal examination results will be posted to all candidates, usually within two weeks of the examination. Candidates should ensure that their current address is registered with AMC Secretariat.

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CRITICAL ERRORS IN MEDICAL CARE

Where critical errors are made by a medical practitioner, these can result in the wrong diagnosis being made, the diagnosis being made much later than ideal, wrong treatment being given, or complication occurring which would otherwise have been unlikely. It is therefore essential for critical errors to be kept to an absolute minimum, preferably zero.

When, during a clinical examination of assessing the competence of an individual candidate, a critical error by the candidate has been identified, the examiner needs to assess the severity of the error and award a mark to the candidate which takes the performance of the critical error into account. In general, the mark awarded in the particular section of the mark sheet should be VERY UNSATISFACTORY FAIL. Errors are only considered critical when that is what they are, not just where performance of the candidate is not up to the expected standard. In general, where a critical error has been made by a candidate, he/she will not pass the particular station in the structured clinical assessment examination, irrespective of their performance in the remainder of that station. The examiner at each station has therefore been advised that, for a candidate to fail a particular station, the following could apply OR the obtaining of two or more UNSATISFACTORY FAIL assessment in two or more areas the obtaining of one VERY UNSATISFACTORY FAIL assessment.This would usually mean the candidate made a critical error.

An unsatisfactory fail performance only in an assessment area which is not identified as a key issue is unlikely to result in the candidate failing the station. EXAMPLE OF CRITICAL ERRORS IN MEDICAL CARE The list below is a guide only, and is NOT exhaustive 1. This could be for any of the following reasons

FAILURE TO MAKE THE CORRECT DIAGNOSIS, OR AN INAPPROPRIATE DELAY IN MAKING THE CORRECT DIAGNOSIS inadequate history being taken from the patient, despite the fact all the data were readily available to indicate which history areas needed to be explored failure to ask about the possible use of hormone replacement therapy or when the last Pap test was performed in a patient with post-menopause bleeding.

inadequate examination being performed only assessed nerve damage, and not tendon damage, after a wrist laceration OR moved unconscious patient inappropriately, risking further injury, etc. OR finding incorrect important physical signs inappropriate investigations being arranged, or failure to request the investigation needed to make the correct diagnosis failure to advise colonoscopy for a patient with bleeding per rectum OR ordering invasive, complex or expensive investigations which were clearly not necessary. Inadequate or incorrect reasoning in considering the history, examination and/or examination results.

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2. 3. 4.

This could be for any of the following reasons

FAILURE TO COMMUNICATE APPROPRIATELY WITH THE PATIENT CONCERNING HIS/HER CONDITION failure to advise the patient of a probable good prognosis for treatment of the condition or malignancy, if this is the case

the provision of grossly wrong information to the patient concerning the likely diagnosis, management, prognosis, etc.

failure to provide appropriate information to the patient to enable informed consent to be given by the patient for a particular investigation, surgical procedure, medical treatment, etc. failure to correctly advise a patient concerning the use of a medical device appropriate use of a blood glucose measuring device, or a Ventolin inhaler, etc. failure to admit a patient to hospital when clearly indicated. BREACH OF ETHICAL BEHAVIOUR

This could be for any of the following reasons

communication with an organisation or person without the consent of the patient

performance of an operative procedure or the administration of potentially harmful drugs without the consent of the patient, except in the life threatening circumstances

performance of a sterilisation procedure in a mentally handicapped individual without the permission of a Court of Law or Guardianship Board. INAPPROPRIATE PRESCRIBING

This could be for any of the following reasons

wrong drug or other treatment given.The drug selection is completely inappropriate, not just less appropriate than a variety of options wrong dose, frequency or wrong route of drug treatment.The mistake made must be potentially harmful to the patient, and must involve a drug which is well known and where the effect of under- or over-dosing is well known failure to recognise interaction between two drugs prescribed simultaneously

failure to check that the patient is not allergic to the drug proposed. Knowledge of any likely cross-sensitivity could be important failure to recognise the need for assessments for adverse effects failure to perform a Full Blood Examination if the patient is being given cytotoxic drugs OR failure to measure serum gentamicin levels when appropriate failure to recognise that certain drugs should not be administered in pregnancy.
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SCORING IN THE STRUCTURED CLINICAL ASSESSMENT EXAMINATION GRADE LEVEL OF PERFORMANCE

The following scoring system is used for individual domains under each station in the clinical examination. Each station will have the appropriate importance of individual domains indicated. Very Satisfactory Satisfactory Unsatisfactory Very Unsatisfactory Covered all essential aspects competently minimal errors or omissions (pass)

Major elements covered, some minor omissions or inaccuracies (pass) Demonstrated significant errors of omission or significant flaws of procedure (fail) Serious omissions or errors, incorrect diagnosis, inadequate explanations, failure to respond to prompts, dangerous or life threatening practice, critical errors (fail).

DETERMINATION OF RESULTS Performance Requirements The overall result for each of the 16 marked stations will be recorded as a Pass or Fail only. Candidates will be globally graded as Clear Pass/Marginal Performance/Clear Fail, as follows: Clear Pass = a pass score in 12 or more of the 16 stations including: at least one Paediatric station as a Pass

at least one Obstetric/Gynaecological station scored as a Pass AND

Marginal Performance = Clear Fail =

a pass score in 10 or 11 of the 16 stations a pass score in nine or less of the 16 stations OR

fails in all three Obstetric/Gynaecological stations, irrespective of the total number of stations passed OR A candidate who obtains a Marginal Performance grade will be eligible to present for a Pass/Fail Re-test to confirm their result as a pass or fail. fails in all three Paediatric stations, irrespective of the total number of stations passed.

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Candidates will be globally graded as Clear Pass/Clear Fail in the Re-test, as follows: Clear Pass = Clear Fail = a pass score in at least six of the eight stations a pass score in five or less of the eight stations.

A candidate who obtains a Clear Fail at the main examination or the Re-test will be required to re-sit the clinical examination. Unsuccessful candidates also receive a more detailed breakdown of their performance against the assessment domains, to assist with revision for future attempts.A sample is shown in APPENDIX I. Each candidate will receive a computer generated transcript of their results and feedback on their performance in the clinical examination.A sample is shown in APPENDIX H.

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ADMINISTRATION ARRANGEMENTS AT THE EXAMINATION CENTRE

On entering the examination venue, candidates will be given a pouch containing a coloured card signifying which group you are in, and which station you will be starting the examination on. Candidates will be taken into the examination area and asked to stand on the red cross on the floor outing their starting station.

The first bell heard will commence the two minute reading time outside the candidates first station.The second bell heard will commence the examination and candidates will then proceed into the appropriate examination room. Some candidates, however, will be starting at a REST STATION (this will be shown on the coloured starting card) and will be required to stay in the rest station for the first ten minutes.The third bell heard will be after eight minutes of assessment and will conclude the first station. Candidates will then move, at the direction of the examination marshal, to their next station and read the information outside their second station. And so on. Each station will last eight minutes, with one examiner assessing each candidates performance. There may be a second person in a station who will be monitoring the station. Candidates DO NOT need to interact with this second person.

If candidates finish a station early, this does not mean that they have done well or failed. It merely means the task has been completed ahead of the allotted eight minutes. If candidates complete a station either early or on time, they will be required to stand on the red cross outside the room just completed, until moved to their next station by the examination marshal. Two minutes are given for the changeover from room to room and to read the information outside each room at the next station.This is to ensure that all candidates have the full eight minutes to complete the task of the station.

Stations may utilise actual patients, standardised patients or examiners role playing as patients. Candidates should regard and treat every patient as they would in a real setting, and therefore need to wash their hands as appropriate after physical examination.

Physical examination in some stations, due to the eight minute examination time period, there is not enough time to do a full physical examination.Therefore, the examiner may interrupt and indicate or request the candidate to move on with the next step.This should not be taken as a negative performance.

Drinking water is provided at each rest station and there will be access to toilets. Candidates must keep quiet whilst in the rest stations, which will be supervised by examination marshals. No questions regarding the examination are permitted. When the final bell sounds, all candidates will have completed all the assessed stations and will be guided out of the examination area. Candidates may finish at a rest station and will be required to wait until the final bell sounds before being allowed to leave the examination area.

Basic equipment for each station will be provided.Therefore, candidates will only be permitted to take into the examination area a stethoscope and a tendon hammer. No books, textbooks, paper or other material are allowed into the examination area, including mobile telephones, handbags, etc. Mobile telephones must be switched off and left in the candidates bag at the allocated baggage area. Candidates are not permitted to write any prompting material, for example, on their skin.
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Any candidate found recording any information during the examination or attempting to circumvent the examination procedures will not be permitted to continue with the examination and may forfeit his or her eligibility to proceed with the AMC examination process.

Listings of candidates results will be available on the AMC website (www.amc.org.au/results.asp) from 9am (AEST) on the Thursday following the examination and remain for a period of four weeks.The candidates listing will be shown by AMC candidate reference number only, in compliance with Commonwealth Privacy Legislation. Formal examination results will be posted to all candidates, usually within two weeks of the examination. Candidates should ensure that their current address is registered with the AMC Secretariat. REVIEW OF CLINICAL SKILLS

PREPARATION FORTHE STRUCTURED CLINICAL ASSESSMENT EXAMINATION The objective of the clinical examination is to assess clinical skills and safety.The clinical examination is designed to evaluate the candidates ability to identify physical signs and symptoms, interpret these to arrive at an accurate diagnosis, briefly discuss the appropriate management of the patient and the condition, and to communicate with the patient or carer. AMC clinical examiners recommend that candidates undertake a comprehensive review of clinical skills and differential diagnosis. Experience suggests that a review of journals which contain articles dealing with common clinical conditions in the Australian community will be more effective in preparing for the clinical examination than spending too much time with reference books.A list of useful journals (essential reading) is set out in APPENDIX C.

The AMC examiners consider that candidates who are able to maintain continuing contact with the practice of clinical medicine in a teaching hospital situation can significantly improve their chances of success in the AMC examination. It is in the candidates best interest to identify their clinical strengths and weaknesses and to focus their efforts to overcome any basic clinical deficiencies. Some candidates overlook the importance of the feedback on the MCQ examination when preparing for the clinical examination. Reviews of the performance of candidates in the clinical examination show that there is a strong correlation between performance in the MCQ and the clinical examination. Candidates who fail component subjects in the clinical examination are often found to have performed poorly (less than 50% correct) in the same subject in the MCQ.

CONDUCT OF CANDIDATES PRESENTING FOR EXAMINATION

Particular attention in the clinical examination needs to be paid to reviewing basic clinical skills, competence and safety to a standard comparable to that expected of an Australian medical graduate and to practising consultations skills and communication in everyday English.The examination format and standards are geared to these aspects as required of Australian medical graduates. The AMC clinical examination is NOT set at postgraduate level in internal medicine, surgery, general practice or other specialties.

Candidates are expected to conduct themselves courteously in examinations, correspondence and in personal contact with examiners, employees or agents of the AMC.A candidate, whose conduct is disruptive or is considered by the AMC to have been outside the bounds of reasonable and decent behaviour, may forfeit their eligibility to sit future AMC examinations.
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All candidates must comply with instructions of clinical examination supervisors during examinations. Failure to do so will constitute a breach of examination procedures and may result in action being taken against the candidate concerned. No books or papers may be used in the examination. Candidates found to be giving, receiving or recording information during the examinations will not be permitted to continue in the examination and may forfeit their eligibility to sit future AMC examinations. Candidates in clinical examinations are expected to observe the confidentiality of patients who participate in the examination and should not discuss the personal details of medical history of patients outside the examination.

Candidates are advised that NO mobile telephones, recording devices or textbooks are to be taken into the clinical examination. Mobile telephones must be switched off and left in the candidates bag at the allocated baggage area. Any candidate found contravening this regulation will be reported to the Board of Examiners for possible disciplinary action. A candidate who attempts to circumvent the examination procedures may forfeit his/her eligibility to proceed with the examination. Action may be taken against any candidate found to be selling or offering for sale examination papers or questions purporting to be AMC examination papers or questions. The AMC will investigate thoroughly a complaint or adverse report concerning any candidate sitting an AMC examination, and disciplinary action may be taken.

Candidates family/friends accompanying them to an examination centre will NOT be allowed into the examination area and are reminded that the use of mobile phones is NOT permitted. THE DOCTOR-PATIENT RELATIONSHIP IN AUSTRALIA Professional boundaries are crossed when any interaction of a sexual nature occurs between a doctor and the patient or an immediate family member of the patient.The State and Territory Medical Boards have codes of practice on this matter. GENERAL PREPARATION FOR THE CLINICAL EXAMINATION

A doctor who crosses professional boundaries will be guilty of professional misconduct and will be sanctioned under the relevant State/Territory Legislation. The following points are suggested to assist candidates in planning for and sitting the clinical examination:

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undertake a comprehensive review of clinical skills leading up to your scheduled clinical examination. Use clinically oriented texts but avoid heavy study of reference books.The candidate is expected to be able to take a focussed history and perform a concise but complete physical assessment based on the patients presenting problem. The clinical examination is not designed to re-test knowledge alone. Candidates do not get extra points because they can recite detailed material from a text book on a particular clinical condition get a good nights rest before presenting for the examination. Avoid the use of stimulants read your venue notice carefully and note the times and locations of your examination

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ensure that you arrive on time for each clinical examination session and give yourself time to settle down before your examination commences listen carefully to the examiners introductory statements, and read carefully any preliminary data given to you if you are uncertain about any instruction or question from the examiners during your clinical examination, you should ask for clarification of the particular matter, or for the question to be repeated

candidates often appear to overlook the fact that there may be role playing examiners or real patients in the clinical examination.The examiners will take note of the manner in which a candidate addresses and deals with the patient.As a medical practitioner , you already have a duty of care to your patients. The patients in the examination have a right to receive the same care exercise care with both the technique and the accuracy of the physical examination of the clinical cases. Failure to identify the physical signs present leads to failure in determining the diagnosis and consequently failure in identifying the appropriate management

avoid discussing patients with other candidates at the clinical examination centre. Patients are rotated and, in some cases, alternative conditions are examined in patients with multiple clinical signs.Any candidate who attempts to formulate a diagnosis or management on the basis of information provided by other candidates, without having examined the patient, is likely to fail on the grounds of clinical safety

CLINICAL EXAMINATION VIDEO/DVD

the final consideration in determining the result in the clinical examination is the safety and appropriateness of the assessment and/or treatment of the patient.These factors should be paramount in any discussion concerning the management of the patient or the relevant condition in both the clinical cases and any viva section of the clinical examination. Many candidates who fail the examination do so because they do not recognise the clinical safety aspect of patient management or prescribe a clinically inappropriate treatment.

The AMC, in association with the Education Resource Centre of the Royal Childrens Hospital, has produced videotape and DVD of the Structured Clinical Assessment A guide to preparing for the AMC Clinical Examination.The videotape/DVD takes the candidate through the new clinical examination and complements the AMC Examination Specification Booklet (www.amc.org.au).

Order forms for the video/DVD are available through the AMC Secretariat and the AMC website

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FORMAL NOTIFICATION OF CLINICAL EXAMINATION RESULTS AND FEEDBACK Formal examination results will be posted to all candidates, usually within two weeks of the examination. Candidates should ensure that their current address is registered with the AMC Secretariat.

Each candidate will receive a computer generated transcript of their results and feedback on their performance in the clinical examination.A sample is shown at APPENDIX H.

Unsuccessful candidates also receive a computer generated breakdown of their performance against the assessment domains, to assist with revision for future attempts.A sample is shown at APPENDIX I. A listing of candidates results will be available on the AMC website (www.amc.org.au/results.asp) from 9am (AEST) on the Thursday following the examination and remain for a period of four weeks.The candidates listing will be shown by AMC reference number only, in compliance with Commonwealth Privacy Legislation. AMC CERTIFICATE

PLEASE NOTE: under no circumstances will final results be given over the telephone Candidates who pass all sections (i.e. MCQ examination, Clinical examination) of the AMC examination and when International Credentials Service of the Educational Commission for Foreign Medical Graduates of the United States (ECFMG) verification of medical qualifications has been confirmed, candidates will be issued with an AMC Certificate. A candidates Certificate will be sent to the Medical Board in the State where the candidate resides approximately six to eight weeks after completion of the clinical examination. It should be noted that the AMC Certificate is only issued in Australia and cannot be re-issued once collected. REQUEST FOR DUPLICATE COPIES OF AMC RESULTS For reasons of privacy, the AMC will not send copies of candidates official examination results to anyone but the candidate. However, upon request for duplicate copies of the results, the AMC will issue candidates with an application form, which should be filled in and returned to the AMC, with the appropriate fee. It may take up to ten working days before duplicate copies of results are received.

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CHANGE OF ADDRESS It is important that candidates advise the AMC Secretariat promptly of each change of address and/or telephone number. This will ensure that contact can be made quickly with candidates as the occasion arises to notify examination venue changes, rule or eligibility changes, or to confirm information provided by the candidate on his or her application forms. Please advise of any changes using the Change of Address form which can be obtained by contacting the AMC Secretariat.The Change of Address form is also available on the AMC website (www.amc.org.au). When advising of a change of address in writing, please include the following details: candidate number full name previous address new address candidate signature date of birth

GENERAL INFORMATION

Under the provisions of the Commonwealth privacy Amendment (Private Sector) Act 2000 (effective from 21 December 2001), the AMC is unable to accept changes of address or other candidate details taken over the telephone or submitted by email. WITH THE AMC Section 19 AB of the Health Insurance Act REQUEST FOR CONFIRMATION OF DATE OF PRELIMINARY APPLICATION

Please obtain a copy of the form Request for Confirmation of Date of Preliminary Application from the Secretariat if you require confirmation in writing of the date your preliminary application was received by the AMC to enable you to apply for an exemption from the Moratorium on the Medicare Provider Number with the Commonwealth Department of Health and Ageing.The form is also available on the AMC website (www.amc.org.au). Further information regarding the Moratorium can be obtained from the Workforce and Quality Branch of the Department of Health and Ageing by contacting them on 02 6289 5903. Please complete and return the form to the AMC to enable the Secretariat to process the request, which will take approximately 10 working days. Under the Commonwealth Privacy Amendment (Private Sector) Act 2000, the AMC is not able to send these details to anyone but the candidate. FURTHER INFORMATION

Candidates are advised to carefully study the current edition AMC publication Information booklet for Candidates (Application and Procedures and Requirements for the AMC Examination) concerning examination procedures and requirements. If a candidate is in doubt about any aspect of the AMC examination, he/she should contact the AMC Secretariat: Australian Medical Council PO BOX 4810 KINGSTON ACT AUSTRALIA
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Telephone: Facsimile: Email: Website:

02 6270 7878 02 6270 9799 clinical@amc.org.au http://www.amc.org.au

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The goal of medical education is to develop junior doctors who possess attributes that will ensure they are initially competent to practice safely and effectively as interns in Australia or New Zealand, and that they have an appropriate foundation for further training in any branch of medicine and for lifelong learning. Attributes should be developed to an appropriate level for the graduates stage of training. Included below is the list of knowledge and understanding, skills and attributes required of graduates completing basic medical education that is included in the AMCs Assessment and Accreditation of Medical Schools: Standards and Procedures. Graduates completing basic medical education should have knowledge and understanding of: 1. 2. 3. 4. 5. 6. 7. 8. 9. KNOWLEDGE AND UNDERSTANDING

ATTRIBUTES OF MEDICAL GRADUATES

APPENDIX A

Scientific method relevant to biological, behavioural and social sciences at a level adequate to provide a rational basis for present medical practice, and to acquire and incorporate the advances in knowledge that will occur over their working life. The normal structure, function and development of the human body and mind at all stages of life, the factors that may disturb these, and the interactions between body and mind. The aetiology, pathology, symptoms and signs, natural history, and prognosis of common mental and physical ailments in children, adolescents, adults and the aged.A more detailed knowledge is required of those conditions that require urgent assessment and treatment. Management of common conditions including pharmacological, physical, nutritional and psychological therapies. The principles of health education, disease prevention and screening. Common diagnosis procedures, their uses and limitations.

Normal pregnancy and childbirth, the more common obstetrical emergencies, the principles of antenatal and postnatal care, and medical aspects of family planning. The principles of amelioration of suffering and disability, rehabilitation, and the care of dying.

10. Systems of provision of health care including their advantages and limitations, the principles of efficient and equitable allocation and use of finite resources. 11. The principle of ethics related to health care and the legal responsibilities of the medical profession.

Factors affecting human relationships, the psychological well-being of patients and their families, and the interactions between humans and their social and physical environment.

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SKILLS

Graduates completing basic medical education should have developed the following skills: 13. The ability to perform an accurate physical and mental state examination.

12. The ability to take a tactful, accurate, organised and problem-focused medical history 14. The ability to choose from the repertoire of clinical skills, those that are appropriate and practical to apply in a given situation. 16. The ability to select the most appropriate and cost effective diagnostic procedures. 17. The ability to interpret common diagnosis procedures.

15. The ability to interpret and integrate the history and physical examination findings to arrive at an appropriate diagnosis or different diagnosis.

18. The ability to formulate a management plan, and to plan management in concert with the patient. 19. The ability to communicate clearly, considerately and sensitively with patients and their families, doctors, nurses, other health professionals and the general public. 20. The ability to counsel patients sensitively and effectively and to provide information in a manner that ensures patients and families can be fully informed when consenting to any procedure.

21. The ability to recognise serious illness and to perform common emergency and lifesaving procedures such as caring for unconscious patient and cardiopulmonary resuscitation.

22. The ability to interpret medical evidence in a critical and scientific manner, and to use libraries and other information resources to pursue independent inquiry relating to medical problems.

23. The ability to use information technology appropriately as an essential resource for modern medical practice.

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ATTITUDES AS THEY AFFECT PROFESSIONAL BEHAVIOUR

At the end of basic medical education, students should demonstrate the following professional attitudes that are fundamental to medical practice: 25. Recognition that the doctor should have the necessary professional support, including a primary care physician, to ensure his or her own well-being. 26. Respect for every human being, including respect of sexual boundaries. 28. A commitment to ease pain and suffering. 27. Respect for community values, including an appreciation of the diversity of human background and cultural values.

24. Recognition that the doctors primary professional responsibilities are the health interests of the patient and the community.

29. A realisation that it is not always in the interests of patients or their families to do everything that is technically possible to make a precise diagnosis or to attempt to modify the course of an illness.

30. An appreciation of the complexity of ethical issues related to human life and death, including the allocation of scarce resources. 31. An appreciation of the need to recognise when a clinical problem exceeds their capacity to deal with it safely and efficiently and of the need to refer the patient for help from others when this occurs. 32. An appreciation of the responsibility to maintain standards of medical practice at the highest level throughout a professional career. 33. An appreciation of the responsibility to contribute towards the generation of knowledge and the professional education of junior colleagues. 34. An appreciation of the system approach to health care safety, and the need to adopt and practice health care that maximises patient safety. 36. A desire to achieve the optimal patient care for the least cost, with an awareness of the need for cost-effectiveness to allow maximum benefit from the available resources. 37. A willingness to work effectively in a team with other health care professionals. 38. A realisation that ones personal or religious beliefs should not prevent the provision of adequate and appropriate information to the patient and/or the patients family, or the provision of appropriate management including referral to another practitioner. 35. An awareness of the need to communicate with patients and their families, and to involve them fully in planning management.

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APPENDIX B SUMMARY OF THE FORMAT OF THE AMC CLINICAL EXAMINATION

20 Station Structured Clinical Assessment (16 Scored + 4 Rest Stations) Includes 3 Obstetric/Gynaecology & 3 Paediatric Stations Some Stations may be unobserved, and may be linked to other stations 8 minutes per station plus 2 minutes changeover and Examiners marking One Examiner per observed station 16 Stations marked
STRUCTURED CLINICAL ASSESSMENT EXAMPLE ONLY TOTAL 20 STATIONS 1 2 (Paeds) Rest Station 3 4 (O or G) 5 6 Rest Station 7 8 (Paeds) 9 (O or G) 10 Rest Station 11 12 13 (Paeds) 14 Rest Station 15 16 (O or G)

CLEAR PASS Pass scores in 12 or more Stations including at least one Pass in O/G and at least one Pass in Paeds Qualifies for AMC Certificate

MARGINAL PERFORMANCE Pass scores in 10 or 11 Stations

CLEAR FAIL Pass scores in nine or less Stations or fails in all three O/G or fails in all three Paeds Repeats Structured Clinical Assessment

Proceeds to Additional Assessment

Re-test (Additional Assessment) Held in conjunction with the next series of examinations) 10 Station Structured Clinical Assessment (8 Scored + 2 Rest Stations) Candidates assessed on basis of 8 additional (new content) stations (including one Obstetric or Gynaecology case and one Paediatric case) CLEAR PASS Pass scores in at least six of the eight stations CLEAR FAIL Pass scores in five or less of the eight stations Repeats Structured Clinical Assessment

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AMC Annotated Multiple Choice Questions

ESSENTIAL READING

APPENDIX C

Distributions:

The AMC publication Anthology of Medical Conditions has been produced not only to assist overseas trained doctors to prepare for the AMC examinations but also as an essential tool for clinical practice.The publication lists over 130 Clinical Presentations of clinical conditions and classifies them to assist in a problem-solving approach to diagnosis and management. It is essential for all doctors to be familiar with the laws of the society in which they practice medicine and the ethics that underpin medical practice. It is also important to understand the organisational aspects of medicine in the Australian context.The Anthology of Medical Conditions contains a separate section dealing with these important issues, entitled Legal, Ethical and Organisational Aspects of the Practice of Medicine (LEO).The publication is enhanced throughout with medical illustrations. The Anthology of Medical Conditions can be ordered from the AMC secretariat via the AMC website for an electronic order or downloading of a hard-copy order form. SUGGESTED TEXTBOOKS The publication is recommended for use in preparing for the AMC multiple choice question (MCQ) and clinical examinations. There are many medical textbooks available and most of them are of high standard.They range from quite short texts, which cover essential knowledge, to long and comprehensive treatises which most people use as reference books.The AMC has drawn up the following list, as a guide to some useful texts.They are not intended as prescribed reading.

Blackwell Publishing Asia 550 Swanston Street CARLTON VIC 3053 AUSTRALIA AMC Anthology of Medical Conditions

The AMC has prepared a selection of over 600 MCQ Questions from its MCQ Question Bank with commentaries and explanations of each question.These questions have been used in previous AMC examinations and will provide candidates with comprehensive guide to the format, scope and standard of the AMC MCQ examination.This book is essential reading for those intending to sit the AMC examination. An order form is enclosed with this book.The book Annotated Multiple Choice Questions details are as follows:

AMC examinations are set on the latest editions of the recommended textbooks. It is up to the AMC candidate to obtain the latest information. Material contained in previous editions of the recommended textbooks, or other unspecified textbooks, may not be correct and will not be used to determine the result of AMC examinations. MEDICINE Devitt P, Barker J, Mitchell J and Hamilton-Craig C. Clinical Problems in General Medicine, 2nd edn. Churchill Livingston, 2003, ISBN 0443073236. http://www.elsevier.com.au Edwards C and Bouchier IA (eds). Davidsons Principles and Practice of Medicine, 18th edn. Livingstone, Edinburgh, 1999, ISBN 0443059446 http://www.harcourt.com.au/healthprof/
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Braunwald, E. Harrisons Principles of Internal Medicine, 16th edn. McGraw-Hill, New York, 2006. ISBN 0070072744 (hardcover). ISBN 0079136869 (hardcover, 2 volume set). ISBN 0071402357 (CD-ROM) http://www.bookstore.mcgraw-hill.com

Larkins R, Smallwood R. Clinical Skills:The Medical interview, Physical Examination and Assessment of the Patients Problems. Melbourne University Press, Melbourne, 1994. ISBN 0522844677 (paperback). http://www.mup.unimelb.edu.au Talley NJ, OConner S. Clinical Examination:A Systematic Guide of Physical Diagnosis. 4th edn. MacLennan & Petty, Sydney, 2001. ISBN 0864331444, http://www.maclennanpetty.com.au

Lau L. Imaging Guidelines, 4th edn.The Royal Australian and New Zealand College of Radiologists, Melbourne, 2001. ISBN 0959285415. http://www.ranzcr.edu.au Warrell DA, Cox TM, Firth JD, Benze EJ Jr (eds) Oxford Textbook of Medicine, 4th Edn. Oxford University Press, New York, 2003. ISBN 0192629220 (set of 3). http://www.mnemosyne.oupusa.org/medical SURGERY Cluine GJA,Tjandra JJ,Thomas R.S.J. Textbook of Surgery, 2nd edn. Blackwell Science Asia, Melbourne, 2001. ISBN 0867930233. http://www.blaksci.co.uk/australi/books.htm

Cluine GJA,Tjandra JJ, Ross H. MCQs and Short Answer Questions for Surgery. Blackwell Science Asia, Melbourne, 1999. Paperback. ISBN 0867930101. http://www.blaksci.co.uk/australi/books.htm Forrest AP, Carter DC, MacLeod IB. Principles and Practice of Surgery A Surgical Supplement to Davidsons Principles and Practice of Medicine, 3rd edn. Churchill Livingstone, Edinburgh, 1995. ISBN 0443048606. http://www.us.elsevierhealth.com Hunt PS, Marshall VC. Clinical Problems in General Surgery. Butterworths, Sydney, 1991. ISBN 0409492132.This publication is out of print and only available second hand. Morris PJ,Wood WC. Oxford Textbook of Surgery, 2nd edn. Oxford University Press, New York, 2001. ISBN 019228844 (three volume set). http://www.mnemosyne,oup-usa.org/medical PAEDIATRICS

Williamson R,Waxman BP, Scott PR. Scott: An Aid to Clinical Surgery, 6th edn. Churchill Livingstone, Edinburgh, 1998. ISBN 044305603X. http://www.us.elsevierhealth.com Hull D, Johnson D. Essential Paediatrics, 4th edn. Churchill Livingstone. Edinburgh, 1999. ISBN 0443059586 http://www,us.elsevierhealth.com

Robinson MJ, Roberton DM. Practical Paediatrics, 5th edn. Churchill Livingstone, Melbourne, 2002. ISBN 044307139X http://www.us.elsevierhealth.com National Health and Medical Research Council (NHMRC). The Australian Immunisation Handbook. 8th edn.Australian Government Printing Service 2003. ISBN 0642822042 http://immunise.health.gov.au/handbook.htm

Royal Childrens Hospital (Melbourne,Vic.). Paediatrics Handbook, 7th edn. Blackwell Science Asia, Melbourne 2004. ISBN 086793431X http://www.blacksci.co.uk/australi/books.htm

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OBSTETRICS & GYNAECOLOGY

Beischer NA, Mackay EV. Obstetrics and the Newborn An Illustrated Text, 3rd edn.WB Saunderers, Sydney 1998. ISBN 0702021237. http://www.us.elsevierhealth.com

Llewellyn-Jones D. Fundamentals of Obstetrics and Gynaecology. Mosby, London 2004, 8th edn ISBN 0723433291 http://www.mosby.com PSYCHIATRY

Mackay EV, Beischer NA, Pepperell R,Wood C. Illustrated Textbook of Gynaecology, 2nd edition,WB Saunders, Sydney 1992. ISBN 0729512118. http://www.us.elsevierhealth.com Gelder M, Lopez-Ibor JJ,Andearsen N. The Oxford Textbook of Psychiatry, 3rd edn, Oxford University Press, 2001. ISBN 0192629700 (paperback) http://mnemosyne.oup-usa.org/medical

American Psychiatric Association. DSM-IV-TR: Diagnostic and Statistical Manual of Metal Disorders, 4th edn text revision.American Psychiatric Association,Washington DC, 2000. ISBN 0890420254 (paperback); ISBN 0890420246 (hardback) http://www.psych.org GENERAL PRACTICE MISCELLANEOUS Murtagh J. General Practice, 2nd edn. Hardcover. McGraw Hill Australia 1998. ISBN 0074704362 Soft cover edition 1999. ISBN 0074707191 http://www.bookstore.mcgraw-hill.com Therapeutic Guidelines from Therapeutic Guidelines Limited, North Melbourne,Vic. http://www.tg.com.au Therapeutic Guidelines:Analgesic Version 4, 2002 Therapeutic Guidelines:Antibiotic Version 12, 2003 Therapeutic Guidelines: Cardiovascular Version 4, 2003 Therapeutic Guidelines: Dermatology Version 2, 2004 Therapeutic Guidelines: Endocrinology Version 3, 2004 Therapeutic Guidelines: Gastrointestinal Version 3, 2002 Therapeutic Guidelines: Neurology Version 2, 2002 Therapeutic Guidelines: Palliative Care Version 1, 2001 Therapeutic Guidelines: Psychotropic Version 5, 2003 Therapeutic Guidelines: Respiratory Version 2, 2000

Note:Available in print individually or as complete set in the form of an electronic subscription (i.e.TG complete). Manual of Use and Interpretation of Pathology Tests, 2nd edn.The Royal College of Pathologists of Australasia, 1997. ISBN 0959335528. 3rd edn, 2002. ISBN 0646409646.This edition available on CD-ROM or online only http://www.rcpa.edu.au MIMS Australia. St Leonards, NSW. MediMedia Australia Pty Limited. Subscriptions: ISSN 10355723 (MIMS Australia Bi-monthly), ISSN 0725-4709 (MIMS Australia Annual),ABNRID 000012656851 (eMIMS, CD-ROM or MIMS on PDA (Personal digital assistant). http://www.mims.com.au
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Australian Medical Handbook, 4th edn. 2003 ISBN 0957852126. Online version available via Health Communication Network. http://www.hcn.com.au/products/kro_druginfo.html

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In addition to major texts, journals should be read selectively, using editorials, annotations and review articles.The following journals are suggested as source material: Australian Family Physician (www.racgp.org.au/publications), Australian Prescriber (www.australianprescriber.com), British Medical Journal (www.bmj.com), British Journal of Hospital Medicine http://www.hospitalmedicine.co.uk), Current Therapeutics (http://www.ctonline.com.au), Lancet (www.thelancet.com), Medical Journal of Australia (www.mja.com.au), New England Journal of Medicine (http://www.content.nejm.org).

JOURNALS

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GENERAL INFORMATION FOR THE STRUCTURED CLINICAL ASSESSMENT

APPENDIX D

There will be 16 marked stations (some unobserved and may be linked to subsequent stations, plus 4 rest stations)

Each station will be of 10 minutes duration (8 minutes for the actual assessment and 2 minutes for change over). During this 2 minute change over time, the candidate is given written information concerning the next station to read, unless the candidates next station is a rest station. Stations may utilise actual patients, standardised patients or examiners role-playing patients.Where possible, appropriately aged individuals are used for these tasks. Candidates should regard the standardised patients or role-playing examiners as patients and treat them as they would treat real patients.There will be registered nurses available to assist the real patients if required. Most equipment will be provided: candidates will only be allowed to take into the examination their own stethoscope and hammer. Each candidate will be allocated one of the stations to start the examination.

An alarm will sound at 8 minutes, when the station will end. Candidates will be required to move to the next station when the alarm sounds at the direction of the examination marshal.

The dress standards are as for clinical work however white coats are not required.

GENERAL INFORMATION FOR THE RE-TEST EXAMINATION

LATE ARRIVAL Candidates who do not attend before the time indicated will be excluded from commencing the examination.

There will be 8 marked stations (some unobserved and may be linked to subsequent stations, plus 2 rest stations)

Each station will be of 10 minutes duration (8 minutes for the actual assessment and 2 minutes for change over). During this 2 minute change over time, the candidate is given written information concerning the next station to read, unless the candidates next station is a rest station. Stations may utilise actual patients, standardised patients or examiners role-playing patients.Where possible, appropriately aged individuals are used for these tasks. Candidates should regard the standardised patients or role-playing examiners as patients and treat them as they would treat real patients.There will be registered nurses available to assist the real patients if required. Most equipment will be provided: candidates will only be allowed to take into the examination their own stethoscope and hammer. Each candidate will be allocated one of the stations to start the examination.

An alarm will sound at 8 minutes, when the station will end. Candidates will be required to move to the next station when the alarm sounds at the direction of the examination marshal.

The dress standards are as for clinical work - however white coats are not required.

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LATE ARRIVAL Candidates who do not attend before the time indicated will be excluded from commencing the examination.

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APPENDIX E STRUCTURED CLINICAL ASSESSMENT STATION Information Sheet for Candidates This patient is a 60-year old patient who presents to his/her General Practitioner because of increasing shortness of breath over a period of some 12 months. YOUR TASK IS TO perform a respiratory examination summarise your findings formulate a provisional diagnosis give a commentary outlining what you are doing as you proceed, summarising the normal and abnormal findings.

YOU WILL NOT NEED TO TAKE A DETAILED HISTORY, but can ask appropriate focused questions. Examiners Instructions The aims of this station are to assess: i) ii) Proficiency in performing a respiratory examination including looking for evidence of RV failure, clubbing, over-distended chest). Ability to detect and describe the key findings (examiner to check): iii) peripheral signs hands, flap, pulse, cyanosis (central), JVP chest inspection (shape, resp.rate, pattern) trachea and apex beat chest expansion (including upper lobes) chest percussion (all areas) auscultation (all areas, including resonance) check pulmonary hypertension bedside pulmonary function tests (check X-ray to be arranged, peak exp. flow rate to be measured, sputum culture).

Ability to formulate an appropriate probability diagnosis.

EXAMINERS ARE TO ENCOURAGE EACH CANDIDATE TO WASH THEIR HANDS AFTER EXAMINING THE PATIENT OR PRIOR TO LEAVING THE ROOM AT THE 8 MINUTES BELL. Key Issues Performance of an adequate respiratory examination. Accurate and complete interpretation of the physical signs. Role Player/ Standardised Patient Sheets The patient will be required to undress down to underwear and put on a hospital gown. He/she will be asked to sit on an examination couch and will need to be willing and able to be subjected to repeated respiratory examinations by sequential candidates. Key aspects of past history to be given if asked, such as asthma yes for 20 years, on Ventolin puffer twice daily, bronchitis occasional, occupational and social history (dust exposure nil, smoking 20 per day), allergies. Never admitted to hospital before.
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Minor technical faults but examination completed reasonably. Minor errors in findings. Candidate displays one or more of the following: - significant omissions - significant errors of technique - poor technique Serious errors or omissions in technique CRITICAL ERROR Serious errors or omissions in findings; reported findings not consistent with physical signs. One or more significant errors in findings. Minor errors in formulation, not interfering with overall adequacy of commentary. Minor omissions or errors in explanations of findings. Diagnosis and differential diagnosis appropriate to case even if not completely accurate. Minor errors in formulation, hesitancy leading to inadequacy. Needed excessive prompting. Significant errors in explanations of findings. Wrong interpretations of findings. Unclear and poorly organised. Diagnosis inappropriate to the case. Choice of investigations inappropriate and with poor perspective. CRITICAL ERROR

Examiner to tick ONE box in each ROW NO OTHER WRITTEN COMMENTS ON THIS MARKSHEET Candidates ID card sighted Very Satisfactory PASS Satisfactory PASS Unsatisfactory FAIL Very Unsatisfactory FAIL Approach to patient Covered all essential Candidate displays one or Candidate displays one or Sound, communicated - empathy; comfort; consideration aspects competently. more of the following: more of the following: essential information to - explanation of examination - poor rapport - inability to establish approthe patient. Some loss of using language that the patient priate rapport and communication rapport or empathy at points in - poor listening skills understands (no jargon) - poor communication skills, fails to put patient at ease the consultation. - causes no discomfort to the patient interfering with some aspects of - does not address patients ques- checks for patient understanding the explanation of the procedure tions or concerns appropriately - answers patients questions - causes unnecessary discomfort - causes harm to the patient - obtains verbal consent to proceed but not serious harm to the CRITICAL ERROR as examiners instructions? patient.

Key Issue Covered all the essential Technique of examination, oraspects competently ganisation and sequence minimal errors or omisDid the candidate carry out an appro- sions. priate focused and relevant examination as per examiners instructions? Key Issue Identified most or all Accuracy of Examination findings accurately. Did the candidate identify the physical findings accurately as per examiners instructions?

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Key Issue Diagnosis/Differential Diagnosis Did the candidate formulate and describe an appropriate diagnosis/differential diagnosis?

Key Issue Covered all essential Commentary to Examiner aspects competently Did the candidate describe the find- minimal errors or omissions, opings with an appropriate commentary timal commentary. as per examiners instructions?

CRITICAL ERROR Serious errors or omissions in presentation, little evidence of logical structure. Needed constant prompting.

Covered all essential aspects competently minimal or no errors or omissions. Logical, clear, well organised.

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Choice of Investigations Did the candidate make an appropriate choice of investigations as per examiners instructions?

Overall rating for this candidate for this station

Covered all essential asSome errors in choice and pects competently priority of investigations minimal errors or omissions. but still reasonable. Choice of investigations optimal and with good perspective.

PASS

FAIL

Diagnosis not given. Serious omissions/errors in interpretation of findings. Clinical reasoning and diagnostic skills markedly deficient. Very poor organisation. If wrong diagnosis would result in harm to patient, this box must be marked. CRITICAL ERROR Serious errors or omissions in choice of investigations. Little evidence of clinical reasoning skills. Scatter gun approach with little apparent perspective CRITICAL ERROR

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Information Sheet for Candidates

STRUCTURED CLINICAL ASSESSMENT STATION

APPENDIX F

This patient is a 25 year old primigravida has just had an ultrasound scan perform at 18 weeks of gestation, which has revealed an anencephalic fetus.A maternal serum screening (MSS) was done at 16 weeks, and this had shown elevated levels of alpha fetoprotein. YOUR TASK IS TO Take any further relevant history. Ask the examiner about appropriate findings likely to be evident on general and/or gynaecological/obstetric examination and appropriate investigation results. Advise patient, in lay terms, of the diagnosis and subsequent management (and, if appropriate, likely response to treatment or prognosis). Examiners Instructions Diagnosis Fetal anencephaly. This is a developmental defect of the brain which has occurred somewhere between 5 and 8 weeks of gestation.The condition is uniformly fatal soon after birth.The patient has the option as to whether to terminate the pregnancy forthwith, or continue until labour occurs. If hydramnios occurs the labour is likely to be premature, otherwise labour post term is common. Examination Findings Uterus 1 cm below umbilicus. Blood pressure 120/80. Pulse 80. Speculum and PV examination not done. Investigation Results Advice to Patient

None done, except MSS and ultrasound as indicted in the instructions to the candidate. The information concerning anencephaly above should be given. Termination of the pregnancy could be performed by using prostaglandins, or by the surgical procedure of dilatation and evacuation.This latter procedure has the advantage of being performed under general anaesthetic with the procedure being over when the patient wakes up. It is quite a difficult procedure except in expert hands, and cervical damage resulting in subsequent cervical incompetence may result when the procedure is done after 16 weeks of gestation. Prostaglandin termination may take several hours or even days and requires uterine contractions similar to those experienced in labour, followed by virginal delivery of the fetus. There is also a possible need for curettage to remove any retained placental fragments.As the patient has indicted she would not wish to continue with the pregnancy because of the abnormality present, these matters must be discussed. If the candidate is not prepared to discuss these matters, or not prepared to do the termination procedure for ethical, religious or other reasons, referral to a person who could follow this through must be arranged.
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If the patient had not requested termination of the pregnancy the potential problems of premature labour and increased risk of placental abruption should polyhydramnios occur, OR postmaturity and increase risk of shoulder dystocia if polyhydramnios does not occur would have needed to be discussed. Postmortem examination of the fetus should be advised to check that no other abnormality is present which might influence the advice given to them concerning the success or otherwise of any subsequent pregnancy. The risk of recurrence of a neural tube defect such as anencephaly, or spina bifida, is somewhere between 2% and 5%. Folic acid administration (in a dosage of 5mg per day) should be commenced prior to conception, and continued until about 12 weeks of gestation, as this has been shown to reduce the risk of a subsequent neural tube defect. Ultrasound examination in a subsequent pregnancy is imperative, and maternal serum alpha fetoprotein assessment at about 15 weeks of gestation, is also useful as a screening test. Key Issues If the candidate obtains a VERY UNSATISFACTORY mark in any of the KEY category areas, or obtains 2 UNSATISFACTORY marks in KEY areas, the overall mark for this case would normally be a FAIL. CRITICAL ERRORS Failure to recognise that this is a lethal abnormality to the baby. Failure to determine the preferences of the mother in respect to termination of pregnancy or not. Failure to counsel the patient appropriately concerning management in a subsequent pregnancy. The critical errors box on the mark sheet should be marked if a critical error is made. It would be rare for a candidate to pass the station where a critical error has been made. Role Player / Standardised Patient Sheets The candidate will generally be expected to take an appropriate history from you in order to manage the case.This will be an assessment of your presenting symptom(s), and any other relevant history which might be appropriate.

The list of responses below is likely to cover most of the questions you will be asked as they are likely to be relevant to the case presented. It is important that information which is not specifically requested by the candidate is not offered, as patients are not meant to give hints to the doctor! If you are asked something which is clearly irrelevant, or for which an answer is not included in the list below, answer no, or I dont know. Lists of Answers relevant to this specific case Did not take any folic acid in early pregnancy. No family history of neural tube defect in pregnancy. Would not wish to continue with the pregnancy if this was feasible. Blood group O positive, indirect Coombs test negative. No asthma or other contraindication to prostaglandin therapy. List of prompts for the Role Player

A list of prompts is provided for the role player. None of these may be required if the candidate covers most or all of the points proposed in the Advice for Patients section. Some could be used to clarify points raised by the candidate, or to introduce topics not considered by the candidate What is wrong with my baby? Can I have the pregnancy terminated? Is this problem likely to occur again?

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Condition: Fetal Neural tube defect

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Information given to patient was appropriate. Adequately explained.

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Examiner to tick ONE box in each ROW NO OTHER WRITTEN COMMENTS ON THIS MARKSHEET Candidates ID card sighted Very Satisfactory PASS Very Unsatisfactory FAIL Satisfactory PASS Unsatisfactory FAIL Covered all essential Sound, communicated Candidate displays one or Candidate displays one or Approach to patient essential information to more of the following: more of the following: - empathy; comfort; consideration aspects competently. the patient. Some loss of rapport - poor rapport - inability to establish appropriate - explanation of examination or empathy at points in the con- - poor listening skills rapport and communication using language that the patient sultation. - poor communication skills, fails to put patient at ease understands (no jargon) interfering with some aspects of - does not address patients ques- causes no discomfort to the patient the explanation of the procedure tions or concerns appropriately - checks for patient understanding - causes unnecessary discomfort - causes harm to the patient - answers patients questions but not serious harm to the - obtains verbal consent to proceed CRITICAL ERROR patient. as examiners instructions? Key Issue Covered all the essential Minor omissions not interSignificant omissions Serious omissions, poorly History aspects competently fering with adequate hisleading to inadequate hisorganised. Totally inadeDid the candidate take an appropri- minimal errors or omistory. tory. quate history, making it diffiately focused medical history as sions. cult if not impossible to define the per examiners instructions? correct diagnosis etc. CRITICAL ERROR Key Issue Covered all essential asMinor errors but did not inSignificant errors which Serious errors or omisInitial Management Plan pects competently miniterfere with an adequate did interfere with an adesions. Inappropriate manDid the candidate formulate and mal errors or omissions. initial management plan. quate management plan. agement and/or describe an appropriate initial man- Optimal management plan. management proposed is potenagement plan as per examiners intially harmful to the patient. structions? CRITICAL ERROR
Correct information proInadequate information provided but inadequately exvided and inadequate explained. The candidate planation given. The displays inadequate communica- candidate displays very inadetion of knowledge of the condi- quate communication of knowltion. edge of the condition. CRITICAL ERROR

Key Issue Covered all essential asPatient Counselling/Education pects competently miniDid the candidate give appropriate mal errors or omissions. counselling to the patient/relative as per examiners instructions?

Overall rating for this candidate for this station

PASS

FAIL

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APPENDIX G STRUCTURED CLINICAL ASSESSMENT STATION Information Sheet for Candidates Johnny, an 8-year-old boy is brought to see you because of a bedwetting problem, which occurs nightly. Johnny has been fully continent by day since he was 3 years old; previously been treated unsuccessfully with nightly Amitriptyline (Tryptanol); is happy at home and does well at school. His parents were exasperated initially by the wetting, but now accept that it is involuntary and both parents are keen to assist in any way possible to help him. YOUR TASK IS TO Advise Johnnys PARENT how you will further assess and manage his condition. Examiners Instructions This scenario describes an eight year old boy with persistent primary bedwetting from 3 years of age. He is well otherwise, has no day time wetting or any other symptoms to suggest a pathological cause for his wetting. His height and weight are on the 50th percentile. The boy himself is very keen to be dry, and his parents are willing to help him achieve this.These are important points the candidate should appreciate. Amitriptyline (Tryptanol) was tried about two years previously to no avail. Johnny is doing well at school and has lots of good friends. The parents are happily married and under no major stresses.There is a younger sibling aged 4 years who has been dry day and night since age 2 years old. The candidate should enquire about family history and one parent was a bed wetter until age 9 years. Before embarking on a plan of action, the candidate should indicate to you that he would: check the boys urine by Multistix testing +/- a urine m/c/s. Renal ultrasound may be suggested but is probably unnecessary unless there is a great deal of parental anxiety Enquire of the childs growth percentiles Ensure his blood pressure is normal Having excluded any organic pathology and having ensured that there are no serious emotional reasons to account for the symptom, the candidate should outline his ongoing plan of management. This should include Empathy with the exasperating nature of the condition particularly with the excessive washing of bedclothes and pyjamas but enthusiasm for the interest the parents are showing in trying to help Johnny. Reassurance that there is no organic pathology present. Advise that even though lifting and restriction of fluids have not been shown to be effective generally, if the parents are keen to try this they should feel free to do so as it occasionally does help some children.
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Outline the plan of management including how the alarm works as a conditioning response to release of urine. Explain how to obtain the alarm, e.g., through pharmacies (hiring), buying or through some Community Health Centres or Childrens hospitals. Discuss the success rate is much higher if the child himself is motivated to become dry as Johnny is. Discuss a recording star chart and reward system. Support and encourage child and parent by regular frequent review to enthuse on even minor successes as a means of encouraging the boy. Explain a plan of action for the use of DDAPV by nasal spray for school camps and sleepovers when it is important to remain dry and avoid any embarrassment. Explain the safety of this substance if used only as directed. Advise that the success rate with Amitriptyline (Tryptanol) is low, it can be a dangerous drug in overdose and is rarely used now. Advise that even with the alarm it may be some weeks before success is achieved and the alarm should be persisted with for up to 3 months. A review appointment should be made 2 to 3 weeks after the alarm has started to review the progress. Key Issues

Candidates should ensure that there is no possibility of organic pathology.This is determined by the history and by arranging simple urine testing.While Ultrasound of the urinary tracts is probably unnecessary, it could be performed if there is excessive parental anxiety. Candidates should be encouraging, empathic and supportive to both child and parent. Advice re plan of action should be logical and clear. Candidates should enquire re a family history as this is an important piece of history. CRITICAL ERRORS There are few in this scenario but a candidate should be marked down if he indicated that there is an organic cause for wetting and wants to put the child through unnecessary invasive investigations. Role Player/Standardised Patient Sheets
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You are the parent of Johnny who has a problem with bedwetting nightly since the age of 3 years. You were initially exasperated by the wetting but now have been accepting that the wetting is involuntary.You have not punished Johnny despite your exasperation. Johnnys general health is excellent, and he has had no major illnesses. He appears to be growing normally and is on his middle line of his graph for height and weight. He has always been dry during the day and never had any incontinence. He has never has a urinary tract infection. Johnny approached you because he is embarrassed and you and your spouse are very keen to help him control his wetting. His father wet the bed until age 9 years. The tablets that were tried 2 years ago made no difference to the wetting. Johnny is going very well at school and enjoys his teacher. He has lots of good friends. You, his parents are happily married and have no major stresses in your lives. Johnny has a 4 year old younger sister who has been dry day and night since the age of two and a half.

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Questions you might ask or statements you could make

Is there something wrong with his kidneys or bladder? Does he need any investigations? Some friends told us we should restrict his fluids after dinner at night and should lift him when we go to bed.What do you think? What about when he is asked to sleep over at a friends place so far we havent let him do this. Is there anything we can do for that? How does this alarm work if he has already passed urine and wet his bed before it goes off?

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Condition: Bed Wetting

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Minor omissions not interfering with adequate history. Significant omissions leading to inadequate history.

Candidates ID card sighted Approach to patient/relative - empathy; comfort; consideration - explanation of examination using language that the patient understands (no jargon) - causes no discomfort to the patient - checks for patient understanding - answers patients questions - obtains verbal consent to proceed as examiners instructions? Key Issue History Did the candidate take an appropriately focused medical history as per examiners instructions? Choice of investigations inappropriate and with poor perspective. Significant errors in explanations of findings. Wrong interpretations of findings. Unclear and poorly organised. Diagnosis inappropriate to the case.
Significant errors which did interfere with an adequate management plan.

Examiner to tick ONE box in each ROW NO OTHER WRITTEN COMMENTS ON THIS MARKSHEET Very Satisfactory PASS Satisfactory PASS Unsatisfactory FAIL Very Unsatisfactory FAIL Covered all essential Sound, communicated Candidate displays one or Candidate displays one or aspects competently. essential information to more of the following: more of the following: the patient. Some loss of - poor rapport - inability to establish approrapport or empathy at points in - poor listening skills priate rapport and communication the consultation. - poor communication skills, interfer- fails to put patient at ease ing with some aspects of the expla- - does not address patients quesnation of the procedure tions or concerns appropriately - causes unnecessary discomfort - causes harm to the patient but not serious harm to the patient. CRITICAL ERROR

Covered all the essential aspects competently minimal errors or omissions.

Choice of Investigations Did the candidate make an appropriate choice of investigations as per examiners instructions? Minor omissions or errors in explanations of findings. Diagnosis and differential diagnosis appropriate to case even if not completely accurate.

Key Issue Diagnosis/Differential Diagnosis Did the candidate formulate and describe an appropriate diagnosis/differential diagnosis?
Minor errors but did not interfere with an adequate initial management plan. Information given to patient was appropriate. Adequately explained.

Covered all essential aspects competently minimal or no errors or omissions. Logical, clear, well organised.

Covered all essential asSome errors in choice and pects competently priority of investigations minimal errors or omisbut still reasonable. sions. Choice of investigations optimal and with good perspective.

Serious errors or omissions in choice of investigations. Little evidence of clinical reasoning skills. Scatter gun approach with little apparent perspective CRITICAL ERROR Diagnosis not given. Serious omissions/errors in interpretation of findings. Clinical reasoning and diagnostic skills markedly deficient. Very poor organisation. If wrong diagnosis would result in harm to patient, this box must be marked. CRITICAL ERROR

Serious omissions, poorly organised. Totally inadequate history, making it difficult if not impossible to define the correct diagnosis etc. CRITICAL ERROR

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Covered all essential aspects competently minimal errors or omissions. Optimal management plan.

Key Issue Initial Management Plan Did the candidate formulate and describe an appropriate initial management plan as per examiners instructions? Key Issue Patient Counselling/Education Did the candidate give appropriate counselling to the patient/relative as per examiners instructions?

Covered all essential aspects competently minimal errors or omissions.

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Overall rating for this candidate for this station

PASS

FAIL

Serious errors or omissions. Inappropriate management and/or management proposed is potentially harmful to the patient. CRITICAL ERROR Correct information proInadequate information provided but inadequately exvided and inadequate explaplained. The candidate nation given. The candidate displays inadequate communica- displays very inadequate commution of knowledge of the condi- nication of knowledge of the contion. dition. CRITICAL ERROR

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Examination Session: Candidate Ref No.:

STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK XXX XXX XXXXXXX

APPENDIX H

Score obtained ( /16 Stations) Paediatric Stations:

Obstetrics and Gynaecological Stations:

XX/16

Candidate Name: XXXXXXXX X/3 X/3 Overall Grade: XXXX

Stations Passed Intermittent claudication Asthma Thyrotoxicosis Symptoms of shortness of breath Insulin injection Ascites Anticoagulant therapy Benign skin lesion Hormone replacement therapy Childhood immunisation Ectopic pregnancy

Stations Failed Interpretation of clinical chemistry result Obesity Contraception Recognition of Bronchiolitis Childhood breath holding attack

Performance Requirements
Clear Pass = a pass score in 12 or more of the 16 scored stations including: at least one Obstetric/Gynaecological Station scored as a Pass; AND at least one Paediatric Station scored as a pass. Marginal Performance = A pass score in 10 or 11 of the 16 stations Clear Fail = a pass score in 9 or less of the 16 stations; OR Fails in all three Obstetric/Gynaecology Stations, irrespective of the total number of stations passed; OR

Fails in all three Paediatric Stations, irrespective of the total number of stations passed.

Please retain this result sheet for your records (An administration fee is incurred for the issue of duplicates of previously issued results.

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Candidate Name: XXXXXXXXXXXXXX Very Satisfactory Satisfactory Unsatisfactory Very Unsatisfactory

AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref. No.: XXXXXXXXXX Examination Session: XXXX

ASSESSMENT DOMAINS

(Numbers in brackets indicate the number of stations,including Retest stations in which this Performance as scored by the examiners domain was assessed) A. ASSESSMENT DOMAINS WITH SATISFACTORY PERFORMANCE **More than 2/3rds satisfactory** Accuracy of Examination Identified most or all findings Minor errors in findings. One or more significant Did the candidate identify the accurately. errors in findings. physical findings accurately as per examiners instructions?

Maximum possible number with this assessment domain

Answers to questions Answers to questions asked?

[1]

Maximum possible number with this assessment domain [1]

1 0 Covered all aspects compe- Minor errors in answer to tently, minimal errors or omis- questions. sions.

Serious errors or omissions in findings; reported findings not consistent with physical signs.

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Approach to patient/relative - empathy; comfort; consideration - explanation of examination using language that the patient understands (no jargon) - causes no discomfort to the patient - checks for patient understanding - answers patients questions - obtains verbal consent as per examiners instructions

Maximum possible number with this assessment domain [9]

Choice of investigations Did the candidate make an appropriate choice of investigations as per examiners instructions?

0 0 Significant errors in the Serious errors or omissions answers to questions. in answers given, or comInadequate plete unfamiliarity with the knowledge/expertise in subjects asked. these areas. 1 1 0 0 Covered all essential aspects Sound, communicated es- Candidate displays one or Candidate displays one or competently. sential information to the more of the following: more of the following: patient. Some loss of rap- - poor rapport - inability to establish appropri- poor listening skills port or empathy at points - poor communication ate rapport and communication in the consultation. - fails to put the patient at ease skills, interfering with some aspects of the ex- - does not address the patients planation of the procedure questions and concerns appro- causes unnecessary dis- priately comfort but not serious - causes harm to the patient. harm to the patient. 1 8 0 0 Serious errors or omissions in choice of investigations. Little evidence of clinical reasoning skills. Scatter gun approach with little apparent perspective 0

APPENDIX I

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Covered all essential aspects Some errors in choice and Choice of investigations competently minimal errors priority of investigations inappropriate and with or omissions. Choice of inves- but still reasonable. poor perspective tigations optimal and with good perspective. Maximum possible number with this 2 2 1 assessment domain. [4]

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Candidate Name: XXXXXXXXXXXXXX

AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref. No.: XXXXXXXXXX Examination Session: XXXX

Covered all essential aspects Minor errors not interfering Significant omissions History leading to inadequate Did the candidate take an appro- competently minimal errors with adequate history. history. priately focused medical history or omissions. as per examiners instructions? 1 8 Reasonably organised approach, diagnostic/ therapeutic plan appropriate despite some errors.

Maximum possible number with [10] this assessment domain

Interpretation of investigation Well organised, logical apDid the candidate interpret the in- proach optimal diagnostic/ vestigations appropriately in formu- therapeutic plan. lating diagnostic/therapeutic plan as per examiners instructions? 0 4

Maximum possible number with this assessment domain [4]

1 Poor interpretation of investigations, diagnostic/ therapeutic plan inappropriate, but not potentially seriously harmful. 0

Serious omissions, poorly organised. Totally inadequate history, making it difficult if not impossible to define the correct diagnosis etc. 0 Little or no evidence of logical structure. Diagnostic/ therapeutic plan inadequate and/or potentially seriously harmful or even lethal. 0

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Candidate Name: XXXXXXXXXXXXXX Very Satisfactory Satisfactory Unsatisfactory

AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref. No.: XXXXXXXXXX Examination Session: XXXX Very Unsatisfactory

ASSESSMENT DOMAINS

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(Numbers in brackets indicate the number of stations,including Retest stations in which this Performance as scored by the examiners domain was assessed) C. ASSESSMENT DOMAINS WITH UNSATISFACTORY PERFORMANCE (Needs significant revision to achieve pass standard overall) * *Less than 1/2 Pass/Satisfactory Technique of examination, or- Covered all essential aspects Minor technical faults but Candidate displays one Serious errors or omissions ganisation and sequence. competently minimal errors examination completed rea- or more of the following: in technique. Did the candidate carry out an - significant omissions sonably. appropriate focused and relevant or omissions. examination as per examiners in- significant errors/techstructions? nique - poor technique. Maximum possible number with [6] this assessment domain 3 0 1 3 Explanation of procedure Clear, well organised, free Some defects but explana- Significant defects in ex- Little evidence of organisation, planation, poorly organ- on ability in explanation: conExplanation of procedure and im- from jargon, optimally extion overall satisfactory. ised, used jargon, plications of patient/relative. plained. fuses and distresses patient. confusing patient. 0 1 Significant errors in use or Serious errors or omissions selection of equipment completely unfamiliar with which interfered with an equipment, resulting in an inadequate assessment adequate assessment being being obtained. obtained. 0 1 0 1

Maximum possible number with this assessment domain [1]

0 2 Familiarity with test equipment Covered all essential aspects Minor error in use or selecDid the candidate demonstrate ap- competently minimal errors tion of equipment. propriate familiarity, selection and or omissions. testing of equipment and material for this procedure as per examiners instructions?

Maximum possible number with this assessment domain [2]

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Candidate Name: XXXXXXXXXXXXXX

AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN Candidate Ref. No.: XXXXXXXXXX Examination Session: XXXX

Page I4 Serious errors or omissions in the presentation, little evidence of the logical structure. Needed constant prompting. 0

Commentary to Examiner Did the candidate describe the findings with an appropriate commentary as per examiners instructions?

Maximum possible number with this assessment domain

Covered all essential aspects Minor error in formulations, Significant errors in forcompetently minimal errors not interfering with overall mulations, hesitancy or omissions, optimal comadequacy of commentary. leading to inadequacy. mentary. Needed excessive prompting. [1] 0 1 0

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Candidate Name: XXXXXXXXXXXXXX Candidate Ref. No.: XXXXXXXXXX Examination Session: XXXX ASSESSMENT DOMAINS Very Satisfactory Satisfactory Unsatisfactory Very Unsatisfactory (Numbers in brackets indicate the number of stations, including Retest stations in which this domain was Performance as scored by the examiners assessed)

AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT EXAMINATION PERFORMANCE FEEDBACK BREAKDOWN

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B. ASSESSMENT DOMAINS WITH MARGINAL PERFORMANCE (Needs attention to achieve pass standard overall) **1/22/3rds satisfactory Initial management plan Covered all essential aspects Minor errors but did not in- Significant errors, which Serious errors or omissions, Did the candidate formulate and competently minimal errors terfere with an adequate ini- did interfere with an ad- Inappropriate management describe an appropriate initial and/or management protial management plan. equate management management plan as per examin- or omissions. Optimal maners instructions? posed is potentially harmful agement plan. plan. to the patient Maximum possible number with [10] this assessment domain 2 2 3 3 Patient counselling/education Covered all aspects compe- Information given to patient Correct information pro- Inadequate information provided but inadequately ex- vided and inadequate explanaDid the candidate give appropri- tently, minimal errors or omis- was appropriate. plained. The candidate tion given. The candidate ate counselling to the patient/rel- sions. Adequately explained. displays inadequate com- displays very inadequate comative as examiners instructions munication of knowledge munication of knowledge of the Maximum possible number with this of the condition. condition. assessment domain [7] 1 2 3 0 Performance of procedure Well organised, logical apReasonably organised ap- Poor performance. Very poor performance. Did the candidate demonstrate an proach and optimal perforproach and reasonable per- Causes unnecessary dis- Causes discomfort or harm. appropriate level of performance in mance. comfort. Or inadequate or Unable to complete proceformance. No significant undertaking the procedure or task incorrect script writing mistakes in completing writ- technique. dure. For script writing, wrote as per examiners instructions in ing task (if asked to write a wrong drug or in a seriously written form? script etc.) wrong dose or at seriously Maximum possible number with this wrong frequency. assessment domain [2] 1 0 1 0 Diagnosis/Differential diagnosis. Covered all essential aspects Minor omissions or errors in ex- Significant errors in expla- Diagnosis not given. Serious Did the candidate formulate and competently minimal or no planation of findings. Diagnosis nation of findings. Wrong omissions or errors in interpretadescribe an appropriate diagno- errors or omissions. Logical, appropriate to the case even if interpretations of findings. tions of findings. Clinical reasonclear, well organised. Unclear and poorly organ- ing and diagnostic skills sis/differential diagnosis? not completely accurate. ised. Diagnosis inappropri- markedly deficient. Very poor orate to case. ganisation. If wrong diagnosis would result in serious harm to Maximum possible number with this patient. assessment domain. [9] 2 5 2 0

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