In the long case, the candidate will have a 35 minute session with the patient, a five minute break, and a 20 minute session with the examiners. Patients may be inpatients or outpatients and will typically have multi- system illness. The patients are seen blind in the first instance by the examiners so that they will have an appreciation of the level of difficulty and so take this into account in candidate assessment.
Candidates will be provided with blank paper and a clipboard to write on during their 35 minutes with the patient. They are not allowed to write anything until the 35 minutes begins. Preformatted notes are not allowed. Candidates may take into the examination a small bag containing their usual examination instruments.
During the five minute break, candidates are able to complete their notes and are encouraged to develop a problem list and plan of management.
No textbooks, electronic devices or other reference sources may be used in the long case either within or outside the examination room. Failure to comply with this directive may mean dismissal from the examination.
During a candidate’s 20 minutes with the examiners, the focus will be on meeting the defined core competencies of the clinical long case. These are the ability to –
- present a clinical history in a systematic and logical fashion;
- establish the correct facts from a clinical history;
- provide evidence of having undertaken a focused and systematic physical examination;
- establish correct findings on physical examination;
- suggest appropriate investigations in a logical sequence in order to establish or rule out relevant diagnoses;
- put forward a relevant diagnosis (diagnoses) including differential diagnoses and relevant weightings for any such diagnoses;
- put forward an appropriate set of acute management strategies for the specific case being undertaken;
- exhibit an ability to communicate with senior colleagues in a clear, well paced fashion.
During the presentation, candidates should provide a comprehensive history of the presenting complaint, past history, social history, medication history, systematic questioning, findings on physical examination and a summary of active and inactive problems. They should then go on to describe how they would have assessed and managed this patient had they presented to the emergency department. For outpatients, this may require the candidate to speculate on possible ways the patient could present to the emergency department in the future, as there may be no current acute problems to deal with. Following this, the examiners will ask questions on issues of direct relevance to the patient being discussed. This could include interpretation of results and discussion of the current or possible future treatment.
About Mike Cadogan
