The short case component begins with a 20 minute session in which the candidate sees two patients with two examiners. After five minutes changeover time, the candidate has a further 20 minutes to see another two patients with another pair of examiners. Candidates may expect that one of their short cases will be a child. Although the split between the two patients with each examiner pair is typically ten minutes each, the split is at the discretion of the examiners and so may be varied to accommodate a harder or easier case.
All candidates will not see the same patients. The choice of cases is at the discretion of the site organisers and will necessarily reflect the cases available. Typically, a candidate will see a cardiovascular case, a neurological case, and two of a gastrointestinal or respiratory case or one “other”. However, there can be no set or totally predictable formula for the mix of cases. The “other case” could be, for example, an examination of the hands, a leg ulcer, speech, pregnant patient, neck mass, higher mental function or a patient with Parkinson’s disease. Site organisers will do their best to ensure that candidates do not see too many short cases from one organ system and will try to adhere to the mix of cases as above. Many of the short cases are likely to be outpatients.
Candidates will be graded by the examiners on the proficiency with which the candidates address the following agreed core competencies ie the ability to –
- perform a structured physical examination of a system or region of the body within the allotted time as directed by the examiners
- elicit the physical signs relevant to the examination undertaken
- report his/her findings to the examiners in a thorough, systematic, professional fashion
- synthesize the physical signs elicited into relevant diagnostic possibilities
- deal with the patient subject to the Clinical Short Case in a professional and empathetic manner
The examiners will introduce each patient with a carefully worded and standardised stem. Typically, a candidate will then be allowed 7-8 minutes to examine the patient and then have 2-3 minutes to present their findings. The presentation may include, as appropriate, the examination findings (relevant positive and negative findings) diagnosis, differential diagnosis, severity, aetiology and complications. Candidates and examiners are instructed that it is the candidate’s choice whether they present findings during their physical examination or only at the end. Conversation with the patient should be limited to that required to ensure the patient’s comfort (eg “are you sore anywhere?”) but may need to be more extensive in a paediatric case in order to gain the confidence of the child and parent.
Examiners allocate a raw mark out of 10 for each of the individual cases. Those raw marks are then totalled and converted to a final consolidated mark out of 10
To achieve an overall pass in the short case component, a candidate must pass at least two of the four cases. A candidate who passes three cases and achieves a total raw score of 15-18 inclusive will be awarded a pass (5). Where the total raw score is 19 or more but only one case has been passed, then a final score of four will be awarded.
About Mike Cadogan
