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GP Supervisors Education Night“The fellowship exams info for your GP registrars”

Written by: Dr. Andrew MoretonPresented by: Dr. Kam Wong

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• The Royal Australian College of General

Practitioners (RACGP) Fellowship exams consist of three segments:

•applied knowledge test (AKT)

• key feature problems (KFP)

• objective structured clinical exam (OSCE)

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Segment Fee

AKT $1670

KFP $1670

OSCE $3315

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What’s the exam structure

• Written exam– Applied Knowledge Test (AKT) - 150 Questions in 4 hrs

– Key Features Problems (KFP) – 26 Questions in 3.5 hrs

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FAQ re on-line Exam

• No alternative available• Pilot very positive • Back-up connection • Program very robust• Practice exam available:• Once Mozilla Firefox is installed you can access

the online examination practice system by going to http://practiceexam.racgp.org.au/practice.

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Written Exam: AKT* Single-best answer

* Extended matching

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A four year old child is brought to you by the kindergarten teacher. She states that the child was not well that morning, has vomited once and has complained of central abdominal pain. She has found the child's temperature to be 39C.

Your clinical examination is most likely to reveal: A. numerous pus cells on microscopy of urineB. inflamed ear drumsC. neck stiffnessD. inflamed tonsils.E. tenderness localised to the R.I.F.

AKT: Single-best answer

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AKT: Extended Matching Questions

Knee painA. ACL tearB. Baker’s cystC. ChondromalaciaD. Complex regional

pain syndromeE. Diabetes mellitusF. FibromyalgiaG. Gout

H. Haemophilia I. Lumbar spinal canal stenosis J. Osgood schlatters diseaseK. OsteoarthritisL. Rheumatoid arthritis M. Septic arthritis N. Tuberculosis

For each of the following patients with knee pain, select the MOST likely diagnosis

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A 2 y.o. boy presents with recurrent painful swelling of his right knee. His Mother says he has previously had similar acute swellings of his ankles and elbows. She notes he bruises easily & had prolonged bleeding after his circumcision.

She believes her father has had similar troubles as well.

AKT: Extended Matching Questions

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• A 69 year old man notices his knee gets sore especially walking down stairs.

AKT: Extended Matching Questions

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Written Exam: KFP

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Key Feature Problems (KFP)

• There are 26 KFP in 3.5 hours • = 8 mins each• Two answer formats

– Write in responses – free text

– Choice of responses – pick list

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Key Feature Problems

• Problems should be common conditions or serious uncommon ones

• Can have 2-3 parts in the question – scenario can evolve

• Think about the key clinical decision making involved• Make sure it is from the point of view of a general

practitioner (although can vary the setting – rural)• May involve Pictures,Pictures, ECGs, x-rays ECGs, x-rays and/or test results test results

as part of the questionas part of the question

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KFP- an example

Mr Paul Young, a 56 y.o. man consults you in the surgery for pain in his left lower leg which has been getting progressively worse over the past 2 days. He says his leg is tender below the knee and swollen around the ankle. He has not had a similar problem before. His other leg is fine.

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What diagnoses would you consider at this time? List, in note form only, up to two diagnoses.

KFP- an example

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What elements of history would you like to elicit?

List up to seven (7) of the following items.

KFP- an example

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1. Activity at onset of symptoms 2. Alcohol intake 3. Allergies 4. Angina pectoris 5. Anti-inflammatory therapy 6. Cigarette smoking 7. Colour of stools 8. Cough 9. Headache 10. Haematemesis 11. Impotence 12. Intermittent claudication 13. Low back pain14. Nocturia 15. Palpitations

16. Paraesthesia 17. Paroxysmal nocturnal dyspnoea 18. Polydipsia 19. Previous back problems 20. Previous knee problems 21. Previous neoplasia 22. Previous urinary tract infection 23. Recent dental procedure 24. Recent immobilisation 25. Recent sore throat 26. Recent surgery 27. Recent work environment 28. Wounds on foot 29. Wounds on hand

KFP- an example

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KFP Answers – according to the College

Question 1 Deep venous thrombosis must be included in the differential diagnoses (Score 1) Providing more than two (2) diagnoses, score = 0. Total score = 1. Question 2 Any seven (7) of the following items are required:

Activity at onset of symptoms Cigarette smoking Previous knee problems Previous neoplasia Recent immobilisation Recent surgery Recent work environment Wounds on foot

All score 1. Selecting more than seven (7) items, score = 0. Total score = 7. Reference: Dr Andrew Moreton’s slide. There may be changes to the above marking criteria recently.

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The clinical exam - OSCE

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OSCE• May and October• 17 stations (3 ‘Rests’ 14 cases)

– 2 19 minute long cases– 12 8 minute short cases

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Components of the Clinical Exam

• Diagnostic interviews• “Management” interviews• Physical Examinations• Viva• +/- Practical Procedure

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Candidate Instructions1. This is an 8 minute station.2. Read the following scenario.3. Take a focussed history.4. Give a brief differential diagnosis to the observing

examiner5. Request the findings of relevant physical

examination.6. Request the results of any investigations you think

appropriate. 7. Discuss the diagnosis and management with the

patient.

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OSCE: Short case - an example

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OSCE- an exampleMiss Debbie Williams is a 27 y.o. receptionist who has

been coming to this surgery since childhood. She has enjoyed good health but has attended for her Pap smears (all normal) and occasional URTI’s. She is not married and has never been pregnant. Her only past regular medications have been the OCP. She has no known allergies and there is no significant family history. She had her appendix removed at the age of 12.

She rang yesterday for an appointment today.

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OSCE: long case - an example

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CANDIDATE INSTRUCTIONS 1. This is a 19 minute station.2. This consultation may be conducted as over a number

of sessions.3. Read the following scenario.4. Take any additional history you think is appropriate.5. Request any physical examination findings you require.6. Give your Differential diagnoses to the observing

examiner.7. Request the results of any investigations you require.8. Outline your management to the observing examiner.

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OSCE – long case- an example• Nell Worthington is an 80 y.o. retired librarian.• She has just moved to your area to be nearer

to her daughter.• She has provided the following summary

sheet from her previous doctor.• She called & made a long appointment 2

weeks ago.

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Nell Worthington – Summary Sheet• Past medical Hx:

– Hypertension – Osteoarthritis – Vaginal hysterectomy for prolapse 1980

• Medication: – Aldactone 25mg mane– Ramipril 10mg daily– Slow K 600mg 2 daily

• Allergies: nil• Social Hx:

– Widowed 1998– non-smoker– 4 grown children

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• The RACGP Fellowship exams consist of three segments:

•applied knowledge test (AKT): 150 Questions in 4 hrs

• key feature problems (KFP): 26 Questions in 3.5 hrs

• objective structured clinical exam (OSCE): 12 short cases (8 minutes each) and 2 long cases (19 minutes each)

SUMMARY

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Thank you for your attention.