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Finals at Barts and the London, Queen Mary’s School of Medicine, University of London Katharine Boursicot Reader in Medical Education Head of Assessment
Finals at Barts and the London, Queen Mary’s School of Medicine, University of London
Katharine BoursicotReader in Medical EducationHead of Assessment
End of course assessment
o Summative
o Assessing whether a student is clinically competentl Knowledge and skills
o Fit for graduationo Fit to practise in a FY1 post
Conditions
¢ Students must pass in-course assessment to be eligible to sit Part 6
¢ Conjunctive model: each part has to be passed separately
Part 6
o Consists of:lWritten test (Part 6A)§ Assessing knowledge and application of
knowledgel OSCE (Part 6B)§ Assessing clinical, communication and
practical skills
Part 6
o Part 6A: 3 hour paperl 125 EMQsl 25 SBAs
o Angoff method
o Part 6B: 3hrs 15 minutes testing timel 17 station OSCE
o Borderline Group method
Part 6A - EMQsTheme : Post-operative complications
A. adhesions B. anastomic leak C. graft thrombosisD. myocardial infarction E. paralytic ileus F. pulmonary atelectasisG. pulmonary embolism H. pneumonia I. urinary tract infectionJ. wound haematoma
For each of the following case scenarios, select the most likeley post-operative complication from the listEach option may be used once, more than once or not at all.
1. A 77 year-old man on day 1 after an elective sigmoid colectomy develops a pyrexia of 37.5oC. On examination, you find that he has a shallow pattern of respiration, rate 20 breaths/min, and decreased breath sounds at the left base.
2. An 82-year-old woman, who underwent anterior resection of a rectal carcinoma five days previously, develops diffuse severe abdominal pain and tachypnoea. On examination, you find she is pyrexial at 38oC, pulse rate 120, with a tender abdomen and no bowel sounds.
3. A 45-year-old woman develops dyspnoea 12 hours after a parathyroid exploration for primary hyperparathyroidism. On examination, she is agitated and has audible harsh inspiration.
4. A 68-year-old man is recovering four days after emergency repair of a ruptured abdominal aortic aneurysm. He is nauseated and complains of some abdominal discomfort. On examination, you find that his abdomen is distended and there are only sparse bowel sounds. Serum potassium is 3.2 mmol/L.
5. A 38-year-old woman has been making an unremarkable recovery for six days after open cholecystectomyand common bile duct exploration when she develops acute dyspnoea. On examination, you find that she is cyanosed, tachycardic and tachypnoeic. Breath sounds are normal and there is no leg swelling or calftenderness.
Part 6A - SBAsTheme: Headache and neck stiffness
A 21 year old physiotherapy student is admitted to A&E with a 6 hourhistory of severe, worsening global headache associated with feverand neck stiffness.
1. Which one of the following rashes is most likely to be associated with this presentation?
A.Non-blanching and purpuricB.Non-blanching and papularC.Blanching and purpuricD.Blanching and macularE.Blanching and papular
o Answer: A
SBAs – cont.
The medical SpR decides she needs an urgent lumbar puncture toassist with the diagnosis and management.
2. Which one of the following set of results would exclude performing an immediate lumbar puncture?A. U+Es: Na+ 131mmol/l; K+ 3.8 mmol/l; Urea 7.8 mol/l; Creatinine 112
mmol/lB. INR 1.9, APTT 58 secs, Platelets 15x 109/lC. FBC: Hb 14.3 g/dl, MCV 91fl, WCC 21.9x 109/lD. Blood glucose 4.9 mmol/lE. ABGs: pH 7.32, PaO2 20.6KPa, Sats 100%, PaCO2 3.1 KPa, HCO3
-
15.8mmol/l, BXS -6.1 mmol/l
o Answer: B
SBAs – cont.The lumbar puncture is performed and shows an opening pressure of19cm of H2O. The CSF fluid is described as ‘turbid’. The initial microscopyand biochemistry shows:
Microscopy Gram negative diplocococci presentProtein 2.7 g/dlBlood 1+Glucose 1.6 mmol/lWhite cell count 2800 cells / mm3
3. Which one of the following organisms is the most likely cause of the CSFresults?
A. Neisseria meningitidisB. Streptococcus pneumoniaeC. Haemophilus influenzaeD. Mycobacterium tuberculosisE. Listeria monocytogenes
SBAs – cont.She is isolated in a side room on ITU. The public health doctorrecommends that the patient’s boyfriend and the anesthetist whoinitially assessed the patient both take appropriate antibiotic prophylaxis for 48 hours.
4. Which one of the following antibiotics is the best prophylactic agent in this case?
A. CeftazidimeB. CefuroximeC. AmoxycillinD. RifampicinE. Gentamicin
o Answer: D
Final Year OSCE: Part 6B
o17 stations
lClinical examination (5 stations)lCommunication skills (6 stations)l Practical procedures (6 stations)
OSCE blueprintOSCE blueprint
IV cannBld trans
Consent for PM
Pre-op assessGeneric
HipBack painMS
ThyroidType 2 diabetes
Metabolism
EyesHeadacheNS
PRAbdoGastroscopyAbdo painGIS
Peak flow
RespHaemoptysisRS
BPCardiacDisch drugsChest painCVS
ProcsExamExplanHistory
Format of Part 6B
oClinical examination (5 stations)l 10 minutes examining a real patient or
SP (with acute signs)l 5 minutes structured oral with
examiner§ Summary of findings§ Clinical reasoning & diagnosis
Format of Part 6B
o Communication skills (6 stations)l A § 10 minutes explanation/information giving§ Candidate interacts with SP§ Examiner observes and scores marking
schedulel B§ 10 minutes history taking from SP§ 5 minutes structured oral with examiner
• Summary of findings• Clinical reasoning & diagnosis
Practical procedures (6 stations)5 minutes
These stations cover the skills listed in ‘Tomorrow’s Doctors’ 2003
• Venepuncture• Inserting a cannula into peripheral vein• Giving intravenous injections• Carry out arterial blood sampling• Perform suturing• Administer oxygen therapy• Use a nebuliser correctly • Perform bladder catheterisation• Perform and interpret peak flow measurement• Perform measurement of BP• Deal with a blood transfusion
And clinical examination skills requiring manikinse.g. breast examination, PR, ophthalmoscopy, otoscopy
Passing criteria
o Overall pass marks (summated pass marks of all 17 stations)
o Minimum number of stations
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
95.0
7 8 9 10 11 12 13 14 15 16 17 18
Number of stations passed
Una
djus
ted
over
all s
core
Overall pass 62.1
Part 6B 2006
Three extra students failed
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0
95.0
100.0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
No of stations passed
Scor
e
Overall pass 64.1
Five extra students failed
Part 6B 2007
Outcomes
o Cronbach’s alpha:l 6A: 0.89l 6B: 0.75
o First sit: Februaryo Remediation and supporto Re-sit: June
