PRE-EXAM CANDIDATE ORIENTATION

Medical Council of Canada Qualifying Examination Part II

ITEMS TO BRING to the exam ITEMS TO LEAVE at home

Entrance card Food

Lab coat Pencils / paper

Reflex hammer All electronic devices

Stethoscope Large bags or purses* − space is limited!

The Medical Counci l of Canada Quali fying Examination (MCCQE) Part I I is a two-day assessment comprised of a series of patient encounters. The purpose is to make a fairand accurate evaluation of the candidate's cl inical ski l ls.

WHAT TO BRING

*A coat check will be available to store SOME personal items.

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Candidate registration and orientation

NOTE: INFORMATION SUBJECT TO CHANGE. PLEASE CHECK BACK 1-2 DAYS BEFORE EXAM.

MCC | MCCQEII Examination | 2014

MEDICAL COUNCIL OF CANADA QUALIFYING EXAMINATION PART II CANDIDATE INFORMATION SHEET EDMONTON – ADMINISTRATION 2

Requirements: YOUR ATTENDANCE IS REQUIRED ON BOTH DAYS.

You must bring your Entrance Card to be admitted to the examination. Also bring a stethoscope, a reflex hammer and a plain white lab coat without a hospital crest to wear during the examination. If the name of theschool or hospital appears on your lab coat, please cover it before you arrive at the exam centre. Your stethoscope and reflex hammer must fit in your lab coat pockets. There will be no extra stethoscopes or reflexhammers available at the site. All other examination materials that you need will be provided. Do not bring ahandbag, books, pens, pencils, notepad or any other extra paper, penlight, electronic devices or cell phones. You will not be permitted access to these items during the examination and storing these items securely will beproblematic. A coat check service will be available. You may wear a watch.

You must view the detailed orientation materials on the Medical Council of Canada (MCC) website prior to examday: mcc.ca/examinations/mccqe-part-ii/exam-preparation-resources/

You are required to attend registration and orientation on both days. Please do not arrive more than 15 minutesearly. Following orientation, a designated member of the staff will guide you through the exam from room toroom.

A light snack or lunch will be provided, depending on the day and time of the administration. If you have specialdietary requirements, you must notify the MCC prior to the examination through your physiciansapply.caaccount or by fax at 613-248-5234, to request permission to bring your own food to the centre.

For security reasons, you may be sequestered at the end of your examination and required to remain on site for a period of time. The end time listed at the top of this information sheet is the approximate time you will be able to exit the facility after any required sequestering. No outside contact will be permitted during this time.

Candidates are requested to not wear perfume, cologne, or scented aftershave on examination day.

Parking/Transit:Jubilee Auditorium Parking Lot (87 Avenue and 114 Street; west of the University of Alberta Hospital) or theEducation Car Park (on the corner of 87 Avenue and 114 Street). Please call 780-492-7275 for the most current information concerning the cost of parking.

Candidate Registration:Classroom 1-490 located on the first floor of the ECHA building [see map].

Sign Out:Immediately after finishing the examination, report to your Group Leader to return your examination materials,i.e. booklet, badge and extra bar code labels. Your examination will not be considered complete until you havesigned out, returned the complete booklet including the extra bar code labels and the badge, and thesequestering period has ended.

Contact Information:For all inquiries prior to exam day, please contact the MCC - mcc.ca/contact-us/For emergencies on the examination days only, call 780-668-8864.

Please note these telephone numbers are emergency contact numbers and will be monitored on exam days only.

Examination Day Arrival Time Approx. End Time Examination Location

Saturday, May 3, 2014 11:15 a.m. 3:05 p.m. Edmonton University Hospital, Edmonton University, 000 Avenue NW Edmonton, AB Sunday, May 4, 2014 10:05 a.m. 12:30 p.m.

Registration times are located on the CANDIDATE INFORMATION SHEET that you will receive in your Exam package.

Register upon arrival:• Hand over your personal belongings and your entrance card

to the exam site staff• You will be given a pencil, a notebook and an ID badge

Orientation is next: • During the session, a facilitator will give a brief overview of the

exam schedule and procedures• Questions are welcome

3

Notebook

What to do with your notebook:

• Use it as a reference and for note-taking during the exam• Hand it back intact at the end of each exam day• Keep the label backing sheet intact

The notebook received at registration contains bar code labels, blank pages and a list of common examples for write-in PATIENT ENCOUNTER PROBES (PEPs).

• Hand bar code labels to the examiner when entering the room• The number of labels to hand to the examiner will be indicated at the bottom of the

CANDIDATE INSTRUCTIONS for each station.

Start station

Your first station of the day will be indicated on the CANDIDATE INFORMATION SHEET and on your ID badge. It is the same for both exam days.

• After completing the start station, you will proceed to the remaining stations innumeric order

• No talking is allowed outside the rooms or between stations

• Exam staff will guide you and answer your questions during the exam

Bar code labels

What not to do with your notebook: • Do not tear out any pages

4

SATU

RDAY

The SATURDAY session consists of:

8 10-minute CLINICAL ENCOUNTER STATIONS and 2 REST STATIONS

Overview of the exam

• You are given 2 minutes to read the instructions posted bythe door

• After 2 minutes, a signal will sound for you to enter the room

• You are given 10 minutes in the room

• You will hear a warning signal at 9 minutes

• A second warning signal will sound at the end of the station.At this point, you must leave the room and proceed to the nextstation.

2 REST STATIONS 8 CLINICAL ENCOUNTER STATIONS

SATURDAY

At each station:

5

SUND

AY

Overview of the exam SUNDAY

The SUNDAY session consists of:

+ 1 LONG STATION 14-minute CLINICAL ENCOUNTER

In a couplet station, you may be required to complete a PATIENT ENCOUNTER PROBE (PEP) before or after the CLINICAL ENCOUNTER.

6-minute CLINICAL ENCOUNTER6-minute PATIENT ENCOUNTER PROBE (PEP)

4 COUPLET STATIONS { }

For additional information on PEPs, refer to p. 18

1 14-minute PATIENT

ENCOUNTER STATION

Here, you will be directed by staff to either Station 03 or Station 04

4 COUPLET STATIONS

6

SUND

AY

Overview of the exam SUNDAY

* At a few stations, you might not have to wait to enter the room after reading the instructions. Exceptions to this timing will be clearly indicated in the candidate instructions.

At the couplet stations:

• You are given 2 minutes to read the instructions posted by the door

• After 2 minutes, a signal will sound for you to enter the room *

• You are given 6 minutes in the room

• You will hear a warning signal at 5 minutes• A second warning signal will sound at the end of the station.

At this point, you must leave the room and proceed to the next station.

At the 14-minute station:

• You are given 2 minutes to read the instructions posted by the door

• After 2 minutes, a signal will sound for you to enter the room *

• You are given 14 minutes in the room

• You will hear a warning knock at 13 minutes Ignore the 5-, 6- and 8-minute signals. Pay attention to the door knocks instead.

• A second warning knock will sound at the end of the station. At this point, you must leave the room and proceed to the next station.

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In any given station, you may

be asked to do one or more of

the following tasks:

In the time between stations:

• Read the candidateinstructions carefully asthey provide informationabout the patient, thetask and the time alloted

• Pay attention to theverbs in the task –these will dictate whatis expected in order toreceive the credit

These same instructions will also be available inside the room.

Candidate instructions

Obtain a history Perform a physical examination

Address the patient's concerns regarding results, a diagnosis or a medical problem and/or counsel the patient

Manage an acute patient problem

Consult with a colleague (nurse or physician)

1

8

4

5

2

3

Candidate instructions will be posted outside of each room.

In any given station, you may

be asked to do one or more of

the following tasks:

• Focus on taking a relevant problem-based history; do not conduct a physicalexamination.

◦ patient management◦ counselingor◦ educat ion

NOTE: DO NOT ENGAGE IN:

Candidate instructionsObtain a history:1 9

Vaginal/rectal examinations 

If you believe that such an examination is appropriate, simply verbally inform the physician examiner. If relevant findings are available, the physician examiner will provide these findings to you.

You are not expected to carry out vaginal or rectal examinations.

• Greet the patient, and report whatyou are doing and your findings toboth the patient and the physicianexaminer

• Ask questions related directly tothe physical examination

Example:

"Does it hurt when you raise your arm?"

Example:

To the patient: "I will press lightly on your abdomen. Tell me if it increases your pain." To the examiner: "There is increased pain in the left lower quadrant."

• Demonstrate your clinical skills. You will only get credit for tasks completed tothe physician examiner’s satisfaction.

Patients in physical examination stations are discouraged from answering in detail about their history. You will not receive

credit for asking the patient questions about his/her medical history and you will use up valuable time.

In any given station, you may

be asked to do one or more of

the following tasks:

2 Perform a physical examination: 10

Candidate instructions sample

In this example, ► your task is to

conduct a physicalexamination. Donot ask the patientquestions about hismedical history.

► treat thestandardized patientas a real patient

• Verbs like “assess and discuss” or “assess and advise” will be in theCANDIDATE INSTRUCTIONS

• You must balance how much you need to know beyond what was provided inthe CANDIDATE INSTRUCTIONS to discuss with the patient and/or advise himappropriately

In any given station, you may

be asked to do one or more of

the following tasks:

3 Address the patient’s concerns and/or counsel the patient:

Instructions:

2 min. Task:

10 min. oral question(s):

0 min.

T01

CANDIDATE INSTRUCTIONS

Joseph Trans, 40 years old, presents to your office with a 2-hour history of abdominal pain.

IN THE NEXT 10 MINUTES: • CONDUCT A FOCUSED AND RELEVANT

PHYSICAL EXAMINATIONAs you proceed with the physical examination,EXPLAIN TO THE EXAMINER what you are doingand DESCRIBE ANY FINDINGS.

GIVE ONE (1) LABEL TO THE EXAMINER.

Examiner

MORE

CLINICAL STATION SAMPLES

cl ick here for

11

In any given station, you may

be asked to do one or more of

the following tasks:

• Verbs like “assess" and "manage” will be in the CANDIDATE INSTRUCTIONS

• You must determine the right balance and order for focused history taking,physical examination, intervention orders (such as "Give oxygen"), investigations,referrals, etc.

• A standardized health professional, such as a nurse, might be present in theroom. If so, it will be stated in the CANDIDATE INSTRUCTIONS. You may direct thenurse to order tests or perform any procedures you believe are appropriate forthis patient.

video

EXAM

PLE

Pat ient management

4 Manage an acute patient problem 12

In any given station, you may

be asked to do one or more of

the following tasks:

• During the examination, you could be asked to discuss a specific situationwith a colleague or another professional.

• In such a case, you must assess how much you need to know beyondwhat was provided in the CANDIDATE INSTRUCTIONS in order to respond

5 Consult with a colleague

appropriately to situations such as ethicaldilemmas, stress, medical error,unprofessional behaviors, request forprofessional support, and preventionof adverse events.

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Oral questions

In some stations, the examiner will ask you 1 to 3 brief questions after the first warning signal. In these stations, you will not be allowed to continue interacting with the patient after the first warning signal.

The oral questions relate to the patient you just consulted. Questions can be related to:

• a diagnosis• management decisions• ethical or legal issues

The CANDIDATE INSTRUCTIONS will clearly state:

• Whether there are oralquestions in the station

• The amount of timeallotted to the patient andto the listed tasks

If there are no oral questions in a station, you will have the full allotted time in the station to interact with the patient.

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Any additional medical equipment other than a stethoscope and a reflex hammer will be available in the room.

Medical equipment and references

A copy of Compendium of Pharmaceuticals and Specialties (CPS) will be available in stations where you are asked to write a prescription. Otherwise, you are expected to know doses of commonly prescribed or used medications.

Normal laboratory values will be provided whenever laboratory test results are given.

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Physician examiners

◦ To ask you to reread the instructions◦ To protect the standardized patient◦ To stop you from performing genital, rectal or other invasive examinations

If such examinations are needed, inform theexaminer that you would normally perform them.

◦ To report findings if they are available.If no findings are reported to you, please trust the findingsfrom your examination of the standardized patient.

In some (but not all) physical examination stations, physician examiners may be directed to give a blood pressure reading or ophthalmoscopic examination results

They can only do this if:

◦ The station protocol requires them to do so◦ You have initiated an examination maneuver

Physician examiners may provide results for some tests

◦ This only occurs at stations where you are expected to ordertests or investigations

NOTE: The physician

examiner's note-taking is not indicative

of your performance (do not let it

distract you).

• Physician examiners observe and assess your performance with station checklists andinteraction rating scales

• A second examiner may be present to observe protocols and for quality assurance• Physician examiners may intervene for the following reasons:

NOTE: Your FINAL

RESULT is not determined

solely by ONE station nor by

ONE physician examiner's

assessment.

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Standardized patients and standardized professionals (SPs)

Standardized patients (SPs) are trained to simulate patients’ signs and symptoms in a reliable and consistent manner.

Treat them as you would treat actual patients and treat their simulated findings as though they were real. You are scored on the way you interact with the SPs.

• Drape the SPs appropriately for thedifferent components of the physicalexamination (regardless of theirgender). SPs that are to be physicallyexamined are already in hospitalgowns, but you may remove the gownif appropriate for performing yourexamination of the patient.

• You must interact with the SPs.Simply explaining what you would dofor someone like this patient is notsufficient; you must demonstrate yourclinical skills, as well as demonstrateyour ability to analyze and processinformation.

NOTE: The standardized

professionals may be

physicians, nurses, social

workers. Interact with them as you would with actual

colleagues.

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In these PEP stations, you will be asked to answer written or oral questions related to the CLINICAL ENCOUNTER that you just completed.

Tasks vary widely – read the questions carefully. In these stations, you may be expected to do one or more tasks such as:

• Write admission orders• Interpret an x-ray• List possible causes of the problem• List the differential diagnoses• Choose from a list of multiple choices• Review the patient's chart or test results

SUNDAY Patient encounter probe

In these PATIENT ENCOUNTER PROBE (PEP) stations, you will be asked to perform some of the following tasks:

• Review and interpret patient-related materials prior to the clinical encounter, such aspatient charts, test results, referral letters, etc.

• Answer written or oral questions based on the material provided• Candidates’ instructions will clearly state whether a copy of the material will be

available in the next room.

You can take notes in your notebook during this time.

CLINICAL ENCOUNTER

BEFORE a clinical encounter

AFTER a clinical encounter

05

For Sunday's overview and timing, refer back to p. 6

06

PATIENT ENCOUNTER PROBE

0506

CLINICAL ENCOUNTER

PATIENT ENCOUNTER

PROBE

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• Write your initials in the topright corner of the PEP sheet

• Read the questionscarefully before answering

• Do not fill in more bubblesthan specified in thequestion

• Write your initials in the top right corner of the PEP sheet

• Write legibly on the PEP sheet• If lines are numbered: only the first answer on each

line will count• If lines are NOT numbered: the number of answers

is not limited – you may write as much as you wishin the space provided

• You may be asked to complete tasks such as writingadmission orders, a prescription, or a SOAP note.You will be expected to fill out the provided marksheet or prescription form.

• You may refer to the list of COMMON EXAMPLESin your notebook.

Multiple choice2

Write-inTYPES OF PEPs: 1 19

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Q1Q2Q3Q4Q5

Page 1 of 1

PLACE CANDIDATE BAR CODE LABEL HEREOR

If necessary, print ID number neatly

Examinersignature: X© MCC / CMC 2016

********************************************************************* FOR MCC USE ONLY ********************************************************************************

MCC Only

PEP PEPMarking QA

Total Total

S16 CW24

PEPmarking

Bubble Score Both

CandidateInitials:

Q1. What is THE most likely cause of the patient's symptoms? [Note: One answer only]

1.One answer per line

Q2. What are the TWO initial investigations that you would do for this patient? [Note: Numbered lines - One answer per line]

1.

2.

One answer per line

One answer per line

Q3. What are your initial management options for this patient?[Note: Short-answer format - Number of answers is not limited]

Total Total

1.

2.

Total Total1.

Draft

PLACE CANDIDATE BAR CODE LABEL HEREOR

If necessary, print ID number neatly

CandidateInitials:

Draft

Record your answer(s) to each question by filling in the bubble(s) in front of your answer(s) with pencil (). To change an answer, completely erase the bubble you do not want counted. Only clearly filled bubble(s) will be scored. The following marks CANNOT be scanned: If you fill in more bubbles than specified in the question, that question will be scored ZERO.

Page 1 of 1© MCC/CMC 2016

S16 CX22

Q1. Based on the history, what is THE most likelydiagnosis? [ONE answer only]

1.1 Acute pancreatitis1.2 Appendicitis1.3 Gastroesophageal reflux disease1.4 Irritable bowel syndrome1.5 Kidney stones1.6 Peptic ulcer disease

Q2. What THREE tests or investigations would help youmake a diagnosis? [Maximum THREE answers]

2.1 Abdominal ultrasound2.2 CBC2.3 CT abdomen2.4 Electrolytes2.5 Liver enzymes2.6 Lipase2.7 Pelvic ultrasound2.8 Renal function2.9 Urine analysis

C X 2 2

,,

Rest stations

Washroom breaks

Sign out

Candidate behaviour

During the application process, you agreed not to reveal to others the exam materials or content. That means you cannot discuss or disclose exam content at any time, in any way, even after the exam is over.Any breach in confidentiality Any breach may lead Examples of this include,

but are not limited to:

• Comparing patient responses with your colleagues• Sharing content with future exam candidates• Posting case information online• Sharing case information in social media

Any breach may lead to disciplinary and legal measures, including invalidating your results and preventing you from participating in future exams.

EXAMINATION SECURITY  Confidentiality reminder

Please sit quietly during these stations and rest before your next station.

Use the washrooms before you start the exam and/or during the sequestering period. If you have an urgent need at other times, please inform site staff.

Before leaving after each exam day, follow these instructions:

• Hand in your notebook (leave all pages intact, including the backing sheet from your barcode labels and any unused labels)

• Hand in your ID badge• Sign your name on the sign-out sheet

Disrespectful behavior toward exam staff will NOT be tolerated and WILL result in an incident report and possible disciplinary action from the MCC.

20

For security reasons, you may be required to remain on site for up to 3 hours before or after the exam on each exam day.• Access to personal belongings and telephones will not be allowed during this time

nor will discussion of exam content

...I lose my notebook and/or my bar code labels?

...I feel ill?

...I don’t know where to go?

...I have additional questions on exam day?

What should I do if…

Ask the FACILITATOR at the Candidate orientation or consult the SITE STAFF as soon as possible.

SITE STAFF are available throughout the day for your questions and to guide you.

Sequestering 21

You are encouraged to review the common mistakes webpage

Helpful tipsCandidate instructions sample

Instructions:

2 min. Task:

10 min. oral question(s):

0 min.

T01

CANDIDATE INSTRUCTIONS

Joseph Trans, 40 years old, presents to your office with a 2-hour history of abdominal pain.

IN THE NEXT 10 MINUTES: • CONDUCT A FOCUSED AND RELEVANT

PHYSICAL EXAMINATION As you proceed with the physical examination, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.

GIVE ONE (1) LABEL TO THE EXAMINER.

Examiner

Inside the station

• Demonstrate your clinical skills. You will not get credit for simply saying youwould do something (with the exception of genital and rectal examinations).

• You will only receive credit for tasks completed satisfactorily.• Treat the SPs as you would treat real patients.

22

► Read the CANDIDATE INSTRUCTIONScarefully in order to complete thespecified task(s).

► For physical examination stations,do not ask the patient his or herhistory as the relevant information isin the CANDIDATE INSTRUCTIONS.

► For history taking stations, do notconduct a physical examination.

cl ick here

Useful links

► Objectives forthe QualifyingExamination

► QualifyingExaminationPart II

► MCCQE Part IIinteractionrating scales

► Preparing forthe OSCEstation format

cl ick here

cl ick here

cl ick here

Complaints and conflicts of interest 

A candidate who believes that problems encountered during the course of an examination session may significantly affect his/her results must:

• immediately communicate such concerns to site staff during the examinationsession in question so they can complete an incident report; and

•

According to MCC standards, there is a conflict of interest if:

• the examiner or standardized patient is related by blood or marriage to thecandidate;

• the examiner or standardized patient is or has been in a significant businessor social relationship with the candidate, or is a professional colleague; or

• a conflict of interest relating to the candidate and the examiner orstandardized patient has been previously identified (e.g., there is anoutstanding complaint in another context).

Please note that knowing or being known to an examiner or standardized patient is not generally deemed to be a conflict of interest.

If you have concerns about a potential conflict of interest prior to the exam, you are strongly encouraged to contact the MCC before exam day. If, during the exam, you determine to have a conflict of interest with an examiner or standardized patient, you should exit the station immediately and inform site staff. Once staff are notified, they will make alternate arrangements for that specific station. You must inform the MCC of the occurrence in writing via physiciansapply.ca within one week of the examination.

submit a written report to the MCC via physiciansapply.ca detailing the incident within one week following the examination.

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