Page|1Saudi Board Promotion Exam of Ophthalmology
OPHTHALMOLOGY SAUDI BOARD PROGRAM
Objectives:
• The general objective of the annual promotion assessment is to evaluatethat the traineehas satisfactorily acquired the theoretical knowledgeandclinicalcompetencesthathe/sheshouldhaveacquiredduringtherelevantyear(s).
• Theannualpromotionassessmentconsistsofthefollowingcomponents:a.Writtenexaminationb.ContinuousAssessment
EligibilityforWrittenExamination:
• ValidregistrationwiththeSCFHS.
• Approvalofthespecialtylocalsupervisorycommittee.
WrittenExaminationFormat:
• A written examination shall consist of one paper with 120 MCQs with asinglebestanswer(onecorrectansweroutoffouroptions).
• The examination shall contain type K2 questions (interpretation, analysis,reasoning and decision making) and type K1 questions (recall andcomprehension),
• Clinical presentation questions include history, clinical finding and patientapproach. Diagnosis and investigation questions; includes the possiblediagnosis and diagnostic methodologies (laboratory investigation,radiological imaging and clinical procedures), Management questions;includes treatment and clinicalmanagement non-therapeutic, therapeutic,patientsafety,complication.Healthmaintenancequestions;includeshealthpromotion,diseaseprevention, risk factorsassessment, andprognosis, seeexamplesbelow.
• The examination shall include different aspects of medicine, surgery andpediatricrelevantforgeneralclinicalpractice(R1)
• Theexaminationshall includebasic conceptandclinicalquestions relevanttoOphthalmology(R2/3),seeblueprintbelow.
Saudi Board Promotion Exam of Ophthalmology 2016
Page|2Saudi Board Promotion Exam of Ophthalmology
ContinuousAssessmentFormats:
• Continuousassessmentformatsconsistof:
a.ContinuousEvaluationReports(CER)
o CERs should be conducted at least three times which covers 9trainingmonthsperyear.
o CERs are submitted to local supervisory committee for eachtraineebasedonaseriesofworkplace-basedassessments(WBA)consideredrelevantbythespecialty.Examplesfoundinappendix4and5.
b.Otherassessmentformats
o Otherassessmentformatsinvolve:
•ObjectiveStructuredClinicalExam(OSCE),
•StructuredOralExam(SOE),
•Researchactivity,
•Internationalexaminations,and/or
•Academicassignments.
c. The percentage for (b) shall not exceed 50% of the continuousassessmentscore.
d. If anyotherassessment format (notmentionedabove) isused theCACmustagreetoitsimplementation.
PassingScoreforPromotion:
• An average of 60% score in the annual promotion assessment with aminimumof50%ineachcomponent(writtenandcontinuousassessment)isrequiredforpassing.
• Inwrittenexamination, if thesamepaper isusedforall training levels (i.e.juniororsenior),pre-determinedpassingscoretoreflecttheleveldifferencein residency training shall be made where applicable. Example: R1=50%,R2=55%andR3=60%.
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ScoreReport:
• All written examination score reports shall go through a post-hoc itemanalysis beforebeing approvedbyboth theAssistantofGeneral Secretaryfor Postgraduate studies of SCFHS and SEC, and then reported to thescientific council for the specialty for promotion decisions for all trainees,withintwoweeksoftheexamination.
• Every SEC is encouraged to provide the scientific council for the specialty
with results feedback represent theperformanceof all residentsbasedoneachsectionoftheexamaccordingtothetestblueprint,andbasedontheirtrainingcenterifpossible.
GeneralRules:
• The written examination shall be held once a year within 4-6 weeks ofcompletionofninemonthsoftraininginthatparticularyear.
• If both examination (written promotion examination and Part I specialtyexamination) conducted at the same year, a candidate who passed Part Ispecialtyexaminationisexemptfrompromotionwrittenexaminationfor(R1only)inthefour-yearSCFHSaccreditedprograms
• Thereshallbenore-sitexamination.• Thereshallbenopromotionwrittenexaminationattheendoffinalyear• Promotionwrittenexaminationandcontinuousassessmentresultsarevalid
forthespecificyearinwhichtheywereconducted.
ExaminationConductandDuration:
2 1/2 hours duration is and examwill be delivered as a computer based testwhenavailable,otherwisepaperandpencil.
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Suggested References for Saudi Board Promotion Examination ofOphthalmology
1. AmericanAcademyofOphthalmology(AAO)BasicandClinicalScienceCourse(BCSC)Sections1-14;2013-2014.
2. AmericanAcademyofOphthalmology(AAO)BasicandClinicalScienceCourse(BCSC)Sections1-14;2014-2015.
3. BowlingB.Kanski'sClinicalOphthalmology,8thEdition.ASystematicApproachSaundersElseviersHealthSciences.ISBN978-0-7020-5572-0.
4. LevinL,NillsonS,VerHoeveJ,WuS,KaufmanP,AlmA.eds.Adler'sPhysiologyoftheEye,11thEdition.Saunders2011.ISBN:9780323057141
5. TabbaraKF,HyndiukRA.eds.InfectionsoftheEye,2ndEdition,1996.Little,BrownandCompany,USA.
6. RoyFH,FraunfelderFWJr.,FraunfelderFT,eds.CurrentOcularTherapy,6thEdition.Saunders;2008.ISBN978-1-4160-2447-7.
7. TraboulsiEI.ed.PracticalManagementofPediatricOcularDisordersandStrabismus.ACase-basedapproach.2016,Springer-Verlag.
8. WrightKW,SpiegelPH.eds.PediatricOphthalmologyandStrabismus;2003.Springer.
9. RabbettsRB.ClinicalVisualOptics,4thEdition.Butterworth-Heinemann2007.ISBN:978-0-7506-8874-1.
10. BartlettJD,JaanusSD.ClinicalOcularPharmacology,5thEdition;2008.Butterworth-Heinemann.ISBN:978-0-7506-7576-5.
Page|5Saudi Board Promotion Exam of Ophthalmology
MCQTestBlueprintforOphthalmologyBoardPromotionexamfor(R1)
Section ProportionGlaucoma 4-6Optics/Refraction 9-11Pathology 9-11Neuro-Opthalmology 4-6Pediatricophth&strabismus 19-21Cornea&anteriorsegment 9-11Oculoplastics/Orbit 9-11Uveitis 9-11Retina/Viterous 9-11Comprehensiveophthalmology 19-21
Total 120
MCQTestBlueprintforOphthalmologyBoardPromotionexamfor(R2)
Section ProportionGlaucoma 19-21Optics&Refractivesurgery 9-11Pathology 4-6Neuro-Opthalmology 1-3Pediatricophth&strabismus 19-21Cornea&anteriorsegment 29-31Oculoplastics/Orbit 2-4Uveitis 4-6Retina/Viterous 9-11Comprehensiveophthalmology 9-11
Total 120
MCQTestBlueprintforOphthalmologyBoardPromotionexamfor(R3)
Section ProportionGlaucoma 9-11Optics&Refractivesurgery 9-11Pathology 4-6Neuro-Opthalmology 11-13Pediatricophth&strabismus 4-6Cornea&anteriorsegment 19-21Oculoplastics/Orbit 9-11Uveitis 7-9Retina/Viterous 11-13Comprehensiveophthalmology 19-21
Total 120
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ExampleQuestions
EXAMPLESOFK1:
Question1:
Inapatientwithneuropathickeratopathyafterastroke,whatocularmedicationisrelativelycontraindicated?
A. FluoroquinolonesB. HypertonicsalineC. BetablockersD. Prostaglandininhibitors
EXAMPLESOFK2:
Question2:
ASevenyear-oldgirlwhohashadarenaltransplantcomplainsofaright-sidedheadachefortwodays.Examinationrevealsrednessofherrightforehead,rightuppereyelid,andnose,withafewclearvesicles.Slit-lampexamshowsconjunctivalhyperemiaandsuperficialpunctatekeratitis.
Whatisthepreferredmanagement?
A. TopicalsteroidsB. TopicalantiviralsC. OralantiviralsD. Oralsteroids
Page 1
OPTHALMOLOGY SAUDI BOARD PROGRAM ANNUAL PROMOTION ASSESSMENT
I. Annual Assessment
50% Continuous Assessment 50% Promotion
Examination
Educational Portfolio EOYE
BSCE Monthly
Evaluation
Attendance
Rotational Mini-CEX
Rotational CBD
Weekly Quiz
MCQs (A type including
recalls, interpretation and
problem solving
R1 20% 15% 15%
50% Continuous Assessment 50% Promotion Examination
Educational Portfolio EOYE
OSCE/OSPE/Oral
Exam
Monthly
Evaluation
Attendance
Weekly Quiz
Rotational Mini-
CEX
Rotational CBD
MCQs (A type)
Recall, Interpretation &
Problem solving
R2 25% 10% 15%
50% Continuous Assessment 50% Promotion Examination
Educational Portfolio EOYE
OSCE/OSPE/Oral
Exam
OKAP
Exam
Monthly
Evaluation
Attendance
Weekly Quiz
Rotational Mini-
CEX
Rotational CBD
MCQs (A type)
Recall, Interpretation &
Problem solving
R3 *20%/25% *5%/0 10% 15%
*Based on OKAP availability, if not available, 5% to be added to clinical examination.
100% Continuous Assessment
OSCE/OSPE/Oral
Exam
Monthly
Evaluation
Attendance
Weekly Quiz
Rotational Mini-
CEX
Rotational CBD
Thesis
R4 50% 15% 15% 20%
Educational Portfolio
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* The educational portfolio reflects performance, assesses clinical competencies (including assessment of
CanMEDS roles implementation in the program) and professional development.
* Portfolio contents (Assessment forms for all placements, mini-CEX/ CBD forms for all placements,
Reflection documents and additional reflection documents for courses, workshops, presentations,
research, etc.).
* BSCE (Basic Science Course Examination) on the 1st
two (2) weeks of January (Examination should
matched and aligned with BSC objectives)
* OSCE/ OSPE (Objective Structured Clinical Examination/ Objective Structured Practical Examination).
* EOYE (End of the Year Examination).
*OKAP Exam (Ophthalmic Knowledge Assessment Program Exam). The OKAP exam is a computer-based examination administrated at Prometric Test Centers. Ophthalmic Knowledge
Assessment Program (OKAP) International is a 250-item multiple choice, in-service exam for ophthalmology trainees around
the world to assess their knowledge and for programs to assess their educational effectiveness.
Requirement for Educational Portfolio
1. End of placement/ rotation assessment (Appendix A)
2. Mandatory formative assessment:
- Mini-CEX (Appendix B)
- CBD (Appendix C)
- Quiz
3. Evidence of achievements in each placement/rotation with descriptive statement
4. Reflection documents (Appendix D)
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Appendix A
EDUCATIONAL PORTFOLIO
RESIDENTS’ ASSESSMENT
RESIDENT NAME: ________________________________ Training Year: R1 R2 R3 R4
ROTATION: ________________________________ ASSESSMENT PERIOD: _________________
CONTRIBUTORS TO Evaluation: _________________________ Hospital: _______________________
Scale Key: Please compare the resident with other residents at his/her training.
Level:
N/A Not Applicable There was no opportunity to enable evaluation of this item.
2 Unsatisfactory* Clearly inadequate in functioning and/or not improving.
3 Borderline/Marginal* Inconsistently meets expectations for domain being evaluated.
4 Meets Expectations A solid performance at his/her level in the program – the majority of residents will fit into this category
5 Exceeds Expectations* Performed in a fashion that exceeds your expectations for most residents in the program, and equals
performance of advance residents and experienced practitioners.
This rating should be given to only a small number of residents and would place them at >90th
percentile.
*Written comments should accompany and support this rating.
Please note that observed progress and evaluation should incorporate sequential integration of prior learning, new knowledge and skills.
N/A 2 3 4 5 Comments
A. COMMUNICATION SKILLS
1. Ability to elicit relevant, concise and accurate
history from patient/parent(s).
2. Ability to present clinical data in an organized,
problem oriented manner at rounds.
3. Ability to effectively discuss relevant information
with attending, and health care team.
4. Establishes a therapeutic relationship with patients
and communicates well with family.
5. Adequate, appropriate and organized
documentation.
B. MEDICAL EXPERTISE DEVELOPMENT: KNOWLEDGE/CLINICAL JUDGMENT/SKILLS/PERFORMANCE
6. Basic Science
7. Knowledge of common problems (related to
subspecialty and level of training)
8. Accurate and efficiency in conducting a complete
and problem focused physical examination (must be
witnessed even if partial e.g. eye motility exam,
anterior segment, fundus exam)
9. Formulation of differential diagnoses, ability to
prioritize and solve problem.
10. Interpretation of relevant laboratory and
diagnostic imaging tests.
11. Competency in performance of procedural tasks
related to subspecialty.
12. Recognition and performance in acute and
emergency situations.
C. HEALTH CARE ADVOCATE
13. Identifies important determinants of health
affecting patients. (e.g. poverty, socio-economic status)
14. Recognizes opportunities to provide health
promotion and anticipatory guidance (e.g. vision test
for preschoolers, recommending immunization, etc.).
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N/A 2 3 4 5 Comments
D. COLLABORATOR and MANAGER
15. Utilizes resources effectively where appropriate
(e.g. evaluates need for and appropriately orders
lab/DI tests).
16. Displays appropriate time management skills.
Prioritizes tasks and performs procedural
interventions in a timely and efficient manner.
17. Understands own limitations, seeks help when
required, receptive to constructive criticism, and able
to adequately handle feedback.
18. Ability to function in a multidisciplinary team
setting.
19. Ability to follow up on outstanding issues in a
timely fashion.
E. SCHOLARLY ACTIVITY
20. Ability to execute a systematic search for evidence
(literature review, chart audit, etc.) in order to
optimize clinical decision-making and clinical care.
21. Ability to critically appraise sources of medical
information.
22. Teaching ability (formal/informal, e.g. clinical
clerks, juniors).
F. PROFESSIONAL ATTITUDE AND PERFORMANCE
23. Demonstrates initiative in achieving educational
objectives, (e.g. preparation for rounds, reading
around cases, discussion on how to improve).
24. Courteous and respectful (to patients/parents and
staff). Open minded to the needs and expectations of
parents. Active listener.
25. Displays empathy for sick patients and their
families.
26. Demonstrates gender and cultural sensitivity.
27. Displays dedication/enthusiasm, sense of
responsibility and punctuality.
28. Delivers highest quality of care with integrity,
honesty and compassion.
29. Displays and able to handle appropriate level of
responsibility for level of training.
30. Establishes effective relationship with seniors,
peers and health professionals.
F. OVERALL COMPETENCE
31. Overall assessment for rotation
No. of
Laser/Surgeries
Name of Procedure Main Surgeon* Assistant
Surgeon
*Main Surgeon means doing more than 75% of the procedure
Strengths: ___________________________________________________________________
Areas requiring further work: ____________________________________________________
Other comments: _____________________________________________________________
Resident comments: ___________________________________________________________
Total Score
-------------------------------------------- x 20% = -------------------
No. of Evaluated Items
Official
Use
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Mini-CEX (Mini-clinical Evaluation Exercise)
Ophthalmology Residents will be responsible for the conduction of at least one Mini-CEX session each
rotation. The process will end with a structures discussion with the supervisor or assessor:
• A selected case from the in-patient or out-patient setting to be interviewed under direct
supervision.
• The case should be presented with a conclusion. It should take no longer than 15 minutes.
• This should be followed immediately by feedback lasting 5-10 minutes that include things done
right and those need improvement.
• A mini-CEX form should be completed with the presence of the Residents
• The assessment form should be part of the educational portfolio.
Case-based Discussion (CBDs)
Competence in patient investigation, patient management, health promotion and disease prevention, and
some aspects of both attitudes/ethics and continuing professional development is assessed using a CBDs
form. These forms can be completed by trainers in the following circumstances:
• During an out-patient clinic. Trainers and trainees may wish to allocate 5-10 minutes to discuss the
management of a patient seen during an out-patient clinic.
• Case selection would be determined by either the trainee or trainer. The trainee should have had
some direct clinical role with the patient e.g. history taking, clinical examination, investigations
ordered or interpreted, management decisions, management of complications, critical incidents
etc.
• At the end of an out-patient clinic. Trainers and trainees may wish to allocate some time at the end
of clinic to review a small number of case notes where the trainee has had a significant role in the
management of the patient.
• Case presentations during postgraduate teaching. Trainees are often asked to present cases at local
or regional postgraduate teaching sessions. A nominated trainer should complete a CBDs form
after the presentation.
• During a designated teaching session. Trainers and trainees may wish to allocate a period of one-
to-one teaching or small group teaching where cases are discussed and a CBDs form completed.
A list of Clinical Scenarios (approximately 40) that cover most of the SBO curriculum. Trainees should
aim to cover all these scenarios in their case based discussions if possible so that their portfolio reflects a
wide range of clinical management situations.
It is recommended that about half the cases for CBDs are chosen by the trainee and half by the trainer.
A guide trainee’s should ensure that a minimum of one case per annual quarter is discussed and a CBDs
form completed. By the end of training a trainee’s portfolio should contain at least 15 CBDs forms.
Page 6
CBDs Scenarios:
• The Ophthalmology Resident is expected to manage a range of clinical scenarios. This may
involve referrals from other health professionals, patient self-referrals or screening for ophthalmic
disease.
Symptoms Signs
Foreign body sensation
Decreases Vision
- Transient
- Sudden
- Gradual
- Painful
Diplopia
Distortion
Dry Eyes
Floaters
Headache
Night Blindness
Pain
- Ocular
-Periocular
Photophobia
Red Eye
Trauma
Visual Disturbance
Tearing
Ametropia
Cataract
Corneal Opacities
Corneo-scleral laceration
Corneal Foreign Body
Conjunctival Pigmentation
Dysgenesis/ Colobomata
Intra-ocular Foreign Body
Lid Lumps
Lid Malposition
Leukocoria
Macular Exudation
Nystagmus
Ocular Tumours
Peri-Orbital swelling
Optic Nerve Atrophy/ Swelling
Buphthalmus
Proptosis
Pupil Abnormalities
Raised Intraocular Pressure
Retinal Haemorrhages
Retinal Pigmentation
Strabismus
Visual Field Defects
Retinal Vasculature abnormalities
Retinal Detachment
Retinoblastoma
Competencies Assessed in Mini-CEX
• Professional approach to patient
• History taking skills
• Physical examination skills
• Clinical diagnostic skills
• Clinical judgment & synthesis
• Patient management skills
• Communication skills
• Overall clinical competences
* See appendix B
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Appendix B
Educational Portfolio
Mini-CEX Form
Resident’s Name: ______________________________
Clinical Setting: ____________________________________
Title of Procedure: __________________________________
Clinical Problem Category
Anterior Segment | Glaucoma | Uveitis | Retina | O.P. | N.O. | Ped & Strabismus
If Other please specify _____________________
New or FU? ________________________
Focus of clinical encounter
History | Diagnosis | Management | Explanation
Number of times patient seen before by trainee _________
Complexity of case __________________________
Assessor’s position _________________________
Number of previous mini-CEX observed by assessor with any trainee: ____________________
Please grade the following area using the scale below:
Please mark as ‘Insufficient Evidence’ if you have not observed the behaviour and feel unable to comment
History Taking
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Physical Examination Skills
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Communication Skills
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Page 8
Clinical Judgment
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Professionalism
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Organization/Efficiency
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Overall Clinical Care
Insufficient evidence | Below expectations | Borderline | Meets expectations | Above expectation
| for completion | for completion
Anything especially good
Suggestions for Development
Agreed Action
Time taken for observation: (in minutes)
Assessor’s Name:
Competencies Assessed in Case-Based Discussion
• Professional approach to patient
• Data gathering and interpretation
• Making diagnosis and decisions
• Clinical management
• Managing medical complexity
• Working with colleagues and in teams
• Maintaining an ethical approach
• Fitness to practice
* See appendix C
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Appendix C Form
Educational Portfolio: CBD Form
Resident’s Name: Date (dd/mm/year)
R1 R2 R3 R4 Other (specify)
Assessor’s Name:
Assessor’s Status: Consultant Residents (R1, R2, R3, R4) Other (specify)
Clinical Scenario (see study guide)
Brief description of case:
Overall difficulty of case: Simple Intermediate Difficult
Subspecialty: Plastic/Lac/Orbits Cornea/Ext Cataract/Ref Glaucoma Retina/Uvea/Oncol Neuro Paeds/Strab
Topic Poor Fair Good V.Good n/a
Medical Record Documentation
Clinical Assessment
Investigation and Referrals
Treatment
Follow-up and Future Planning
Professionalism
Clinical Judgment
Leadership/Manager Issues
Overall performance in this assessment Poor Fair Good V.Good
Meets Expectations/Does not meet Expectations (for stage of training)
Anything especially good?
Suggestions for development:
Agreed action:
Signature of Assessor: Signature of Trainee:
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Appendix D
Educational Portfolio
Reflection Form
Rotation (____): Comprehensive Ophthalmology
1. Clinical Management:
Strength:
Areas of Improvement:
New Skills:
2. Medical Practice:
Strength:
Areas of Improvement:
New Skills:
3. Professionalism:
Strength:
Areas of Improvement:
New Skills:
4. Communication Skills:
Strength:
Areas of Improvement:
New Skills:
5. Leadership and Teamwork:
Strength:
Areas of Improvement:
New Skills:
Page 11
I. Annual Promotion Assessment
A. Objectives
1. The general objective of annual assessment is to evaluate that the trainee has satisfactorily
acquired the theoretical knowledge and clinical competence to which he/she was exposed during
the relevant year(s).
2. The following specialties have to be covered for R1:
BSC, E.R., Neuro-Ophthalmology, Oculo-Plasty, Pediatrics Ophthalmology & Strabismus,
comprehensive Ophthalmology and ancillary services.
3. The following specialties have to be covered for R2:
E.R., Retina, Uvitis, Glaucoma, Anterior Segment, Cornea & External Eye Disease, Neuro-
ophthalmology and Oculo-plastic.
4. All specialties have to be covered for R3 and R4.
B. Eligibility of Promotion Examination
1. Completion of at least nine (9) months of training in the concerned year of residency.
2. Satisfactory report by the Supervisory Training Committee and the Annual Continuous
Assessment.
C. General Rules
1. The trainees learning capabilities, performance, interest, etc., shall be monitored by the
trainer/Program Director on the forms of continuous assessment of rotation throughout the
year and the marks awarded shall be submitted to SCFHS.
2. Written promotion examination (EOYE) shall be held once a year for all the residents except
R4.
3. The written examination question paper (EOYE) shall ensure proper coverage of all the areas
of syllabus specified for the relevant year(s) (see above).
4. The OSCE/OSPE shall ensure proper coverage of all the areas of syllabus specified for the
relevant year(s) (see above).
5. Promotion to next year of residency shall depend on passing the Annual Continuous
Assessment requirement and the written promotion examination which will have equal
weightage.
6. EOYE is obligatory and applicable for all the residents except fourth year residents.
D. Written Examination Format
1. A written examination consisting of 120 MCQs (A Type) shall be attempted in two (2) hours.
2. Three (3) different papers, one for each level i.e. R1, R2 and R3 shall be given.
E. Passing Score
1. An average of 60% score in the promotion examination and continuous assessment with a
minimum of 50% in each is required for passing the 1st
three years of the program.
Page 12
2. An average of 60% score in the continuous assessment with a minimum of 50% score in
OSCE (i.e. 25 out of 50) is required for passing and completing the program for fourth year
residents.
F. Declaration of Result
All written examination score reports shall go through a post-hoc item analysis before being
approved by both the Assistant of General Secretary for Postgraduate studies of SCFHS and SEC,
and then reported to the scientific council for the specialty for promotion decisions for all trainees,
within two weeks of the examination.
G. Eligibility:
Valid registration with Saudi Council for health Specialties.
Specialties.