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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

Page 2

* 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)

Page 3

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.).

Page 4

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

Page 5

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

Page 7

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

Page 9

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:

Page 10

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.


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