Sample Case 2016

For Candidate Only

INFORMATION FOR THE CANDIDATE

PMC Final Professional Clinical Examination

Station: OBSERVED HISTORY TAKING

Patient : Ms Jasmine, 55 year old university lecturer

Your role : House Officer in Accident & Emergency Dept

Problem : Breathless for one day

Please read the scenario below. When the bell sounds, enter the room. You have 11 minutes to take a history from
the patient, 1 minute to collect your thoughts and 8 minutes for discussion. You may make notes if you wish.

Scenario:

This patient presents in A & E Department, Penang Hospital at 10pm. Her main complaint is breathlessness.

Your task is to

1. Interview the patient and,

2. Based on the history you obtain, construct possible causes of her breathlessness and

3. Plan for investigation and management.

DO NOT EXAMINE THE PATIENT

Any notes you make must be handed to the examiners at the end of the station.
Sample Case 2016

For Examiners Only

INFORMATION FOR THE EXAMINER

PMC Final Professional Clinical Examination

Station: OBSERVED HISTORY TAKING

Examiners should advise candidates when there are 2 minutes remaining (i.e. at 9 minutes). Please stop the
candidate at 11 minutes for his or her time for reflection (only 1 minute allowed). After this, start your discussion
with the candidate for 8 minutes (PLEASE TIME YOURSELVES).

If the candidate appears to have finished early remind them how long is left at the station and enquire if there is
anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and
allow the candidate that time for reflection. The surrogate should remain until the end of the 12-minute period.

A good candidate would be expected to

(1) Take a focused history which includes all relevant social history and possible risk factors

(2) Demonstrate good communication skills and professionalism (Note: A good candidate would also give the
patient the opportunity to ask any further questions before closure) (Also note: It is not necessary for
candidates to agree a summary with the patient during their interview).

At the end of the consultation, the candidate should be able to:

(3) Make a summary (Examiner will first ask the candidate to do this)

(4) Formulate differential diagnoses or problem list (Examiner may ask what the expected physical findings are
if this is appropriate)

(5) Suggest investigations (Examiner may test by suggesting some investigation results BUT not to show
investigations like ECG or CXR to test the candidate), and

(6) Propose management

Examiners are encouraged to make a rough record of the candidate’s consultation with the patient as it progresses.
This may highlight omissions in history taking, ambiguities that remain unresolved, and additional points that were
not ‘in the script’.

Examiners should refer to the marking guidelines in the SIX skill domains on the mark sheet.

The box on the following page indicates areas of potential interest in this case. Both examiners should consider
these, and any other areas they feel appropriate, and agree the issues that a candidate should address to achieve a
‘Satisfactory’ or be given an ‘Unsatisfactory’ award for each domain.
Sample Case 2016

Date:
STUDENT NO: Paste your STUDENT PLACE: *PGH /SJH/TAIPING
NUMBER here (*DELETE NOT APPLICABLE)

INFORMATION FOR THE EXAMINER

For Examiners Only
PMC Final Professional Clinical Examination

Station: OBSERVED HISTORY TAKING

Examiners are reminded that the boxes below indicate areas of potential interest, but are not intended
as absolute determiners of “Satisfactory” performance.

Patient : Ms Jasmine, 55 year old university lecturer

Your role : Medical Officer in Accident & Emergency Dept

Problem : Breathless for one day

SKILL DOMAINS KEY ISSUES SCORES/COMMENTS

(see below Marking Scheme;

Give marks at intervals of 5)

(1) History taking Acute asthma exacerbation

Trigger factors
Normal asthma control
Full drug history
Comorbidities relevant to asthma
Daily living
(2) Communication Skills & professionalism

(Include given explanation where necessary and giving Obesity issue patient is concerned (steroid related?)
opportunity to ask any further questions before closure)

(3) Making a summary Chronic persistent severe asthma (requiring anti-IgE therapy)
Comorbidity of allergic rhinitis and GORD and obesity
Impact as a university lecturer
(4) Formulating differential diagnoses or problem list Acute asthma exacerbation
Pneumothorax/ lung collapse from mucus plugging
(5) Suggest investigations ABG for severity of asthma attack
CXR to exclude other disease (pneumothorax etc)
PEFR in A & E
(6) Propose plan of management Standard emergency treatment of asthma attack

GLOBAL FINAL MARK (Multiples of 5)

(Both examiners MUST reach a consensus)

(See Marking Scheme below)

Sample Case 2016

COMMENTS: (REQUIRED FOR ANY “FAIL” CANDIDATE ) … … … … … … … … …

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Sample Case 2016

PMC Final Professional Clinical Exam Marking Scheme (Modified* from RCSI P-system marking scheme)

Extended Criterion
Referenced Grading Extended Criterion Referenced Marking Scheme
Scheme

Outstanding performance, A candidate who displays outstanding physical examination technique,

85/90/95/100
communication skills and clinical acumen. First class honours.

Exceptional in all aspects of history-taking, examination technique, communication skills and clinical acumen.
75/80 Excellent theoretical knowledge and application of same to clinical problem-solving. The candidate may even

display outstanding attributes in some, but not all measurable criteria. First class honours.
Excellent in all respects of history-taking, physical examination technique, communication skills. Excellent
70
P+ theoretical knowledge and application of same to clinical problem-solving. First class honours.

Very good overall. Very clearly an above average candidate in terms of history-taking and presentation,
65 examination technique, communication skills Very good theoretical knowledge and application of same to

clinical problem-solving. Second class honours, division 1.

Very good in most respects of history-taking and presentation, examination technique and communication but
60 not in all aspects. Very good theoretical knowledge and application of same to clinical problem-solving. Must

be considered an overall solid performance. Second class honours, division 2.

Good sound overall performance without displaying any attributes out of the ordinary. The candidate displays
P+/P 55 an overall adequate standard of history-taking, physical examination technique and presentation. Has sufficient

theoretical knowledge and application of same to clinical problem-solving. Clear pass

Adequate Just about reaches an acceptable standard in history-taking, physical examination and presentation.
P 50 Minimal competence in theoretical knowledge and application to clinical problem-solving. Safe borderline

candidate who just reaches a pass standard. Borderline pass

Poor performance in either history taking, physical examination or presentation. Sub-optimal theoretical
P/P- 45 knowledge and application of same to clinical problem-solving. The candidate may display some adequate

attributes but does not reach an acceptable pass standard overall. Borderline fail
FAIL. Very poor performance in two of: history taking, physical examination or presentation. Sub-optimal
theoretical knowledge and application of same to clinical problem-solving. The minimum standard required is
P- 40 not attained. This candidate does not demonstrate the competencies required of an intern and requires a

further period of training. Clear Fail

The lowest mark any PMC candidate can be given is 40.