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Department of Medicine, Faculty of Medicine & Health Sciences, Stell. Univ.

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GUIDELINES FOR PRESENTATION OF CLINICAL CASES IN THE FCP(SA) PART II EXAMINATION

The time allocated for examination of candidates is as follows: 

2 short cases – 30 minutes each (includes 5 minutes for the examiners to review the case) 
1 long case – 45 minutes (includes 5 minutes for the examiners to review the case) 

With   the   intention   of   improving   the   quality   of   presentations   and   standardising   the   method   of   presentations 
nationally, the following recommendations have been made: 

  1. The actual presentation of the case should take less than 10 minutes for each of the short cases, and less  than 15 minutes for the long case. The remaining time is available for questioning the candidate. 
  2. The   following format of presentation is recommended, the aim being for the candidate to provide a succinct assessment of the patient in 3 or 4 sentences. 

The first sentence should provide brief biographical notes on the patient to show 

  • that you have troubled to know the patient as person and not just as illness or case 
  • that you have insight into how the patient’s occupation has impacted on the development of the illness or, conversely, how the illness has impacted on the daily life of the patient and, 
  • where relevant, that you have insight into the fact that the patient’s occupation, habits, hobbies might have played a role in the genesis of the illness. 
Some examples: 

“This   is   Ms  Cloete,   a   34   year   old   single   mother   of two,   previously   employed   as   a   saleswoman   but  who unfortunately has been unable to continue working since the onset of her illness; she has applied for a disability grant.” 

“I’d like to introduce Mr Buthelezi aged 59 who is married and has 3 adult children; Mr Buthelezi has worked underground in the goldmines since the age of 25. He has a 20 pack year smoking history.” 

“Mrs Martins is a 50 year old banking clerk and is the mother of 4 teenage children; she admits to a history of alcohol abuse following the death of her husband 12 years ago”. 

You then proceed to offer your assessment of the patient in the form of a 

  • definitive diagnosis, if that is possible thus “Ms Cloete has systemic sclerosis which is complicated by interstitial pulmonary fibrosis and cor pulmonale”. 
  • problem, your decision being that a definitive diagnosis without further investigations is not possible thus … “Mr Buthelezi has the problem of a large right pleural effusion for which the likeliest cause is carcinoma of the bronchus; he has also signs of chronic obstructive airways disease and, given his long mining history may also have underlying pneumoconiosis”. 
  • differential diagnosis 
    thus   …   “Mrs   Martins   has (signs   of)   chronic   liver  disease   with   decompensation;   the   likeliest   cause   is alcoholic cirrhosis but I should like also to investigate for autoimmune hepatitis or chronic hepatitis B leading to cirrhosis”. 
This summary assessment should be justified by presenting pertinent features on history and clinical examination. If there is a differential diagnosis, these should be given in order of likelihood. In the instance of the long case, there may be several diagnoses / problems, but the above principles of presentation still apply. 

The abovementioned method of presentation should provide for a more succinct and focused presentation and allow sufficient time for examiners to question the candidate on aspects of the clinical presentation (including the demonstration of physical signs), diagnosis and differential diagnosis, investigations and management.

MARKING GUIDE FOR EXAMINERS FOR CLINICAL CASES

MARK

DESCRIPTION

Less than 40%

Please specify mark within this range

The candidate:

Fails to elicit most of the important aspects of the history and/or physical examination, as would be expected of a competent specialist physician

OR

Reaches his/her conclusions by fraudulent or dishonest means, in the examiners’ opinion

OR

Displays serious disrespect towards the patient

40 – 45%

Please specify mark within this range

The candidate:

Fails to elicit some important aspects of the history and/or physical examination, as would be expected of a competent specialist physician

OR

Manufactures” or finds features on history or physical examination which are, in fact, not present.  Examiners must satisfy themselves by their own independent evaluation that this is the case

OR

Is unable to make a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation.

52 – 69%

Please specify mark within this range

The candidate:

Successfully elicits most of the relevant aspects of the history and physical examination, as would be expected of a competent physician.  Examiners should be satisfied that no important aspects of the history or physical examination have been missed

AND

Makes a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation

70 – 74%

Please specify mark within this range

The candidate:

Successfully elicits all the relevant aspects of the history and physical examination, as would be expected of a competent physician

AND

Makes a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation

AND

Demonstrates clinical maturity, insight and a breadth of experience and knowledge

75 – 100%

Please specify mark within this range

The candidate:

Successfully elicits all the relevant aspects of the history and physical examination, as would be expected of a competent physician

AND

Makes a pathophysiologically plausible clinical assessment, with an appropriate differential diagnosis, and a rational plan of further investigation

AND

Demonstrates clinical maturity, insight and an outstanding grasp of clinical medicine, including both a broad and deep experience and theoretical knowledge

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