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:
- 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.
- 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.
“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.