flowers 2 template. pa... · practice assessment (pa) test the candidates: workplace based (family...

19 August 2020

What to

prepare

What will be

assessed

Random check (PMP

review)

Part C II (Dangerous

drugs management)

Part D (Medical records)

Part E (Investigatio

ns)

Practice Assessment

1

Tips onGood

practice

Pre-examination Workshop for candidates 2021 Exit Examination

Practice Assessment (PA) test the candidates’:

Workplace based (family medicine clinic)

2

Application of skills

Knowledge

Organize and

manage

PA will be more

oriented on:

Examination date

Will be within either: No exam on public holidays

Examiners will visit according to the Candidate’s clinic opening hours in the application

Candidate will be informed2 working days before thedate of PA

Candidates will be notified of the Examination period:

Within the 2 weeks

after

Exam Application Deadline

This is HKCFP Specialty Board… Examiners will go to your clinic for PA on …

Your cooperation appreciated!

3

Exam date once confirmedcannot be changed

Dec Jan Feb Mar

Period A Period BOR

Exact dates of each period:please refer to the updated Exam Announcement

2021 Exit ExaminationImportant dates (i)

4

Exit Examination Application deadline(first attempt candidates), and submit PA documents

Cases collection period for PA:• Part D / Attachment 12 • Part E / Attachment 13

PMP report prepared:between 1 May 2020 to 31 October 2020

Deadline to submit demo video (CSA)

5

2021 Exit ExaminationImportant dates (ii)

Deadline of Clinical Audit Report / Research Report submission

Exit Examination Application deadline(for re-attempt candidates)

Christmas:No Exit Examination will be arranged

Exam Period A for CSA and PA

6

2021 Exit ExaminationImportant dates (iii)

Chinese New Year:No Exit Examination will be arranged

Exam Period B for CSA and PA

PA Document required at Examination Application

7

PA Document What to

prepare

Attachment 1

Attachment 2

Attachment 3

Attachment 4

Attachment 5

Attachment 6

Attachment 7

Attachment 8

Attachment 9

Attachment 10

Attachment 11

Attachment 12

Part D

(Medical Records)

Attachment 13

Part E

(Investigations)

One copy

Four copies(A4 size)



8

Preparatory Workshop

earlier this year:

Suggestion on printing and binding your PA Document

On the pages, insert

header/ footer; indicating:

• Candidate number /

name

• Attachment no.

• Page number

Detachable bindingpreferred

What to

prepare

2-sided printingpreferred

9

Random check(PMP review)

10

Random Check (PMP review) What will be

assessed

Making sheet (PA rating form)

Items and relevant Attachment(s)

selected from:

1. Parts A or/ and B; AND

2. Part C

• The assessment format will be broadly

the same as PMP visit

• Please answer the Examiners’

questions with demonstrate as

applicable

Your PMP report

11

What will be

assessed

Passing Random Check (PMP review)

Both PA Examiners give pass (A or C) = Pass in Random check

12

Part C II(Dangerous drugs management)

13

What will be

assessed

Making sheet (PA rating form)

Part C II

• The assessment format will be broadly the same as PMP

visit

• In your clinic: answer the Examiners’ questions with

demonstration as applicable

Your PMP report

Part C II

14

Passing Part C II (Dangerous drugs management) What will be

assessed

Both PA Examiners give pass = Pass Part C II15

Part D(Medical records)

16

Part D (Medical Records): general requirements

On the exam date:

provide a room of adequate audio-visual privacy for up to three examiners to assess your records

What to

prepare

300 Medical records of the patient that consulted you from16th Septemberto31st October, 2020inclusive

Summarize the medical records

17

Attachment 12

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Part D: collecting the medical records for exam

Acceptable format of

medical records

Handwritten records

Print-out from computer system

What to

prepare

300 patients that consulted you from

16th September

to

31st October, 2020

inclusive

Head counts

Candidate

Readily retrievable and available upon Examiners’ request

May be required to verify the genuineness e.g. through the clinic computer record system/ relevant persons

18

AND / OR

Health Screening / Medical Assessmentshould be excluded

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Preventive care

Consultation noteDr. Candidate

Consultation noteDr. Colleague B


Consultation noteDr. Colleague A

Each of them should, at least (e.g. print out from computer), include:

Lab report

Referral letter

Patient information

Chronologically the previous five consultations’ notes (as applicable):

For examiner’s reference

The date seen by you as stated in your Attachment 12

Some information in the past consultation notese.g. Blood pressure, BMI; chronic medications usage, controlof medical condition(s) under your clinic’s attentionmay affect the examiner’s judgement of your consultation note

D2

D3

D4

on those results you handled / followed up in D4(as applicable)

those you issued in D4 (as applicable)

What to

prepare

Part D: content of the medical records expected

19

What are D2, D3, D4 ?

Page 22

Serial no.

Patient record number

Patient initials

sex age diagnosis Date of the consultation

Date of first attended the clinic

1 3216 NFK F 25 URTI 20 SEP 2018 18 OCT 2010

2 8839 LKF F 46 DEPRESSION 20 SEP 2018 25 JUL 2011

3* 292 KPW M 87 DM, HT, HYPERLIPIDEMIA

21SEP 2018 18 SEP 1999

4 9932 STKM F 1 URTI 21 SEP 2018 6 AUG 2011

5 6677 CHL F 12 ALLERGIC RHINITIS

21 SEP 2018 12 MAY 2011

6 4454 CHC M 67 HT 21 SEP 2018 12 JAN 2011

… … …. … … … …. ….

300 2323 LKH M 38 URTI 24 OCT 2018 24 OCT 2011

Cases used in Part E (investigations) are marked with *

Confidentiality: Do not include patient’s name, HKID

Attachment 12: in a standard formatWhat

to prepare

20

Suggestions in presenting exam materials What

to prepare

Attachment 12

You can use paper flags to identify

the relevant sections e.g. D4

Medical records

21

Part D: When Examiners in your clinic What will be

assessed

You can briefly show the basic layout of your medical records to the Examiners

Basic information is charted here …; the lab reports are …

They will read and assess the records independently in your absence

They will mark on four areas:D1 (Legibility)

D2 (Basic information)

D3 (Anticipatory / preventive care in the recent 12 months)

D4 (Consultation notes)

They will choose ten records from your Attachment 12 for assessment

22

D1 (Legibility)

Examiners proceed to assess the record

Illegible the whole case will not be markedpro-rata mark deduction in Part D total score

Use abbreviations sensibly • Understood by most general practitioners• Can prepare a ‘reference list of abbreviations’ for the

Examiners: but all subject to the Examiner’s judgments

23

What will be

assessed

D2 (Basic information) What will be

assessed

• Current medication list: refers to the regular medications from your clinic

• preferred• Should have significant

‘negatives’ e.g. Allergy: nil known

• Inappropriate ‘blanks’ on the template/ table may be regard as missing information

• At least (but not limited to) 2 generations

• Relevant & specific for the patient

• Show index patient• Family members’ health

condition if deceased: cause & age of death

• Show members who are living together

dated updated consistent with other parts

of the medical record

24

Areas to be examined Templates/ tables Genogram

Tips on Good

practice

no genogram in some cases could be acceptable, e.g.

• Language barrier

• Communication difficulty (e.g. impaired

cognition, hearing, speech)

• Lack of appropriate informants

• Medical emergency encountered

25

D2 (Basic information): GenogramWhat will be

assessed

D3 (Anticipatory / preventive care in the recent 12 months)

• preferred• Should have significant

‘negatives’ • Inappropriate ‘blanks’ on

the template/ table may be regard as missing information

dated updated consistent with other parts of the medical record

• Growth chart: for pediatric patients• Immunization: appropriate to patient’s age /

contemporary risk• Relevant action and review: e.g. on BMI/

overweight; high BP; smoking

26

Areas to be examined Templates/ tables

What will be

assessed

Tips on Good

practice

Attachment 12 (Part D)

Serial no.

Patient record number

Patient initials

sex age diagnosis Date of the consultation

Date of first attended the clinic

1 3216 NFK F 25 URTI 20 SEP 2011 18 OCT 2010

2 8839 LKF F 46 DEPRESSION 20 SEP 2011 25 JUL 2011

3* 292 KPW M 87 DM, HT, HYPERLIPIDEMIA

21SEP 2011 18 SEP 1999

If this case is chosen by the Examinersassessed (D4)

27

D4 (Consultation notes) What will be

assessed

28


assessed

Main reason(s)of the consultation

Clinical Findings

Diagnosis / Working diagnosis

Management

Areas to be examined


assessed

29

Tips on Good

practice

Main reason(s)of the consultation

• State clearly in the initial part of the consultation note; e.g.

o FU DM, HT, hypothyroidism

o C/O: runny nose 2/7

• Avoid preceded by irrelevant past information;

if there is any ‘introductory information’ e.g. significant past / current medical

information, trim and keep it concise and relevant;

so that the main reason(s) of the consultation would not sink into the

paragraphs causing confusion / misunderstanding


assessed

30

Tips on Good

practice

Clinical Findings

• Group the findings under history, physical exam, diagnosis / impression,

management, etc. e.g.

Hx:

Watery nasal discharge,

Mild ST, Not much cough

No fever

TOCC –ve

……….

PE:

GC sat

Temp: ….

Hydration N

…….

• Record positive and significant negative clinical findings

Hx:

Good compliance to Rx

Tolerated

No hypoglycemia

Diet: usual care; but avoiding sweety fatty

foods

Ex: nil regularly

……….

PE:

GC sat

BP

Hstix 2 hr pp …….

Positive: showing Significant negative: showing

had been considered


assessed

31

Tips on Good

practice

Clinical Findings

• Follow up significant issue(s) raised in previous visits; e.g. overweight, smoking,

elevated blood pressure

• ICE (idea / concern / expectation),

Elaboration on psycho-social history:

o Most likely would be required in situations such as:

Such information is volunteered by the patient / relatives in the consultation

The consultaion is related to a psychological complaint / condition; e.g.

insomnia, depression follow up

Sophisticated encounter: e.g.

diagnostic difficulty,

occurrence of a potentially sinister condition (e.g. suspected malignancy)

suboptimal chronic disease control

distressed patient / relatives

o Explicit documentation may not be necessary in straightforward episodic physical

/ chronic follow up cases


assessed

32

Tips on Good

practice

Diagnosis / Working diagnosis

• Must be stated in the consultation note

• For straightforward episodic / follow up cases: state the diagnosis usually

sufficient

• Status of control in chronic disease e.g.

o HT, stable

o DM suboptimal control

o lipids on statin, at target (< 2.6)

• ‘Triple diagnosis’: psycho-social status as appropriate; e.g.

o Dementia, care-taker (wife) stress

o Depression, recently employed

• In case cannot arrive at a (working) diagnosis, give differential diagnoses (ddxs);

usually two to three ddxs would be sufficient; e.g.

o Dizziness; ddx: BPPV, vestibulitis

o Weight loss: bowel pathology?, hyperthyroid

o LUTS: BPH, Co-existing UTI?


assessed

33

Tips on Good

practice

Management

• Drug use or/ and non-pharmacological measures: RAPRIOP approach

• Injudicious use of drugs e.g. steroids will be penalized

• Investigation: please refers to ‘Part E’

• Follow up

o ‘planned’:

the interval appropriate to the nature of problem(s) to be reviewed

o ‘FU p.r.n.’, ‘open FU’:

give appropriate advice e.g. ‘return if’

the tongue ulcer not improve in the next 2 weeks

rash / vesicles develop

• Referral

o if you expect the patient should be seen by a designated specialist with high

priority / urgent basis, consider:

• follow up / contact the patient

• remind patient such as return / contact clinic if not seen by Breast Clinic

within three weeks

D2Basic information

( ) X 3.5

= Part D score

Yes

No

Pro-rata mark

deduction due to D1?

Pro-rata deduction for Case no:

____________________

pro-rata deducted

Part D score: _____

Summation of Part D score

D3Anticipatory care

( ) X 1.5

D4Consultation notes

( ) X 5

What will be

assessed

34

Marking reference: See next page

4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9

Examiners assess all the eligible/ suitable medical records A global mark will be given in Part D2, D3, D4; E2, E4

Demonstrates serious defects; clearly unacceptable standard overall

Consistently demonstrates outstanding performance in all components (Outstanding)

Marking reference in Part D & Part E What will be

assessed

35

OR below OR above

D2Basic information

( 6.5 ) X 3.5

= Part D score

Yes

No

Pro-rata mark



____________________

pro-rata deducted

Part D score: _____

Summation of Part D score: example 1

D3Anticipatory care

( 7 ) X 1.5


( 7 ) X 5 68.25

22.75 10.5 35

36

What will be

assessedUsual situation

D2Basic information

( 6.5 ) X 3.5

= Part D score

Yes

No

Pro-rata mark



____________________

pro-rata deducted

Part D score: _____

D3Anticipatory care

( 7 ) X 1.5


( 7 ) X 5 68.25

22.75 10.5 35

61.4

37

What will be

assessed

Summation of Part D score: example 2

“Case 131”:

Record not

legible

2 32 58 100 131 157 178 213 266 298

131

Part D (Medical records): pass or fail

Average of the two PA Examiners’ scores ≥ 65%?

Pass in Part D

Difference of the two Examiners mark ≥ 3.8?

Yes No

Send 3rd Examiner:the score ≥ 65%?

Fail in Part D No

Yes

Yes

No

38

Part D score

calculated based on cumulative exam data

Part E(Investigations)

39

Part E (Investigation): general requirements

On the exam date:

provide a room of adequate audio-visual privacy

for up to three examiners to assess your records

Same as Part D

What to

prepare

Summarize

the medical records into

Attachment 13

Medical records of 10

individual patients;

whom had

investigations initiated

and followed up by

the candidate as

specified

40

What to

prepare

Investigations initiated, ordered, documented in the medical record by the candidate 16th September --- 31st October, 2020

Can come from the 300 cases listed in your Attachment 12 (Part D)

The results are followed up, documented by the candidate between

If follow up consultation not possible, follow up by:

document in the medical record!

Part E: find 10 suitable cases for exam

Within

16th September --- 31st October, 2020

41



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What to

prepare

The cases can be:

• Patient’s complaint(s) in episodic/ regular visit• Monitoring of existing / chronic medical condition

The cases cannot be,solely for the purpose of:

• Health screening / Medical assessment• Monitoring of possible side effects of medication/

treatment in asymptomatic patients,e.g. RFT after using ACEI; Blood liver enzymes after statins; CBP to screen neutropenia on carbimazole

42


What to

prepare

For each case • assign an ICPC-2 code to the Provisional diagnosis / Chief condition that

necessitate the investigation(s); e.g. T90, R74• show the code on your Case Summaries and the Summary Table (Attachment 13)Among the ten cases • No more than two cases should belong to the same ICPC - 2 “Chapter” (the

alphabet)• No more than one T-90 (type II diabetes mellitus) is allowed• No more than one K-86 (uncomplicated hypertension) is allowed

43


Attention!!

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44

ICPC - 2

What to

prepare

Pro-rata deduction of Part E total Score

Unsuitable case(s)

The investigation/ laboratory reports (or copy) NOT available for Assessment

Pro-rata deduction of E4 (follow up) score

Select another

case

Specialty Board staff may not help you

Not sure if the case is suitable?

Handwritten records

Print-out from computer

system

Acceptable format of medical records

can use paper flags to identify the relevant sections of your records e.g. E1, E3, E4

Missing!

45


Next page

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Lab reportDate: 4 Sep 2019

Referral letterTo: Geriatrics SOPC

Preventive care

Patient information


1 Sep 2019

Retired seafarer With wife. C/O: progressive poor memory 6/12 …..

e.g. confused on date/ events…

…..ADL independent, went out for lunch / market by self…

Quitted smoking / drinking since retired age 60

Exercise: nil regularly

PE: GC sat, normal gait BP 129/78 P 89 euthyroid….

--- AMT 6/10

Imp: cognitive impairment/ ? Dementia or MCI

Mx:

Brief explain cogn. Impairment with pamphlet

Bld test (CBC, L/RFT, FBS, Lipids, TFT, Vit B12,folate, VDRL)

FU 3/52


21 Sep 2019

with wife and daughter today

Consult. 1/9/ 2019 refers;

Dementia bld work up (4 Sep 2019): CBC, L. RFT, TFT, Vit B12, folate: N; VDRL: no-reactive

Daughter concerned ….

Imp: cognitive impairment/ likely MCI

Mx:

Suggest SFI CT brain; relatives need time to think about

Encourage regular social activities / exercise. : e.g. visit nearby elderly community center

Refer:

Occ therapist (assessment and training)

Geri SOPC

FU 12/52

Patient: XXXM/72No: GK 123984

Patient: XXXM/72No: GK 123984

E1

E3

E3

E4If applicable

E2

Please note: the consultation notes content are simulated and not implying a standard of pass or fail in the Exam

What to

prepare

46

Part E: content of the medical records expectedEach of them should, at least (e.g. print out from computer), include:

What areE1, E2, E3, E4?

Page 50

E4

The information must be consistent with the medical recordsConfidentiality: Do not include patient’s name, HKID

AndSummary table

Case no: 1Patient initials:

Clinic record number:

Sex: Age:

Provisional diagnosis / Chief condition requiring investigations:(date of the consultation: DD/MM/YYYY):

ICPC-2 code

Investigations performed:

Results:

Follow up: (date: DD/MM/YYYY)

Comments:

What to

prepare

Attachment 13: Two documents in standard format

47

Cases summaries of

the ten patients Case no.

Diagnosis/ condition requiring investigation

ICPC-2 Code Tests ordered

1 malaise A 04 (weakness / tiredness)

CBC, L/RFT, TFT, Urine C/ST, CXR

2 Anemia ? Large bowel pathology

B 82 (anemia other/ unspecified)

CBC, Fe-profile, CEA, Stool OB X 3

3 Post-prandial dyspepsia D 07 (dyspepsia / indigestion)

OGD, US upper abdomen

4 Annual hypertension check

K 86 (uncomplicated hypertension)

RFT, FBS, lipid profile, Urine Protein

5 Sprained ankle L 77 (sprain / strain of ankle)

XR ankle

6 Low back pain L 03 (low back symptoms / complaints)

XR LS spine

7 Hyperlipidemia, newly started on statins

T 93 (lipid disorder) Lipid profile, ALT

8 Dystrophic toe nails S 22 (nail symptoms / complaints)

Nail clipping for fungal culture

9 Amenorrhea, pregnancy test negative

X 05 (menstruation absent / scanty)

FSH, LH, Prolactin, TFT; US pelvis; PAP smear

10 Hyperthyroidism on treatment (carbimazole)

T 85 (hyperthyroidism)

Free T4, TSH

Case No: 6 Patient initials: LKH Clinic record number: GOSY 1810XY21 Sex: M Age: 83

Provisional diagnosis / Chief condition requiring investigations:(date of the consultation: DD/MM/YYYY): Weight loss, ? Bowel pathologyC/O Weight loss 6 to 7 Ib in last 3/12B O change from daily to once every 3/7PE GC sat, mild pallor, abd soft non-tender/ no mass….PR: empty no mass felt

ICPC-2 code

Investigations performed: CBC, CEA, thyroid function (TSH), stool Occult blood X 3

Results:CBC: Hb 9.8 (low), WBC 4.8, Platelet count 345, CEA 2.0 (ref < 3.0), TSH normal, Stool OB +ve X 1

Follow up: (date: DD/MM/YYYY)Results informedDiscussed with patient and daughter…Mx: referral to Surgical SOPC (seek early appointment)

Comments:

T08 (weight loss)

• The code that best describe the case; • Also put down description of the code

• Optional; marks will not be deducted for leaving this section blank • For discussion on investigation justification, limitations of the performance, area of improvement, possible

remedial actions• Preferably avoided: clinic protocols, departmental guidelines, literature references, expert opinions; or general

summary from the medical record

• Less than 300 words #

• Concise summary from the medical record


# Section(s) grossly

exceed the words limit may be blocked and cannot be seen by Examiners

What to

prepare

• Concise summary from the medical record


48

Sample Case Summary for each patient (Attachment 13)

49

Sample Summary table (Attachment 13) What to

prepare

Summary tableCase no.

Diagnosis/ condition requiring investigation

ICPC-2 Code Tests ordered

1 malaise A 04 (weakness / tiredness)

CBC, L/RFT, TFT, Urine C/ST, CXR

2 Anemia ? Large bowel pathology

B 82 (anemia other/ unspecified)

CBC, Fe-profile, CEA, Stool OB X 3

3 Post-prandial dyspepsia D 07 (dyspepsia / indigestion)

OGD, US upper abdomen

4 Annual hypertension check K 86 (uncomplicated hypertension)

RFT, FBS, lipid profile, Urine Protein

5 Sprained ankle L 77 (sprain / strain of ankle)

XR ankle

6 Low back pain L 03 (low back symptoms / complaints)

XR LS spine

7 Hyperlipidemia, newly started on statins

T 93 (lipid disorder) Lipid profile , ALT

8 Dystrophic toe nails S 22 (nail symptoms / complaints)

Nail clipping for fungal culture

9 Amenorrhea, pregnancy test negative

X 05 (menstruation absent / scanty)

FSH, LH, Prolactin, TFT; US pelvis; PAP smear

10 Hyperthyroidism on treatment (carbimazole)

T 85 (hyperthyroidism) Free T4, TSH

Monitoring of possible side effects of medication/ treatment in asymptomatic patients added

Health screening added

OK

OK

Part E: When Examiners in your clinic What will be

assessed

Candidate can briefly show the basic layout of your medical records to the Examiners

Basic information is charted here …; the lab reports are …

Examiners will read and assess the records independently in your absence

Base on the medical records, Examiners will mark on four areas:E1 (Investigation indication documentation)E2 (Justification)E3 (Results documentation)E4 (Follow up)

Examiners had read your Attachment 13 before coming to your clinic

Candidates should have the ten medical records ready for assessment

50

51

E1 (Investigation indication documentation) What will be

assessed

Consultation notePatient: XXXM/72No: GK 123984

1 Sep 2019







--- AMT 6/10


Mx:



FU 3/52

Please note: the consultation note content are simulated and not implying a standard of pass or fail in the Exam

(candidate) Dr. ABC

Clinical information

Provisional diagnosis / Chief condition requiring investigations

Test(s) ordered

Indication of the investigation documented (E1)

Present in record

Present in record

Present in record

ICPC coded in Attachment 13

E1 (Investigation indication documentation) What will be

assessed

Indication(s) of the investigation documented in record

Indication(s) of the investigation cannot be found in the record

52

Examiners proceed to assess the record

the whole case will not be assessed pro-rata mark deduction in Part E total score

53

E2 (Justification) What will be

assessed

Consultation note Patient: XXXM/72No: GK 123984

1 Sep 2019







--- AMT 6/10


Mx:



FU 3/52

Please note: the consultation note content are simulated and not implying a standard of pass or fail in the Exam

(candidate) Dr. ABC

Marking of E2 (Justification)is the Examiner’s judgement on the record’s :

Clinical information

Provisional diagnosis / Chief condition requiring investigations

Test(s) ordered

E2 (Justification) What will be

assessed

Examiner assess all the eligible/ suitable medical records regarding the justifications of the investigations

4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5

A global mark will be given:

54

• Employ test(s) that are recognized and accepted in our local primary

care setting

• Perform the test(s) at an appropriate time / interval

(e.g. for disease monitoring)

• Test(s) are in line with the patient’s problem(s), beware of

o under-investigations: omit test(s) that help to solve the problem

o over-investigations: order irrelevant / redundant test(s)

• Consider individual needs

• Consider availability of the test in your practice setting

• Unnecessary to put down explicit explanation in the medical record to support your

choice of investigations in most cases.

Tips on Good

practice

E2 (Justification): some tips on practice

Tips on Good

practice

Investigation can be performed for a number of reasons, some

diagnostic, others therapeutic (House, 1983):

• To confirm or to make more precise a diagnosis suspected …

• To exclude an unlikely but important and treatable disease, …

• To monitor the effect or side effect of medicine, ….

• To screen asymptomatic patients, e.g. cervical cytology …

• To reassure an anxious patient that nothing is seriously

wrong, …

• To convince a sceptical patient that something is wrong and

that lifestyle amendments should be made, e.g. liver function

in a heavy drinker.

From:Robin C. Fraser. Clinical Method: A general practice approach. 3rd edition

But please note:

These two groups

of cases should not

be submitted for

the exam

56


Tips on Good

practice

The decision to investigate a patient …is based on clinical

judgement,

which is influenced by many factors –

• the clinical findings on history and examination (including social

and psychological factors),

• the doctor’s temperament and attitudes,

• the doctor-patient relationship, and

• organizational factors such as the availability of diagnostic

services,

• the time of the day or night, etc.

such decisions are often finely balanced.

In public setting, consider self-finance

basis as appropriate


57


Tips on Good

practice

…clinicians should ask themselves before requesting an investigation…

• Why am I ordering this test?

• What am I going to look for in the result?

• If I find it, will it affect my diagnosis?

• How will this affect my management of the case?

• Will this ultimately benefit the patient?


In general, investigations should be performed only when the following criteria are satisfied:

• The consequence of the result of the investigation could not be obtained by a cheaper,

less intrusive method, e.g. taking a more focused history or using time

• The risks of the investigations should relate to the value of the information likely to be

gained

• The result will directly assist in the diagnosis or have an effect on subsequent

management

58


59

E3 (Results documentation) What will be

assessed


(candidate) Dr. ABC

Investigation results/ findings

Copy of the investigation reports, e.g.

Results documented (E3)

documented in record

Present for Examiner’s inspection

21 Sep 2019






Mx:



Refer:


Geri SOPC

FU 12/52

For plain X-Ray:

CT scan

Ultrasound scan

OR

film



E3 (Results documentation)What will be

assessed

“Follow up” of the case will not be assessed pro-rata mark deduction in E4 (follow up) score

Examiners proceed to assess the record, E4 (follow up)

• The investigation results documented in the medical record

AND• The investigation/

laboratory report (copy) available

60

• The investigation results NOTdocumented in the medical record

OR• The investigation/

laboratory report (copy) NOT available



61

E4 (follow up) What will be

assessed


(candidate) Dr. ABC

21 Sep 2019






Mx:



Refer:


Geri SOPC

FU 12/52

Marking of E4 (follow up)is the Examiner’s judgement on the record’s:

Investigation results/ findings:

Further clinical information elicited (if any)

Diagnosis

Management

In the Medical record

and

E4 (follow up) What will be

assessed

Examiner assess all the eligible/ suitable medical records regarding the follow up

4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5

A global mark will be given:

62

OR

E4 (follow up)

• Recognize normal / abnormal results

• If necessary, elicit further clinical information in situations e.g.

o to help interpret incidental finding in the investigation

o refine the diagnosis

o to help planning the management

• Inform the patient on the significance and implication of the

investigation results

• Management: according to the tests results and the clinical context

• Provide appropriate management / follow up on other significant

health issues, though apparently not related to the problem investigated.

Examples: smoking, obesity, comorbidities

63

Tips on Good

practice

E4 (follow up): some tips on practice

= Part E score

Yes

No

Pro-rata mark

deduction due to E1?


____________________

E2

Justifications

( )5

Pro-rata mark deduction due to E3(If applicable) Case no. ________

pro-rata deducted

Part E score: _____

E4

Follow up

( )

What will be

assessed

64

Summation of Part E score

= Part E score

Yes

No

Pro-rata mark



____________________

Summation of Part E score: example 1

E2

Justifications

( 7 )705


pro-rata deducted

Part E score: _____

E4

Follow up( 7 )

++ +++ +++ +++ ++ ++ ++

++ ++ ++ ++ ++ ++ +++ + +

65

What will be

assessedUsual situation

= Part E score

Yes

No

Pro-rata mark



____________________

E2

Justifications

( 6.5 )645


pro-rata deducted

Part E score: _____

E4

Follow up

( 6.3 )

++ +++ +++ +++ ++ ++ ++

++ ++ ++ ++ ++ +++ + +

3

Case no. 3:

investigation

report copy NOT

available

66

What will be

assessed


= Part E score

Yes

No

Pro-rata mark



____________________

E2

Justifications

( 6.5 )67.55


pro-rata deducted

Part E score: _____

E4

Follow up

( 7 )

++ ++ +++ +++ ++ ++ ++

++ ++ ++ ++ +++ + +++

960.75

Case no. 9: Cannot found in the

record why the

investigations

(…CXR and blood

tests…) were done…

67

What will be

assessed


Part E (Investigations): pass or fail

Average of the two PA Examiners’ scores ≥ 65%?

Pass in Part E

Difference of the two Examiners mark ≥ 3.4?

Yes No

Send 3rd Examiner:the score ≥ 65%?

Fail in Part E No

Yes

Yes

No

68

Part E score

calculated based on cumulative exam data

Observations in previous PA and recommendations

69

About Candidates Issue noted Recommendation

Random check(PMP review)

Part C II (DangerousDrugs management)

DD registry printed with recycled paper• Recycled papers contain irrelevant

information• To be avoided

Part D (Medical Records)

Duplicate cases in Attachment 12• Risk of penalty & disqualifications• To be avoided

Part E (Investigations)

Not included Ix report copy (ECG) mark deduction pro-rata in E4 Fail in Part E


Submitted three cases with same ‘alphabet’ (Chapter) of ICPC-2 code Part E mark deduction pro-rata Fail


Presented a different/ amended version of medical record print-out to the 3rd

examiner

• Should present the same version seen by the previous PA examiner

• Indicate to the 3rd examiner on the area(s) amended if needed

70

Pass / Fail in PA

71

72

• One examiner ‘pass’; another ‘fail’

3rd Examiner will be sent to decide pass or fail in the following situations

The 3rd examiner• may go to your clinic in either Period A or Period B; with a 2-working-day notice in advance• assesses the same materials / Random check seen by the previous PA Examiners

What will be

assessed

• One examiner ‘pass’; another ‘fail’; and

• average of the two examiners’ marks < 65; and

• a significant gap between the two

(calculated based on culminative data)

Random check (PMP review)

C II (DD Management)

D (Medical records)

E (Investigations)

All Candidate• must keep all the examination materials seen by the previous PA Examiners;

at least until the end of Period B

73

From PA to pass the Exit Examination

Random check

Grade ‘A’ or ‘C’

Fail in PA:All the failed Part(s) need to be re-attempted as a set

Part CIIPass in both Knowledge

Practice

Part DScore

65 % or above

Part EScore

65 % or above

Pass in PA:Valid for five years; same as other individual Segments of Exit Examination Pass

in Research/

Clinical Audit

Pass in

Consultation Skill

Assessment

Pass in

Practice Assessment

Pass in Exit Examination

Candidate must have valid passes in all three Segments (CSA + PA + Research / Clinical Audit) at the same time in order to pass the Exit Examination

73

74

Enquiry

Specialty Board secretary:

[email protected]

Tel: 2871 8899 (Alky or John)

END

mailto:[email protected]

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