flowers 2 template. pa... · practice assessment (pa) test the candidates: workplace based (family...
TRANSCRIPT
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)
Four copies(A4 size)
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
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
Preventive care
Consultation noteDr. Candidate
Consultation noteDr. Colleague B
Consultation noteDr. Candidate
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
D4 (Consultation notes) What will be
assessed
Main reason(s)of the consultation
Clinical Findings
Diagnosis / Working diagnosis
Management
Areas to be examined
D4 (Consultation notes) What will be
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
D4 (Consultation notes) What will be
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
D4 (Consultation notes) What will be
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
D4 (Consultation notes) What will be
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?
D4 (Consultation notes) What will be
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
deduction due to D1?
Pro-rata deduction for Case no:
____________________
pro-rata deducted
Part D score: _____
Summation of Part D score: example 1
D3Anticipatory care
( 7 ) X 1.5
D4Consultation notes
( 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
deduction due to D1?
Pro-rata deduction for Case no:
____________________
pro-rata deducted
Part D score: _____
D3Anticipatory care
( 7 ) X 1.5
D4Consultation notes
( 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
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
Part E: find 10 suitable cases for exam
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
Part E: find 10 suitable cases for exam
Attention!!
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
Part E: find 10 suitable cases for exam
Next page
Lab reportDate: 4 Sep 2019
Referral letterTo: Geriatrics SOPC
Preventive care
Patient information
Consultation noteDr. Candidate
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
Consultation noteDr. Candidate
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
• Less than 300 words #
# 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
• Less than 300 words #
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
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
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
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
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
E2 (Justification): some tips on practice
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
From:Robin C. Fraser. Clinical Method: A general practice approach. 3rd edition
57
E2 (Justification): some tips on practice
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?
From:Robin C. Fraser. Clinical Method: A general practice approach. 3rd edition
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
E2 (Justification): some tips on practice
59
E3 (Results documentation) What will be
assessed
Consultation notePatient: XXXM/72No: GK 123984
(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
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
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
Consultation notePatient: XXXM/72No: GK 123984
(candidate) Dr. ABC
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
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?
Pro-rata deduction for Case no:
____________________
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
deduction due to E1?
Pro-rata deduction for Case no:
____________________
Summation of Part E score: example 1
E2
Justifications
( 7 )705
Pro-rata mark deduction due to E3(If applicable) Case no. ________
pro-rata deducted
Part E score: _____
E4
Follow up( 7 )
++ +++ +++ +++ ++ ++ ++
++ ++ ++ ++ ++ ++ +++ + +
65
What will be
assessedUsual situation
= Part E score
Yes
No
Pro-rata mark
deduction due to E1?
Pro-rata deduction for Case no:
____________________
E2
Justifications
( 6.5 )645
Pro-rata mark deduction due to E3(If applicable) Case no. ________
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
Summation of Part E score: example 2
= Part E score
Yes
No
Pro-rata mark
deduction due to E1?
Pro-rata deduction for Case no:
____________________
E2
Justifications
( 6.5 )67.55
Pro-rata mark deduction due to E3(If applicable) Case no. ________
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
Summation of Part E score: example 3
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
Part E (Investigations)
Submitted three cases with same ‘alphabet’ (Chapter) of ICPC-2 code Part E mark deduction pro-rata Fail
Part E (Investigations)
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:
Tel: 2871 8899 (Alky or John)
END