Examination Performance

general practice Aug 05, 2018

Well, hello everyone.

I'll see if the signal works.

I just got home.

It's been a long day because I did a nursing home visit and also a visit to one of my patients who's had a crush fracture and is recovering in her home.

So it's like ten past six, it's date night and I'm going to take my wife out for dinner tonight .

If you're a GP and I'm going to strongly recommend you try out weekly date nights to preserve your relationship with your significant other, your wife or your husband or whoever that is in your life.

I'm finding it pretty helpful so that's the first tip for tonight.

What I wanted to cover is how exam performance can be impeded by poor preparation across clinical knowledge, critical skills and clinical reasoning.

So I was talking to a doctor yesterday and he said, "You know, Tom, I've know I've failed 2018.2."

I said, "Well, how can you know that?" And he said, "Well, the night before I hardly slept."

So I said, "Okay. What happened there?"

And as we dug a little deeper it came out that his clinical knowledge wasn't as tight as he thought it was.

It wasn't as good as he thought it was so there was a couple of skin questions where he didn't get any marks and then I asked about clinical skills.

And I'm like, "Well, how do you examine the respiratory system?"

He's like, "What are you talking about?"

"Well, you know, like a systematic approach to clinical skills."

And eventually he was like, "Oh okay, I get you.

You're talking about looking at fingernails and then checking the pulse and then looking for conjunctival pallor then the rest of the examination through to listening to the lungs."

I was like, "Yes. Yes, that there."
And just felt like that wasn't that tight so they may have been marks around the systematic approach to clinical examination that were hidden in the KFP that he may have missed.

Questions like... what's your approach to examining this patient with a cough and there were marks there for that systematic approach.

And then the last part because the clinical knowledge was weak and the clinical skills were weak then the clinical reasoning was weak as well and he lost marks around being asked to come up with missed diagnoses or list of diagnoses and that just wasn't strong or hadn't really put enough thought into that those questions were coming or likely in the KFP.

Now in my book, even though these were all problems, the overall outcome for him was on the night before the exam there was not enough sleep because his confidence was being effected. 

He was unable to sleep because he was thinking have I done enough work?

Have I covered everything?

Have I put in the hours?

And I think that, that really came through and showed up in the lack of sleep and then when he sat the exam, it meant that the fatigue from the sleep actually did impair the results plus the weakness across the other areas.

So the message that I'm going to give, if you are sitting the FRACGP Exams your exam performance will depend on your capacity to be organized and to put in the work across the three major areas, clinical knowledge, the foundational piece, clinical skills, which is going to be necessary for OSCE but you want to be practicing it beforehand so there's not a huge cramp after you've passed AKT and KFP and then the last thing is clinical reasoning.

Actually thinking about how are you going to get from a presenting complaint through to the diagnoses whether there's enough information to work out that it's just a single diagnosis or whether it's a very vague presentation that there's multiple diagnoses on the table from the beginning.

So actually doing that work beforehand, before your exam will mean you can sleep in the nights before the exam.

All right, that's all I got for tonight.

I'm going to go and have a nice meal.

We're going to head to Foxy Lu-Lu's I think it is. It's a Vietnamese restaurant in town.

Fortunately the number of Vietnamese restaurants has increased greatly in Byron Bay from being zero about two years ago to now we have three good ones and another good one called Pink Lotus just opened in Mullumbimby, which is where I work.

So I'm excited for that so if you're a GP, go try out the date night thing.

If you're sitting your exams I got two things for you.

One, go check out my book called Master Your GP Fellowship at mastergpfellowship.com or if you know that you need help and you didn't have a very good exam or you just want to really nail your exams and take away the question marks then head over to graduatemedicine.com/applygpea and we will talk about if we are a good fit for each other.

That's the General Practice Exam Accelerator, a program that I run to accelerate your progress and make sure that you get your fellowship. .

All right, you guys, have a great night.

Talk you soon.


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