Clinical Examination Specifications PDF
Clinical Examination Specifications PDF
Clinical Examination Specifications PDF
S P E C I F I C AT I O N S
A u s t r a l i a n
M e d i c a l
C o u n c i l
The purpose of the Australian Medical Council is to ensure that standards of education, training
and assessment of the medical profession promote and protect the health of the Australian Community.
Statement on privacy
The AMC is required to observe the provisions of the Privacy Amendment (Private Sector) Act
2000, (effective from 21 December 2001) which sets out the requirements for the collection
and use of personal information collected before and after that date.
Each of the Application Forms required by the AMC includes a statement relating to the
AMCs privacy procedures. Each must be signed by the applicant to give formal consent for
the AMC to collect and hold personal information.
Please note: if this consent is not provided, the AMC will not be able to process the
application.
Contents
1. Guidelines and specifications
1.1 Introduction
1.2 Assessment aims and objectives
1.3 Objective of the clinical examination
1.4 Structure of the AMC Examination
1.5 Standard of the AMC Examinations
1.6 Appeals procedure
2. Clinical examination
2.1 Requirements for the clinical examination
2.2 Standard of performance required
2.3 Format of the clinical examination
2.4 Arrangements for the clinical examination
2.5 Workplace based assessment
2.6 Scheduling process for the clinical examination
2.7 Venue
2.8 Examination fees
2.9 Structured clinical assessment
2.10 Assessment criteria
2.11 Assessment objective for the clinical examination
2.12 Clinical examination content
2.13 Retest
2.14 Results
3. Marking in the structured clinical assessment examination
3.1 Key steps
3.2 Domains
3.3 Determination of results
4. Administration arrangements at the NTC in Melbourne
5. Preparation for the structured clinical assessment examination
5.1 Review of clinical skills
5.2 Conduct of candidates presenting for examination
5.3 The doctor patient relationship in Australia
5.4 General preparation for the clinical examination
5.5 Formal notification of clinical examination results and feedback
5.6 AMC certificate
5.7 Request for duplicate copies of AMC results
6. General information
6.1 Change of address
6.2 Further information
Appendix A:
Graduate outcome statements
Appendix B:
Summary of the format of the AMC Clinical Examination
Appendix C:
Structured clinical assessment station sample
Appendix D:
Recommended reading
Appendix E:
General information for the structured clinical assessment
Candidates should study these guidelines in conjunction with the current edition of the AMC
publication Information booklet for candidates (application procedures and requirements for
the AMC examination), which sets out the formal procedures for the AMC examination.
The MCQ examination focuses on basic and applied medical knowledge across a wide range
of topics and disciplines, involving understanding of disease process, clinical examination,
diagnosis, investigation, therapy and management, as well as on the candidates ability to
exercise discrimination, judgment and reasoning in distinguishing between the correct
diagnosis and plausible alternatives.
The clinical examination also assesses the candidates capacity in such areas as history
taking, physical examination, diagnosis, ordering and interpreting investigations, clinical
management and communication with patients, their families and other health workers.
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1.4. Structure of the AMC Examination
The AMC examination consists of two parts:
A computer-adaptive multiple-choice question (MCQ) examination, testing medical
knowledge. The MCQ is a computer-administered examination of three hours and thirty
minutes duration and consists of 150 questions.
A clinical examination (following a pass result in the MCQ examination), testing a wide
range of clinical and communication skills. The clinical examination is of three hours and
20 minutes duration and is administered on a single morning or afternoon. A retest
examination, duration of one hour and 40 minutes, will be administered if required.
Conditions for awarding a retest result are detailed further below.
The graduate outcomes forming the basis of medical education in Australia, as determined by
the AMC for the accreditation of medical schools, are expressed in terms of four domains:
history taking
examination
diagnostic formulation
management/counselling/education
Important Note: Candidates who lodge an appeal for a clinical examination may not apply
for a clinical examination until the outcome regarding the appeal has been received by the
candidate.
2. Clinical examination
2.1. Requirements for the clinical examination
Candidates are required to meet the pass standard in the MCQ examination before being
eligible to proceed to the clinical examination.
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2.3. Format of the clinical examination
A summary of the clinical examination is set out in Appendix B.
Examinations are held at the AMC Vernon C Marshall National Test Centre in Melbourne.
Occasionally, examinations are also held periodically in Perth and Townsville.
Candidates may only apply for one examination at a time. Therefore, candidates who have
been scheduled for a clinical examination may not lodge an application for another
examination before they have received the results of the scheduled examination.
About 2,500 places are available in each calendar year. Currently, there is no wait time to get
a placement in the AMC Clinical examination and places are allocated on a first come, first
served basis.
The scheduling process allows candidates to view exact examination dates on the AMC
website. Candidates can view the examinations open for scheduling, the closing dates and
the number of places available.
Once an examination is open for scheduling, candidates can select either Main or Retest.
Depending on the selection, relevant dates will be shown. Please note: you will only be able
to select the examination that you are eligible for (i.e. Main or Retest).
Candidates can then directly apply for the preferred examination date and select the payment
method (credit card, cheque or via ASDOT funding), a tick box option will be available for
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candidate selection. There are different closing dates depending on the method of payment.
Credit card payment: A candidate can make payment right up until the examination
closing date. Candidates paying by credit card will receive a placement letter once
payment is successfully processed. This should be immediate.
2.7. Venue
Candidates must arrive promptly and report to the administrative staff in attendance. Once
candidates have reported, they will be required to remain, under the direction of the
administrative staff, until the examination session concludes.
Candidates
Candidates are required to wait at the venue of the examination at the direction of the
administrative staff in attendance.
Due to the multi-station structure of the examination, candidates arriving late will be excluded
from commencing the examination.
The fees for the AMC examination are reviewed from time to time and are subject to variation.
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The examination fees for the clinical examination (based on current examination costs) are
shown on the AMC website (www.amc.org.au). Information regarding withdrawal fees,
currently applying to the examination are also available on the AMC website.
A retest (additional pass/fail assessment) for candidates with marginal performance will be
offered at the next available opportunity.
Candidates will rotate through a series of 20 stations, 16 of which will be assessed, and will
undertake a variety of clinical tasks. All candidates in a clinical examination session will be
assessed against the same stations.
Rest stations will not be scored, but will provide candidates with an opportunity to have a
break between the assessed stations. There are four rest stations in addition to the 16
assessed stations.
Each station will be of 10 minutes duration (two minutes changeover and reading time, and
eight minutes for the assessment). One examiner will be involved in each assessed station.
Stations may use actual patients, standardised patients, role-playing patients, or video patient
presentations. Models and other relevant equipment may also be used in the examination
(e.g. prescription pads).
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physical examination of a patient with suspected thyrotoxicosis
[examination station]
interpretation of a clinical chemistry result [diagnostic formulation station]
diagnosis of a common skin lesion [diagnostic formulation station]
counselling of an asthmatic patient on the use of an inhaler
[management/counselling/education station]
counselling of a patient with obesity [management/counselling/education station]
The structured clinical assessments will make use of examiners from all disciplines.
During the reading time the candidate evaluates the given information and plans their
approach to the assessment phase. They should plan their time, taking into account the
number and type of tasks, including any given time guidelines.
During the assessment time the candidate conducts the interaction as required and performs
the designated clinical tasks.
The clinical tasks include but are not limited to: history taking, physical and mental state
examination, investigation planning and interpretation, diagnostic formulation, management
planning, counselling and performance of procedures.
A clinical scenario may test a candidate's ability in responding to these tasks in various health
care settings, including:
community or general hospital services
metropolitan, regional or remote locations
any phase of health care: preventative, acute/critical care and continuing care
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any patient age group: new born to aged
direct patient care: carer and family interactions or multidisciplinary team interactions.
A clinical scenario may be based on normal development, prevention or on any common
and/or important diseases or syndromes, from any clinical system.
2.13. Retest
(Additional pass/fail assessment for marginal performance)
Candidates with borderline or marginal performances will have an opportunity to validate their
result as a pass or fail in the form of a retest clinical examination. There is an additional fee
for a retest. Dates of the next available retest are available on the AMC website. .
If a candidate schedules into a retest examination but fails to attend, then the overall result
will be confirmed as a fail.
The retest will involve eight assessed stations, including one women's health station and one
child health station, each of 10 minutes duration (two minutes changeover and reading time,
and eight minutes for the assessment).
To pass the retest examination, and therefore the whole structured clinical assessment
examination, a pass must be obtained in at least six of the eight assessed stations.
2.14. Results
A listing of candidates results will be available on the AMC website
(www.amc.org.au/results.asp) in the week following the examination and remain displayed for
a period of four weeks. The candidate listing will be shown by AMC candidate reference
number only, in compliance with Commonwealth privacy legislation.
Formal examination results will be posted to all candidates, usually within two weeks of the
examination. Candidates should ensure that their current address is registered with the AMC
secretariat.
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The marking system for the examination has changed. The very unsatisfactory/
unsatisfactory approach, as described in previous editions of this booklet, is no longer in use.
The revised marking system for the examination now contains two main approaches, key
steps and domains. Each station will have several key steps and domains that are relevant to
that station.
3.2. Domains
Domains may include (but are not limited to) such items as approach to the patient, history
taking, choice and technique of physical examination, accuracy of physical examination,
differential diagnosis, choice or interpretation of investigations, management, and patient
education/counselling.
Each domain selected for the station will be rated on a seven-point scale. Typically, there will
be between three and five domains in each station that a candidate will be assessed on. The
expectations of the candidate are described specifically in each domain as relevant to the
individual station.
In addition, the examiner makes a global rating of the candidates ability on the station, at the
level of an exiting medical student, again on a seven-point scale. At present, a score of three
or below constitutes a fail score, and four or above constitutes a pass score.
For a clear pass, candidates must obtain a pass score in 12 or more of the 16 assessed
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stations including:
a pass in at least one womens health station and
a pass in at least one child health station
For a clear fail, candidates must obtain a pass score in nine or less of the 16 assessed
stations
or
a fail score in all three womens health stations, irrespective of the total number of stations
passed
or
a fail score in all three child health stations, irrespective of the total number of stations
passed.
A candidate who obtains a marginal performance grade will be eligible to present for a
pass/fail retest to confirm their result as a pass or fail.
Candidates will be globally graded as clear pass or a clear fail in the retest, as follows:
clear pass (a pass score in at least six of the eight stations)
clear fail: a pass score in five or less of the eight stations.
A candidate who obtains a clear fail at the main examination or the retest will be required to
re-sit the clinical examination.
With the implementation of new format mark sheets in clinical examinations conducted from
May 2014, information is obtained in relation to a number of aspects of each individual case
that can be used to provide feedback to candidates. Such information is gathered as a score
from examiners on a scale from 1 to 7, with a score of 4 or above considered satisfactory for
that particular aspect of the station, and is reported to candidates on the feedback provided.
It is important to note, however, that the scores for the aspects that are reported as part of the
feedback provided to candidates, are not the scores from examiners that determine a Pass or
a Fail for the station. This is determined by examiners making a separate Global Judgement
about candidate performance that looks at performance across all aspects of the case, not
just those for which feedback has been provided. A pass in the clinical examination remains
at 12+/16 stations passed (with 10/16 or 11/16 constituting a retest).
Although the aspects of a case that are reported as part of the feedback provided to
candidates may contribute to an examiner's Global Score, it is not possible to determine
whether a Global Score that would result in a station being passed or failed was obtained for
a case simply by looking at the scores associated with the aspects of the case provided in the
candidate feedback.
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The first audio notification will indicate the start of the two-minute reading time outside the
candidates first station. The second audio notification will indicate the start of the examination
and candidates will then proceed into the appropriate examination room. Some candidates,
however, will be starting at a rest station (this will be shown on the starting card) and will be
required to stay in the rest station for the first ten minutes. The third audio notification will be
after eight minutes of assessment and will conclude the first station. Candidates will then
move, at the direction of the examination marshals, to their next station and read the
information outside their second station. Each station will last eight minutes, with one
examiner assessing each candidates performance.
If candidates finish a station early, this does not mean that they have done well or failed. It
merely means the task has been completed ahead of the allotted eight minutes. If candidates
complete a station either early or on time, they will be required to stand outside the station
just completed, until directed to their next station by an examination marshal.
Candidates have two minutes to move to, and read the information outside their next station.
Stations may use actual patients, standardised patients or role-playing patients. Candidates
should regard and treat every patient as they would in a real setting, and therefore need to
clean their hands as appropriate after physical examination.
In some stations, due to the eight-minute examination time period, there is not enough time to
do a full physical examination. Therefore, the examiner may interrupt and request the
candidate to move on to the next task. This should not be taken as a negative performance.
Drinking water and access to toilets will be provided at each rest station. Candidates must
remain quiet while in the rest stations, which will be supervised by examination marshals.
When the final audio notification sounds, all candidates will be guided out of the examination
area. Candidates may finish at a rest station and will be required to wait until the final
notification sounds before being allowed to leave the examination area.
For health and safety reasons, candidates are required to bring their own stethoscope to the
examination. Candidates are also permitted to carry a tendon hammer into the examination
area, although these will be provided in the station if they are required.
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All basic equipment will be provided in the examination room.
No books, textbooks, paper or other material are allowed into the examination area, including
mobile telephones or handbags. Mobile telephones must be switched off and kept in the
provide locker. All candidate belongings must be left in the locker provided during the sign in
process. Candidates are not permitted to write any prompting material, for example, on their
skin.
Any candidate found recording any information during the examination or attempting to
compromise the examination content or procedures will not be permitted to continue with the
examination and may forfeit his or her eligibility to proceed with the AMC examination
process.
Listings of candidates results will be available on the AMC website
(www.amc.org.au/results.asp) from 9am (AEST) the week following the examination and
remain for a period of four weeks. The candidates listing will be shown by AMC candidate
reference number only, in compliance with Commonwealth privacy legislation.
Formal examination results will be posted to all candidates, usually within two weeks of the
examination. Candidates should ensure that their current address is registered with the AMC
Secretariat.
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The AMC examiners also consider that candidates who are able to maintain continuing
contact with the practice of clinical medicine in a teaching hospital or other relevant clinical
service can significantly improve their chances of success in the AMC examination. It is in
each candidate's best interest to identify their clinical strengths and weaknesses and to focus
their efforts on overcoming any basic clinical deficiencies before sitting the examination.
Some candidates overlook the importance of the feedback from their MCQ examination when
preparing for the clinical examination. Reviews of performance in the clinical examination
show that there is a strong correlation between performance in the MCQ and clinical
examinations. Candidates who fail certain topics in the clinical examination are often found to
have performed poorly in the same topics in the MCQ examination.
Particular attention in the clinical examination needs to be paid to reviewing basic clinical
skills, competence and safety to a standard comparable to that expected of an Australian
medical graduate and to practising all aspects of consultation skills and doctorpatient
communication in clear, non-technical English. The examination format and standards are
geared to these aspects as required of Australian medical graduates. The AMC clinical
examination is not set at postgraduate level in internal medicine, surgery, general practice or
other specialties.
All candidates must comply with the instructions of clinical examination staff during
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examinations. Failure to do so will constitute a breach of examination procedures and may
result in action being taken against the candidate concerned.
No books, papers or electronic devices may be used in the examination. Candidates found to
be giving, receiving or recording information during the examinations will not be permitted to
continue in the examination and may forfeit their eligibility to sit future AMC examinations.
Candidates in clinical examinations are expected to observe fully the confidentiality of patients
or role playing patients who participate in the examination and should not discuss the
personal details of the consultations outside the examination at any time, with any person.
Any candidate found in breach of exam regulations will be reported to the Board of Examiners
for possible disciplinary action.
A candidate who attempts to compromise the examination procedures may forfeit his/her
eligibility to proceed with the examination. Action may be taken against any candidate found
to be selling or offering for sale materials or details purporting to be AMC examination
content.
The AMC will investigate thoroughly a complaint or adverse report concerning any candidate
sitting an AMC examination, and disciplinary action may be taken.
Family and friends accompanying candidates to an examination are NOT permitted to enter
the examination venue.
A doctor who crosses professional boundaries while undertaking the AMC's clinical
examination will be guilty of professional misconduct and may be sanctioned under the
relevant Legislation.
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condition.
Get a good nights rest before presenting for the examination. Avoid the use of stimulants
or other drugs that may impair your performance.
Read your placement letter carefully and note the times and locations of your
examination.
Ensure that you arrive on time for each clinical examination session and give yourself time
to settle down before your examination commences.
If travelling from interstate, ensure that you check any interstate time differences and allow
extra time in case of delayed flights or travel time between the airport and the city.
Listen carefully to the examiners, and read carefully any preliminary data given to you.
If you are uncertain about any instruction or question from the examiners during your
clinical examination, you should ask for clarification of the particular matter, or for the
question to be repeated.
Do not overlook the fact that there may be role-playing, standardised, simulated or real
patients in the clinical examination. The examiners will take note of the manner in which a
candidate addresses and deals with the patient. As a medical practitioner, you already
have a duty of care to your patients. The patients in the examination have a right to
receive the same care.
Where physical examination is required, exercise care with both technique and accuracy.
Ensure that you do not cause any unnecessary discomfort to the patient. Ensure that you
can identify correctly the physical signs that are present and absent. Avoid discussing
patients with other candidates who may attend the clinical examination centre in the future.
Patients are rotated and, in some cases, alternative conditions are examined in patients
with multiple clinical signs. Any candidate who attempts to formulate a diagnosis or
management on the basis of information provided by other candidates, without having
examined the patient, is likely to compromise their assessment.
The final consideration in determining the result in the clinical examination is the safety,
accuracy and appropriateness of the assessment and/or management of the patient.
A list of recommended reading is at APPENDIX D.
General information for the structured clinical assessment is at APPENDIX E.
Formal examination results will be posted to all candidates, usually within two weeks of the
examination. Candidates should ensure that their current address is registered with the AMC
secretariat.
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A listing of candidates results will be available on the AMC website
(www.amc.org.au/results.asp) in the week following the examination and remain displayed for
a period of four weeks. The candidate listing will be shown by AMC candidate reference
number only, in compliance with Commonwealth privacy legislation.
Please note: Under no circumstances will final results be given over the telephone.
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6. General information
6.1. Change of address
It is important that candidates advise the AMC secretariat promptly of each change of
address, email address and/or telephone number. This will ensure that contact can be made
as quickly as possible with candidates to notify them of examination venue changes, rule or
eligibility changes, or to confirm information provided by the candidate on his or her
application forms.
Change of address can be made via the telephone or by using the Change of address form
which can be obtained by contacting the AMC Secretariat. The change of address form is
also available on the AMC website (www.amc.org.au).
When advising of a change of address in writing, please include the following details:
candidate number
full name
previous address
new address
candidate signature
date of birth
Under the provisions of the Commonwealth Privacy Amendment (Private Sector) Act 2000
(effective from 21 December 2001), the AMC is unable to accept changes of address or other
candidate details submitted by email, unless provided on the Change of address form.
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Included below is the list of graduate outcome statements, . These statements, divided into
four domains, reflect the skills, knowledge and attitudes Australian medical students are
required to demonstrate upon graduation. Graduate outcome statements can also be found in
the AMCs Standards for assessment and accreditation of primary medical programs.
Domain 1
Science and Scholarship: the medical graduate as scientist and scholar
On entry to professional practice, Australian and New Zealand graduates are able to:
1.1 Demonstrate an understanding of established and evolving biological, clinical,
epidemiological, social, and behavioural sciences.
1.2 Apply core medical and scientific knowledge to individual patients, populations and
health systems.
1.3 Describe the aetiology, pathology, clinical features, natural history and prognosis of
common and important presentations at all stages of life.
1.4 Access, critically appraise, interpret and apply evidence from the medical and scientific
literature.
1.5 Apply knowledge of common scientific methods to formulate relevant research
questions and select applicable study designs.
1.6 Demonstrate a commitment to excellence, evidence based practice and the generation
of new scientific knowledge.
Domain 2
Clinical Practice: the medical graduate as practitioner
On entry to professional practice, Australian and New Zealand graduates are able to:
2.1 Demonstrate by listening, sharing and responding, the ability to communicate clearly,
sensitively and effectively with patients, their family/carers, doctors and other health
professionals.
2.2 Elicit an accurate, organised and problem-focussed medical history, including family
and social occupational and lifestyle features, from the patient, and other sources.
2.3 Perform a full and accurate physical examination, including a mental state examination,
or a problem-focused examination as indicated.
2.4 Integrate and interpret findings from the history and examination, to arrive at an initial
assessment including a relevant differential diagnosis. Discriminate between possible
differential diagnoses, justify the decisions taken and describe the processes for
evaluating these.
2.5 Select and justify common investigations, with regard to the pathological basis of
disease, utility, safety and cost effectiveness, and interpret their results.
2.6 Select and perform safely a range of common procedural skills.
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2.7 Make clinical judgements and decisions based on the available evidence. Identify and
justify relevant management options alone or in conjunction with colleagues, according
to level of training and experience.
2.8 Elicit patients questions and their views, concerns and preferences, promote rapport,
and ensure patients full understanding of their problem(s). Involve patients in decisionmaking
and planning their treatment, including communicating risk and benefits of
management options.
2.9 Provide information to patients, and family/carers where relevant, to enable them to
make a fully informed choice among various diagnostic, therapeutic and management
options.
2.10 Integrate prevention, early detection, health maintenance and chronic condition
management where relevant into clinical practice.
2.11 Prescribe medications safely, effectively and economically using objective evidence.
Safely administer other therapeutic agents including fluid, electrolytes, blood products
and selected inhalational agents.
2.12 Recognise and assess deteriorating and critically unwell patients who require
immediate care. Perform common emergency and life support procedures, including
caring for the unconscious patient and performing CPR.
2.13 Describe the principles of care for patients at the end of their lives, avoiding
unnecessary investigations or treatment, and ensuring physical comfort including pain
relief, psychosocial support and other components of palliative care.
2.14 Place the needs and safety of patients at the centre of the care process. Demonstrate
safety skills including infection control, graded assertiveness, adverse event reporting
and effective clinical handover.
2.15 Retrieve, interpret and record information effectively in clinical data systems (both
paper and electronic).
Domain 3
Health and Society: the medical graduate as a health advocate
On entry to professional practice, Australian and New Zealand graduates are able to:
3.1 Accept responsibility to protect and advance the health and wellbeing of individuals,
communities and populations.
3.2 Explain factors that contribute to the health, illness, disease and success of treatment
of populations, including issues relating to health inequities and inequalities, diversity of
cultural, spiritual and community values, and socio-economic and physical environment
factors.
3.3 Communicate effectively in wider roles including health advocacy, teaching, assessing
and appraising.
3.4 Understand and describe the factors that contribute to the health and wellbeing of
Aboriginal and Torres Strait Islander peoples and/or Mori, including history, spirituality
and relationship to land, diversity of cultures and communities, epidemiology, social
and political determinants of health and health experiences. Demonstrate effective and
culturally competent communication and care for Aboriginal and Torres Strait Islander
peoples and/or Mori.
3.5 Explain and evaluate common population health screening and prevention approaches,
including the use of technology for surveillance and monitoring of the health status of
populations. Explain environmental and lifestyle health risks and advocate for healthy
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lifestyle choices.
3.6 Describe a systems approach to improving the quality and safety of health care.
3.7 Understand and describe the roles and relationships between health agencies and
services, and explain the principles of efficient and equitable allocation of finite
resources, to meet individual, community and national health needs.
3.8 Describe the attributes of the national systems of health care including those that
pertain to the health care of Aboriginal and Torres Strait Islander peoples and/or Maori.
3.9 Demonstrate an understanding of global health issues and determinants of health and
disease including their relevance to health care delivery in Australia and New Zealand
and the broader Western Pacific region.
Domain 4
Professionalism and Leadership: the medical graduate as a professional and leader
On entry to professional practice, Australian and New Zealand graduates are able to:
4.1 Provide care to all patients according to Good Medical Practice: A Code of Conduct
for Doctors in Australia and Good Medical Practice: A Guide for Doctors in
New Zealand.
4.2 Demonstrate professional values including commitment to high quality clinical
standards, compassion, empathy and respect for all patients. Demonstrate the qualities
of integrity, honesty, leadership and partnership to patients, the profession and society.
4.3 Describe the principles and practice of professionalism and leadership in health care.
4.4 Explain the main principles of ethical practice and apply these to learning scenarios in
clinical practice. Communicate effectively about ethical issues with patients, family and
other health care professionals.
4.5 Demonstrate awareness of factors that affect doctors health and wellbeing, including
fatigue, stress management and infection control, to mitigate health risks of
professional practice. Recognise their own health needs, when to consult and follow
advice of a health professional and identify risks posed to patients by their own health.
4.6 Identify the boundaries that define professional and therapeutic relationships and
demonstrate respect for these in clinical practice.
4.7 Demonstrate awareness of and explain the options available when personal values or
beliefs may influence patient care, including the obligation to refer to another
practitioner.
4.8 Describe and respect the roles and expertise of other health care professionals, and
demonstrate ability to learn and work effectively as a member of an inter-professional
team or other professional group.
4.9 Self-evaluate their own professional practice; demonstrate lifelong learning behaviours
and fundamental skills in educating colleagues. Recognise the limits of their own
expertise and involve other professionals as needed to contribute to patient care.
4.10 Describe and apply the fundamental legal responsibilities of health professionals
especially those relating to ability to complete relevant certificates and documents,
informed consent, duty of care to patients and colleagues, privacy, confidentiality,
mandatory reporting and notification. Demonstrate awareness of financial and other
conflicts of interest.
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take a relevant focused history to enable you to further evaluate this problem; you
should take no more than five minutes for this task
obtain the relevant examination findings from the examiner; the examiner will only
give you the results of the examination findings you specifically request
explain to the patient the probable diagnosis and the possible differential diagnoses
giving your reasons
take a relevant focused history from you to further evaluate this problem
obtain the relevant examination findings from the examiner
explain to you the probable diagnosis and the possible differential diagnoses
inform you of their immediate plan of management.
Opening statement:
'I'm worried about my breathing. Yesterday at work I suddenly became short of breath and I
was not doing anything energetic.'
In response to further open questions such as When did it all start? say:
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'At the time, I was sitting in a meeting, and noticed quite suddenly that I was short of breath
even though I was just sitting down. At the same time I noticed I was coughing up phlegm.'
In response to further open questions such as 'Have you noticed anything else?', say:
'I don't think I've noticed anything more, although I'm still a little breathless.'
In response to direct or specific questions from the candidate, provide the following
information (do not provide this in response to broad/open-ended questions):
I couldn't sleep last night because of breathlessness and had to sleep sitting up.
I'm not as short of breath today as I was yesterday.
I've never had shortness of breath like this before.
I've been able to walk on the flat easily, but have had trouble walking up stairs in the
last 24 hours.
I haven't noticed any chest pain.
There have been no palpitations.
I've been coughing up phlegm since developing the shortness of breath.
It was white and clear but it had a few spots of blood in it today (only provide this
detail if the candidate asks about the phlegm colour).
I have not fainted or lost consciousness.
I don't have any wheezing.
I've never had asthma.
I have not had any fever.
I have not had any recent colds or the flu.
I haven't had any leg or ankle swelling.
There's been no calf pain or tenderness.
Three weeks ago I was on holidays in the States and arrived home six days ago
(again: don't give any of this information unless travel has been specifically asked
about).
I took sleeping tablets to help me sleep during the flight. I managed to sleep most of
the way home.
I'm not on the oral contraceptive pill or any other medications. I get my sexual partner
to use a condom.
I have never had DVT or blood clots.
No one in my family had DVTs or blood clots.
I smoked about ten cigarettes a day from my late teens until about two years ago.
I'm only a social drinker and have an occasional glass of white wine at weekends.
To other questions, respond with either 'no', 'I dont know' or 'I'm not sure'.
Responses after candidate starts to explain the likely diagnosis and its management:
If a diagnosis that the average patient would not know much about (i.e. pulmonary
embolism), say: 'What is that?' and 'Is it serious?'
If only one diagnosis is mentioned, ask: 'Could it be anything else?'
If told that you will have to go to hospital, say: 'Is that really necessary?' and: 'What
will they do?'
26
Information for examiners
The aim of this station is to assess the candidate's ability to:
take an appropriate focused history to evaluate and diagnose the likely cause of the
sudden onset of shortness of breath in this woman. The possible diagnosis could be
asthma, pulmonary embolism, pneumothorax, or chest infection (including bird flu)
each of these possibilities should be addressed in the history.
explain to the patient the most likely diagnosis and the appropriate differential
diagnoses
Vital signs: Pulse 104/min and regular, BP 110/65mmHg, Temp 36.8C, Respiratory
rate 2426/minute, oxygen saturation 90% on room air.
Height 155 cm, weight 68kg, BMI 28 (overweight range)
The patient is short of breath, but not otherwise in distress.
The trachea is not deviated.
There is no evidence of cyanosis.
Heart: Apex beat 5LICS, no parasternal heave, two normal heart sounds, pulmonary
second sound is not increased, no bruits.
JVP: not increased.
Lungs: normal findings on inspection, palpation, percussion and auscultation, no
rubs.
Abdominal examination: normal.
27
Diagnosis/Differential diagnoses:
pulmonary embolism
pneumothorax
infection: bacterial or viral
asthma
myocardial infarction
acute left ventricular failure
Management plan:
The immediate plan of management should include:
admission to hospital
investigations: CT pulmonary angiogram (CTPA) or lung scan, chest X-ray, ECG and
cardiac enzymes, FBE, arterial blood gases, and peak flow)
anticoagulant therapy:
o Usually low molecular weight heparin is initially administered, followed by
six months of oral warfarin.
o Heparin is administered first because of its short onset of action.
o Fractionated low molecular weight heparin is commonly used because of its
easy dosing and administration (once or twice daily and subcutaneously) and
because blood monitoring is not required.
o Warfarin should be started immediately.
The candidate must convey to the patient, without unnecessarily alarming her, that this is a
serious illness which could be life threatening, requiring immediate management in hospital
for investigation and treatment.
sighted
Key Steps: Did the candidate exhibit the following key steps in the station?
NO
1.
2.
3.
4.
YES
Level of Performance Observed: Rate the candidate in each of the following domains.
History
2.
3.
4.
Diagnosis/Differential diagnoses
Considered the likely diagnosis of pulmonary embolism and
differential diagnoses of pneumothorax and chest infection.
Management plan
Advised the patient, without unnecessarily alarming her, that
this was a serious illness which could be life{hreatening, and
required immediate management in hospital for investigation
and treatment. lndicated to the patient that the key
investigations would be a CT lung scan, ECG and blood tests
PASS
FAIL
Date: l9103/2015
28
Surgery
Burkitt HG, Quick CRG, Reed JB. Essential Surgery Churchill Livingstone 2007 ISBN
Tjandra JJ, Clunie GJA, Kay AH, Smith J. Textbook of Surgery, 3rd edn Wiley-Blackwell,
Oxford 2005. ISBN 9781405126274. www.wiley.com
Hunt PS, Marshall VC. Clinical Problems in General Surgery. Butterworths, Sydney, 1991.
ISBN 0409492132. This publication is out of print and only available second hand.
Child health
South M, Isaacs, D. Practical Paediatrics, 7th edn. Churchill Livingstone, 2012. ISBN
9780443102806. www.us.elsevierhealth.com
Royal Childrens Hospital (Melbourne, Vic.). Paediatric Handbook, 8th edn. Wiley-Blackwell,
Oxford 2013. ISBN 9781405174008. www.wiley.com
National Health and Medical Research Council (NHMRC). The Australian Immunisation
Handbook. 9th edn. Australian Government Printing Service 2008. ISBN 1741864836.
www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home
Hull D, Johnston D. Essential Paediatrics, 4th edn. Churchill Livingstone, Edinburgh, 1999.
ISBN 0443059586. www.us.elsevierhealth.com
Women's health
Llewellyn-Jones D. Fundamentals of Obstetrics & Gynaecology, 9th edn. Mosby, London
2010. ISBN 9780723435099. www.us.elsevierhealth.com
Beischer NA, Mackay EV. Obstetrics and the Newborn - An Illustrated Text, 3rd edn. WB
Saunders, Sydney 1998. ISBN 0702021237. www.us.elsevierhealth.com
Mackay EV, Beischer NA, Pepperell R, Wood C. Illustrated Textbook of Gynaecology, 2nd
edition, WB Saunders, Sydney 1992. ISBN 0729512118. www.us.elsevierhealth.com
Mental health
Cowen P, Harrison P, Burns T. Shorter Oxford Textbook of Psychiatry, 6th edn, Oxford
University Press, 2012. ISBN 0198566670 (paperback).
www.oup.com/us/corporate/publishingprograms/medical/?view=usa
29
American Psychiatric Association. DSM-V: Diagnostic and Statistical Manual of Mental
Disorders, 5th edn. American Psychiatric Association, Washington DC, 2013. ISBN
0890420254 (paperback); ISBN 0890420246 (hardback). www.psych.org
General Practice:
Murtagh J. General Practice, 5th edn. Hardcover. McGraw Hill Australia, 2011. ISBN
9780074717790. www.mhprofessional.com
Murtagh J. Practice tips, 5th edn. Soft cover. McGraw Hill Australia, 2008. ISBN
9780070158986. www.mhprofessional.com
Population Health:
Online resources and guidelines
The following list provides a summary of guidelines on a range of Australian population health
topics. These are freely available online from the Heart Foundation and the Royal Australian
College of General Practitioners website.
Guidelines for preventive activities in general practice (The Red Book) 7th Edition 2009
www.racgp.org.au/guidelines/redbook
Putting Prevention Into Practice - The Green Book 2nd edition
www.racgp.org.au/guidelines/greenbook
SNAP: a population health guide to behavioural risk factors in general practice
www.racgp.org.au/guidelines/snap
National guide to a preventive assessment in Aboriginal and Torres Strait Islander peoples.
www.racgp.org.au/guidelines/nationalguide
National Heart Foundation of Australia physical activity recommendations for people with
cardiovascular disease
www.racgp.org.au/guidelines/cardiovasculardisease
Smoking cessation guidelines for Australian general practice
www.racgp.org.au/guidelines/smokingcessation
The Australian Immunisation Handbook 9th Edition 2008
www.racgp.org.au/guidelines/immunisation
National HPV vaccination program
www.racgp.org.au/guidelines/immunisation/hpv
Diabetes management in general practice (16th Edition) 2010/11
www.racgp.org.au/guidelines/diabetes
Absolute cardiovascular disease risk assessmentquick reference guide
30
www.heartfoundation.org.au/SiteCollectionDocuments/A_AR_QRG_FINAL%20FOR%20WEB
.pdf
Care of Patients with Dementia
www.racgp.org.au/guidelines/dementia
Refugee Health
www.racgp.org.au/guidelines/refugeehealth
Cancer Councils recommendations for screening and surveillance for specific cancers:
Guidelines for general practitioners.
www.cancer.org.au/File/HealthProfessionals/CCA-Screening-Card-for-GPs.pdf
Journals
In addition to the major texts, journals should be read selectively, using editorials, annotations
and review articles. The following journals are suggested as source material:
Australian Family Physician (www.racgp.org.au/publications)
Australian Prescriber (www.australianprescriber.com)
31
British Medical Journal (www.bmj.com)
British Journal of Hospital Medicine (www.hospitalmedicine.co.uk)
Current Therapeutics, Lancet (www.thelancet.com)
Medical Journal of Australia (www.mja.com.au)
New England Journal of Medicine (www.nejm.org/)
32