MAKING MANDATORY CPD EASIER

n order to help the Fellows of the College • Reduce research time of individual trainee resources, while a longer term goal

I meet the requirements of mandatory

CPD, the RACP has initiated an online
resources portal project.
The online resources portal, called
MyResources Gateway, is an online website
•

•
Fellows and trainees
Standardise criteria for assessment and
review of content quality and relevance
Ensure that educational resources are
is to develop the Gateway in the style of an
interactive ‘communities of practice’ site
where Fellows can directly participate in
the discussion, creation and evaluation of
material that informs site content.
of sufficient quality.
which will facilitate easy access to a The MyResources Gateway Steering
collection of high-quality resources and will Currently, the sourcing and dissemination Committee would like to establish lines of
be available to Fellows and trainees across of resources has been undertaken by the communication and cooperation across all
the Divisions, Chapters and Faculties of the organisers of individual programs and Divisions, Faculties and Chapters in order
College. modules within the narrow scope of their to ensure that the resources identified are
target audience. This project will create a suitable and to link any related projects
The MyResources Gateway project will
centralised point from which notification that are being developed with the work of
identify educational resources, determine
and access can be provided through the Resources Gateway. Most Societies,
their quality and suitability for CPD,
established online College infrastructure. Faculties and Chapters have already been
and then provide easy access through
contacted either directly or via a letter of
the creation of the online MyResources The MyResources Gateway has an invitation, and although there has been
Gateway. The project will also assist the anticipated launch date of June 2010 but is some very positive feedback, we would
College to identify gaps in resources and to seen as an ongoing project that will require like to continue to build participation. If
address those gaps through commissioning continuing maintenance in identifying you would like to know how your Society,
the development of and/or sourcing of new
and evaluating new resources, while also Faculty or Chapter can become involved in
educational material.
assessing the relevance of existing content. the MyResources Gateway, please contact
The development of this project will create the Project Officer at
Although the primary role of the
a centralised and catalogued resource portal Eamon.Vale@racp.edu.au for more
MyResources Gateway is to provide easy
which will have the following benefits: information.
access to College-produced learning modules
• Provide easy access to relevant and support CPD resources, the project has Eamon Vale
educational resources many more exciting possibilities. Initially, CPD Education Resource Officer
the Gateway will be extended to include Education Deanery

A LATTE WITH THE EXAMINERS

THE CLINICAL EXAMINATION 2009

T
he usual, thanks John—although ‘What do you think the echo will show for Ahmed led a useful discussion about the
Ahmed might be more settled if Mr Briggs, Anne?’ Ahmed had detected importance of assessing the carotid pulse
his coffee was decaffeinated, now a systolic murmur on a patient admitted volume and the relevance of the fourth
that he has passed the Clinical overnight with falls, with the usual heart sound, while we waited for the coffee.
Examination.’ We were half-way through our sloppy admission notes. He had raised
round, taking our usual coffee break. So far ‘How was your feedback on the cases,
the possibility of aortic stenosis. ‘I’m not Ahmed?’ Nothing could really dent his
things had been going very well and we had entirely sure,’ she replied, ‘but the way
seen some interesting patients. enthusiasm and new confidence since the
Ahmed is going at present, he’s probably examination, but I knew that the obsession
‘I’m not sure why Mrs Tankard has got right again’. Mike smirked. with detail that would make him a good
splenomegaly, Ahmed. But I agree, it’s physician would also have caused him to pour
‘Yes, but the question is, if you think Mr
definitely palpable when you get her to relax over every item of the examiners’ comments.
Briggs has aortic stenosis, do you think it is
and take a deep breath. You could feel it,
severe enough to be relevant to his falls,’ I ‘Generally, I found it helpful but it was a bit
couldn’t you Mike?’
asked. Anne had been spending a lot of time frustrating in parts. I still don’t know what
This was rhetorical—Mike, our medical with her books, preparing for the written they were getting at in the patient with the
student, always agreed about signs. examination next year. We needed to make rheumatoid hands. I made the diagnosis and
sure she didn’t forget her clinical skills. did a pretty good functional assessment but I

RACP News December 2009 21

 Education

only got a 4 plus,’ said Ahmed. ‘And yet, in the myotonic dystrophy are essentially a spot List of Short Case Diagnoses
peripheral neuropathy with the sensory signs diagnosis; others depend on a specific search Adult Medicine Clinical
that I was sure I had completely bombed, I for myotonia. Generally, in patients with an Examination 2009
passed with the same score.’ obvious spot diagnosis, a good candidate
will try to focus more on the information
Experience with trainees since they have been Cardiovascular No. of Cases
that has been given about the patient, rather
receiving the examiners’ reports is that their Mitral Incompetence 27
than running the routine. The patient
judgement about their own performance Aortic Stenosis 18
with limited scleroderma is introduced as
is often more critical than the examiners’ Aortic Incompetence 15
being increasingly short of breath. A good
and that the examiners’ reports are often a
candidate will spend time trying to work out Hypertrophic Obstructive 14
surprise. Examiners review the short cases Cardiomyopathy
if the shortness of breath is due to interstitial
without any prior knowledge and are well Mixed Mitral and Aortic Valve disease 13
fibrosis or perhaps to primary pulmonary
aware of the difficulty of individual patients. Pulmonary Hypertension +/– Tricuspid 13
hypertension. The focus will be on the chest, Incompetence
Sensory examination can be difficult to assess
the right ventricle and second heart sound, Congenital Heart disease 12
and sometimes made more so by a patient
rather than on the number of fingers than VSD 11
trying hard to contribute to the examination.
can be inserted into the patient’s mouth. Mixed Aortic Valve disease 10
In such cases, the examiners usually pay
more attention to the process of physical The key to performing well in short cases Prosthetic Valve(s) 7

examination and whether the technique of lies in familiarity with the tasks of physical Mitral Valve Prolapse 5

sensory examination is well practised. The examination. A candidate who is at ease with Mitral Stenosis 5

correct interpretation of muscle wasting and patients, clearly and succinctly explains to Mixed Mitral Valve disease 4
a good technique for assessing reflexes are them what it is they are trying to achieve Pulmonary Incompetence 4
likely to carry more weight. The examiners and moves through the examination Other 3
will be well satisfied with a diagnosis tasks smoothly almost always scores well. TOTAL 161
of ‘peripheral neuropathy, both motor In contrast, a candidate who is unable
and sensory, probably long standing’. A to position a patient correctly, struggles
comprehensive list of differential diagnoses, to achieve adequate exposure without Neurology No. of Cases

including the rare cause for a specific patient, embarrassing themselves or the patient, Polyneuropathy — Others (Pure motor, 21
sensorimotor etc.)
may not be required. and looks blankly at a blood pressure cuff is
Muscular Dystrophy — Myotonic 14
telling us that these are unfamiliar tasks and
Conversely, the examiners may require Cranial Nerve lesions including 13
that they need another year of preparation. Pituitary Tumours
more than a diagnosis in an obvious case
Following the 2009 Adult Medicine Clinical Multiple Sclerosis 12
like a patient with rheumatoid hands. Was
the trainee particularly careful with the Examination in July, an audit was performed Myopathy / Myositis 10

examination when told that the patient of the examiners’ feedback sheets. These are Polyneuropathy — Charcot Marie Tooth 7

complained of pain in the hands? Did the filled in by the national examiner after the Motor Neurone Disease 7

trainee search carefully for signs of activity, patient’s signs have been agreed between Parkinsons Disease / PSN / Huntingdons 7

as opposed to deformity, in any of the joints? examiners. Despite the limited time available Cerebrovascular lesions 7
Were tests for functional impairment fitted to to complete the sheets, they are surprisingly Polyneuropathy — CIDP 6
the patient’s deformities—or did they seem to thorough in most cases. They contain Muscular Dystrophy — FSH / 6
information about the way the patient was Bulbospinomuscular
be part of a routine without much thought?
introduced, the system for examination, the Hereditary Spastic Paraparesis 6
The National Examining Panel has been
diagnosis that was reported for the patient Other spinal cord lesions / Syringomyelia 6
discussing whether some short cases are
(completed after the signs had been agreed) Other LMN lesions 6
intrinsically more difficult for trainees in
and the physical signs for the patient. In Neuro Others (electrical injury, Niemann 6
the Clinical Examination. Is a patient with Pick, undefined UMN etc.)
some cases, examiners also indicate which
myotonic dystrophy an easier neurological Friedrichs Ataxia / Spinocerebellar Ataxia 5
signs were considered difficult and which
case than one with a visual field abnormality? Cerebellar disease 5
signs in particular were thought to be
What does a trainee have to do to produce Cervical Myelopathy / Other spinal cord 5
important and should be found by a trainee.
a better than expected performance with lesions

a patient with limited scleroderma and As part of this audit, we established this Poliomyelitis 3

interstitial fibrosis? diagnostic list for Adult Medicine patients Brachial Plexus lesion 2
used in the Clinical Examination in July 2009. TOTAL 154
The answers depend on the specific patient
being examined. Some patients with

22 RACP News December 2009

Respiratory System No. of Cases The National Examining Panel thought
Interstitial Lung Disease +/– CREST 39
that it would be helpful for trainees to have MEDICO-LEGAL
this information. While individual trainees
Bronchiectasis 16
can expect a random selection of four
REPORT WRITING
Pneumonectomy / Lobectomy 9
patients from this list in their examination, COURSE
Pleural effusion 7
it would be sensible to ensure familiarity Saturday, 13 February 2010
Resp — Others 6
with the clinical characteristics of the 9 am – 5 pm
Lung Cancer 4
commonly occurring cases. We are now
COAD 4 Stamford Grand Hotel
assessing which types of cases have best
TOTAL 85
Glenelg, Adelaide
discrimination as examination cases and
what impact there is when patients with Registration Fees $575

Musculoskeletal System No. of Cases

spot diagnoses are used in the examination. Trainees $350
Rheumatoid Arthritis 29
We are also assessing the variation in
This trans-jurisdictional course is
performance that exists for individual
Limited Scleroderma / Scleroderma 19 essential for anyone involved in the
trainees on specific cases. The audit will
Psoriatic Arthropathy 10 process of requesting, writing or
provide useful information about the interpreting reports in compensable
Ankylosing Spondylitis 8
individual components of the examination injuries, workers’ compensation, motor
Gout 3
that contribute to reliability and help with vehicle accidents and personal injury.
Others (Haemachromatosis, SLE) 2
its standardisation.
TOTAL 71 The course will provide you with the
We examined the list of diagnoses together. unparalleled opportunity to learn from
the experts about:
‘So, Anne, how do you think you would go
Haematology No. of Cases
with a patient with a right upper lobectomy, • Customer needs and report
Chronic Lymphocytic Leukaemia / 17 content—what does the
Lymphoma or with a patient who has a foot drop?’
customer do with your report?
Myelofibrosis / Chronic Myeloid 16 Anne’s eyes widened pensively. Ahmed
Leukaemia
looked at her encouragingly. Mike finished • How to write defensible reports—
Polycythaemia Rubra Vera 4 slurping the froth from his cappuccino and common techniques that trip up
Others (HIV, Isolated Splenomegaly, 3 smirked again. the experts
Sarcoidosis)

TOTAL 40 Associate Professor Stephen Judd FRACP • How to conduct the examination
• What you need to document and
why
Renal No. of Cases

Polycystic Disease +/– Renal Transplant 32

• Communication, report format,
written expression, addressing
TOTAL 32
the needs of the referrer and the
MyCPD APPROVED patient
Gastrointestinal System No. of Cases
AS PROTECTED • Critical thinking, decision making
Chronic Liver Disease +/– Portal 21 and bias
Hypertension QUALITY
Hepatomegaly undefined 3 ASSURANCE • How to distinguish between
causality and predisposition—is it
Splenomegaly (Others) 3
ACTIVITY IN NZ truly work-related?
Hepatomegaly Metastatic disease 2
The Hon. Tony Ryall, the New • Pre-existing conditions—
Hepatosplenomegaly (Others) 2
Zealand Minister of Health, advised acceleration, aggravation and
Abdominal mass (Ca Pancreas) 1
on 22 September 2009 that MyCPD exacerbation
TOTAL 32
has been approved as a Protected
Quality Assurance activity under the • Testing the evidence and
Health Practitioners Competence procedural fairness
Endocrine System No. of Cases
Assurance Act 2003. Associated with For more details on this course and
Goitre 10
this approval are mandatory annual online registration visit:
Acromegaly 4 reporting requirements which will be www.dcconferences.com.au/afoem.
Others 2 the responsibility of the New Zealand ime
TOTAL 16 CPD Committee in conjunction with
the New Zealand Joint Executive.

RACP News December 2009 23