2014 Candidate Orientation Presentation - Certification Examination in Family Medicine

The OSCE Format of the

Clinical skills component of the

Certification Examination in family medicine:

Pre-exam orientation for candidates

The Certification Examination in family medicine

The Certification Examination in family medicine is comprised of two components: a written examination and a 12-station clinical skills examination.

• The clinical skills examination is comprised of eight 10-minute objective structured clinical examinations (OSCEs) and four simulated office orals (SOOs) each 15 minutes in length.

• OSCEs take place on Saturday and SOOs on Sunday.

Certification Examination in Family Medicine, OSCE portion

Introduction

Meet Dr. Campbell and Dr. Fournier. They will be taking the OSCE portion of the clinical skills component of the Certification Examination in family medicine today. Let’s follow them as they go through the OSCE.


What to bring

The list of items to bring to the OSCE is included in the Candidate Information Sheet that will be sent to you by mail prior to the examination.


Items to bring to the exam Items to leave at home

Entrance card (will be sent to you by mail)

Your lunch

Lab coat Pencils/paper

Reflex hammer Electronic devices

Stethoscope Large bags or purses

Watch (there might not be clocks in the exam rooms)

Coat check

A coat check will be provided at the site to store your personal items during the examination and sequestering period.

However, as storage space will be limited, we ask that you please leave all large bags and handbags at home.


Candidate registration

Dr. Fournier has arrived at the examination site. Once he has registered, exam staff will hand him an ID badge, a pencil and a notebook before directing him to the orientation room.


Candidate orientation

During the candidate orientation on examination day, the facilitator will give a brief presentation and answer your questions.


In her notebook, Dr. Campbell will find bar code labels and blank pages.


I can use my notebook throughout the examination for reference and note taking. The notebook will not be graded.

I won’t tear out any pages because I have to hand in my

notebook INTACT at the end of each examination day. This includes the label backing

sheet.

Each notebook contains a few extra labels. If I lose one or two, I don’t need to worry.

Candidate notebook

Overview of the OSCE


0102

03

04

0506

07

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10The Saturday session of the examination is comprised of ten 10-minute stations:

• eight patient-encounter stations (in blue);

• two rest stations (in yellow).

Start station


Exam staff will be there to guide me and answer my questions during the

examination.

My start station will be written on the Candidate Information Sheet I will

have received in the mail and on my ID badge.

I will start at this station number and will then go through the remaining

stations in numeric order.

0102

03

04

0506

07

08

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10

Timing of OSCE stations

• You will have two minutes to read the candidate instructions posted by the door before the buzzer sounds, prompting you to enter the room.

• You will then have 10 minutes in the room.

– A warning buzzer will sound at nine minutes.

– A second buzzer will signal the end of the station. At this point, you will have to leave the room.

• You will then get two minutes to read the instructions for the next station, and so on.


10-minute stations

Candidate instructions

In any given station, you may be asked to do one or more of the following tasks:

– perform a physical examination;

– obtain a history;

– manage an acute patient problem;

– respond to a patient’s concerns;

– counsel the patient and/or a colleague.


Before entering the room, I will read my instructions carefully in order to determine what my task is for

the station.

The instructions will also be available in

the room.

Joseph Trans, 40 years old, presents himself to your office with a two-hour history of abdominal pain.

IN THE NEXT 10 MINUTES:

• CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION.

As you proceed, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.

GIVE ONE LABEL TO THE EXAMINER.


My task here is to conduct a physical examination. Therefore, I won’t ask history questions to the patient.

I’ll treat the standardized patient as a real patient because I will only get credit for tasks I complete satisfactorily.

More sample stations are available.

SampleCandidate instructions

http://mcc.ca/examinations/mccqe-part-ii/exam-preparation-resources/#station

Bar code labels


As I walk into the room, I hand one bar code label to the examiner.

Oral questions


In some stations, the examiner will ask me one to three brief questions after the warning buzzer. In these stations, I will not be able to continue interacting with the patient after the warning buzzer, even after I have finished answering the examiner’s question(s). (If there are no oral questions for a station, I will have the full 10 minutes to interact with the patient.)

The oral questions are related to the patient I just saw and are about matters like diagnoses, management decisions, or ethical or legal issues.

The candidate instructions will clearly state whether there are oral questions for a station.

Medical equipment

If a station requires the use of medical equipment other than a stethoscope and a reflex hammer, it will be provided in the room.


Patient management stations

During the examination, you might be asked to manage a patient problem.

In these stations, a standardized health professional, such as a nurse, might be present in the room.


I will direct the nurse to order any tests or perform any procedures I believe are

appropriate for this patient.

I may be evaluated on my interaction with the nurse.

If a standardized health professional is present in the room, the candidate

instructions will clearly state so.

Download a video clip of a

candidate in this type of station

http://www.youtube.com/watch?v=OA6e2UauM0U&list=TLWLPWfgCw6QFhM-bILn1UEwMSh0rqntSm





Physician examiners

• Examiners observe and assess your performance with pre-set score sheets.

• A second observer may be present to observe protocols and to ensure exam quality.

• In physical examination stations:


• Tell the examiner what you are doing and briefly describe your findings.

• You must demonstrate your clinical skills. You will only get credit for tasks completed to the examiner’s satisfaction.

Examiner interventionsExaminers may intervene:

• by asking you to reread the instructions;

• to protect the standardized patient;

• to stop you from doing genital or rectal examinations.


– If such examinations are needed, clearly inform the examiner that you would perform them.

• By reporting findings if they are available. If no findings are reported to you, please trust the findings from your examination of the standardized patient.

Download a video example of an examiner

intervening

http://www.youtube.com/watch?v=yQD-EpfJ3bg&list=TLWLPWfgCw6QFhM-bILn1UEwMSh0rqntSm



Standardized patients (SPs)

SPs are trained to simulate patients’ signs and symptoms in a reliable and consistent manner.


Treat them as you would treat actual patients and accept their simulated findings as real.

You may be scored on the way you interact with them.

Rest stations

• Rest stations may be included in the examination for each session.

• During these stations, there are no patients, no questions and no evaluations.

• Please sit quietly. You can take this time to rest before your next station.


I might sit through a few rest stations during the examination.

Sequestering

For security reasons, candidates may be required to remain on site for up to three hours before or after the examination session.

• You will not have access to your personal belongings or telephones during this time.


Any breach of the rules or lack of co-operation on my part

could invalidate my examination results and prevent access to future

examinations.

Sign out

Before leaving after each exam day, follow the instructions of the exam staff:

• hand in your notebook (leave all pages intact, including the backing sheet from your bar code labels and any unused labels);

• hand in your ID badge;

• sign out on the sheet.


Confidentiality reminder


During the application process, we agreed to use examination materials solely for the purpose of completing the examination and to not disseminate or reveal to others the examination

materials or content.

That means you CANNOT discuss or disclose exam content (including patient portrayals and findings, oral questions, etc.) at ANY TIME, in ANY WAY even after the examination is over.

Examples of this include comparing patient responses with your colleagues, sharing content with future exam candidates, and

posting case information online.

Any breach in confidentiality of exam materials may lead to disciplinary and legal measures,

including invalidating your results and preventing you from participating in future

examinations.

What do I do if…

You can use the washrooms:

• before you start the examination;

• while in sequestering.

If you have an urgent need at other times, please inform exam staff.


I have to go to the bathroom?

What do I do if…

Consult the exam staff as soon as possible.

The staff members are there to help you and are aware of the protocols to follow.

It is imperative that you remain calm and co-operative.


I lose my notebook and/or my bar code labels?I feel ill? I don’t know where to go?

Helpful tips

• Read your instructions carefully.

• Complete the specified task(s).


Candidate instructions

Joseph Trans, 40 years old, presents himself to your office with a two-hour history of abdominal pain.

IN THE NEXT 10 MINUTES:

• CONDUCT A FOCUSED AND RELEVANT PHYSICAL EXAMINATION.

As you proceed, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.

GIVE ONE LABEL TO THE EXAMINER.

Helpful tips


Inside the station

• Demonstrate your clinical skills. You will not get credit for simply SAYING you would do something (with the exception of genital and rectal examinations).

• You will only receive credit for tasks completed satisfactorily.

• Treat the SPs as you would treat real patients.

Useful links


The College of Family Physicians of Canada

www.cfpc.ca

The Certification Examination in family medicine

http://www.cfpc.ca/fmexam/

http://www.cfpc.ca/

http://www.cfpc.ca/fmexam/

Questions?


And remember, exam staff will be available throughout the day to answer

your questions and guide you to your stations.

Please take the time to review the information in this presentation and on the cfpc.ca website. If

you have any questions on the

examination day, you can ask the facilitator

during your Candidate Orientation. For other enquiries

prior to or following the examination, please contact the CFPC.

Education

2014 Candidate Orientation Presentation - Certification Examination in Family Medicine