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PACESPractical Assessment of Clinical Examination Skills(Use this in conjunction with the materials available on the ACES for PACES website in particular examples of cases) ♥ The PACES examination is the last part of the examination for membership of the Royal Colleges of Physicians. ª It is a practical examination and tests the practical skills of would be members of the colleges. ¨ This is the most important fact that candidates should keep in mind § It is not a theory test. Theory has already been tested in the first two parts, the written sections. ♥ When preparing for a practical examination one should concentrate on the following: · The examination · Methods · Findings and Causes · Presentation The Examinationª In undertaking any examination, it is of utmost importance to know and understand what the exam is about. Do not think about going for an examination without studying the exam in detail. ¨ Learn about examinations in general and the MRCP PACES examination in particular. (ACES for PACES chapter 1) This chapter will also give you important hints on how to study medicine. Methods: § Clinical method is very important when approaching a practical assessment. One should learn correct clinical method and practice endlessly to achieve a high degree of competence. ª To learn correct method it would be ideal to seek out a good teacher who is willing to give you personal guidance. This is not always possible and in any case you will also need a book on clinical method. ª When learning method it is essential to break down the method into its components, learn each component and then learn how to link the components together. One should also learn to complete each step of the process before moving on to the next. Never try to do more than one thing at a time, pay attention to the task at hand and this will allow one to bring one’s mind to bear on the task at hand and observe everything of importance. ¨ Following initial instruction one should engage in hours of practice and then obtain help from a teacher or colleague to observe one’s techniques and correct faults in technique. Learning Clinical Method§ First, you must understand WHY you do WHAT you do (ACES for PACES chapter 2-7)♥ Learn the method of history taking and practice it repeatedly (ACES for PACES chapter 4) ª Next, learn how to examine the different systems. (ACES for PACES chapter 8-17) The first part of each chapter will take you through clinical method in detail ¨ Learn the method of communication (ACES for PACES chapter 18) § Practice the methods, revise the chapters, repeat ad infinitum. Findings and Causes: ♥ If one adopts correct methods then it is highly likely that one will detect abnormal findings without much difficulty. ª However, it is essential to be aware of the findings that one may obtain in different situations and in addition one should be aware of the causes of these findings. ¨ This knowledge may be obtained by reading extensively but more importantly by seeing as many patients as possible as practical experience is far superior to theoretical knowledge. § It is also important to know the causes of the findings that one may obtain on examination. To do this it is essential to read widely and more important see as many patients as possible. ♥ The chapters on the various systems have a section on lesions that may occur. Study this so that you are aware of the lesions that may occur and focus your studying on these lesions. ª Read the chapters on the various systems in ACES for PACES and learn the clinical features that may occur in diseases of the different systems and their causes Presentation: ¨ This is very important. § If the candidate is unable to present his or her findings in a clear manner how can the examiners ascertain the degree of competence of the candidate? ♥ The only way to become proficient at presentation is to practice. It is best to do this by taking every opportunity at ward rounds and clinics to present one’s findings to seniors and in addition one should try and practice with a good teacher or if this is not possible at least with one’ colleagues. Findingsª Present findings in the same order that you examined the patient, as this will make it easier to remember. ¨ Give the positive findings and relevant negative findings Diagnosis§ Give a complete diagnosis (ACES for PACES chapter 3) ♥ If you are unable to determine one of the components of the diagnosis use the checklists to give a list of possibilities (ACES for PACES chapter 3) Investigations and Managementª Plan investigation and management before presentation. This should be part of your revision. Have a reliable method of planning (ACES for PACES chapter 18)
Clear Thinking
¨ One of the most important aspects of good presentation is to have clear thinking. § An important aspect of demonstrating one’s competence as a clinician is to show the examiners that one is capable of clear thinking. ♥ A theoretician can list all the causes of a clinical finding. But this is not the point. ª A clinician will be able to tease out which of these causes is important in the case of the patient under consideration. ¨ As an example, if one is appearing as a candidate for the examination in the U.K. the causes of hepatosplenomegaly that one may encounter are different to those that one may encounter if one were a candidate in Cairo. § Similarly when one is asked on what findings one based one’s diagnosis, the examiners are asking what the findings are in that patient. Not what the findings are in that condition. ♥ DO NOT memorise the typical findings of a case from a book and regurgitate this at the exam ª This also applies to investigations and treatment. The idea is to determine what investigations and treatment would apply to the patient under consideration not patients in general. Preparation for MRCP PACES (Preparing for MRCP PACES) ¨ Learn correct methods (ACES for PACES) and practice repeatedly · Practice methods · Practice presentation § Use the methods from ACES for PACES to go through the available: · Exam textbooks · Course materials · Website materials ♥ Make yourself familiar with the cases and clinical scenarios that may occur at the examination. ª Use the examples of cases on the ACES for PACES website to guide you in the use of ACES for PACES in analysis of cases Common Cases and Scenarios ¨ Know the common cases and scenarios that occur in MRCP PACES § Analyse the clinical features of these cases and scenarios using the methods given in ACES for PACES. This will make recall easy ♥ Know the common causes of the clinical conditions that may be seen in the exam ª Study the causes that are likely in the exam centre that you are being examined in (British centre, Egypt, Malaysia etc) ¨ Use the methods described in ACES for PACES for easy recall of the causes of these conditions (ACES for PACES chapter 3) § Go through the lists of causes given in ACES for PACES and underline or highlight the causes that are common in the centre in which you are being examined. ♥ Plan the investigations that you would arrange in relation to these causes using the plan for investigation described in ACES for PACES chapter 18 ª Plan management strategies for these conditions using the plan for management described in ACES for PACES chapter 18 ¨ Plan explanation using the plan for investigation described in ACES for PACES chapter 18 Making a Diagnosis♥ There are several methods clinicians use to make a diagnosis ª The most commonly used and the method that most clinicians ultimately use is called the hypothetico-deductive method ¨ This is where an initial idea comes to mind and one pursues this finding clues in favour of and against this idea and ultimately deducing the answer § The examples given in the aces for paces website and the cases described in the clinical skills blogspot will make this clearer ♥ For a further explanation of this method read the preface in ACES for PACES ª Another method that is described is pattern recognition ¨ In this method one gathers all the information available and then tries to match these features to a pattern that one may recognise § This is an unreliable method and is not recommended ♥ In addition in the PACES examination one is not given time to think about the diagnosis after finishing examination ª Questions will be asked almost immediately and one’s thoughts should be clear by then ¨ The hypothetico- deductive method allows one to come to a diagnosis more quickly and with greater reliability and is hence the method of choice § In summary Use the hypothetico-deductive method not pattern recognition ACES for PACES
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