FOREIGN MEDICAL GRADUATE EXAMINATION IN INTERNAL MEDICINE
THE CLINICAL ASSESSMENT
FORMAT OF THE CLINICAL ASSESSMENT
You will be assigned to a Durban teaching hospital for the assessment. You will be instructed to examine three patients with medical problems spanning a number of organ systems. You will assess each patient for no more than 20 minutes in the presence of the examiner, who will direct you to the aspects you should pay attention to and will assess your competence in doing so.You will meet a different examiner for each patient.
WHAT WE ARE ASSESSING IN THE DIRECTLY OBSERVED CLINICAL ASSESSMENT
In this examination we assess:
- your competence in working with patients
- your ability to elicit a brief, focussed history
- your technical competence in physical examination
- ability to recognise abnormal physical signs
- your ability to interpret the significance of abnormal symptoms and physical signs
- your competence in putting all the findings together to come up with reasonable diagnostic suggestions.
Note that the purpose of the clinical examination is not necessarily to see whether you can get the right diagnosis. It is to assess your competence in each of the steps listed above, and you may find that you are not even asked for a final diagnosis.
PREPARING FOR THE DIRECTLY OBSERVED CLINICAL EXAMINATION
Many candidates perform very poorly in the clinical examination. Notethat most of the foreign graduates who fail the clinical examination do so because they cannot carry out the physical examination to the satisfaction of the examiner. You should be prepared for the fact that both the system and the standard of physical examination you were taught in your own medical school may may not match that expected by a South African medical school. Bear in mind too that your own skills may have become rusty in the years since you graduated.
We suggest the following approach as you prepare for this exam.
- The first step is to find out whether your history taking and examination techniques match those required by South African medical schools . You should ask a colleague whose competence you trust and who preferably was trained in a South African or British medical school to observe you closely while you perform a full, exhaustive clinical examination of each of the major organ systems: the general examination, respiratory examination, cardiovascular examination, abdominal examination, nervous system examination and musculoskeletal system examination. They should provide you with an honest appraisal of the extent to which your techniques and your competence match or do not match what was required in their own medical school.
- Work on correcting any deficiencies and on tightening up your confidence and skill in physical examination. Download our in-house handbook of clinical methods which we provide to our own students (Use the link at the foot of this page). Thoroughly examine as many patients as you can, following the system set out in that handbook, practising until it becomes second nature.
- Ask the trusted colleague to observe you again as you examine each system in a number of patients and to point out any remaining deficiencies.
- Repeat all three steps until your colleague and you are confident that the techniques you employee and the proficiency you showing the use matches that required in South African medical schools.
- See many patients and practice the skills repeatedly until you can perform them quickly, accurately and efficiently.
This will prepare you in terms of the standard of your examination skills. Once you are sure your examination skills are adequate, you need practice inrecognising abnormality and interpreting abnormal findings appropriately, in other words, putting all the positive and negative findings together to come up with a reasonable suggestion of the patient’s clinical problems. This is not something you can learn by reading books. You need to see as many patients with the medical problems set out in our syllabus as you can in the months before the examination. You should see the cases without knowing the diagnosis, and then present them to an experienced colleague who is competent in internal medicine and will be able to assess he appropriateness or otherwise of your findings and/or formulation.
HANDBOOK OF CLINICAL METHODS
Click on the following link to download our Handbook of Clinical Methods. This will guide you in the examination techniques expected in our clinical assessments.