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AMC TIPS and Tricks July 2014

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AMC TIPS and Tricks July 2014
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  AMC clinical examination tips and tricks  (July 2014)You should know by now that the AMC clinical examination is a vey unusual and vey stess!ul examination #oweve$ it is actually at the level o! a !inal yea medical student and %uite &doable' with the aoiate eaation and undestandin o! the natue o! it Most *M+s !ind that it is not so much a test o! medical knowlede (that was coveed in the MC, exam-)$ but much moe a atient cented$ communication skill testin examination .hat means the eaation !o this examination is not so much about moe knowlede ac%uisition but about you behaviou and you o!essional attitude .his exam is like a ame / you need to lay by the ules- thes say it is like a dance and you have to know the stes well o it is like takin at in a movie and you have to know you ole well---You will deal mainly with oleayes and usually the examine does not ask any %uestions but ust obseves you e!omance .he olelayes ae o! vayin %uality$ o!ten youn medical students layin eldely atients which can be %uite con!usin when you walk into the oom .hee ae some eal atients$ e  with heumatoid !eatues$ cadiac mumus$ eiheal neuoathy$ oint oblems$ live symtoms etc but they ae a aity *n eneal the olelayes$ atients and examines ae vey suotive and want to hel you (even thouh you miht not believe this)- 3o lease listen to them cae!ully$ they o!ten ty to ive you valuable hints-n many occasions thee is a second examine esent (not in the new .C in Melbouneanymoe-) who is actually thee to assess the ocess o! the examination itsel! and otates thouh the stations .hat examine does not ude you e!omance$ so lease do not woy about he5is esence PREPARATION: .he &AMC #andbook o! Clinical Assessment' is the best investment you can eve make *t ives you vey comehensive exlanation o! the examination ocess$ has incedibly imotant hints !o the di!!eent clinical aeas coveed in the exam and ives !antastic examles with detailed exlanations o! all asects o! a scenaio 6ach chate is e!aced by most valuable exlanatoy notes which * encouae you to ead thoouhly because they exlain the Austalian aoach- A eat examle is the intoduction to &.he 7sychiatic Consultation' which coves in a vey bie! and ecise way what you ae exected to conside when examinin a mental health atient Cases !om the book and !om the &ecalls' aea eulaly in the examination and suisinly many candidates !ail these stations--- &8ecalls' can be vey misleadin and athe than to otelean the stations * ecommend to be awae o! toics but to wok thouh them in a thoouh way ealisin that a scenaio can easily chane$ e  89, ainin a !emale atient miht be aendicitis in one exam but could be ectoic$ an twisted ovaian cyst$ enal colic o domestic violence in anothe exam You eally have to have a ood undestandin o! the undelyin issues--- My exlanation o! this henomenon is that the examine !inds out vey %uickly i! a candidate has ust ote leant a case$ euitatin !acts but not demonstatin a thoouh undestandin o! the case * believe that the ublication o! the book has iven *M+s an ootunity to undestand thenatue and e%uiements o! this examination much bette than eve be!oe and it is eally imotant to know about the exectations and to undestand the imotance o! !o examle citical eos 7ae 1  the necessay books and esouces in ioity listin: 1.  John Mutah;s &+eneal 7actice' 2. .ally < ;Conno &Clinical 6xamination' 3. &7aediatic #andbook'$ 8oyal Childen;s #osital and also on the net : www.rch.org.au/clinicalguide/index.cfm?fuseaction=home.titles4. .he 8oyal =omen;s Clincial +uidelines http://www.thewomens.org.au/AtoZIndex. &.heaeutic +uidelines Antibiotic' but thee ae many othes which ae wothwhile eadin !. >alan;s Clinical 7sychiaty 8eadin othe books covein suey$ medicine$ ?+$ sychiaty and othe !ields  lease e!e to the AMC web site *n you eaation concentate on the ?+ and aeds cases !ist because you have to  ass at least one o! each othewise you !ail the whole exam .hat means you should evisethe aoximately 1@0 aeds ecalls and 10 ?+ ecalls which should ive you a ood chance to aleady ass B stations--- / simle mathematical odds---.he thid ioity oes to sychiaty because thee ae usually two sychiaty scenaios in the exam and most *M+s don;t !eel com!otable with mental health issues .he intoduction to the sychiatic consultation in the AMC handbook (aes 4B44B) is an excellent statin oint and hihlihts the aeas we exect doctos in Austalia to know about-.hee ae obably about 0 sych ecalls *! you o thouh them$ you now should have a ood chance to have assed aleady  stations--- simle mathematical odds---You should ty to cove at least 4 yeas o! ecalls$ i! not even @---Anothe &mathematical' hint ovided by a evious AMC candidate is that the se%uence o! the stations has always been the same u to now (con!imed by many exam candidates)$ althouh be awae that this system could chane one day:1 Medicine$ +eneal 7actice o 6meency Medicine2 7aediatics 8est station4 3uey@ ?+B +eneal 7actice 5 Medicine o 6meency MedicineD 7sychiaty o +eneal 7actice 5 Medicine 5 6meency Medicine 8est stationE Medicine 5 +eneal 7actice 5 6meency Medicine10 7aediatics11 ?+12 3uey1 8est station14 +eneal 7actice 5 6meency Medicine1@ Medicine1B 7aediatics1D 3uey1 8est station1E 7sychiaty o +eneal 7actice20 ?+7ae 2  7sychiaty is usually station D and 1E$ althouh sometimes +eneal 7actice Medicine aeas in one o! these stations Medicine$ +eneal 7actice and 6meency Medicine sead ove @ stations (1$B$E$14 and 1@) 3tations @$11 and 20 ae ?+$ station 2$10 and 1B aeds and station 4$12 and 1D suey *n summey you should know what !ield is tested in which station .his can be imotant in a &dual toic' station Fo examle i! a woman esents with a ynae oblem but also has a sychiatic comonent it would haveto be a sychiatic main oblem i! it was the sych station but an ?+ main oblem i! itwas an ?+ station-.he etest has usually the !ollowin stuctue:1 Medicine2 7aediatics 8est station4 3uey@ ?+B Medicine 5 +eneal 7acticeD 7sychiaty 8est stationE +eneal 7actice 5 Medicine10 3uey “Objective tr!ct!red Clinical Examination #OCE$ and “M!ltidisciplinar% Clinical Assessment Tasks #MCAT$:  .he assessment domains include: ã Aoach to atient ã 7atient counsellin 5 education ã #istoy ã .echni%ue o! examination$ oaniGation and se%uence ã Accuacy o! examination ã Commentay to examine  ã Choice o! investiations ã *nteetation o! investiastions ã Hianosis 5di!!eential dianosis ã *nitial manaement lan ã 6xlanation o! clinical ocedue ã 7e!omance o! ocedue ã Familiaity with test e%uiment ã Answes to examine;s %uestionsA ood st!d% &ro!p  is most bene!icial and you should actively olelay and be vey citical with each othe- Fom my exeience the best study ou has  eole (one candidate$ one Iexamine;$ one obseve) because eveyone will want the chance to  e!om and you will lean by e!omin- 6veybody should et a chance to olelay and ivin honest citi%ue is vey use!ul !o the obseve as well as !o the ole laye-*deally you should oaniGe eal &tial exams' with you study ou$ !o examle  o 1B cases in a ow$ even cases out o! the book- *nclude hanin the stem on the wall o a doo and etend that you come into the examination oom *t hels you to undestand the essue o! the exam and to lean how to ut a bad e!omance behind you 7ae   9ike the  &7;s' in eal estate (osition$ osition$ osition)$ hee it is practice' practice' practice(((  *t is eally wothwhile doin& it- Just eadin and thinkin about these execises does not hel$ do it like .homas .he .ank ( a lovely childen;s stoy) and you;ll !ind )o! can do it(((T*E TEM: 8ead the instuctions cae!ully-.#6 @ ,s (%uestions) (always ask yousel! at the doo while eadin the case in!o):1 =ho am * (+7 o unio M)2 =hee am * (eneal actice o hosital / ual o meto) =hat ae the oblems (dianosis$ di!!eential dianoses$ main and hidden issues$e  olyuia esentin as ostate oblem$ but bein .2HM o head banin child whee the mothe has sini!icant social oblems which need to be addessedas well)4 *s it an emeency (immediate hysical examination$ H8AKC and manaement !ist$ make sue atient is 3AF6---)@ =hat ae my tasks (stick to the tasks---$ manae you time aoiately-) You only have  minutes$ so be well oaniGed-6vey wod has a meanin- *! the stem mentions that the atient is an &abattoi' woke$ this can be an extemely imotant !act that he miht su!!e !om a Goonosis$ a disease tansmitted by wokin with animals- *! the stem says that a atient is on &tamoxi!en'$ she obably had beast ca *! you ae not sue about any asect eadin the stem$ you will have an ootunity to ask the examine !o clai!ication a!te you have enteed the oom .he scenaios ae usually sinle toic stations$ the main dianosis will be aaent !aily ealy$ sometimes even a!te !inishin eadin the stem outside the oom *! it seems to be acase o! cholecystitis ty to demonstate an oaniGed$ stuctued and !ocused aoach$ honin in onto the &main oblem' #oweve$ kee an oen mind and talk about di!!eential dianoses as well$ because you miht ust think it is &cholecystits' but in eality it miht be anceatitis o somethin else .his becomes esecially imotant i! theole laye o the examine makes comments like: &H last time * had cholecystitis$ it !elt %uite di!!eent' (this is only an examle-) 7ick u you eas and stat to eview i! the ole laye miht ty to ive you a hint that this case is somethin di!!eent ccasionally one station can contain two seaate issues$ e  a aeds case miht be comlicated by a aent with a sych o social oblem and you miht be exected to cove both toics *! you deal %uite well with the aediatic comonent but inoe the !athes &dinkin oblem' (!o examle)$ you could be at hih isk to !ail the station *n summay$ in most stations you should have a ood idea about the task and a well stuctued lan o! aoach in you head at the end o! the eadin time and be!oe you walk into the oom .hee is anothe coy o! the instuctions in the oom and o!ten it is use!ul to look at them aain to make sue that you ae !ollowin the escibed tasks .hee is also a en and ae$ so lease make notes eithe !o you own lan o! oess$ e  1 $2 $ etc o H8AKC o dawins !o the atient to exlain thins 7ae 4

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