Practice Assessment Pre-examination Workshop for candidates 2021 Exit Examination
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Pre-examination Workshop for candidates
2021 Exit Examination
Practice Assessment
Random Part C II
check Part D Part E
(Dangerous
(Medical (Investigatio
(PMP drugs
records)
management) ns)
review)
What What Tips on
to will be Good
prepare assessed practice 19 August 2020
1
Practice Assessment (PA)
test the candidates’:
Workplace based (family medicine clinic)
Organize
and PA will be
manage more
oriented on:
Application of skills
Knowledge
2
Examination date
Will be within either: No exam on Candidates will be notified
Period A OR Period B public holidays of the Examination period:
Dec Jan Feb Mar Within the 2 weeks
after
Exam Application
Exact dates of each period:
Deadline
please refer to the updated
Exam Announcement
Candidate will be informed Exam date once confirmed Examiners will visit
2 working days before the cannot be changed according to the Candidate’s
date of PA clinic opening hours in the
application
This is HKCFP
Specialty Board…
Examiners will go
to your clinic for
PA on …
Your cooperation appreciated!
3
2021 Exit Examination
Important dates (i)
PMP report prepared:
between 1 May 2020 to 31 October 2020
Cases collection period for PA:
• Part D / Attachment 12
• Part E / Attachment 13
Exit Examination Application deadline
(first attempt candidates), and
submit PA documents
Deadline to submit demo video (CSA)
4
2021 Exit Examination
Important dates (ii)
Exam Period A for CSA and PA
Exit Examination Application deadline
(for re-attempt candidates)
Christmas:
No Exit Examination will be arranged
Deadline of
Clinical Audit Report / Research Report
submission
5
2021 Exit Examination
Important dates (iii)
Exam Period B for CSA and PA
Chinese New Year:
No Exit Examination will be arranged
6
PA Document required at
Examination Application
7
PA Document What
to
prepare
Preparatory Attachment 1
Workshop Attachment 2 Attachment 12
earlier this year: Attachment 3 Part D
Attachment 4
(Medical Records)
Attachment 5
Attachment 6
Four copies
Attachment 7 (A4 size)
Attachment 8
Attachment 9
Attachment 10
Attachment 11 Attachment 13
Part E
(Investigations)
Four copies
Four copies
(A4 size)
(A4 size)
One copy 8
What
Suggestion on printing and binding your PA Document to
prepare
On the pages, insert
header/ footer; indicating:
• Candidate number / 2-sided printing Detachable binding
name preferred preferred
• Attachment no.
• Page number
9
Random check
(PMP review)
10Random Check (PMP review) What
will be
assessed
Your PMP report Making sheet (PA rating form)
• The assessment format will be broadly
Items and relevant Attachment(s)
the same as PMP visit
selected from:
• Please answer the Examiners’
1. Parts A or/ and B; AND
questions with demonstrate as
2. Part C
applicable
11Passing Random Check (PMP review) What
will be
assessed
Both PA Examiners give pass (A or C) = Pass in Random check
12Part C II
(Dangerous drugs management)
13Part C II What
will be
assessed
Your PMP report Making sheet (PA rating form)
Part C II
• The assessment format will be broadly the same as PMP
visit
• In your clinic: answer the Examiners’ questions with
demonstration as applicable
14Passing Part C II (Dangerous drugs management) What
will be
assessed
Both PA Examiners give pass = Pass Part C II 15Part D
(Medical records)
16Part D (Medical Records): general requirements
What
to
prepare
300 Medical records Summarize On the exam date:
of the patient that the medical records provide a room of
consulted you from adequate audio-visual
16th September privacy for up to three
to examiners to assess
31st October, 2020 your records
inclusive Attachment 12
17What
Part D: collecting the medical records for exam to
prepare
Acceptable
format of
Head Candidate
medical records
counts
300 patients that
consulted you from Print-out
from
16th September computer
to system
31st October, 2020 May be required to
Readily retrievable
AND / OR verify the genuineness
inclusive and available upon
e.g. through the clinic
Examiners’ computer record
Health Screening / request system/ relevant
Medical Assessment persons
should be excluded
Handwritten
records
18Part D: content of the medical records expected What
to
prepare
Each of them should, at least (e.g. print out from computer), include:
Consultation note Lab report
Preventive careD3 Dr. Colleague B
on those
Consultation note results you
Dr. CandidateD4 Consultation note
handled /
D2
Patient information Dr. Candidate
followed up
Consultation note
in D4
Dr. Colleague A
(as applicable)
Referral letter
those you
issued in D4
(as applicable)
The date seen by you as Chronologically the previous five
stated in your Attachment 12 consultations’ notes (as applicable):
For examiner’s reference What are D2, D3, D4 ?
Some information in the past consultation notes
e.g. Blood pressure, BMI; chronic medications usage, control
of medical condition(s) under your clinic’s attention Page 22
may affect the examiner’s judgement of your consultation note
19What
Attachment 12: in a standard format to
prepare
Serial Patient record Patient sex age diagnosis Date of the Date of first attended
no. number initials consultation the clinic
1 3216 NFK F 25 URTI 20 SEP 2018 18 OCT 2010
2 8839 LKF F 46 DEPRESSION 20 SEP 2018 25 JUL 2011
3* 292 KPW M 87 DM, HT, 21SEP 2018 18 SEP 1999
HYPERLIPIDEMIA
4 9932 STKM F 1 URTI 21 SEP 2018 6 AUG 2011
5 6677 CHL F 12 ALLERGIC 21 SEP 2018 12 MAY 2011
RHINITIS
6 4454 CHC M 67 HT 21 SEP 2018 12 JAN 2011
… … …. … … … …. ….
300 2323 LKH M 38 URTI 24 OCT 2018 24 OCT 2011
Cases used in Part E (investigations) are marked with *
Confidentiality: Do not include patient’s name, HKID 20What
Suggestions in presenting exam materials to
prepare
Attachment 12 Medical records
You can use paper flags to identify
the relevant sections e.g. D4
21Part D: When Examiners in your clinic What
will be
assessed
Basic information is
charted here …; the
lab reports are …
They will mark on
four areas:
They will choose You can briefly They will read
D1 (Legibility)
ten records from show the basic and assess the
D2 (Basic information)
your Attachment layout of your records
D3 (Anticipatory /
12 for assessment medical records to independently in preventive care in the
the Examiners your absence recent 12 months)
D4 (Consultation notes)
22D1 (Legibility) What
will be
assessed
Examiners proceed to assess the record
Illegible the whole case will not be marked
pro-rata mark deduction in Part D total score
Use abbreviations sensibly
• Understood by most general practitioners
• Can prepare a ‘reference list of abbreviations’ for the
Examiners: but all subject to the Examiner’s judgments
23D2 (Basic information) What
will be
assessed
Tips on
Good
practice
Areas to be examined Templates/ tables Genogram
• Current medication list:
refers to the regular • preferred • At least (but not limited to)
medications from your • Should have significant 2 generations
clinic ‘negatives’ • Relevant & specific for the
patient
e.g. Allergy: nil known
• Show index patient
• Inappropriate ‘blanks’ • Family members’ health
dated on the template/ table condition
updated may be regard as if deceased: cause & age
consistent with other parts
missing information of death
of the medical record
• Show members who are
living together
24What
D2 (Basic information): Genogram will be
assessed
no genogram in some cases could be acceptable, e.g.
• Language barrier
• Communication difficulty (e.g. impaired
cognition, hearing, speech)
• Lack of appropriate informants
• Medical emergency encountered
25What Tips on
D3 (Anticipatory / preventive care in the recent 12 months) will be
assessed
Good
practice
Areas to be examined Templates/ tables
• Growth chart: for pediatric patients • preferred
• Immunization: appropriate to patient’s age / • Should have significant
contemporary risk ‘negatives’
• Relevant action and review: e.g. on BMI/ • Inappropriate ‘blanks’ on
overweight; high BP; smoking the template/ table may
dated be regard as missing
updated information
consistent with other parts of the medical record
26D4 (Consultation notes) What
will be
assessed
Attachment 12 (Part D)
Serial Patient Patient sex age diagnosis Date of the Date of first
no. record initials consultation attended the clinic
number
1 3216 NFK F 25 URTI 20 SEP 2011 18 OCT 2010
2 8839 LKF F 46 DEPRESSION 20 SEP 2011 25 JUL 2011
3* 292 KPW M 87 DM, HT, 21SEP 2011 18 SEP 1999
HYPERLIPIDEMIA
If this case is chosen by the Examiners
assessed (D4)
27D4 (Consultation notes) What
will be
assessed
Areas to be examined
Main reason(s)
of the consultation
Clinical Findings
Diagnosis / Working diagnosis
Management
28D4 (Consultation notes) What
will be
assessed
Tips on
Good
practice
• State clearly in the initial part of the consultation note; e.g.
o FU DM, HT, hypothyroidism
Main o C/O: runny nose 2/7
reason(s) • Avoid preceded by irrelevant past information;
of the if there is any ‘introductory information’ e.g. significant past / current medical
consultation information, trim and keep it concise and relevant;
so that the main reason(s) of the consultation would not sink into the
paragraphs causing confusion / misunderstanding
29D4 (Consultation notes) What
will be
assessed
Tips on
Good
practice
• Group the findings under history, physical exam, diagnosis / impression,
management, etc. e.g.
Hx:
Hx: Good compliance to Rx
Watery nasal discharge, Tolerated
Mild ST, Not much cough No hypoglycemia
No fever Diet: usual care; but avoiding sweety fatty
TOCC –ve foods
………. Ex: nil regularly
PE: ……….
GC sat PE:
Temp: …. GC sat
Clinical Hydration N BP
Findings ……. Hstix 2 hr pp …….
• Record positive and significant negative clinical findings
Positive: showing Significant negative: showing
had been considered
30D4 (Consultation notes) What
will be
assessed
Tips on
Good
practice
• Follow up significant issue(s) raised in previous visits; e.g. overweight, smoking,
elevated blood pressure
• ICE (idea / concern / expectation),
Elaboration on psycho-social history:
o Most likely would be required in situations such as:
Such information is volunteered by the patient / relatives in the consultation
The consultaion is related to a psychological complaint / condition; e.g.
Clinical
Findings insomnia, depression follow up
Sophisticated encounter: e.g.
diagnostic difficulty,
occurrence of a potentially sinister condition (e.g. suspected malignancy)
suboptimal chronic disease control
distressed patient / relatives
o Explicit documentation may not be necessary in straightforward episodic physical
/ chronic follow up cases
31D4 (Consultation notes) What
will be
assessed
Tips on
Good
practice
• Must be stated in the consultation note
• For straightforward episodic / follow up cases: state the diagnosis usually
sufficient
• Status of control in chronic disease e.g.
o HT, stable
o DM suboptimal control
o lipids on statin, at target (< 2.6)
Diagnosis /
Working • ‘Triple diagnosis’: psycho-social status as appropriate; e.g.
diagnosis o Dementia, care-taker (wife) stress
o Depression, recently employed
• In case cannot arrive at a (working) diagnosis, give differential diagnoses (ddxs);
usually two to three ddxs would be sufficient; e.g.
o Dizziness; ddx: BPPV, vestibulitis
o Weight loss: bowel pathology?, hyperthyroid
o LUTS: BPH, Co-existing UTI?
32D4 (Consultation notes) What
will be
assessed
Tips on
Good
practice
• Drug use or/ and non-pharmacological measures: RAPRIOP approach
• Injudicious use of drugs e.g. steroids will be penalized
• Investigation: please refers to ‘Part E’
• Follow up
o ‘planned’:
the interval appropriate to the nature of problem(s) to be reviewed
o ‘FU p.r.n.’, ‘open FU’:
give appropriate advice e.g. ‘return if’
Management
the tongue ulcer not improve in the next 2 weeks
rash / vesicles develop
• Referral
o if you expect the patient should be seen by a designated specialist with high
priority / urgent basis, consider:
• follow up / contact the patient
• remind patient such as return / contact clinic if not seen by Breast Clinic
within three weeks 33Summation of Part D score What
will be
assessed
Marking
reference:
See next page
D2 D3 D4
Basic information Anticipatory care Consultation notes
( ) X 3.5 ( ) X 1.5 ( )X5
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
Part D score: _____ deduction due to D1?
____________________ Yes
No
= Part D score
34Marking reference in Part D & Part E What
will be
assessed
Examiners assess all the eligible/ suitable medical records A global mark will be given in
Part D2, D3, D4; E2, E4
4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9
OR below OR above
Demonstrates Consistently
serious
defects; demonstrates
clearly outstanding
unacceptable performance in all
standard
overall components
(Outstanding)
35Summation of Part D score: example 1 What
will be
assessed
Usual situation
68.25
D2 D3 D4
Basic information Anticipatory care Consultation notes
( 6.5 ) X 3.5 ( 7 ) X 1.5 ( 7 )X5
22.75 10.5 35
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
Part D score: _____ deduction due to D1?
____________________ Yes
No
= Part D score
36Summation of Part D score: example 2 What
will be
assessed
2 32 58 100 131 157 178 213 266 298
“Case 131”:
Record not
legible
68.25
D2 D3 D4
Basic information Anticipatory care Consultation notes
( 6.5 ) X 3.5 ( 7 ) X 1.5 ( 7 )X5
22.75 10.5 35
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
Part D score: 61.4
_____ 131
____________________ Yes
deduction due to D1?
No
= Part D score
37Part D (Medical records): pass or fail
Part D score
Average of the two PA Examiners’ scores ≥ 65%?
Yes No
Difference of the two calculated
Examiners mark ≥ 3.8? based on
cumulative
Yes No exam data
Send 3rd Examiner:
the score ≥ 65%?
Yes No
Pass in Part D Fail in Part D
38Part E
(Investigations)
39What
Part E (Investigation): general requirements to
prepare
Medical records of 10 Summarize On the exam date:
individual patients; the medical records into provide a room of
Attachment 13 adequate audio-visual
whom had privacy
investigations initiated for up to three
examiners to assess
and followed up by your records
the candidate as Same as Part D
specified
40What
Part E: find 10 suitable cases for exam to
prepare
Investigations initiated, ordered, The results are followed up, documented
documented in the medical record by by the candidate between
the candidate 16th September --- 31st October, 2020
If follow up consultation not possible,
follow up by:
Within
Can come from the 300 cases listed
16th September --- 31st October, 2020
in your Attachment 12 (Part D)
document in the medical record!
41What
Part E: find 10 suitable cases for exam to
prepare
The cases can be:
• Patient’s complaint(s) in episodic/ regular visit
• Monitoring of existing / chronic medical condition
The cases cannot be,
solely for the purpose of:
• Health screening / Medical assessment
• Monitoring of possible side effects of medication/
treatment in asymptomatic patients,
e.g. RFT after using ACEI; Blood liver enzymes after statins;
CBP to screen neutropenia on carbimazole
42What
Part E: find 10 suitable cases for exam to
prepare
For each case
• assign an ICPC-2 code to the Provisional diagnosis / Chief condition that
necessitate the investigation(s); e.g. T90, R74
• show the code on your Case Summaries and the Summary Table (Attachment 13)
Among the ten cases
• No more than two cases should belong to the same ICPC - 2 “Chapter” (the
alphabet)
• No more than one T-90 (type II diabetes mellitus) is allowed Attention!!
• No more than one K-86 (uncomplicated hypertension) is allowed
43ICPC - 2
44What
Part E: find 10 suitable cases for exam to
prepare
Not sure if the Acceptable format
case is suitable? of medical records
Unsuitable case(s)
Pro-rata deduction of Select Specialty Board
another staff may not Handwritten Print-out from
Part E total Score records computer
case help you
system
Missing! The investigation/
laboratory reports
(or copy) NOT
available for
Assessment
can use paper flags to identify
Next page Pro-rata deduction of the relevant sections of your
E4 (follow up) score records e.g. E1, E3, E4
45Part E: content of the medical records expected What
to
prepare
Each of them should, at least (e.g. print out from computer), include:
Preventive care E3 Lab report
Date: 4 Sep 2019
Referral letter
To: Geriatrics SOPC
Patient information
E4
If applicable
Consultation note Patient: XXX
M/72
Consultation note Patient: XXX
M/72 Dr. Candidate No: GK 123984
E1 Dr. Candidate No: GK 123984
21 Sep 2019
1 Sep 2019 with wife and daughter today
Retired seafarer With wife. Consult. 1/9/ 2019 refers;
C/O: progressive poor memory 6/12 …..
e.g. confused on date/ events…
Dementia bld work up (4 Sep 2019):
CBC, L. RFT, TFT, Vit B12, folate: N; VDRL: no-reactive E3
…..ADL independent, went out for lunch / market by self… Daughter concerned ….
Quitted smoking / drinking since retired age 60 Imp: cognitive impairment/ likely MCI
Exercise: nil regularly
PE: GC sat, normal gait BP 129/78 P 89 euthyroid….
Mx:
Suggest SFI CT brain; relatives need time to think about
E4
--- AMT 6/10 Encourage regular social activities / exercise. : e.g. visit nearby What are
elderly community center
Imp: cognitive impairment/ ? Dementia or MCI
E2 Refer:
E1, E2, E3, E4?
Mx:
Occ therapist (assessment and training)
Brief explain cogn. Impairment with pamphlet
Geri SOPC
Bld test (CBC, L/RFT, FBS, Lipids, TFT, Vit B12,folate, VDRL)
FU 12/52
FU 3/52
Page 50
Please note: the consultation notes content are simulated and not implying a standard of pass or fail in the Exam 46Attachment 13: What
to
prepare
Two documents in standard format
Cases summaries Summary table
of And Case
no.
Diagnosis/ condition
requiring investigation
ICPC-2 Code Tests ordered
the ten patients 1 malaise A 04 (weakness /
tiredness)
CBC, L/RFT, TFT, Urine C/ST,
CXR
2 Anemia ? Large bowel B 82 (anemia CBC, Fe-profile, CEA, Stool OB
pathology other/ unspecified) X3
3 Post-prandial dyspepsia D 07 (dyspepsia / OGD, US upper abdomen
Patien Clinic record Sex: Age: indigestion)
Case no: 1 t
initials:
number:
4 Annual hypertension K 86 RFT, FBS, lipid profile, Urine
Provisional diagnosis / Chief condition requiring ICPC-2 code check (uncomplicated Protein
investigations:
(date of the consultation: DD/MM/YYYY): hypertension)
5 Sprained ankle L 77 (sprain / strain XR ankle
of ankle)
Investigations performed:
6 Low back pain L 03 (low back XR LS spine
Results:
symptoms /
complaints)
Follow up: (date: DD/MM/YYYY) 7 Hyperlipidemia, newly T 93 (lipid disorder) Lipid profile, ALT
started on statins
8 Dystrophic toe nails S 22 (nail Nail clipping for fungal culture
symptoms /
Comments: complaints)
9 Amenorrhea, pregnancy X 05 (menstruation FSH, LH, Prolactin, TFT; US
test negative absent / scanty) pelvis; PAP smear
10 Hyperthyroidism on T 85 Free T4, TSH
treatment (hyperthyroidism)
(carbimazole)
The information must be consistent with the medical records
Confidentiality: Do not include patient’s name, HKID 47Sample Case Summary for each patient (Attachment 13) What
to
prepare
Case No: 6 Patient initials: LKH Clinic record number: GOSY 1810XY21 Sex: M Age: 83
Provisional diagnosis / Chief condition requiring investigations: ICPC-2 code
(date of the consultation: DD/MM/YYYY): T08 (weight loss)
Weight loss, ? Bowel pathology • Concise summary from
C/O Weight loss 6 to 7 Ib in last 3/12 the medical record • The code that best describe the case;
B O change from daily to once every 3/7 • Also put down description of the code
• Less than 300 words #
PE GC sat, mild pallor, abd soft non-tender
/ no mass….PR: empty no mass felt
Investigations performed:
CBC, CEA, thyroid function (TSH), stool Occult blood X 3
Results: # Section(s) grossly
CBC: Hb 9.8 (low), WBC 4.8, Platelet count 345, CEA 2.0 (ref < 3.0), TSH normal, Stool OB +ve X 1
exceed the words
Follow up: (date: DD/MM/YYYY) limit may be blocked
• Concise summary from and cannot be seen
Results informed
the medical record by Examiners
Discussed with patient and daughter…
Mx: referral to Surgical SOPC (seek early appointment) • Less than 300 words #
Comments:
• Optional; marks will not be deducted for leaving this section blank
• For discussion on investigation justification, limitations of the performance, area of improvement, possible
remedial actions
• Preferably avoided: clinic protocols, departmental guidelines, literature references, expert opinions; or general
summary from the medical record
• Less than 300 words #
48Sample Summary table (Attachment 13) What
to
prepare
Summary table
Case Diagnosis/ condition ICPC-2 Code Tests ordered
no. requiring investigation
1 malaise A 04 (weakness / CBC, L/RFT, TFT, Urine C/ST,
tiredness) CXR
2 Anemia ? Large bowel B 82 (anemia other/ CBC, Fe-profile, CEA, Stool OB
pathology unspecified) X3
3 Post-prandial dyspepsia D 07 (dyspepsia / OGD, US upper abdomen
indigestion)
4 Annual hypertension check K 86 (uncomplicated RFT, FBS, lipid profile, Urine Monitoring of possible
hypertension) Protein side effects of
medication/ treatment
5 Sprained ankle L 77 (sprain / strain of XR ankle
in asymptomatic
ankle) patients added
6 Low back pain L 03 (low back XR LS spine
symptoms / complaints) OK
7 Hyperlipidemia, newly T 93 (lipid disorder) Lipid profile , ALT
started on statins
8 Dystrophic toe nails S 22 (nail symptoms / Nail clipping for fungal culture
complaints) Health screening
added
9 Amenorrhea, pregnancy X 05 (menstruation FSH, LH, Prolactin, TFT; US
test negative absent / scanty) pelvis; PAP smear OK
10 Hyperthyroidism on T 85 (hyperthyroidism) Free T4, TSH
treatment (carbimazole)
49Part E: When Examiners in your clinic What
will be
assessed
Examiners had read
your Attachment 13
before coming to Basic information is
your clinic charted here …; the
lab reports are …
Base on the medical
records, Examiners will
Candidate can Examiners will
mark on four areas:
briefly show the read and assess E1 (Investigation
basic layout of your the records indication
medical records to independently in documentation)
the Examiners your absence E2 (Justification)
Candidates should have E3 (Results
the ten medical records documentation)
ready for assessment E4 (Follow up)
50E1 (Investigation indication documentation) What
will be
assessed
Consultation note
Patient: XXX
M/72
No: GK 123984
1 Sep 2019 Clinical information
Retired seafarer With wife.
C/O: progressive poor memory 6/12 ….. Present in record
e.g. confused on date/ events…
ICPC coded in
Attachment 13
…..ADL independent, went out for lunch / market by self…
Quitted smoking / drinking since retired age 60
Provisional diagnosis / Chief
Exercise: nil regularly
condition requiring investigations
PE: GC sat, normal gait BP 129/78 P 89 euthyroid….
--- AMT 6/10 Present in record
Imp: cognitive impairment/ ? Dementia or MCI
Mx:
Brief explain cogn. Impairment with pamphlet
Bld test (CBC, L/RFT, FBS, Lipids, TFT, Vit B12,folate, VDRL)
Test(s) ordered
FU 3/52
Present in record
(candidate) Dr. ABC
Indication of the investigation
documented (E1)
Please note: the consultation note content are simulated and not implying a standard of pass or fail in the Exam 51E1 (Investigation indication documentation) What
will be
assessed
Indication(s) of the
investigation
documented in record
Examiners proceed to assess the record
Indication(s) of the
investigation cannot be
found in the record
the whole case will not be assessed
pro-rata mark deduction in Part E total score
52E2 (Justification) What
will be
assessed
Consultation note Patient: XXX
M/72
No: GK 123984
Marking of E2 (Justification)
1 Sep 2019
Retired seafarer With wife.
is the Examiner’s judgement on the record’s :
C/O: progressive poor memory 6/12 …..
e.g. confused on date/ events…
…..ADL independent, went out for lunch /
market by self… Clinical information
Quitted smoking / drinking since retired age 60
Exercise: nil regularly
PE: GC sat, normal gait BP 129/78 P 89
euthyroid….
--- AMT 6/10
Provisional diagnosis / Chief
Imp: cognitive impairment/ ? Dementia or MCI
condition requiring investigations
Mx:
Brief explain cogn. Impairment with pamphlet
Bld test (CBC, L/RFT, FBS, Lipids, TFT, Vit
B12,folate, VDRL) Test(s) ordered
FU 3/52
(candidate) Dr. ABC
Please note: the consultation note content are simulated and not implying a standard of pass or fail in the Exam 53E2 (Justification) What
will be
assessed
Examiner assess all the eligible/ suitable medical records regarding
the justifications of the investigations
A global mark will be given:
4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5
54E2 (Justification): some tips on practice Tips on
Good
practice
• Employ test(s) that are recognized and accepted in our local primary
care setting
• Perform the test(s) at an appropriate time / interval
(e.g. for disease monitoring)
• Test(s) are in line with the patient’s problem(s), beware of
o under-investigations: omit test(s) that help to solve the problem
o over-investigations: order irrelevant / redundant test(s)
• Consider individual needs
• Consider availability of the test in your practice setting
• Unnecessary to put down explicit explanation in the medical record to support your
choice of investigations in most cases.E2 (Justification): some tips on practice Tips on
Good
practice
Investigation can be performed for a number of reasons, some
diagnostic, others therapeutic (House, 1983):
• To confirm or to make more precise a diagnosis suspected …
• To exclude an unlikely but important and treatable disease, … But please note:
• To monitor the effect or side effect of medicine, …. These two groups
of cases should not
• To screen asymptomatic patients, e.g. cervical cytology … be submitted for
• To reassure an anxious patient that nothing is seriously the exam
wrong, …
• To convince a sceptical patient that something is wrong and
that lifestyle amendments should be made, e.g. liver function
in a heavy drinker.
From:
Robin C. Fraser. Clinical Method: A general
practice approach. 3rd edition 56E2 (Justification): some tips on practice Tips on
Good
practice
The decision to investigate a patient …is based on clinical
judgement,
which is influenced by many factors –
• the clinical findings on history and examination (including social
and psychological factors),
• the doctor’s temperament and attitudes,
• the doctor-patient relationship, and
• organizational factors such as the availability of diagnostic
services,
In public setting, consider self-finance
• the time of the day or night, etc. basis as appropriate
such decisions are often finely balanced.
From:
Robin C. Fraser. Clinical Method: A general
practice approach. 3rd edition 57E2 (Justification): some tips on practice Tips on
Good
practice
…clinicians should ask themselves before requesting an investigation…
• Why am I ordering this test?
• What am I going to look for in the result?
• If I find it, will it affect my diagnosis?
• How will this affect my management of the case?
• Will this ultimately benefit the patient?
In general, investigations should be performed only when the following criteria are satisfied:
• The consequence of the result of the investigation could not be obtained by a cheaper,
less intrusive method, e.g. taking a more focused history or using time
• The risks of the investigations should relate to the value of the information likely to be
gained
• The result will directly assist in the diagnosis or have an effect on subsequent
management From:
Robin C. Fraser. Clinical Method: A general
practice approach. 3rd edition 58E3 (Results documentation) What
will be
assessed
Consultation note
Patient: XXX
M/72
No: GK 123984 Investigation results/ findings
21 Sep 2019
with wife and daughter today
documented in record
Consult. 1/9/ 2019 refers;
Dementia bld work up (4 Sep 2019):
CBC, L. RFT, TFT, Vit B12, folate: N; VDRL: no-
reactive Copy of the investigation reports, e.g.
Daughter concerned ….
CT scan
Imp: cognitive impairment/ likely MCI
Ultrasound
Mx: scan
Suggest SFI CT brain; relatives need time to
think about
Encourage regular social activities / exercise. :
e.g. visit nearby elderly community center
Refer:
Occ therapist (assessment and training)
For plain X-Ray:
Geri SOPC
FU 12/52
OR
(candidate) Dr. ABC Present for
Examiner’s
film inspection
Results documented (E3)
59What
E3 (Results documentation) will be
assessed
• The investigation
results documented in
the medical record
AND
• The investigation/
laboratory report
Examiners proceed to assess the record, E4 (follow up)
(copy) available
• The investigation
results NOT
documented in the
medical record
OR
• The investigation/ “Follow up” of the case will not be assessed
laboratory report (copy) pro-rata mark deduction in E4 (follow up) score
NOT available
60E4 (follow up) What
will be
assessed
Consultation note
Patient: XXX
M/72
No: GK 123984
21 Sep 2019
Marking of E4 (follow up)
with wife and daughter today is the Examiner’s judgement on the record’s:
Consult. 1/9/ 2019 refers;
Dementia bld work up (4 Sep 2019):
CBC, L. RFT, TFT, Vit B12, folate: N; VDRL: no- Investigation results/ findings:
reactive
Daughter concerned ….
Imp: cognitive impairment/ likely MCI In the
Mx: Medical and
Suggest SFI CT brain; relatives need time to
think about record
Encourage regular social activities / exercise. :
e.g. visit nearby elderly community center
Refer:
Occ therapist (assessment and training)
Geri SOPC
FU 12/52 Further clinical information elicited (if any)
(candidate) Dr. ABC Diagnosis
Management
61E4 (follow up) What
will be
assessed
E4 (follow up) Examiner assess all the eligible/
suitable medical records regarding
OR the follow up
A global mark will be given:
4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5
62E4 (follow up): some tips on practice Tips on
Good
practice
• Recognize normal / abnormal results
• If necessary, elicit further clinical information in situations e.g.
o to help interpret incidental finding in the investigation
o refine the diagnosis
o to help planning the management
• Inform the patient on the significance and implication of the
investigation results
• Management: according to the tests results and the clinical context
• Provide appropriate management / follow up on other significant
health issues, though apparently not related to the problem investigated.
Examples: smoking, obesity, comorbidities
63Summation of Part E score What
will be
assessed
Pro-rata mark deduction due to E3
(If applicable) Case no. ________
E2 E4
Justifications
( )
Follow up
( )
5
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
deduction due to E1?
Part E score: _____ ____________________ Yes
No
= Part E score 64Summation of Part E score: example 1 What
will be
assessed
Usual situation
++ ++ + ++ ++ ++ + ++ + ++
++ ++ ++ + ++ + + ++ ++ ++
Pro-rata mark deduction due to E3
(If applicable) Case no. ________
E2 E4
Justifications
( 7 )
Follow up
( 7 ) 5 70
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
deduction due to E1?
Part E score: _____ ____________________ Yes
No
= Part E score 65Summation of Part E score: example 2 What
will be
assessed
++ ++ + ++ ++ ++ + ++ + ++
Case no. 3: ++ ++ + ++ + + ++ ++ ++
investigation
report copy NOT
available
Pro-rata mark deduction due to E3
3
(If applicable) Case no. ________
E2 E4
Justifications
( 6.5 )
Follow up
( 6.3 )
5 64
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
deduction due to E1?
Part E score: _____ ____________________ Yes
No
= Part E score 66Summation of Part E score: example 3 What
will be
assessed
++ ++ + ++ ++ ++ + ++ ++
Case no. 9:
Cannot found in the
record why the
investigations ++ ++ ++ + ++ + + ++ ++
(…CXR and blood
tests…) were done…
Pro-rata mark deduction due to E3
(If applicable) Case no. ________
E2 E4
Justifications
( 6.5 )
Follow up
( 7 )
5 67.5
pro-rata deducted Pro-rata deduction for Case no: Pro-rata mark
Part E score: 60.75
_____ 9
____________________ Yes
deduction due to E1?
No
= Part E score 67Part E (Investigations): pass or fail
Part E score
Average of the two PA Examiners’ scores ≥ 65%?
Yes No
Difference of the two calculated
Examiners mark ≥ 3.4? based on
cumulative
Yes No exam data
Send 3rd Examiner:
the score ≥ 65%?
Yes No
Pass in Part E Fail in Part E
68Observations in previous PA
and recommendations
69About Candidates Issue noted Recommendation
Random check
(PMP review)
Part C II (Dangerous • Recycled papers contain irrelevant
Drugs DD registry printed with recycled paper information
management) • To be avoided
Part D • Risk of penalty & disqualifications
Duplicate cases in Attachment 12
(Medical Records) • To be avoided
Part E Not included Ix report copy (ECG)
(Investigations) mark deduction pro-rata in E4
Fail in Part E
Submitted three cases with same
Part E
‘alphabet’ (Chapter) of ICPC-2 code
(Investigations)
Part E mark deduction pro-rata Fail
• Should present the same version
Presented a different/ amended version
Part E seen by the previous PA examiner
of medical record print-out to the 3rd
(Investigations) • Indicate to the 3rd examiner on the
examiner
area(s) amended if needed
70Pass / Fail in PA
713rd Examiner will be sent to decide pass or fail What
will be
in the following situations assessed
Random check (PMP review)
• One examiner ‘pass’; another ‘fail’
C II (DD Management)
• One examiner ‘pass’; another ‘fail’; and
D (Medical records) • average of the two examiners’ marks < 65; and
E (Investigations) • a significant gap between the two
(calculated based on culminative data)
The 3rd examiner
• may go to your clinic in either Period A or Period B; with a 2-working-day notice in advance
• assesses the same materials / Random check seen by the previous PA Examiners
All Candidate
• must keep all the examination materials seen by the previous PA Examiners;
at least until the end of Period B
72From PA to pass the Exit Examination
Random check Part CII Part D Part E Pass
Grade Pass in both Score Score in
‘A’ or ‘C’ Knowledge 65 % or 65 % or Practice
Practice above above Assessment
Fail in PA: Pass
All the failed Part(s) need to be re-attempted in
as a set Consultation
Skill
Assessment
Pass in PA:
Valid for five years; same as other individual
Segments of Exit Examination Pass
in
Research/
Clinical Audit
Candidate must have valid passes in all three
Segments (CSA + PA + Research / Clinical Audit)
at the same time in order to pass the Exit
Examination Pass in Exit Examination 73
73Enquiry
Specialty Board secretary:
alkyyu@hkcfp.org.hk
Tel: 2871 8899 (Alky or John)
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