SURGICAL FINALS Passing the Clinical - PasTest

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S E C T I O N 1Bleep the FY1 and FY2 and ask for lists of patients to see as long andshort cases. Ask when patients are to be admitted. Also find out when daysurgery lists take place: here you will find many swellings, ulcers, varicoseveins and hernias to examine.Revise efficientlyThis book gives plenty of lists of clinical features and provides tablesof differential diagnoses. Modify these to make your own lists: you willremember best what you compile yourself. Laptops or card systems maybe a useful revision aid at this stage.Try not to work late into the night, relax before you go to bed, avoidexcess coffee and keep up physical exercise. You will retain much moreif you are alert during the revision period than if you are exhausted.Remember that hypnotics and anxiolytics can dull your mind on the dayof the examination: take them only under medical supervision.6
2The OSLER /long caseLong cases in finals may be combined medical and surgical assessmentwith one or two examiners. You may or may not be observed duringthe history and examination. Often you are taken back to a patient todemonstrate specific signs.The traditional long case format has inherent problems of objectivityand reliability. In response to such problems, standardised patients andmarkings systems have been introduced. These include the introductionof the ‘objective structured long examination record’ (OSLER). The OSLERmight include more than one case (a real patient, a simulated patient ora video, see page 4), each allocated 20–30 minutes, usually with a singleexaminer. This allows the examiner to test specific aspects of knowledge,skills or management decisions. Shorter periods may be allotted tospecific parts of the history taking or focal examination.Allocating your timeBe sure that you know well in advance how much time you will be givenfor the long case. This varies from school to school. Normally, 20 minutesis the minimum. This provides very little time for complex peripheralvascular or GIT problems; listen to or read the instructions very carefully.If it looks as if the history will take longer than half the allotted time, startexamining after you have taken the details of the presenting complaintand past medical history. The remainder of the history can be taken atconvenient points during the examination. It is essential that you practisethis.7
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