SURGICAL FINALS Passing the Clinical - PasTest

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S E C T I O N 1Seek clues from the beginning: observe all the artefacts around thepatient such as drips and catheters. Plastic gloves next to a patient witha submandibular swelling indicate that you are expected to palpate thegland bimanually. A glass of water next to a patient with a neck swellingsuggests a goitre.Never forget to look at the patient as a whole, even when you are askedto examine one small part: rheumatoid nodules on the elbow suggest thediagnosis before you have even looked at the hands.OSCEs assess your interpretive skills, preparation and progress, as well asfactual recall; they include task-oriented items and they can examine yourpowers of decision making, problem solving and behavioural attitudesin simulated professional practice. The overall effect is to provide a validassessment of clinical practice.14
4Frequently askedquestions andthe vivaMedicine involves a great deal of communication, with both patientsand colleagues from all disciplines. Thus presenting clinical findings,answering related questions, and discussing differential diagnoses andsubsequent management are a routine part of clinical practice. Do nottherefore be surprised to be asked further questions about your clinicalfindings.Vivas are widely practised in postgraduate examinations but less so inundergraduate examinations because they can be subjective and providea patchy assessment of the curriculum. You may particularly dreadthem because the field is vast and ‘they can ask you anything’. The vivadoes, however, provide an examiner a rapid way of covering essentialknowledge in a form that relates to subsequent clinical practice. This iswhy some schools retain a pass or fail viva for borderline candidates.If you are unfortunate enough to be in this group, take courage from thefact that there are usually two examiners looking for reasons to passyou. The examination usually follows a standard approach, and payingattention to the viva techniques outlined below and the content of thesubsequent pages will make it less of an ordeal. They are likely to cover anumber of topics to ensure that your knowledge across the syllabus is at asafe and competent level for you to progress.You should also be aware that any part of the clinical examination can turninto a ‘mini viva’. The frequently asked questions throughout the textcover the topics, and answers, that make up the standard surgical viva.The other type of viva that you may be fortunate enough to be part ofis the distinction viva – equally terrifying! Here the rules are different;the examiners are assessing a depth of surgical knowledge beyondthe contents of this book. They may start off with the same standardquestions, but will then ask the details of probably two topics, pushingyou to your limit. You may think that you shouldn’t be there and betempted to withdraw – but don’t – it is as an enlightening experience, youcan’t be marked down and your luck may hold! Scan through topics that15
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SURGICAL FINALS Passing the Clinical - PasTest

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