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Clinical/Oral examinations

John Allen, 3rd year PhD student in Paediatrics and Graduate Teaching Assistant in Paediatrics, talks about his experience of clinical/oral examinations. 

       

What do clinical/oral examinations look like in your discipline? 

Clinical examinations are one of the most important forms of assessment in the later years of the medical degree and their use continues in postgraduate “membership” examinations. They are usually individual assessments where the student is brought to one or more patients in a real or simulated clinical environment. At times the patient can be replaced by an actor or model. The student is usually required to take a focussed history from the patient and/or perform an examination, while being observed by a set of examiners (usually two). The examiners assess the student on their history-taking, examination and communication skills. The examiners may then use the clinical scenario to assess the student’s knowledge by asking them to formulate differential diagnoses, investigation and management plans and related discussions. Other elements, such as X-rays or blood results, may be introduced to stimulate further discussion and assess the student’s knowledge of these investigations. There are many variations on this format but most have these basic elements at their core.

Following the clinical examination, students are sometimes called for a Viva Voce examination. These usually take the form of discussions around 2-3 pre-prepared clinical scenarios. Again, the student is usually assessed by more than one examiner.

How do you prepare for clinical/oral examinations?

The main way to prepare for this exam is practice. I spent lots of time taking histories and practicing examination techniques, both in the clinical setting and in simulated environments (e.g. with friends). It can be useful to have someone watch you and provide feedback e.g. a peer or a doctor on one of the teams you work with. Knowing the basics of history-taking and examination off by heart helps to ensure that you can perform well, even when exam nerves kick in.

Observe how experienced clinicians interact and examine patients in clinic or on the wards. If you see something that you think was particularly effective, reflect afterwards on the encounter and adopt the elements that you find useful.

Tell us about your experience of clinical/oral examinations

These assessments can be challenging, particularly in the beginning. Nerves and anxiety can be an issue but these usually settle within the first few minutes of the exam. I have found most examiners very understanding of the nervousness that goes along with these exams and they do their best to put the student at ease. Real-life patients can be unpredictable, especially if they are acutely unwell, and sometimes unexpected things happen during the course of the exam. However, my experience is that examiners are very understanding of these instances and make rapid adaptations to make sure the student is not disadvantaged. The benefits of this type of exam are that they are usually quite quick and they are flexible so you can show off your knowledge. You also get used to the format and they become easier over time.

What advice would you give to someone doing clinical/oral examinations? 

  • Try to be as calm as possible.
  • Breathe and think before you speak.
  • Be logical and give answers in a step-wise manner.
  • Remember that patient safety is the number one priority.
  • Don’t forget your communication skills and build rapport with the patient.

What tools/digital technologies do you use to complete clinical/oral examinations? 

This assessment happens in the moment, so few tools are required. You need basic equipment to perform a clinical examination such as a stethoscope, patella hammer etc, although much of the time there is spare equipment in the exam venue.



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