Clinical Pediatrics for PostGraduate Examination - Free ebook download as PDF File .pdf), Text File .txt) or read book online for free. Clinical Pediatrics for. by Terence Stephenson DM FRCP FRCPCH (Author), Hamish Wallace MD FRCP(Edin) (Author), Angela Edgar (Author) & 0 more. An essential, system-by-system guide to the clinical examination of children, within the postgraduate exam context. includes throughout tips for handling examiners. PDF. Book Review. Clinical Paediatrics for Postgraduate Examinations. Free This is a PDF-only article. The first page of the PDF of this article appears above.
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Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (K), or click on a page image below. Clinical Paediatrics for Postgraduate Examinations, 3e pdf by T. Stephenson DM FRCP FRCPCH. An essential system guide to the postgraduate exam should. Clinical Paediatrics for Postgraduate Examinations by Terence Stephenson, , available at Book Depository with free delivery.
All candidates are assessed with a standardized checklist, meet the same or an equivalent standardized patient, and are assessed by the same or an equivalent examiner. But OSCEs have also been used to assess undergraduate students in pediatric clerkships, 7 - 11 using children as standardized patients. Joorabchi and Devries, 17 when they compared faculty expectations with pediatric residents' performances on the OSCE over 3 years, found evidence of content, construct, and concurrent validity, as well as a high degree of reliability for the OSCE.
Efforts are constantly being made to improve the evaluation of and the feedback to postgraduate residents in Canada. None of these individually is believed to be a sufficiently reliable and valid assessment of the residents' clinical competence.
The Use of an Objective Structured Clinical Examination With Postgraduate Residents in Pediatrics
In this context, the Department of Paediatrics at the University of Toronto Faculty of Medicine, Toronto, Ontario, decided to institute an OSCE as a formative assessment of postgraduate pediatric residents' clinical skills. This article describes this formative OSCE and assesses its usefulness for evaluating and providing feedback to pediatric residents.
Subjects and methods In , the Postgraduate Medical Education Committee of the Department of Paediatrics, University of Toronto Faculty of Medicine, agreed that all pediatric residents should participate in an OSCE, if possible, given the limitations of their clinical schedules, and that the results of the examination would be included in each resident's evaluation file.
The OSCE was administered during a weekday March 29, to all of the 61 general pediatric residents who were able to take part in the examination. The osce The couplet station format was used for the OSCE: a clinical encounter followed by a postencounter probe PEP station at which students answered open-ended or multiple-choice questions based on the clinical scenario just completed.
At each station, the residents' performance was assessed with a standardized checklist and an examiner's global rating the examiners included one of us [S.
The 5 stations developed for the OSCE were based on important educational objectives for the general pediatric residency program. Each station was given an equal weighting; each checklist was scored out of 15 points, each global assessment out of 5 points, and each PEP out of 10 points.
These 5 problems were presented: 1 a father concerned about his year-old son's short stature; 2 a mother concerned about her 8-year-old daughter, who had hematuria; 3 a year-old girl with secondary amenorrhea; 4 a year-old boy with abdominal pain; and 5 a teenage mother with a newborn who was feeding poorly.
Administration of the osce Twenty-three faculty members acted as examiners including one of us [S. To accommodate all the residents, 2 equivalent circuits of 5 stations were used simultaneously, and each circuit was repeated twice.
Fifteen empty rooms were required. There were 4 equivalent standardized patients for each scenario to accommodate rest breaks.
The costs to administer this OSCE were recorded ie, the costs for the standardized patient, the standardized patient trainer, and the refreshments served. On completion of all 5 stations, the residents were given the expectations for each station and an outline of the checklist.
After all the examinations were marked, the residents received their total score for the OSCE and their individual scores for each of the 5 stations. Comparison of the osce with the iter At the end of the academic year, we reviewed the rotational ITERs.
The ITERs' descriptive assessments of the residents' clinical skills, knowledge, clinical judgment, professional attitudes, and overall assessment were each converted to a numerical score on a 5-point Likert scale: 1, unsatisfactory; 2, below expectations; 3, meets expectations; 4, above expectations; and 5, outstanding.
The ITERs evaluate the performance of residents according to the residents' level of training. Re-introduce yourself. Make eye contact with the parents and child, not the examiners. Use the child's first name. Ask the parents whether they are happy for you to discuss the child's problem in front of the child, unless a pre-verbal infant. Speak in lay language. Avoid abbreviations and technical terms. Be sensitive about issues such as genetic inheritance, malignancy, puberty, disability and survival if an older child is present.
Tell the family briefly what area you are going to discuss introductory summary , then say it, and then tell them again brief re-iteration of 'take "0 home message'. Ask the parents whether they have any questions about what you have a. Example Examiner: 'Please explain to the parents of Amy a month-old girl what the lumbar puncture which you have suggested involves. I am Dr Miles and I'm just going to explain about one of the special tests which your baby may need.
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This is called a lumbar puncture- you may have heard of it? We can then test this fluid in the laboratory.
We will put cream on first to numb the skin over Amy's lower back and then insert some local anaesthetic- just like the dentist uses. The needle is very fine, similar to the needles she has had for blood tests in the past. We do not routinely put children to sleep- a complete general anaesthetic - for lumbar puncture because it is usually fairly quick and, with the local anaesthetic, painless. However, because we cannot explain to such a young child what we are doing, it will be necessary to hold her tightly and she may cry then.
But just to recap, she will not be crying because of pain, but just because she is being held. Is there anything you want to ask me about what I have just said?
You can give Amy a cuddle immediately afterwards. Can you briefly say back to me your understanding of what we have just covered? Time is up. Please wait outside for lhe next part of your exam.
Too many candidates speak to the examiners in medical jargon, effectively excluding the parents, rather than talking to the parents in simple, plain English. If this is the case, the candidate loses ea::;y marks.
Unlike the long case, in which there is a little time in which to collect one's thoughts after examining the patient, the short cases are conducted in the presence of the examiners to allow them to assess technique. The candidate must decide quickly what is wrong with the child and it is this ability to gently, quickly and correctly elicit physical signs and rapidly interpret them which the short cases are designed to test. The time allotted for short cases is 30 minutes; usually each examiner questions the candidate for 15 minutes while the other examiner marks.
A bell may sound after 15 minutes to indicate that they should change roles, but this sequence is sometimes altered by individua l examiners. The examiners will both have seen the cases before and agreed the physical signs, how difficult they are to elicit and whether it is appropriate to expect a new specialist registrar to be able to detect the signs.
The examiners aim to use the short cases to assess the candidate on at least four systems, almost always including a developmental assessment. You may be asked to examine an entirely normal child. Newer techniques involving the use of mechanical aids, such as cardiopulmonary resuscitation models, videos, etc.
Begin each short case by introducing yourself. Try to talk to the child as much as possible. Get down to the child's level and place the child in the position you want.No sign.
Tell the child what you are going to do - do not ask permission, as he or she may say no.
Current symptoms Investigations What investigations has the child undergone so far and why? Children frequently have a palpable liver edge up to 2 em. What previous treatinents have been tried and have failed? Developmental assessment e Milestones must be viewed in light of the corrected gestational age e Delayed motor development may be exacerbated by: After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT Medical College Admission Test in their junior or early senior year in college.