Examination Medicine: A Guide to Physician Training by Nicholas J. Talley, Simon O’connor Read Free Book Online
Authors: Nicholas J. Talley, Simon O’connor
pairs, with each person taking turns to be the examiner. Practising being an examiner helps you to appreciate the bad habits that annoy the real examiners.
Equipment is always provided at the hospital where the examination is held. However, it is important to take the following:
• a familiar stethoscope that you have used for a long time. Do not buy a new fancier stethoscope the day before the test; it takes time to get used to a new instrument. Electronic stethoscopes are not generally allowed unless a candidate has a hearing problem and has obtained permission from the College
• a hand-held eye card – obtainable from OPSM for a moderate charge and essential for cranial nerve or eye examinations (see Ch 16)
• a red-tipped hatpin – you can buy a plain one and paint the top with nail polish; this is invaluable for visual field testing (see Ch 16)
• paper and pens.
It is debatable whether candidates should take in their own bags of instruments. Many favour bringing their own ophthalmoscope and pocket torch (with fresh or recharged batteries in both). Others also like to have cotton wool, neurology pins (an unused one for each case) and spatulas, as well as tuning forks (256 Hz and 128 Hz) and a patella hammer, which is too much to carry in the pockets. This has led to a trend for leather briefcases to house all the equipment (see Fig 3.3 ). However, the occasional difficult examiner has been known to complain about this! There is a legend about one candidate’sbriefcase, which was filled with such elaborate equipment, including an inverted cardigan for testing dressing apraxia, that his examiners spent their time inspecting the contents rather than watching him examine the patient (not a recommended approach!).
FIGURE 3.3 A candidate’s bag
1. Eye charts
2. Buttons and long patella hammer (underneath)
3. Stethoscope
4. Torch
5. Tape measure
6. Tuning forks
7. Ophthalmoscope and auriscope
8. Hatpins (red and white)
9. Jar with lid (containing key for key grip assessment)
10. Disposable neurology pins
11. Cotton wool
12. Spatula
13. Cotton buds and spare patella hammer
14. Carefully shaped foam inserts
A few more cautionary tales:
• Candidates who have just bought their bags have been known to forget the combination number needed to release the lock at the critical moment in the exam when the bag has to be opened.
• One candidate placed her open bag on the sink in the examination room for her first case, only to have the bag flooded with water when one of the examiners leaned closer to watch the examination and accidentally turned on the tap above the sink ( Fig 3.4 ).
FIGURE 3.4 Incorrect positioning of bag #1
• Leaving your bag on the floor might also be problematic. Many a examiner has been anxious that a candidate might walk backwards, trip over his or her bag and be impaled by a patella hammer ( Fig 3.5 ).
FIGURE 3.5 Incorrect positioning of bag #2
• During the assessment of the patient by the examiners one examiner mocked the old-fashioned stethoscope of his colleague: ‘You have a 19th-century stethoscope and I have a 21st-century one,’ he said. On going to examine the patient with his electronic stethoscope (not usually allowed to candidates), he stopped and said; ‘Ah, the battery is flat.’ ‘Don’t worry, you can borrow mine,’ said his helpful colleague. If you have permission to use one make sure it is charged. It would be embarrassing to have to ask to borrow the examiner’s.
• Most candidates fly in to the examination city on the day before their exam. At least one candidate arriving in jeans and a T-shirt found that his luggage, containing his suit and tie, had been sent by the airline to Hawaii (or somewhere). It was too late to buy more clothes. He sat the exam in these casual clothes, having explained to the exam organisers what had happened. The story had a happy ending, but the anxiety caused by such an occurrence is
Equipment is always provided at the hospital where the examination is held. However, it is important to take the following:
• a familiar stethoscope that you have used for a long time. Do not buy a new fancier stethoscope the day before the test; it takes time to get used to a new instrument. Electronic stethoscopes are not generally allowed unless a candidate has a hearing problem and has obtained permission from the College
• a hand-held eye card – obtainable from OPSM for a moderate charge and essential for cranial nerve or eye examinations (see Ch 16)
• a red-tipped hatpin – you can buy a plain one and paint the top with nail polish; this is invaluable for visual field testing (see Ch 16)
• paper and pens.
It is debatable whether candidates should take in their own bags of instruments. Many favour bringing their own ophthalmoscope and pocket torch (with fresh or recharged batteries in both). Others also like to have cotton wool, neurology pins (an unused one for each case) and spatulas, as well as tuning forks (256 Hz and 128 Hz) and a patella hammer, which is too much to carry in the pockets. This has led to a trend for leather briefcases to house all the equipment (see Fig 3.3 ). However, the occasional difficult examiner has been known to complain about this! There is a legend about one candidate’sbriefcase, which was filled with such elaborate equipment, including an inverted cardigan for testing dressing apraxia, that his examiners spent their time inspecting the contents rather than watching him examine the patient (not a recommended approach!).
FIGURE 3.3 A candidate’s bag
1. Eye charts
2. Buttons and long patella hammer (underneath)
3. Stethoscope
4. Torch
5. Tape measure
6. Tuning forks
7. Ophthalmoscope and auriscope
8. Hatpins (red and white)
9. Jar with lid (containing key for key grip assessment)
10. Disposable neurology pins
11. Cotton wool
12. Spatula
13. Cotton buds and spare patella hammer
14. Carefully shaped foam inserts
A few more cautionary tales:
• Candidates who have just bought their bags have been known to forget the combination number needed to release the lock at the critical moment in the exam when the bag has to be opened.
• One candidate placed her open bag on the sink in the examination room for her first case, only to have the bag flooded with water when one of the examiners leaned closer to watch the examination and accidentally turned on the tap above the sink ( Fig 3.4 ).
FIGURE 3.4 Incorrect positioning of bag #1
• Leaving your bag on the floor might also be problematic. Many a examiner has been anxious that a candidate might walk backwards, trip over his or her bag and be impaled by a patella hammer ( Fig 3.5 ).
FIGURE 3.5 Incorrect positioning of bag #2
• During the assessment of the patient by the examiners one examiner mocked the old-fashioned stethoscope of his colleague: ‘You have a 19th-century stethoscope and I have a 21st-century one,’ he said. On going to examine the patient with his electronic stethoscope (not usually allowed to candidates), he stopped and said; ‘Ah, the battery is flat.’ ‘Don’t worry, you can borrow mine,’ said his helpful colleague. If you have permission to use one make sure it is charged. It would be embarrassing to have to ask to borrow the examiner’s.
• Most candidates fly in to the examination city on the day before their exam. At least one candidate arriving in jeans and a T-shirt found that his luggage, containing his suit and tie, had been sent by the airline to Hawaii (or somewhere). It was too late to buy more clothes. He sat the exam in these casual clothes, having explained to the exam organisers what had happened. The story had a happy ending, but the anxiety caused by such an occurrence is
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