The short case

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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Chapter 3 The short case

The short-case section of any postgraduate examination covers a number of systems (typically cardiovascular, respiratory, abdomen, neurological), and different countries’ learned colleges vary in their approach. In Australia, the individual FRACP short case tends to have a lead-in that is fairly broad, for example ‘Examine the gait’, and a comprehensive examination is expected. Each short-case examination lasts 15 minutes.

On the day of the examination, in Australia, there are four short cases, two in the morning cycle and two in the afternoon cycle, and the candidate is examined by four sets of examiners. For each short case, the candidate is given 15 minutes with the patient. The candidate is supplied with a written introduction on a card, posted outside the door of the examination room, outlining a short history and indicating the system(s) to be examined, such as ‘Ian is a 7 year old boy who has had increasing trouble climbing stairs over the last 6 months. Please examine his gait’. The candidate has 2 minutes to read this introduction before meeting the patient. The same introduction is used for all candidates. The candidate should perform a relevant physical examination; the examiners are interested in the method of examination, and appropriate interpretation of signs elicited. Practice is the key to success.

In the UK, the individual MRCPCH short cases tend to have a lead-in that is more directed, so a more focused examination is in order: the examiner may say ‘Listen to the heart’, and that is what the candidate must do—not pick up the hands, take the pulse and look for clubbing, but get the stethoscope and listen. The short cases here are deliberately set out in the ‘comprehensive’ approach; it is easy to adapt the relevant portion of the examination to whichever lead-in the examiner gives. A short case tests the candidate’s ability to examine a child with the ease and accuracy of a consultant paediatrician, rather than a paediatric registrar, although the examiners are judging the candidate at his or her expected level of training.

A short-case examination should be sufficiently comprehensive for the lead-in given, but directed. It should be confidently performed, quick enough to be within the confines of examination timing, and above all conducted kindly and with consideration for the patient and the parent.

The emphasis is as much on the method of physical examination as on the interpretation of the signs elicited. Remember that the examiners are judging you as a (future) peer. Thus a high standard is mandatory.

Proficiency in short cases, even more so than in long cases, is dependent upon months of practice, preferably on a daily basis, perfecting a coherent approach to every possible clinical problem likely to be presented. Several examination problems, such as short stature or precocious puberty, require a great deal of clinical material to be covered in 15 minutes, so a well prepared routine is essential. This book gives an outline of an approach to most of the commonly seen short-case topics.

For several of the short cases outlined, there is an accompanying diagram that visually supplements the content of the text. The author found it easier to remember a diagram than a long list written on a card.

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