Instructions to Candidates (New Zealand)

Download a PDF version of the Instructions to candidates (New Zealand) (updated 14 March 2019)

Preamble

The Divisional Clinical Examination (DCE) is designed to test clinical skills, attitudes and interpersonal relationships.

The clinical skills include history taking, physical examination, interpretation of findings, construction of a diagnosis or differential diagnosis, method of investigation and general management of patients.

As you have already passed the Divisional Written Examination (DWE) any detailed discussion in the DCE will be directed to testing clinical skills. Questions testing your factual knowledge will be at a level appropriate to making adequate management decisions in the case being discussed. 

Eligibility

  • have 24 months of certified training by the end of the training year in the year prior to the examination
  • be in an accredited training position or an approved interruption in training
  • completion of all PREP requirements
  • comply with the limit on the number of examination attempts and other requirements for progression through training, which are detailed in the Progression Through Training Policy
  • have paid all associated training fees. Trainees with outstanding training fees will not be eligible to sit the examination unless they have made an application in writing to the Honorary Treasurer requesting special consideration

The Progression through Training Policy states that you must be in an accredited training site and be completing requirements even if you have completed 36 months of Basic Training.

Application Form

Eligible candidates will be emailed a copy of the 2019 DCE application form. This form must be completed and returned to the RACP by Monday, 25 March 2019.

If you believe you are eligible and have not received an application form email examinations@racp.org.nz

Dates

The DCE will be held on the following dates:

Paediatrics and Child Health: 24 – 26 May 2019
Adult Medicine: 21 – 23 June 2019

Candidates should not assume that their own examination will be at the same time as other candidates from their hospital or city.

Venues

The Examination will be held in the following locations:

Adult Medicine

Whangarei Hospital 
Auckland Hospital 
Manukau Superclinic 
North Shore Hospital 
Taranaki Base Hospital 
Tauranga Hospital 
Gisborne Hospital 
Rotorua Hospital 
Waikato Hospital

Paediatrics and Child Health

Waikato Hospital 
Greenlane Clinical Centre 
Hawkes Bay Hospital 
Taranaki Base Hospital 
Christchurch Hospital 

Candidates will not be examined in their own hospitals and should be prepared to travel to a different city. The College will try to advise candidates of their allocated venue with as much prior notice as possible.

Please note that due to unforeseen circumstances, these venues may change at short notice.

Proof of Identity

Candidates must ensure they take proof of identification (e.g. a passport, a photo driver's license or hospital photo identification card) as this will be checked upon arrival at the examination.

Format of the DCE 

The examination format will require candidates to be examined on two long cases and four short cases. The examination will consist of two examination cycles (morning and afternoon) on the one day. In each cycle, candidates will be examined on one Long Case patient and two Short Case patients. In one cycle the Long Case will be seen before the Short Cases, while in the other cycle the Long Case will follow the Short Cases. Each candidate will be examined during these two cycles by at least four pairs of examiners. Each case will be scored independently, and the candidate's final result will be determined by the aggregate mark.

Long Case Assessment

The purpose of the Long Case is to test clinical examination skills with an emphasis on: accuracy of history; accuracy of the clinical examinations; synthesis and prioritisation of clinical problems; understanding the impact of the illness on the patient and the family; and the development and discussion of an appropriate management plan.

Examiners will assess whether candidates display the skills listed above to the relevant standard in the time allowed, based on the criteria set out in the appendices at the end of these instructions.

Excessively lengthy case presentations are not advisable and may be interrupted by an examiner, to prompt the candidate regarding case timing.

You will be allotted 60 minutes to take a patient’s history, examine the patient, and develop a management plan for the patient. You will then have 10 minutes to prepare discussion points. After that, candidates move to the examiners’ room where they then will spend 25 minutes discussing the patient with their allocated examiner team.

You can take some items into the patient’s room to assist in the physical examination of the patient (see ‘Items to bring’ below). However, no printed material (including textbooks, notes, MIMS or other drug compendia), pro-forma sheets or electronic devices are permitted. The aim of these restrictions is to make the examination as fair as possible for everyone.

Note: Where relevant, you will be given access to medication lists and results of urinalysis/rectal examinations.

Candidates are reminded that all patient records, including their notes about patients, should be treated confidentially. All notes regarding patients must be left with the organisers at the examination for destruction.

If you know the patient you are seeing in the examination, please inform the staff onsite immediately. College staff and local organisers go to great lengths to ensure that the patients you will examine are not known to you. However there remains the possibility, for whatever reason, that a candidate has seen a patient before. 

Failure to inform the staff of a prior knowledge of the patient could be seen as a breach of the Academic Integrity in Training Policy.

Short Case Assessment

The purpose of the Short Case is to test clinical examination skills with an emphasis on: the interaction with the patient and/or family; technique and accuracy of physical examination; interpretation and synthesis of physical findings; and investigations/management. As part of the assessment of your findings, you may be asked to comment on relevant diagnostic tests (e.g. x-rays, ECGs) and/or nominate appropriate investigations.

Examiners will assess whether you display the skills listed above to the relevant standard in the time allowed, based on the criteria set out in Appendices at the end of these instructions.

Each Short Case examination will last 15 minutes.

Before entering the Short Case room, you will be given two minutes to read a written introduction to the Short Case (the ‘stem’), which will be outside of the Short Case room door. This introduction is written by the examiners and will contain the patient’s name, the relevant body system and, sometimes, the dominant clinical problem. It will be standardised prior to your entry into the examination room and is designed to be accurate, short and directive.

Standard required

For trainees of the College, the standard required includes the breadth of knowledge, aptitude and skills sufficient for the management of general medical or paediatric patients to enable you to enter Advanced Training.

Quality and safety standards

To maintain appropriate health and safety standards during the conduct of the examination, examiners and candidates must both ensure that they wash their hands prior to, and after, carrying out any physical examination.

You may be dealing with patients with infectious diseases and you are advised to take the appropriate precautions. A supply of clean disposable pins will be supplied for neurological examinations (for both the Long and Short Cases). You will not be permitted to use your own pins unless they are disposable.

Case selection

A broad range of cases is selected for the examination however candidates may be asked to examine similar systems on more than one patient.

Adolescent patients

On the examination day, you should not request a patient’s parents or guardians leave the room to interview adolescent patients privately. This request is inappropriate during preparation for the examination and is not expected during the DCE.

Examiner review of patients

Examiners will have taken a history from each Long Case patient and examined and identified relevant issues for discussion prior to each cycle of the examination. This is done without the aid of patient notes or prepared histories to enable a more accurate appraisal of the patient's ability to give a clear history and of the accuracy of signs.

Short Cases are also assessed 'blind' by the examiners prior to each cycle.

Examination day timetable

 One half of candidates  Other half of candidates
 Morning
9.20am - 11.50am
One Long Case followed by two Short Cases
9.35am - 12.20pm
Two Short Cases followed by one Long Case
 Afternoon
2.15pm - 5pm
Two Short Cases followed by one Long Case
2pm - 4.30pm
One Long Case followed by two Short Cases

Most hospitals will provide light refreshments during the course of the examination cycle, however candidates are responsible for provision of their own lunches (unless the examining centre is remote).

All candidates should arrive at the examination site by 9am.

Number of examiners

Each team is made up of at least two examiners and each candidate sees at least four pairs of examiners. At each hospital venue, there may be additional examiners allocated to teams. Therefore, a team may consist of more than two examiners, however, only two will actively examine you and determine your score. Where this occurs, the third person is called an 'observer' to differentiate them from the 'examiners'. 

Items to bring

You must bring your own stationery for use during the DCE - for example, blank manila folders, blank cards or paper, and pens/pencils. Pre-printed/written templates or reminders are not permitted.

You are also required to bring your own equipment to the examination. The rationale for the standardisation of acceptable equipment includes fairness to everyone and ensuring that, as far as possible, the clinical signs that you elicit will match those obtained by the examiners, who will likewise use standard equipment.

You may bring the following approved equipment (relevant to your discipline):

Paediatrics & Child Health

  • Blank paper/cards and pencils/pens
  • Stethoscope (which must not be electronically augmented unless you have obtained specific permission for medical reasons) 
  • Standard handheld ophthalmoscope (not a Panoptic ophthalmoscope) 
  • Red-topped hat pin or equivalent, for visual field testing
  • Standard auroscope
  • Pocket torch
  • Tape-measure and/or ruler
  • Tendon hammer
  • Single-use spatulas
  • Tuning forks (128 and 256 Hz)
  • Handheld visual acuity chart(s)
  • Cotton wool 
  • Single-use neurological examination pins for testing sensation
  • Printed picture for higher centres testing
  • Props such as a jar, key and shirtsleeve with button, for hand function testing
  • Standard growth chart 
  • Toys for distraction and testing of development 

Adult Medicine

  • Blank paper/cards and pencils/pens
  • Stethoscope (which must not be electronically augmented unless you have obtained specific permission for medical reasons)
  • Standard handheld ophthalmoscope (not a Panoptic ophthalmoscope)
  • Red-topped hat pin or equivalent, for visual field testing
  • Standard auroscope
  • Pocket torch
  • Tape-measure and/or ruler
  • Tendon hammer
  • Single-use spatulas
  • Tuning forks (128 and 256 Hz)
  • Handheld visual acuity chart(s)
  • Cotton wool
  • Single-use neurological examination pins for testing sensation
  • Printed picture for higher centres testing
  • Props such as a jar, key and shirtsleeve with button for hand function testing

You are not allowed to bring in references, iPads/tablets, smartwatches, mobile phones, or other data- storing/sharing/recording devices, whether written or electronic.

If you inadvertently bring any of these items, or any other equipment that is not considered acceptable to the examination, you must declare this to the examination organisers, who will take the item(s) for safekeeping until the examination is finished.

Anyone who takes unauthorised material into any of the examining rooms may be disqualified from the examination.

Anyone found with a recording device, including a mobile phone, will be automatically disqualified from the examination.

Your examination cases may be checked on examination day. 

Preparation for the examination

Regular clinical activities in the hospital will prepare you for clinical examination of patients. In most hospitals the Director of Physician/Paediatric Physician Education (DPE) and members of other College training committees will often assist trainees by discussing the DCE and undertaking Long and Short cases at practice sessions. 

Pre-examination contact at examination sites

In the past, some candidates have approached the allocated examination hospital after receipt of the allocation notification, attempting to obtain information regarding the patients selected for the examination, or on the types of cases in which the hospital specialises.

Certain actions may be perceived as attempting to gain an advantage in the examination and may lead to disqualification from the examination and/or affect your progress through training. These actions include: 

  • Any attempt to gain information pertaining to possible cases from staff organising the examination at the allocated hospital.
  • Attendance at practice cases or practice exams at the allocated hospital after notification of examination allocation.
  • Any attempt to inspect, or to organise to inspect, specific rooms or departments that may be involved in the examination at the allocated hospital.
  • Any attempt to find out who will be the examiners at the allocated hospital.
  • Any attempt to contact potential examiners to seek guidance on how to improve performance in the examination.
  • Any attempt after the DCE to contact the examiners encountered during the examination day, apart from through the standard feedback procedures for unsuccessful candidates. 

Please note we understand that you may want to go to the hospital the day before your examination to ensure that you know where to go. Out of respect for the site and the staff who are working, please do not go in and ask to look at the area where the examination will take place.

Marking

Each case for the DCE is marked out of 6 points as per the scoring guides provided in the Appendices at the end of these instructions. Since all patient cases are slightly different, each case mark may reflect a performance assessed using only part of the marking guide and will score overall case performance.

Both markers will provide an independent mark, then will discuss their scores and the candidates’ performance to come to a final consensus score for each case.

Criteria for assessment of performance

Criteria for assessment of performance - Adult

Criteria for assessment of performance - Paediactrics and Child Health

Pass mark

Short Case and Long Case scores will be combined to determine a candidate’s overall outcome using the Score Combination Grid. This approach uses a two-step process to determine a candidates’ outcome.

In the first step, Long Case performance is used to determine the ‘band level’. Once the band level is determined, the band rules determine the level of performance on the Short Cases that is required to meet the standard. Lower band levels indicate poor Long Case performance and will require stronger Short Case performance.

Details and examples of determination of the pass standard are found on the Divisional Clinical Examination webpage.

Deadlines for special consideration

Ideally applications for pre-exam special consideration should be made at the time of application.

Paediatrics and Child Health Adult Medicine
Pre-examination special consideration requests close  Friday, 5 April 2019 Tuesday, 23 April 2019
Examination day special consideration requests close (Technical and procedural issues) 12pm Tuesday, 28 May 2019  12pm Tuesday, 25 June 2019 

Results

Your results will be emailed to you on the following dates:

Paediatrics and Child Health: 6 June 2019
Adult Medicine: 27 June 2019 

Feedback

Examiners complete a form designed to provide feedback to candidates in order that they may learn from the DCE experience. The feedback form for individual candidates is filled out immediately after each case. Examiners only have a short time to do this. The feedback sheet does not provide a list of pass/fail points. It should not be used as a means of disputing the basis of an unsatisfactory performance. It cannot and will not be used as a means of “remarking” a candidate’s performance.

Candidates who are successful in their attempt at the examination will be sent a copy of their feedback sheets after the full duration of the clinical exam process.

Candidates who are unsuccessful in the examination will have a feedback session with a supervisor or mentor of their choosing to discuss their performance. The feedback sheets will be given to the candidate at this session to provide information which may assist preparation for re-examination. In the interest of patient confidentiality, case summaries will be provided to the feedback person and must be destroyed following the feedback session.

It is the responsibility of the candidate to arrange this interview time. Candidates may also wish to invite a support person to attend this session.

Number of Attempts

Limits on the total training time allowed and the number of examination attempts are specified by the Progression Through Training Policy. The revised policy was implemented from 1 January 2017.

Transition arrangements are in place which may be relevant to trainees sitting the DWE and DCE in 2019. You can view your examination attempts to date on the Basic Training Portal.

For more details please see the Progression Through Training Policy.

Withdrawal from the examination

If you wish to withdraw from the DCE, you must notify the Examinations Team by emailing examinations@racp.org.nz. Withdrawals are not counted as examination attempts. You may withdraw up until the commencement of the examination.

Please note the following:

Candidates who withdraw their applications will be entitled to the following refunds:

  • If withdrawing before the closing date for applications – a full refund of the fee.
  • If withdrawing after the closing date for applications, but not later than 14 days before commencement of the DCE – a refund of 50% of the fee.
  • If withdrawing within 14 days of the commencement of the DCE – no refund.

To request a refund outside of these rules on medical or compassionate grounds, you must submit an application under the Special Consideration for Assessment policy.

If you withdraw from the DCE you may re-apply to sit the examination in the following year provided you meet the eligibility criteria. Please note that application fees cannot be ‘rolled over’ from one year to another.

Fee

Clinical examination fee: $3,321.20 (GST inclusive) 

Completion of Basic Training

Eligibility for entry into Advanced Training is contingent upon

  • Completion of 36 months of satisfactory Basic Training
  • Passing both the DWE and DCE
  • Completing PREP requirements                                                                                 

If you have NOT completed 36 months of satisfactory Basic Training at the time of passing the DCE, you will be directed to complete further training before you can apply for the Advanced Training program.

Contact with the College

All queries regarding the examination should be directed to the examinations team.

Telephone: 0508 69 7227
Email: examinations@racp.org.nz

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