Format of the Comprehensive Objective Examination in PEDIATRICS

Comprehensive objective examinations make it possible to obtain a more complete evaluation of the candidate’s strengths and weaknesses. Success or failure is based on consideration of all components of the examination. Candidates who are unsuccessful at this examination must, if within their period of eligibility, repeat all components of the examination. The written component of the examination will be taken in early Spring. Eligibility to challenge the OSCE component will be based on performance on the written component. After determining the mark on the written component, only those candidates who have a chance of passing the examination based on the written score will be invited to the OSCE component. As with all Royal College examinations, the result from the written component will be combined with the OSCE component to determine whether a candidate passes or fails the certification examination. Clarification of Terms Used in the Examination Within any of the exam components, when a clinical scenario is presented the questions posed relate to that clinical scenario. With respect to specific terms: • MOST likely: refers to the response most likely for that clinical scenario • INITIAL: refers to the first step you would do in that specific clinical scenario • NEXT: refers to the next step you would do in that specific clinical scenario • ASSESSMENT: refers to the clinical assessment for that scenario, which would include

history, physical examination, bedside point of care testing (but would not include lab investigations)

• INVESTIGATIONS: refers to all investigations for that specific clinical scenario, and may include laboratory, diagnostic imaging, ECG, referral to other specialties/ subspecialties, etc.

• TREATMENT: refers to all therapies for that specific clinical scenario and may include pharmacological treatments, non-pharmacological treatments, fluids and electrolytes, nutritional therapies, education, counseling, and follow-up

• MANAGEMENT: refers to the steps you would take in the clinical assessment, investigations, and/or treatment for that specific clinical scenario

a) Written Component The written component is made up of two three-hour papers. One paper consists of

approximately 150 multiple-choice questions and the other consists of 50 to 60 short-answer questions. The questions are allocated on the basis of key features sampled from the Specialty Training Requirements for Pediatrics.

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- 2 – Samples of Multiple Choice Question (MCQ) Component

QUESTION 1. You are following a 6-year-old boy for iron deficiency anemia. Two months after

initiation of therapy (6 mg/kg/day of elemental iron) there has been minimal improvement in the hemoglobin and ferritin levels despite adequate adherence. His history and physical examination are normal. What is the next MOST appropriate investigation to perform?

1. serology for anti-tissue transglutaminase levels 2. upper gastrointestinal (GI) series with small bowel follow-through 3. upper endoscopy 4. bone marrow aspirate

Correct answer: 1

2. Which of the following is the MOST common, long-term sequela of bacterial meningitis in a child?

1. seizure disorder 2. intellectual disability 3. hearing loss 4. hemiparesis Correct answer: 3

Sample of Short Answer Question (SAQ) Component As a guideline, the number of lines for the answer indicates the number of responses. In each question where a specific number of responses are required, only the first responses listed will be marked (e.g., If the question says, "List Four", only the first four responses will be counted. Indicate one response per line).

QUESTION You are assessing a 14-year-old boy who has had two episodes of syncope. List FOUR pieces of historical information that would indicate that he has an increased risk of sudden cardiac death. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Acceptable answers: 1 mark for 1 answer, maximum 4 marks 1. episodes of syncope during exercise/exertion 2. family history of sudden cardiac death 3. past history of congenital heart disease - repaired complex congenital disease, aortic

stenosis with mod-severe gradient 4. family history of arrhythmia/prolonged QTc 5. past history of acquired cardiac disease - ie Kawasaki's with coronary involvement,

myocarditis, hypertrophic cardiomyopathy 6. SNHL (Jervell and Lange - Nielson Syndrome 7. medications known to prolonged QTC 8. personal history of prolonged QTC

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b) OSCE (Stations) Component The OSCE component consists of approximately ten examination stations, each 15 minutes in duration. The stations may involve patient encounters with parents or older children and young adolescents, demonstration of a focused physical examination, telephone consultation, visual recognition (laboratory reports, illustrations), videos, critical appraisal, structured oral encounters, and short verbal questions based on the patient encounter. Please note that the OSCE stations of day one and day two will be equivalent in difficulty but will consist of completely different clinical scenarios. For each station, the candidates will have two minutes to read the instructions posted outside the examination room. At the sound of the signal the candidates must enter the room to begin the station. The instructions to candidates will also be on a table in the examination room. The candidates must follow the instructions for that station. At the end of the 15 minutes, there will be another signal at which time the candidate must exit the room and progress to the next station. The total duration of the OSCE component will be approximately four hours. In stations involving a patient encounter you may be asked to demonstrate a focused physical examination. As you perform the requested examination, please speak out loud so that the examiner is aware of what you are demonstrating. Further instructions will be provided in the station scenario. Candidates do NOT require any medical equipment (i.e. stethoscope). All required equipment will be provided.

The timing for each OSCE station will be as followed:

• You will have 2 minutes to read the scenario and instructions outside the examination room.

• You will then have 15 minutes in the examination room to complete that station. Timing within each station will be specified in the Candidate Instructions.

• You will then proceed directly to the next station where you will have 2 minutes to read and prepare for that station.

• You will continue in this pattern until you have completed all stations.

Evaluation: A combination of two assessment methods will be used to evaluate candidate performance on each OSCE station. These are described below: • Item Checklist: This will be used to document the specific skills, questions or

advice that you have demonstrated during the station. Every station will have a unique checklist. The checklist captures “what” was done during a given station.

• Global Rating Scale: This will be used to assess relevant aspects of care demonstrated during the station, such as data gathering, organization, clinical reasoning, communication skills, empathy, etc. Every station will have a unique Global Rating Scale (GRS). The GRS captures “how” things were done during a given station.

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Sample OSCE Stations

1. Sample Patient Encounter Station:

INSTRUCTIONS TO CANDIDATE (posted outside the examination room): You are a consultant pediatrician. A family doctor has referred an 8-year-old female, Sarah Smith with hematuria. You will have eight (8) minutes to obtain a focused history from Sarah’s mother. The child will not be present for this encounter. Your examiner will let you know when you have one minute left for the history. You will then have seven (7) minutes to answer THREE questions based on the case from the examiner in the room.

What to expect: In the first part of this station, the examiner will observe you taking a focused history from the mother. In the second part of this station, you will interact directly with the examiner who will ask you specific questions. The examiner will assess your performance on both parts of the station.

2. Sample Structured Oral Station:

INSTRUCTIONS TO CANDIDATES (posted outside the examination room):

You are asked by the emergency department physician to attend to an 18-month-old previously well boy who presented by ambulance to the emergency department with a generalized tonic-clonic seizure for at least 30 minutes in duration. He is cyanosed and having tonic-clonic movements of all extremities. Heart rate is 140/min, respiratory rate is 40/min, temperature is 36.8ºC and blood pressure is 100/70 mmHg.

In the first 12 minutes of this station, you will be asked by the examiner to discuss the steps in MANAGEMENT of this child. You will be provided with information as you progress through the case. In the last 3 minutes you will be asked 3 brief questions related to this case. The examiner will guide your time. What to expect: This station does not involve a patient or parent. All parts of this station will involve direct interaction with the examiner. In discussing the specific aspects of management for this patient, it would be important to group related questions together. Ideally in this station, you would begin with discussing how you would assess and stabilize this patient. You should then proceed to history, further physical examination, and investigations. In describing the questions you would ask in each section, you should describe all of the questions together and at the end of each section the examiner will provide you with responses to your questions so that you can progress through the case. The examiner will guide your time. For example, although you have 12 minutes allotted to discuss your management, in the sample station above, the examiner would move you through the case, providing relevant information as you progress. It is important that you are organized and focused in your data gathering. In the sample above, the examiner would interrupt you, at preset time intervals, to move you on to the next section and ensure that you had sufficient time to complete all aspects of the management (stabilization, history, physical examination, investigations).

© 2012 Royal College of Physicians and Surgeons of Canada. All rights reserved.

Revised November 2014