We came across an issue this week regarding the issue of history and examination findings. There has always been a bit of a blurred line in the exam between the two, but in general history was stuff that you asked the patient, and examination was stuff you looked for and found on the patient.
So, in the context of an obstructed airway, are voice changes, difficulty swallowing secretions and stridor or wheeze history, or examination findings?
"..more precisely, it depends on how you ask the question and how you answer it...."
A couple of weeks ago in our virtual study group - a key component of the fellowshipexam.com course - we had a great question.
What is the best (or definitive way) to reduce a pulled elbow?
As a question, it highlights two very important issues when studying for the fellowship exam.
When you’re studying for the fellowship exam in particular:
"If you lined up 10 FACEMs and asked them....they'd each give slightly different answers."
Earlier this week we posed the question:
A 27 year old woman presents to your ED with RIF pain and PV bleeding. She is sexually active and uses a Mirena device. Her only gynaecological and obstetric history is an incidental diagnosis of ovarian cysts as a 22yo. A urine bHCG is positive.
Which of the following statements is true?
A) this patient's symptoms are likely due to an ovarian cyst
B) Because this patient has no documented history of PID an ectopic pregnancy is unlikely
C) This patient's use of an intrauterine contraceptive device places her at an increased risk of an ectopic pregnancy
D) This patient may have an ectopic probably caused by exposure to diethylstilbestrol
It's a good example of a clinically based multi-choice question that should be featuring on the new exam.
Now, knowing is NOT enough - you need to able to reason as well.
The fellowshipexam.com team were bemused to hear some recent exam candidates (not our students!) speak about ACEM's second new fellowship examination. It seems that several of the questions were a bit out of left field.....
"In fact, we here at fellowshipexam.com were similarly outraged, until irony of ironies one of our faculty actually had to perform the procedure under question last weekend!"
It's a big day on Thursday for everyone finishing up from the current fellowship course - the fellowship written!
Preparing for the big day is exactly what the course is all about. It's natural to be a bit scared the day before the exam, but we want you to think about the exam in the context of the fellowship course.
"Above all, we want you to remember the immortal words of Douglas Adams: Don't Panic!"
In the fellowshipexam.com blog a few weeks ago we mentioned the importance of structure in your exam answers. Funnily enough, how you put down your answer is almost as important as what you write down. Part of preparing for the big day is thinking about how and more importantly *why* you write what you write.
"The exam has rules and like any rules they should be used to maximal advantage..."
One of the things candidates and their families often underestimate is the human aspect of the exam. Today's blog comes direct from resus.com.au (our parent site). Dr Peter Kas, the founder of the fellowshipexam.com course talks about what the fellowship exam meant to him and why we at fellowshipexam.com do what we do. Check it out below...
"...that if you don’t get it [the exam], we’ve maxed out the credit card and will probably lose the house..."
There is a real and appreciable difference between examination emergency medicine and “real life”. Often in the ED senior doctors are handed an ECG and asked to interpret it. This is analogous to the “old” VAQ exam and the “describe and interpret” type questions. The only way to approach the ECG was with a systematic drill, and work through it logically. But, the new exam is different.
Take question 2 from the most recent paper....
To paraphrase Doctor Who, time in exams is less than linear and much more “wibbly-wobbly".
For the second fellowshipexam.com microblog we thought we’d have a look at a recent question published by the college from the first new exam paper.
A 55 year old female patient is brought by ambulance to the emergency department after being involved in a high speed MVA. The pelvic x-ray from her trauma series is reproduced (in the previous question, showing an open pelvis).
Massive transfusion has been administered while waiting for the retrieval team to provide transfer to the local level 1 trauma centre. An arterial blood gas has been performed.
In the context of the case we are asked two specific questions:
"The most important thing is to have a consistent, well drilled approach to questions such as these, so that the number of marks garnered (and therefore the candidate’s chance of passing) is maximized."
ACEM has now released a copy of the new written fellowship exam. It's available at:
https://www.acem.org.au/getmedia/0384ec35-94b5-4787-b71d-55de6c7b369c/Item-Writing-Handbookv2-compressed2.pdf.aspx (ACEM members will need to login).
Looking through the paper, our first impressions are that it was what we were expecting. There are a lot of knowledge focussed questions, with a large number of "props" to support them. Gone are the old nebulous "describe and interpret" type pictures - now a specific number of findings are requested of each prop, and directed questions about the implications of these findings have replaced the interpretation phase.
The fellowship faculty
We work as emergency physicians, and teach, blog and write at resus.com.au