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Exit Examination
[Guidelines on 2008 Supplementary Exit Examination of Vocational Training in Family Medicine]
[Clinical Audit Report] [Practice Assessment] [Consultation Skills Assessment]
 
CONSULTATION SKILLS ASSESSMENT
 
The consultation skills assessment is based on the Leicester Assessment Package (LAP) for assessment of consultation competence in General Practice developed by Robin C Fraser.
 
ASSESSMENT PROCESS
 
Two examiners appointed by the Specialty Board, who may be accompanied by a third examiner and/or observing examiner (maximum four examiners), will visit the candidate's practice in any day during the specified period (July 2 - September 30, 2008). Each examiner will present to the candidate a letter from the HKCFP for identification and an assurance of confidentiality for the consultation skills assessment. Each consultation will be assessed individually and then an overall score will be made from all the observations independently by the examiners. A third examiner's mark may be taken into account if the Specialty Board decides that this is necessary. The assessment by the third examiner may be done during the same visit with the first two examiners or on a separate visit. No videotaping of the consultations will be done.
 
The examiners will sit in the candidate's consultation room to observe six consecutive patient consultations within the allowed time during the visit. The assessment will proceed as in steps to follow (appendix E). The candidate should seek written consent from patients before the consultations and present a brief summary of the patient's significant past information. This should include the date and the reason for the last consultation and to state whether the current consultation is a planned follow-up or not. The candidate can then proceed to history taking. After history taking, the candidate needs to present a brief summary of the patient's presenting history. The candidate will then be asked to give the hypotheses on diagnosis and/or problems of the patient. The candidate will be observed to perform the physical examination, and then be asked to present his/her physical examination findings. The accuracy of the physical signs will be checked by the examiners. The candidate will then give his/her explanation on the management plan, and the medical records will subsequently be assessed
 
The time normally allowed for six consultations is two hours. The time taken for each consultation (counted from the time of handing in the patient's consent form to the examiners to after explanation of the management plan to the examiners) will be noted and assessed on whether the duration of the consultation is appropriate. The examiners can request to observe more consultations in the same visit or arrange for a second visit if they have not had enough information for rating, or if the assessment cannot be completed within 3 hours.
 
ASSESSMENT CRITERIA
 
The consultation skills assessment criteria (appendix F) from LAP are adopted. The passing standard of this assessment is 65% when candidate consistently demonstrates capability in almost all components to a high standard and a satisfactory standard in all, with duration of most consultation appropriate.
 
SUGGESTED READING
 
  1. Fraser RC. Clinical Method: A General Practice Approach (3rd Ed). Butterworth-Heinemann, 1999
  2. Fraser RC. Assessment of Consultation Competence in General Practice, The Leicester Assessment Package (LAP)
 
CRITERIA FOR A PASS IN THE EXIT EXAMINATION
 
A candidate must score a minimum of >=65% in each of the three segments to pass the whole Exit Examination. The score of a segment of the Exit Examination can be retained for a maximum of three years if a score of >65% is achieved in that segment. Unsuccessful segments can be retaken in subsequent supplementary or full Exit Examination. A candidate must pass all segments of the Exit Examination within three years from the year of the first attempt in order to be certified pass in the Exit Examination. Those candidates who are not able to pass all segments within three years would be required to undertake remedial training determined by the BVTS before any re-attempt to re-sit all three segments of the Exit Examination. The results of previous Exit Assessment/Examination(s) cannot be carried in the latter situation.
 
TROPICAL CYCLONE OR RAINSTORM WARNING
 
  1. Examination will be cancelled if, within four hours before the appointed time of the examination, Tropical Cyclone Warning Signal No.8 or above is hoisted or remains in force or Rainstorm Black Warning is issued or remains in force. The examination will be re-arranged as soon as possible.
  2. If Tropical Cyclone Warning Signal No.8 or above is hoisted or Rainstorm Black Warning is issued while an examination is in progress, the examination will be continued if circumstances allowed until the examination finished, or the examiner(s) appointed by the Specialty Board will decide whether to adjourn or continue with the examination.
 
FEEDBACK SESSION
 
As the Examination is an educational process, the Chairman of the Specialty Board will invite candidates to attend feedback session usually within two months after the Examination. The feedback session is the only channel to give feedback to candidates. The feedback is on an individual basis and preference is given to unsuccessful candidates.
 
During the feedback session, the Chairman or segment co-ordinator(s) will discuss with the candidate on the areas of weakness with some suggestions for making improvement. Comments and expectations from the candidate are always welcomed and taken seriously. Most former candidates found these sessions useful.
 
REVIEW OF EXAMINATION RESULTS
 
The Specialty Board has made great effort to ensure the validity and reliability of markings in the Exit Examination. Candidates will be exposed to as many different assessors as possible. Each candidate is marked by at least two examiners independently in each segment. The marks are double-checked by College secretariat and the co-ordinator of each segment for any clerical or mathematical error. All examiners are requested to name all the candidates whom they prefer not to assess to avoid any conflict of interest.
 
  1. A candidate may request a review of his/her examination results only if he/she believes that there has been an administrative or procedural error during the examination.
  2. A candidate who believes that there has been an error in administration or procedure must give a written notice to the Chairman, Specialty Board (Room 701, 7/F., HKAM Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, Hong Kong) which must be received within 14 days of the examination results being published. The notice must set out any reasons and evidence to support the candidate's belief. There is an administration fee of HK$1,000 for each segment and a cheque for this amount, payable to the HKCFP Education Limited, should be forwarded to the Specialty Board, Room 701, 7/F., HKAM Jockey Club Building, 99 Wong Chuk Hang Road, Aberdeen, Hong Kong with the request for review notice
  3. As soon as possible after receiving the notice from the candidate, the Chairman or his/her delegate will review the candidate's request to determine if it complies with the criteria outlined in clause 1.
  4. Provided that the candidate request meets the criteria in clause 1, the Chairman or his/her delegate will continue with the review procedure set out in these Rules.
  5. The next step in the review procedure is consultation. The Chairman or his/her delegate will investigate the administrative or procedural error alleged by the candidate. The candidate must have included in their initial request for review any documentary evidence of the alleged administrative or procedural error. The Chairman or his/her delegate will discuss the alleged errors with the segment co-ordinator, examiners and the examination administrative staff.
  6. The Chairman or his/her delegate may, after consultation in accordance with clause 5:
    a. decide against the candidate; or
    b. if the Chairman or his/her delegate is satisfied that there has been an error in administration or procedure, the Chairman or his/her delegate may give the candidate:
      i. a correction of the candidate's mark that has been caused by an administrative error;
      ii. an opportunity to sit a subsequent scheduled examination;
      iii. no action if the error is judged not to have affected the candidate's performance.
       
  7. The Chairman or his/her delegate will give the candidate written notice of the decision promptly after the review process is complete. The notice will specify the decision and the reasons for the decision
  8. All examination materials will be destroyed after completion of examination.