2020.2 KFP – public report

Case 1: Obstetrics/Gynecology

• Subject Area: Post-partum mastitis and breast lump investigation.
• Key Topics Discussed: Targeted history for mastitis, pharmacological management, and initial investigations for a breast lump.
• Candidate Performance: Lacked specificity in history taking; errors in articulating diagnostic value elements.
• Improvement Areas: Focus on case-specific, relevant history taking and diagnostic approaches.

Case 2: Oncology/Gastroenterology

• Subject Area: Bowel cancer risk and management of adenocarcinoma.
• Key Topics Discussed: Measures to reduce bowel cancer risk, differential diagnoses for post-hospital admission abdominal pain, and patient management upon clinical deterioration.
• Candidate Performance: Inadequate tailoring of preventive health measures and differential diagnoses to the clinical case.
• Improvement Areas: Ensure preventive and management strategies are closely aligned with the patient’s clinical presentation and history.

Case 3: Ophthalmology/Dermatology

• Subject Area: Raised intraocular pressures, blepharitis, and facial skin lesion.
• Key Topics Discussed: Risk factors for raised intraocular pressures, non-pharmacological management of blepharitis, and diagnosis of a facial skin lesion.
• Candidate Performance: Confusion between symptoms and risk factors; inappropriate management advice for blepharitis.
• Improvement Areas: Differentiate between symptoms and risk factors; provide case-relevant management advice.

Case 4: Pediatrics/Vaccinology

• Subject Area: Routine childhood immunizations and vaccine opposition.
• Key Topics Discussed: Identifying contraindications to vaccination, handling vaccine opposition, and managing a facial rash.
• Candidate Performance: Lack of knowledge on contraindications and legal aspects of vaccination.
• Improvement Areas: Enhance understanding of vaccination contraindications and legal frameworks regarding parental opposition.

Case 5: Gynecology

• Subject Area: Management of heavy periods and abnormal cervical screening.
• Key Topics Discussed: Initial investigations for heavy periods, pharmacological management, and interpretation of cervical screening results.
• Candidate Performance: Gaps in managing heavy periods and interpreting cervical screening results.
• Improvement Areas: Improve pharmacological management strategies for heavy periods and understanding of cervical screening guidelines.

Case 6: Otorhinolaryngology

• Subject Area: Rhinosinusitis and behavioral management.
• Key Topics Discussed: Initial investigations and management of rhinosinusitis, handling inappropriate and aggressive conduct.
• Candidate Performance: Failing to take responsibility for clinical care and focusing solely on organic causes of behavior.
• Improvement Areas: Assume responsibility for comprehensive care and address behavioral issues with appropriate strategies.

Case 7: General Internal Medicine

• Subject Area: Fatigue, weight gain, and joint pains.
• Key Topics Discussed: Differential diagnoses, initial investigations, and pharmacological options for weight loss.
• Candidate Performance: Inconsistent differential diagnoses with clinical features.
• Improvement Areas: Use clinical features to guide differential diagnoses and investigation choices.

Case 8: Neurology

• Subject Area: Chronic headaches and rash management.
• Key Topics Discussed: Differential diagnoses for chronic headaches, pharmacological management, and rash management.
• Candidate Performance: Non-specific differential diagnoses.
• Improvement Areas: Provide specific and relevant differential diagnoses and management plans.

Case 9: Urology

• Subject Area: Urinary incontinence in an older female.
• Key Topics Discussed: Differential diagnoses, examination findings, and non-pharmacological management.
• Candidate Performance: Non-specific differential diagnoses and irrelevant examination findings.
• Improvement Areas: Focus on specific, relevant differential diagnoses and examination findings related to urinary incontinence.

Case 10: Pediatrics/Audiology

• Subject Area: Hearing impairment in a child.
• Key Topics Discussed: Interpretation of audiogram, history taking, and differential diagnosis. Management of a complaint.
• Candidate Performance: Difficulty in interpreting audiogram and providing relevant history and differential diagnoses.
• Improvement Areas: Enhance skills in audiogram interpretation, specific history taking, and identifying relevant differential diagnoses.

Case 11: Geriatrics

• Subject Area: Proactive health care in an older man.
• Key Topics Discussed: Pharmacological management based on past medical history and blood investigations, handling request for a medical certificate.
• Candidate Performance: Reiteration of previous pharmacological options and misalignment with key case features.
• Improvement Areas: Tailor pharmacological management to patient’s history and current clinical presentation.

Case 12: Obstetrics/Nutrition

• Subject Area: Antenatal care and emergency obstetrics.
• Key Topics Discussed: Nutritional advice during pregnancy, interpretation of first trimester genetic screening tests, and management of severe abdominal pain and vaginal bleeding in the third trimester.
• Candidate Performance: Inappropriate emphasis on pharmacological responses to nutritional advice and misinterpretation of genetic screening results.
• Improvement Areas: Provide specific, nutritional guidance tailored to pregnancy and accurately interpret genetic screening tests, with appropriate emergency management for obstetric emergencies.

Case 13: Pain Management

• Subject Area: Opiate prescription management.
• Key Topics Discussed: Managing opiate prescriptions, dealing with lost prescriptions, and medico-legal issues regarding stolen prescriptions.
• Candidate Performance: Reiteration of case details without actionable management plans, and lack of focus on direct management of prescription misuse.
• Improvement Areas: Develop strategies for safe opiate prescribing, handling lost prescriptions securely, and responding appropriately to medico-legal concerns.

Case 14: Hematology

• Subject Area: Investigation of raised haemoglobin and mean cell volume.
• Key Topics Discussed: Differential diagnoses for hematologic abnormalities, relevant examination findings, and further investigative steps.
• Candidate Performance: Gaps in interpreting hematologic results and connecting them with potential differential diagnoses.
• Improvement Areas: Improve hematologic knowledge, specifically the implications of abnormal blood results, and tailor further investigations to these findings.

Case 15: Emergency Medicine/Orthopedics

• Subject Area: Management of a workplace hand injury.
• Key Topics Discussed: Diagnosis based on clinical context and X-ray results, immediate management actions, and handling requests for opiate medications for ongoing symptoms.
• Candidate Performance: Lack of specificity in diagnosis and management, with inadequate consideration of the rural context.
• Improvement Areas: Enhance diagnostic accuracy, provide clear management plans, and develop strategies for managing chronic symptoms and medication requests.

Case 16: Endocrinology

• Subject Area: Management of elevated fasting blood glucose and pregnancy.
• Key Topics Discussed: Non-pharmacological management of elevated blood glucose, immediate management actions after a positive pregnancy test.
• Candidate Performance: Holistic patient management overlooked, and failure to connect past medical history with current clinical presentation.
• Improvement Areas: Focus on comprehensive patient care, integrating non-pharmacological management with patient’s overall health and pregnancy considerations.

Case 17: Endocrinology

• Subject Area: Management of hypothyroidism symptoms and complications.
• Key Topics Discussed: Appropriate investigations for hypothyroidism, pharmacological management, and investigation of new symptoms.
• Candidate Performance: Errors in pharmacological dosing and management.
• Improvement Areas: Precise pharmacological management of hypothyroidism, including dosing, and thorough investigation of new symptoms.

Case 18: Musculoskeletal Medicine

• Subject Area: New-onset back pain with a focus on serious underlying conditions.
• Key Topics Discussed: Clinical presentation indicative of serious conditions, appropriate investigations, and prognosis regarding return to work.
• Candidate Performance: Non-specific responses and unclear relevance to clinical scenarios.
• Improvement Areas: Identify specific clinical indicators of serious conditions, choose relevant investigations, and assess factors influencing prognosis for work return.

Case 19: Dermatology

• Subject Area: Management of a new mole and keloid scar.
• Key Topics Discussed: Clinical assessment of a mole, management of keloid scars, and handling patient complaints.
• Candidate Performance: Failure to address the specific dermatological conditions presented.
• Improvement Areas: Dermatological assessment skills, keloid scar management, and effective communication strategies for handling patient complaints.

Case 20: Geriatrics/Neurology

• Subject Area: New symptoms of cognitive decline and stiffness.
• Key Topics Discussed: Differential diagnosis for cognitive changes, initial investigations, and non-pharmacological management for behavior changes.
• Candidate Performance: Inadequate specificity in pharmacological management not tailored to the case.
• Improvement Areas: Focus on specific non-pharmacological interventions for cognitive and behavioral symptoms, guided by differential diagnosis.

Case 21: Nephrology

• Subject Area: Acute limb swelling and abnormal urinalysis in an Aboriginal man.
• Key Topics Discussed: Likely diagnosis based on swelling and urinalysis, appropriate investigations, and non-pharmacological management for an itchy rash.
• Candidate Performance: Insufficient knowledge on differential diagnosis and inappropriate pharmacological focus for a non-pharmacological management question.
• Improvement Areas: Accurate diagnosis and tailored investigation choices, with emphasis on non-pharmacological management strategies.

Case 22: Pediatrics/Respiratory Medicine

• Subject Area: Acute respiratory symptoms in a child.
• Key Topics Discussed: Immediate management for coughing and shortness of breath, identification of signs requiring hospital admission, and management during transfer.
• Candidate Performance: Lack of immediate action knowledge for an acutely unwell child.
• Improvement Areas: Emergency management skills for acute respiratory distress and criteria for hospital admission.

Case 23: Cardiology

• Subject Area: Atrial fibrillation management.
• Key Topics Discussed: ECG interpretation, diagnostic investigations, and pharmacological management for atrial fibrillation.
• Candidate Performance: Non-specific answers and mismatch with the underlying diagnosis.
• Improvement Areas: Specific ECG interpretation skills, appropriate selection of investigations, and targeted pharmacological management.

Case 24: Sports Medicine

• Subject Area: Acute shoulder pain post-injury.
• Key Topics Discussed: Diagnosis, investigations, and management of acute shoulder injury.
• Candidate Performance: Incorrect diagnoses, irrelevant investigations, and inappropriate medication prescriptions.
• Improvement Areas: Accurate injury assessment, relevant diagnostic investigations, and evidence-based management strategies.

Case 25: Psychiatry

• Subject Area: Cyclical mood changes and professional boundary issues.
• Key Topics Discussed: Diagnosis and management of mood changes related to menstrual cycle, handling disclosure of a relationship with a psychologist.
• Candidate Performance: Underestimation of the seriousness of professional boundary violations.
• Improvement Areas: Effective management of mood symptoms and ethical handling of professional boundary issues.

Case 26: Dermatology

• Subject Area: New-onset rash management and confidentiality.
• Key Topics Discussed: Differential diagnosis for a rash, pharmacological management, and handling enquiries from a patient’s family.
• Candidate Performance: Inappropriate management actions unrelated to the clinical presentation.
• Improvement Areas: Specific dermatological management, maintaining patient confidentiality, and ethical communication with family members.