Format of Short Cases
First of all, the exam will test on four major systems, namely cardiology, respiratory, abdomen and neurology stations. The minor area such as rheumatology or dermatology will not be tested individually, but they can appears as part of a major stations and candidates are expected not to missed it.
Timing for each station is 20 minutes. Ten minutes for the examinations and the rest of the time is for the presentation and discussion. There is no rest time in between stations and you are expected to start the next stations immediately as the bell rings.
Upon approaching the case, you will be greeted by the examiners. There will be two examiners per station. Sometimes there will be an observer too. Among the examiner, there will be one person that dominate the discussion. They will ask you to read the print-out instruction and you will decide your approach to the case. At times, they can hint you that you are starting to derail. Do take those hints seriously.
After you have completed the examinations, the presentation and discussion of the case happens by the bed side. After the bell rings, you move on to the next station.
Preparation for Short Case
The key to excel in short case is to practice more. The examination technique has to have finesse in it. The steps is systematic. There is no going back and forth. Most importantly, both you and your patients are comfortable with the examination. There is no room for mistakes such as causing pain to the patient.
You are expected to present the case as if you have done it thousand times. Points are laid out systematically. The content of presentation should be succinct without too much words. The relevant positive and negatives are put up first. Skim on non relevant points. Differential diagnosis should be mature and reflect your readiness as physician. Discussions are logical and reflects your wealth of knowledge about the disease.
The only way to reach this level is to practice more. Practice to present to your colleague, to your lecturer, to your spouse, to the mirror. Don't be afraid to make mistakes as they are the only way we can improve ourselves. Listen to how you present by recording your own words. If the presentation does not appeal to you, most likely it will not to the examiners as well.
Participate in local PACES preparatory courses will help you tremendously. Not only it gives you a similar feel of the exams, you get the chances to practice on very good short cases that is hard to come by.
Practice whenever you have the opportunity. Be it a case during your oncall, during clinic sessions, during rounds, during evening sparing with friends. As the technique is a very personal thing and you will develop your own style in examination. Try to examine in full sequence if the time allows. A tip from my teacher is to practice short case examination during on call time. You will be doing the case under stress of fatigue and time constraints, So you will polish your subconscious mind on examination. Don't worry is you are doing simplified examinations; as long as you constantly try to remind yourself that you are skipping this steps and that maneuver. This is to make sure that old habits does not appear during exams.
As of the script of presentations, there are many textbooks that can be a good guidance. If you like systematic way of presentation, you can go with Oxford Specialty Training series. If you like a more abbreviated presentations, Ryders would be your options. Read Jansen Koh for a good foundations in the short cases as the author lay out almost all type of cases in an organized manner, which is easy to remember. My take would be to read Jansen Koh then follow with either Ryders or OST. Get the foundation right then polish the individual scenarios so you are prepared in every type of case.
D-Day
Time management is very crucial. Often the only clock you can depend on is your inner body clock. If the examiner allows, you can request to bring along a stop watch. This is to gauge the time took in examination and when to speed things up.
Cortisol level invariably will be much elevated during the exam. There is no easy way to alleviate this stress, except learn to control your mind. Take every exams as your day-to-day practice. Learn to overcome your fears. Tell yourself that you are prepared for every circumstances and you are going to impress the examiners today with what you know. That's why during the waiting time prior to exams, it's not advisable to cram in anymore new information. Breathing exercise helps to maintain the inner peace.
If the particular station not turned out as you would have expected, or you did exceptionally well until you think you have nailed it, please put that aside and let's not carry any emotions to the next station. As each stations is individually marked by 8 different examiners, no one will know how you perform the station before. The moment is now. Each case is a new challenge to take.
Finally, enjoy every moment. You had come this far. You have done whatever you could. Put aside toughts such as ''I should have' or 'given more time'. Think of the journey, not the destination, just yet.
Hope you will benefit from my sharing. Please do comment if you have any questions.
